Abstract
Background and Objectives: Whether physical activity (PA) is a risk factor for amyotrophic lateral sclerosis (ALS) is controversial since data on life-long PA are rare. The main objective of this study is to provide insight in PA as a potential risk factor for ALS, reporting data on cumulative PA, leisure time PA and occupational PA. This study also aims at gathering evidence on the role of PA as a prognostic factor in disease course.
Methods: Lifetime PA values collected by questionnaires addressing work and leisure time were quantified into metabolic equivalents (MET). A population-based case-control study embedded in the ALS Registry Swabia served to calculate odds ratio (OR) of ALS by PA in different time intervals and prognosis.
Results: In ALS cases (393 cases, 791 age- and sex-matched controls), we observed reduced total PA at interview and up to 5 years before interview compared to controls. Total PA was not associated with ALS risk 5-55 years before interview. Heavy occupational work intensity was associated with increased ALS risk (OR=1.97, 95%-CI (1.34, 2.89)). Total PA levels were associated with survival in a nonlinear manner: inactive patients and highest activity levels (25 METh/week) revealed the worst survival time of 15.4/19.3 months, respectively. Best median survival with 29.8 months was seen at 10.5 METh/week after adjusting for other prognostic factors.
Discussion: Lifetime combined PA sharply decreased several years before disease onset compared to controls. The risk of developing ALS was not associated with former total PA levels 5-55 years before interview in contrast to occupational PA, probably reflecting work associated exposures. We found a strong nonlinear association of current and pre-diagnostic PA level and survival in ALS cases with the best survival with moderate PA. PA intensity may be a disease modifying factor with an unfavourable outcome in sedentary and hyperactive behaviour.
Classification of evidence: This study provides Class III evidence that physical activity was not associated with the development of ALS.
- Received April 5, 2021.
- Accepted in final form August 18, 2021.
- © 2021 American Academy of Neurology
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