Jun 7, 2024

Relationships between physical activity, health, and the environment – Insights from a pediatric neuroinflammatory disorders population

Dr. E. Ann Yeh from the Division of Neurology at The Hospital for Sick Children, and member of the Edwin S.H. Leong Centre for Healthy Children, provides an update on her pediatric neuroinflammatory disorders study.

By: Paul Yoo, Sonika Kumari, Samantha Stephens, and E. Ann Yeh

In Canada, almost 600 children/year experience an episode of neuroinflammation. This may manifest clinically with marked neurological dysfunction such as seizures, paralysis, and visual dysfunction. Common diagnoses include autoimmune encephalitis, multiple sclerosis (MS), neuromyelitis optica spectrum disorders, and myelin oligodenodrocye glycoprotein associated disorders. Notably, while complete motor recovery occurs in most children with neuroinflammation, up to 75% of these children may suffer from depression, fatigue, or cognitive impairment. Strategies that can reduce mental health and cognitive comorbidities are therefore needed.


Physical activity may fill this gap. Our group has shown that higher levels of physical activity associate with lower levels of depression, fatigue and disease activity in youth with MS. However, youth with MS and other neuroinflammatory disorders are inactive. Understanding barriers and facilitators of physical activity behavior at the individual and societal level is the first step to developing interventional strategies to increase this modifiable lifestyle behavior.  Of importance, previous literature has demonstrated associations between factors such as socioeconomic status and neighbourhood features (e.g., community facility access, walkability and transit among others) and physical activity behaviour in healthy children. However, little is known about the associations between these factors and physical activity participation in youth with neuroinflammatory disorders. The goal of our research was therefore to investigate these associations.

To achieve this aim, we have linked registry data from the Neuroinflammatory Disorders Registry at SickKids with a national environmental dataset – the Canadian Urban Environmental Health Research Consortium (CANUE), using postal codes. Data drawn from our registry include physical activity metrics (Godin Leisure Time Exercise Questionnaire) and mental health outcomes including depression, anxiety, fatigue, and disability. We will consider age, sex, ethnicity, and socioeconomic variables of family income and educational attainment in our analysis. CANUE data extracted include neighbourhood marginalization (Canadian Marginalization Index), and greenspace (Growing Season Max Value) at 500m within the postal code.

Our preliminary analysis within a subset of our patient population –MS –has demonstrated higher levels of physical activity in children with greater access to greenspace (< 500m from their postal code). Our logistic regression model to predict physical activity based on greenspace at 500m demonstrated that youth residing in areas with closer proximity and greater access to greenspace are 1.6 times more likely to be physically active than other children. Our assessment of diversity characteristics within this population has demonstrated that those who are recent immigrants and/or self-identified visible minorities report worse fatigue symptoms than other participants.

We are currently expanding our analyses to include all patients within our registry and introduce multivariate modelling approaches to better understand these relationships. We will share our findings with key knowledge users including youth, families, clinicians, researchers, community organizations, and policymakers. As our ultimate aim is to create environments that facilitate physical activity participation in youth with neuroinflammatory disorders, we will engage in several additional knowledge translation and advocacy efforts through collaborations with members of different stakeholder groups, including the MS Society of Canada and family advisors through the SickKids Family Advisory Network.