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Accelerometry-derived activity fragmentation as a predictor of brain atrophy and disability progression in multiple
Angeliki G Filippatou1, Muraleetharan Sanjayan1, Blake E Dewey1
1Division of Neuroimmunology and Neurological Infections, Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Multiple Sclerosis (Houndmills, Basingstoke, England)
|April 20, 2026
Summary
Worsening activity fragmentation in multiple sclerosis (MS) predicts increased disability and brain atrophy. This measure of how often activity is interrupted may signal early neurological decline in MS patients.
Area of Science:
- Neurology
- Biomedical Engineering
- Rehabilitation Science
Background:
- Activity fragmentation, the interruption of active periods by sedentary ones, is linked to adverse health outcomes in the general population.
- Its prognostic value in multiple sclerosis (MS) is currently unknown.
Purpose of the Study:
- To investigate the association between activity fragmentation and disability progression in MS.
- To determine if activity fragmentation correlates with brain atrophy in MS patients.
Main Methods:
- People with MS (PwMS) used wrist accelerometers over time.
- Disability was assessed using the Expanded Disability Status Scale (EDSS), and brain structure was evaluated using MRI.
- Active-to-sedentary transition probability (ASTP) during the 10 most active hours (M10) was analyzed for within-person changes.
Main Results:
- Increased activity fragmentation (higher ASTP slope) within individuals was linked to a greater risk of EDSS-plus progression (HR=1.21, p=0.05).
- Worsening fragmentation also correlated with reduced deep gray matter and thalamic volumes over time (p=0.003 and p=0.004, respectively).
Conclusions:
- Worsening activity fragmentation is associated with an increased risk of neurological decline in MS.
- Activity fragmentation may serve as an early indicator of MS progression, potentially reflecting compensatory mechanisms for reduced physiological reserve.
