Abstract
Background: Multiple sclerosis (MS) is a disabling autoimmune disease in which the myelin sheets in the central nervous system are attacked by the immune system. Previously, physical exercises were considered as a contraindication for MS patients due to heat sensitivity. However, it is now advocated that physical exercise is effective for MS patients. The aim of the study was to evaluate the association between physical exercise, the quality of life of MS patients, and the level of disability.
Methods: This is a cross-sectional study conducted among MS patients in the Eastern Region of Saudi Arabia and in Bahrain. A self-administered questionnaire was distributed via an online platform targeting MS patients. The questionnaire comprised the following scales: the Multiple Sclerosis Quality of Life-29, which measured the quality of life (QoL); the Expanded Disability Status Scale, which measured physical disability; and the International Physical Activity Questionnaire, which measured the physical activity of the MS patients, along with the basic demographic data. The statistical analyses were carried out using SPSS version 21.
Results: A small number of patients were physically highly active (39%), while nearly all had low impairment (85.7%). Among the QoL and its subscales, the mean physical health score was the highest (mean: 78.6), while the mean energy score was the lowest (mean: 49.4), whereas the mean overall QoL score was 69.5. Low impairment was more associated with a high PA (p < 0.001), while poor QoL, physical, and mental health were more associated with low PA (all p < 0.001). Furthermore, the older age group (>35 years) had a significantly lower PA (p = 0.012), while the short duration of MS (1-5 years) was more significantly associated with high PA (p = 0.037).
Conclusion: Although the physical activity of low impaired patients was generally sufficient, it, however, did not reflect severe disability, while the increase in the levels of PA significantly improved their QoL, along with their physical and mental health conditions.

Key words: Multiple sclerosis, physical activity, disability, quality of life.