Fear of falling, not falls, impacts leisure-time physical activity in people with multiple sclerosis

•PwMS with concerns about falling are less physically active.•History of falls is less likely to differentiate between activity groups.•Physical activity is associated with fears of falling, despite disability level. There is a consensus that physical activity is imperative for people with MS (PwMS). However, regardless of the benefits, many PwMS do not participate in any meaningful physical activity. To examine the relationship between leisure-time physical activity with clinical characteristics and common symptoms in PwMS. The sample included 190 PwMS (107 women), mean age 40.8 (S.D = 13.1) and mean disease duration of 6.4 (SD = 8.3) years since diagnosis. Outcome measures included the Godin Leisure-Time Exercise Questionnaire (GLTEQ), Four Square Step Test (FSST), 2-Minute Walk test (2 mWT), Timed Up and Go test (TUG), Timed 25-Foot Walk test (T25FW), fall status, Falls Efficacy Scale International (FES-I), Modified Fatigue Impact Scale (MFIS), walking speed and the Multiple Sclerosis Walking Scale self-reported questionnaire (MSWS-12). Eighty-six PwMS were classified as active (GLTEQ = 31.6 (S.D = 16.7); 104 were insufficiently active (GLTEQ = 3.0 (S.D = 4.3). Insufficiently active PwMS demonstrated a slower walking speed, elevated fatigue, more concerns of falling and additional walking difficulties compared to active PwMS. Non-significant differences between groups were observed in the TUG, 2 mWT, FSST, T25FWT and fall status. According to the linear regression, by utilizing the FES-I we observed a 12.2% variance related to leisure-time physical activity. The independent variables: EDSS, MSWS-12, fatigue and walking speed were non-significant. The present findings highlight the impact of concern of falling on physical activity in PwMS. This knowledge may represent an opportunity to improve care and enhance physical activity in the MS population.