Outcome expectations and physical activity in persons with longstanding multiple sclerosis

Increasing Physical Activity in Persons With Spinal Cord Injury With an eHealth-Based Adaptive Exercise Intervention: Protocol for a Sequential Multiple Assignment Randomized Trial

BACKGROUND

Participating in an adequate amount of physical activity to acquire health benefits is challenging for people with spinal cord injury (SCI) due to personal and logistic barriers. Barriers in the built and social environments may include lack of transportation, lack of accessible facilities or programs, and lack of training among fitness personnel. Low self-efficacy, lack of self-regulation skills, and improper outcome expectations are examples of personal barriers. Current approaches to investigating physical activity programs in people with SCI have been limited to traditional "one-size-fits-all" design, which has yielded low adherence rates, high dropout rates, and participants not maintaining physical activity levels at follow-up.

OBJECTIVE

The primary aim of this study is to test the feasibility of a tele-exercise program that applies an adaptive intervention design for 30 adults with SCI, targeting increases in adherence to the exercise program and physical activity participation.

METHODS

The Sequential Multiple Assignment Randomized Trial for Home-based Exercise and Lifestyle Tele-Health (SMART-HEALTH) is a 12-week, home-based, movement-to-music (M2M) program. The goal of a SMART-designed study is to develop an adaptive intervention that modifies support provisions based on response levels. In SMART-HEALTH, 2 groups of participants will undergo 3-week and 6-week asynchronous M2M interventions in the first phase. Participants who did not achieve the desired adherence rate (≥95% of video watch minutes) will be rerandomized into M2M Live (switch) or individualized behavioral coaching (augmented with the asynchronous M2M program). The study will primarily assess rates of recruitment or enrollment, adherence and retention, timing to identify nonresponders, and scientific outcomes (eg, physical activity and exercise self-efficacy). The study will qualitatively evaluate the acceptability of the study using semistructured interviews among participants who complete the 12-week intervention.

RESULTS

Recruitment procedures started in June 2022. All data are expected to be collected by September 2023. Full trial results are expected to be published by March 2024. Secondary analyses of data will be subsequently published. Results will include exercise adherence rates; changes in self-reported physical activity levels and blood pressure; and changes in secondary conditions including pain, sleep, and fatigue. Thematic analysis of semistructured interviews will include results on participant enjoyment and acceptability of SMART-HEALTH and inform modifications for future delivery of the program.

CONCLUSIONS

This study will strengthen our understanding of the potential benefits of the tele-exercise intervention for people with SCI and build upon adaptive intervention design and its delivery strategies that aim to increase adoption and sustainable exercise behavior. This pilot trial will inform future SMART-designed studies and provide new and innovative strategies for investigating intervention effects on physical activity behavior in the SCI population.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04726891; https://classic.clinicaltrials.gov/ct2/show/NCT04726891.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/47665.

The Interplay Between Expected Psychological Responses to Exercise and Physical Activity in Analogue Generalized Anxiety Disorder: a Cross-sectional Study

BACKGROUND

Expectations for psychological responses to exercise are not well characterized, particularly in people at risk for anxiety-related illnesses. Given the substantial evidence for salutary effects of exercise on anxiety symptoms and emerging recognition for expectations as a critical mechanism of placebo/nocebo effects, this study explored the interplay between expectations and physical activity in young adults with and without analogue generalized anxiety disorder.

METHODS

Participants (N=470, 23.2±4.8 years, 63% female) completed a physical activity and mood survey, including a 7-day physical activity recall questionnaire, and a 20-item questionnaire designed to measure positive and negative expectations for psychological and perceptual responses to exercise, particularly expectations for symptoms in the generalized anxiety disorder symptom profile. Analogue generalized anxiety disorder status was determined using the Generalized Anxiety Disorder subscale of the Psychiatric Diagnostic Screening Questionnaire.

RESULTS

For select outcomes, expected exercise-induced changes significantly differed according to analogue generalized anxiety disorder (whole-body pain, sleep quality, psychological well-being, stress, relaxation) and active versus inactive (anxious mood, depressed mood, concentration, physical function, psychological well-being, relaxation) status. However, these findings did not survive corrections for multiple comparisons and the magnitude of these differences was small, approximating 0.25 standard deviations. Expectations for anxious (Spearman's ρ=-0.14, p≤0.002) and depressed mood (ρ=-0.15, p≤0.002), and psychological well-being (ρ=0.15, p≤0.001) were significantly associated with higher physical activity levels. Exercise expectations for anxious mood explained a significant, but small (+1.5%, p≤0.03), amount of variance in physical activity.

CONCLUSIONS

Expectations for exercise-induced improvements did not significantly differ between young adults based on analogue generalized anxiety disorder or physical activity status.

Motivating young adults to connect with nature for stress relief: A study in Taiwan during the COVID-19 pandemic

It is known exposure to and connectedness with nature is beneficial for psychological wellbeing and stress relief. However, many factors hinder people, including young adults, from utilizing natural resources for healing. The present study indicates using a motivational enhancement approach and additional motivational elements in public messaging to address ambivalence toward nature exposure successfully results in favorable impacts on belief, intention, recall of positive nature elements, and perceived stress. Because this study coincided with the development of the COVID-19 pandemic in Taiwan, it offers a valuable opportunity for exploring how effective the motivational indicators were at different stages of the pandemic, as well as how connectedness to nature can explain perceived stress. In measuring motivation, we captured the essential elements of mobilizing young adults to connect with nature while also exploring potential expansion of behavioral indicators. We discuss how to foster inspiration during a pandemic to enhance connectedness to nature.

Determinants of Continuance Intention to Use Health Apps among Users over 60: A Test of Social Cognitive Model

Promoting healthy behavior among seniors is important in reducing the burden of care and healthcare expenses in a rapidly aging society. Health apps can play an important role in health promotion for older adults, but the level of user retention in health apps is low. To increase continued health app use among older adults, this study examined the factors influencing older users’ continuance intentions to use health apps. The research model was developed based on the social cognitive theory of health behavior, which integrates cognitive, environmental, and behavioral perspectives. To test the research model, an anonymous online survey was conducted among respondents aged 60 to 79 years who were using health apps. The measurement items in the questionnaire were developed based on validated scales from the literature. A total of 250 samples were analyzed. The assessment of the measurement model indicates that the reliability and validity of the items are satisfactory. The results of testing the structural model illustrate the determinants of health app continuance intention: health technology self-efficacy, self-evaluative outcome expectations, self-regulation, and privacy risk. The interrelationships among determinants are also investigated. Theoretical and practical implications are suggested to encourage older adults’ continued health app use and promote their health behavior over the long term.

The role of expectations and future-oriented cognitions in quality of life of people with multiple sclerosis: A systematic review

PURPOSE

Multiple Sclerosis (MS) is a highly variable condition characterised by uncertainty of disease course which can make formation of expectations about the future difficult. This systematic review aimed to examine associations between expectations, or Future Oriented Cognitions (FOCs), and Quality of Life (QOL) in people with MS (PwMS).

METHODS

Following PRISMA guidelines, literature up to October 2019 was searched using Medline, EMBASE, PsycINFO and Web of Science. Quantitative studies that investigated relationships between FOCs and QOL in PwMS (assessed using a standardised QOL assessment) were considered for inclusion. After data extraction, results were analysed using narrative synthesis, focusing on the valence of FOCs (positive, negative, unvalenced). Quality appraisal was conducted using the Mixed Methods Appraisal Tool (MMAT). All stages of the review were patient-led by a person with MS.

RESULTS

A total of 13 studies met the review inclusion criteria, with a combined sample size of 4,179. Of these studies, 11 involved measures of positive FOCs, most commonly self-efficacy, one measured a negative FOC, with one FOC unclassified. Nine studies found significant associations between QOL and self-efficacy. Although other positively valenced constructs were less frequently reported, significant associations with higher QOL were also evidenced.

CONCLUSIONS

Identifying ways to foster positive FOCs, particularly self-efficacy, may have beneficial effects on QOL. More research is needed to understand the impacts of negative FOCs on QOL to determine whether these processes could be meaningfully targeted in interventions.

Associations between positive treatment outcome expectations, illness understanding, and outcomes: a cohort study on non-operative treatment of first carpometacarpal osteoarthritis

PURPOSE

More positive outcome expectations and illness perceptions are associated with better outcomes for patients with several osteoarthritic orthopedic conditions. However, it is unknown whether these factors also influence outcomes of non-operative treatment for first carpometacarpal osteoarthritis (CMC-1 OA). Therefore, we assess the role of pre-treatment outcome expectations and illness perceptions in reports of pain and hand function 3 months after non-operative treatment for CMC-1 OA.

MATERIALS AND METHODS

We conducted a cohort study with 219 patients treated non-operatively for CMC-1 OA between September 2017 and October 2018. Patients were included in the study if they completed measures of pain and hand function, illness perceptions (scale: 0-10), and expectations (scale: 3-27) as part of routine outcome measurements. Pain and hand function were measured before treatment and 3 months after starting treatment using the Dutch version of the Michigan Hand Outcomes Questionnaire. Multivariable linear regression analysis was used to assess the influence of outcome expectations and illness perceptions on pain and hand function.

RESULTS

Both positive outcome expectations (B = 0.64; 95% CI [0.1-1.2]) and a better illness understanding (an illness perception subdomain; B = 1.53; 95% CI [0.2-2.9]) at baseline were associated with less pain at 3 months. For hand function, similar estimates were found.

CONCLUSIONS

We found that positive outcome expectations and a better illness understanding, were associated with a better outcome of non-operative treatment for CMC-1 OA.IMPLICATIONS FOR REHABILITATIONNon-operative treatment can often be successful for patients with arthritis of the thumb.Outcome expectations and illness perceptions are associated with pain and hand function 3 months after non-operative treatment for thumb base osteoarthritis.Improving the outcome expectations and illness perceptions of patients through better education could improve the outcome of non-operative treatment.

The impact of exercise perceptions and depressive symptoms on polycystic ovary syndrome–specific health-related quality of life

Background:

Studies indicate that women with polycystic ovary syndrome have high depressive symptom scores and more perceived barriers than benefits to exercise, factors that may affect health-related quality-of-life. The purpose of this cross-sectional study was to explore the impact of perceived exercise benefits and barriers, exercise outcome expectations, and depressive symptoms on polycystic ovary syndrome–specific health-related quality-of-life.

Methods:

A survey link was posted on polycystic ovary syndrome Facebook groups. Women with polycystic ovary syndrome (n = 935) answered questionnaires about demographics, polycystic ovary syndrome–specific health-related quality-of-life, exercise benefits and barriers, exercise outcome expectations, and depressive symptoms. Data were collected using Qualtrics, transferred to SPSS, and statistically analyzed using regression analyses. Mean responses were reported for the questionnaires, with exercise benefits and barriers means divided for a ratio.

Results:

Respondents were 32 ± 10.6 years of age, mostly White (72%), and employed full-time (65%). The total mean scores were health-related quality-of-life, 2.7 ± 0.1; exercise outcome expectation, 2.4 ± 0.8; and depressive symptoms, 12.4 ± 5.8. The benefit/barrier ratio was 0.9. HRQoL increased 0.32 points for every additional perceived exercise benefit and 0.61 points for every additional exercise outcome expectation (EOE). HRQoL was reduced by 1.19 points for every additional perceived exercise barrier and 2.82 points for every additional one-point increase of the depressive symptoms score.

Conclusions:

Respondents reported low health-related quality-of-life, greater exercise barriers than benefits, neutral exercise outcome expectations, and high depressive symptoms. These results suggest that promoting exercise benefits, overcoming exercise barriers, and addressing management of depressive symptoms are important foci of future efforts to improve health-related quality-of-life among women with polycystic ovary syndrome.

Social cognitive theory as a guide for exercise engagement in persons with multiple sclerosis who use wheelchairs for mobility

Multiple sclerosis (MS) is an immune-mediated neurodegenerative disease of the brain, optic nerves and spinal cord. Among persons with MS, 30% experience significant mobility impairment that requires use of a wheelchair for mobility. Exercise is an evidence-based second-line therapy that can improve mobility; however, little research has focused on individuals that use wheelchairs for mobility. Framed by social cognitive theory (SCT), we conducted a formative qualitative study examining exercise status and perceptions among 20 persons with MS who use wheelchairs for mobility. Using deductive, semantic thematic analysis, we coded for SCT variables (i.e. self-efficacy, knowledge, outcome expectations, barriers and facilitators) and identified participants as regular or inconsistent exercisers. In total, 12 participants were classified as regular exercisers and 8 inconsistent exercisers. Regular exercisers more frequently reported high self-efficacy, consistent exercise knowledge and numerous facilitators. All participants reported some positive outcome expectations and several barriers and facilitators. These findings can inform future intervention studies supporting exercise behavior change through SCT. Strategies such as increasing self-efficacy, imparting instructional materials, shaping realistic outcome expectations and providing tools directed toward overcoming barriers and identifying facilitators may work to support the exercise endeavor of persons with MS who use wheelchairs for mobility.

Differences among participants' response to a wellness intervention for individuals with spinal cord injuries

BACKGROUND

Individuals with spinal cord injuries (SCI) often struggle with lifestyle adjustment following injury. Effective wellness interventions may aid in improving quality of life; however, treatment response heterogeneity is a concern for behavioral interventions.

OBJECTIVE

To identify differences among adults with SCI who were responders and non-responders in a wellness intervention.

METHODS

There were 29 persons with SCI who received a wellness intervention. Participants engaged in six in-person workshops over a 3-month period, led by wellness experts with peer mentors available. Individual intervention participant change was compared to the mean among control group participants target outcomes variables (i.e., satisfaction with life, self-efficacy for health practices, secondary conditions, health promoting behaviors, and perceived stress) to classify responders versus non-responders.

RESULTS

Of the 29 participants, 18 who completed the intervention were classified as responders and 11 were non-responders. The mean age was 43.2 ± 11.2 years, and years post-injury were 12.0 ± 9.8. Decision tree regression analysis for demographic variables and injury characteristics showed that single/divorced participants were more likely to not respond to the intervention (52%), compared to married participants (17%). Further, participants who were single/divorced and ≤50 years old were more likely to not respond to the intervention (62%) than those who were older (25%).

CONCLUSIONS

Single/divorced individuals with SCI may respond differently to behavioral wellness interventions than married individuals. Additionally, the effects of age on treatment response in behavioral interventions should be further examined. Identifying non-modifiable factors related to response heterogeneity may help guide the creation of tailored interventions specific to patient characteristics.

Well on wheels intervention: Satisfaction with life and health for adults with spinal cord injuries

Objective/Background: To examine how demographic and injury characteristics identify satisfaction with life (SWL), and assess the differential effects of a wellness intervention by baseline SWL groups.Design: Baseline and longitudinal analysis of a randomized controlled pilot intervention using decision tree regression and linear mixed models.Setting: Community based.Participants: Seventy-two individuals with spinal cord injury (SCI) were randomized to an intervention group (n = 39) or control group (n = 33). Participants were aged 44.1 ± 13.0 years and 13.1 ± 10.6 years post-injury. Most participants were male (n = 50; 69.4%) and had paraplegia (n = 38; 52.7%). Participants were classified as high versus low SWL at baseline using a cutoff score of 20.Interventions: The intervention aimed to increase self-efficacy, and in turn, increase engagement in health-promoting behaviors related to SWL. Six 4-hour in-person workshops were conducted over a 3-month period led by experts and peer-mentors who were available for support.Outcome measure(s): Self-efficacy for health practices, secondary condition severity, health-promoting behaviors, perceived stress, and SWL.Results: At baseline, participants with low SWL were recently injured (<4.5 years), while persons with high SWL were married and younger (<49 years old). Intervention participants with low SWL at baseline significantly improved SWL over time compared to those with high SWL (P = 0.02).Conclusion: Certain injury and demographic characteristics were associated with SWL, and intervention participants with low SWL at baseline improved their SWL over 2 years. Healthcare providers should consider time post-injury, marital status, and age in identifying individuals at risk for low SWL that may benefit from wellness interventions.

Social Cognitive Factors, Physical Activity, and Mobility Impairment in Adults with Multiple Sclerosis

Among those with multiple sclerosis (MS), mobility impairment is common and significantly affects independent functioning and quality of life. The purpose of the study was to examine the role of physical activity in mobility impairment in individuals with MS and explore the social cognitive factors of social support, outcome expectations, and self-efficacy that facilitate physical activity among those with the disease. A sample of 319 individuals with MS were assessed on the following: family and friend social support, self-efficacy, and physical and social outcome expectations. Self-reported physical activity, perceived ambulation disability, balance confidence, and fall history were also measured. The structural model fit the data (χ² (29) = 24.49, p = 0.70; Root Mean Square Error of Approximation < 0.01; Comparative Fit Index = 1.0; Normed Fit Index = 0.96; Goodness of Fit Index = 0.98; Standardized Root Mean Square Residual = 0.03). The primary findings of the study revealed that physical activity was strongly linked to mobility impairment (path coefficient, -0.43), such that increasing levels of physical activity were associated with less mobility impairment. The most important predictors of health-promoting levels of physical activity were self-efficacy (path coefficient, 0.48) and social support (path coefficient, 0.38), with support from friends being a stronger indicator of social support than support from family. It may be prudent to design interventions aimed at increasing physical activity, especially in regard to helping individuals become more efficacious and building larger social networks, as this may serve to forestall advancing mobility impairment in those with MS.

Neurological, physical and sociodemographic correlates of employment in multiple sclerosis: A meta-analysis

Illness severity and sociodemographic characteristics of 7,053 employees with multiple sclerosis and 11,043 peers not in the workforce were compared (Hedges' g with 95% confidence interval and p values). Pooled findings from 25 studies confirmed the main role of a relapsing-remitting disease course and higher education to employment. To a lesser extent, disease duration, fatigue and pain symptoms and age also differentiated the two groups. Vocational interventions for persons with multiple sclerosis should focus on job retention, including mechanisms to accommodate and facilitate functional independence. Longitudinal data are needed to distinguish the characteristics of those who achieve and maintain competitive employment.

‘The positive feel’: Unpacking the role of positive thinking in people with multiple sclerosis’s thinking aloud about staying physically active

People with multiple sclerosis experience barriers to physical activity. Thought processes are interwoven with garnering motivation to overcome these barriers. This study investigated in-depth the role of positive thinking in physical activity motivation of two women and two men with multiple sclerosis. Participants thought aloud while completing standardised measures of physical activity, stages of change and self-efficacy, and in response to planned and spontaneous questions. Four themes were formulated using inductive thematic analysis: thoughts about purpose, self-efficacy, the past and reinforcement through positive thinking. These findings have implications for physical activity theories and delivering appropriate physical activity interventions to the multiple sclerosis community.

Systematic Review of Correlates and Determinants of Physical Activity in Persons With Multiple Sclerosis

OBJECTIVE

To review the current evidence regarding correlates and determinants of physical activity (PA) in persons with multiple sclerosis (pwMS).

DATA SOURCES

PubMed and Scopus (1980 to January 2015) and reference lists of eligible studies.

STUDY SELECTION

Eligible studies include adults with multiple sclerosis; have a cross-sectional or prospective observational design; or examine the effect of a theory-based intervention trial on PA, including a mediation analysis. Eligible studies also apply a quantitative assessment of PA and correlates or proposed mediators and are published in English or German language.

DATA EXTRACTION

Two reviewers independently evaluated the risk of bias, extracted data, and categorized variables according to the International Classification of Functioning, Disability and Health.

DATA SYNTHESIS

Consistency and the direction of associations were evaluated with a semiquantitative approach. Fifty-six publications with data from observational studies and 2 interventional studies provided evidence for 86 different variables. Consistent correlates of PA were the disability level, walking limitations in particular, PA-related self-efficacy, self-regulation constructs, employment status, and educational level. One interventional study provided evidence for a causal relation between self-regulation and PA. However, 59 of the 86 investigated variables in observational studies are based on 1 or 2 study findings, and most results stem from cross-sectional designs.

CONCLUSIONS

Beside the importance of the general disability level and walking limitations, the results highlight the importance of personal factors (eg, PA-related self-efficacy, self-regulatory constructs, sociodemographic factors). Limitations and implications of the current review are discussed. Research that is more rigorous is needed to better understand what affects PA in pwMS.