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Parsaei M, Amanollahi M, TaghaviZanjani F, Khanmohammadi S, Jameie M, Naser Moghadasi A. Effects of non-pharmacological interventions on gait and balance of persons with Multiple Sclerosis: A narrative review. Mult Scler Relat Disord 2024; 82:105415. [PMID: 38211505 DOI: 10.1016/j.msard.2023.105415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/15/2023] [Accepted: 12/27/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Multiple Sclerosis (MS) is among the most common reasons for disability in young adults. Mobility impairment, primarily related to gait and balance, is ranked as the preeminent concern among persons with MS (PwMS). Gait and balance dysfunction can directly affect the quality of life and activities of daily life in PwMS, hence the importance of effective treatment strategies. Previous studies have demonstrated the positive effect of various non-pharmacological rehabilitation methods, including physiotherapy and electrical stimulation, on gait and mobility in PwMS. Non-pharmacological methods can be tailored to the individual needs and abilities of each patient, allowing healthcare providers to create personalized training programs. Furthermore, these methods typically result in minimal or no side effects. PURPOSE This review provides a comprehensive overview of an array of non-pharmacological treatment approaches aimed at enhancing ambulatory performance in PwMS. METHODS We performed a narrative review of the original papers available in PubMed, investigating the effects of different nonmedical approaches on the gait and balance performance of the PwMS. Reviewed treatment approaches include "exercise, physical rehabilitation, dual-task (DT) rehabilitation, robot-assisted rehabilitation, virtual reality-assisted rehabilitation, game training, electrical stimulation devices, auditory stimulation, visual feedback, and shoe insoles". RESULTS AND CONCLUSIONS Eighty articles were meticulously reviewed. Our study highlights the positive effects of non-pharmacological interventions on patients' quality of life, reducing disability, fatigue, and muscle spasticity. While some methods, including exercise and physiotherapy, showed substantial promise, further research is needed to evaluate whether visual biofeedback and auditory stimulation are preferable over conventional approaches. Additionally, approaches such as functional electrical stimulation, non-invasive brain stimulation, and shoe insoles demonstrate substantial short-term benefits, prompting further investigation into their long-term effects. Non-pharmacological interventions can serve as a valuable complement to medication-based approaches.
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Affiliation(s)
- Mohammadamin Parsaei
- Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mobina Amanollahi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Melika Jameie
- Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran; Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Ramari C, Awadia Z, Bansi J, Casey B, Feys P, Pilutti LA, Sandroff BM, Paul L. The MoxFo initiative - outcomes: Outcome measures in studies of exercise training in multiple sclerosis; scoping review of reviews and classification according to the ICF framework. Mult Scler 2023; 29:1578-1594. [PMID: 37880966 DOI: 10.1177/13524585231204451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND The number of published studies of exercise training in multiple sclerosis (MS) has grown exponentially with increasing numbers of outcomes capturing exercise effects. This has complicated the selection of relevant indicators and interpretation of intervention effects. OBJECTIVES The Outcomes subgroup of the MoXFo initiative aimed to (1) identify outcome measures and biomarkers in studies of exercise training in MS; (2) systematically map retrieved outcomes to International Classification of Functioning, Disability and Health (ICF) categories; (3) identify gaps where relevant ICF categories have been omitted. METHODS Electronic databases and registers were searched from 2010 to July 2020 to identify systematic reviews or meta-analyses of controlled trials of exercise training on any outcome in MS. Retrieved outcomes/biomarkers were mapped to the corresponding ICF category. RESULTS Eighty-one review articles reporting 235 different outcomes were included. The outcomes corresponded to 15 chapters and 45 categories within the ICF. Outcomes mapped primarily to body function (30 categories) and activities and participation (9 categories) components. Few outcomes mapped to body structures (2 categories) or environmental factors (1 category). CONCLUSION This sets the stage to develop a resource for researchers/clinicians that will aid in the selection of appropriate outcomes/biomarkers when examining exercise effects in MS.
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Affiliation(s)
- Cintia Ramari
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- University MS Center (UMSC), Hasselt, Belgium
| | - Zain Awadia
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Jens Bansi
- Physical Activity for Health (PAfH) Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- University MS Center (UMSC), Hasselt, Belgium
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Brian M Sandroff
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, West Orange, NJ, USA
| | - Lorna Paul
- Research Centre for Health (ReaCH), School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Ahmed M, Herrmann N, Chen JJ, Saleem M, Oh PI, Andreazza AC, Kiss A, Lanctôt KL. Glutathione Peroxidase Activity Is Altered in Vascular Cognitive Impairment-No Dementia and Is a Potential Marker for Verbal Memory Performance. J Alzheimers Dis 2021; 79:1285-1296. [PMID: 33427735 PMCID: PMC7990450 DOI: 10.3233/jad-200754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Coronary artery disease (CAD) increases risk for vascular cognitive impairment-no dementia (VCIND), a precursor to dementia, potentially through persistent oxidative stress. Objective: This study assessed peripheral glutathione peroxidase activity (GPX), which is protective against oxidative stress, in VCIND versus cognitively normal CAD controls (CN). GPX activity was also evaluated as a biomarker of cognition, particularly verbal memory. Methods: 120 CAD patients with VCIND (1SD below norms on executive function or verbal memory (VM)) or without (CN) participated in exercise rehabilitation for 24 weeks. Neurocognitive and cardiopulmonary fitness (VO2peak) assessments and plasma were collected at baseline and 24-weeks. Results: GPX was higher in VCIND compared to CN (F1,119 = 3.996, p = 0.048). Higher GPX was associated with poorer baseline VM (β= –0.182, p = 0.048), and longitudinally with VM decline controlling for sex, body mass index, VO2peak, and education (b[SE] = –0.02[0.01], p = 0.004). Only CN participants showed improved VM performance with increased fitness (b[SE] = 1.30[0.15], p < 0.005). Conclusion: GPX was elevated in VCIND consistent with a compensatory response to persistent oxidative stress. Increased GPX predicted poorer cognitive outcomes (verbal memory) in VCIND patients despite improved fitness.
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Affiliation(s)
- Mehnaz Ahmed
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Nathan Herrmann
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Geriatric Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jinghan Jenny Chen
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Mahwesh Saleem
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Paul I Oh
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Ana C Andreazza
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Alexander Kiss
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Krista L Lanctôt
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Geriatric Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
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Donisi V, Gajofatto A, Mazzi MA, Gobbin F, Busch IM, Ghellere A, Klonova A, Rudi D, Vitali F, Schena F, Del Piccolo L, Rimondini M. A Bio-Psycho-Social Co-created Intervention for Young Adults With Multiple Sclerosis (ESPRIMO): Rationale and Study Protocol for a Feasibility Study. Front Psychol 2021; 12:598726. [PMID: 33708157 PMCID: PMC7940381 DOI: 10.3389/fpsyg.2021.598726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS), the most common neurological disease that causes disability in youth, does not only affect physical functions but is also associated with cognitive impairment, fatigue, depression, and anxiety and can significantly impact health-related quality of life (HRQoL). Since MS is generally diagnosed at a young age-a period of great significance for personal, relational, and professional development-adaptation can become highly challenging. Therefore, enhancing the competence of young people to adaptively cope with these potential challenges is of utmost importance in order to promote their potentialities and talents. It has been shown that psychological interventions targeting MS patients can enhance resilience and HRQoL and that regular physical activity (PA) and social engagement can improve psychological well-being. However, literature on the development of global interventions based on the bio-psycho-social model of the disease is missing. Even less attention has been paid to interventions dedicated to young adults with MS (YawMS) and to the involvement of patients in the development of such programs. AIMS In collaboration with MS patients, this study aims to develop a bio-psycho-social intervention (ESPRIMO) for YawMS, aiming to improve their HRQoL and to explore its feasibility, acceptability, and effects. METHODS To tailor the intervention to the specific needs of YawMS, "patient engagement principles" will be adopted in the co-creation phase, performing a web survey and focus groups with patients and healthcare professionals. In the intervention phase, a pilot sample of 60 young adults with MS will be enrolled. The co-created intervention, composed of group sessions over a 12-week period, will cover psycho-social strategies and include physical activities. Adopting a longitudinal, pre-post evaluation design, self-report questionnaires measuring HRQoL and other bio-psycho-social features (e.g., resilience, well-being, mindfulness traits, self-efficacy, perceived social support, psychological symptoms, illness perception, committed action, fatigue, attitudes, subjective norms, perceived behavioral control, motivation, perception of autonomy support for PA, barriers and intentions to PA) will be administered, the quantity and quality of PA will be measured, and a questionnaire developed by the authors will be used to evaluate the feasibility and acceptability of the ESPRIMO intervention.
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Affiliation(s)
- Valeria Donisi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alberto Gajofatto
- Section of Neurology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Angela Mazzi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Gobbin
- Section of Neurology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Isolde Martina Busch
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Annamaria Ghellere
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alina Klonova
- Section of Movement Sciences, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Latvian Academy of Sport Education, Riga, Latvia
| | - Doriana Rudi
- Section of Movement Sciences, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Vitali
- Section of Movement Sciences, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Schena
- Section of Movement Sciences, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michela Rimondini
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Arntzen EC, Straume BK, Odeh F, Feys P, Zanaboni P, Normann B. Group-Based Individualized Comprehensive Core Stability Intervention Improves Balance in Persons With Multiple Sclerosis: A Randomized Controlled Trial. Phys Ther 2019; 99:1027-1038. [PMID: 30722036 PMCID: PMC6665948 DOI: 10.1093/ptj/pzz017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 10/23/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Balance and trunk control are often impaired in individuals with multiple sclerosis (MS). Interventions addressing these issues are needed. OBJECTIVE The objective of this study was to compare the immediate and long-term effects of a 6-week individualized, group-based, comprehensive core stability intervention (GroupCoreDIST) with standard care on balance and trunk control in individuals with MS. DESIGN This study was a prospective, assessor-masked, randomized controlled trial. SETTING The GroupCoreDIST intervention was conducted by 6 physical therapists in 6 municipalities in Norway. Standard care included the usual care for individuals with MS in the same municipalities. Assessments at all time points took place at a Norwegian hospital. PARTICIPANTS Eighty people with Expanded Disability Status scores of 1 to 6.5 participated in this trial. INTERVENTION Randomized, concealed allocation was used to assign the participants to the GroupCoreDIST intervention (n = 40) or to standard care (n = 40). The GroupCoreDIST intervention was conducted with groups of 3 participants (1 group had 4 participants), for 60 minutes 3 times per week. MEASUREMENTS Assessments were undertaken at baseline and at weeks 7, 18, and 30. Outcomes were measured with the Trunk Impairment Scale-Norwegian Version, Mini Balance Evaluation Systems Test, and Patient Global Impression of Change-Balance. Repeated-measures mixed models were used for statistical analysis. RESULTS One individual missed all postintervention tests, leaving 79 participants in the intention-to-treat analysis. GroupCoreDIST produced significant between-group effects on the mean difference in the following scores at 7, 18, and 30 weeks: for Trunk Impairment Scale-Norwegian Version, 2.63 points (95% confidence interval [CI] = 1.89-3.38), 1.57 points (95% CI = 0.81-2.33), and 0.95 point (95% CI = 0.19-1.71), respectively; for Mini Balance Evaluation Systems Test, 1.91 points (95% CI = 1.07-2.76), 1.28 points (95% CI = 0.42-2.15), and 0.91 points (95% CI = 0.04-1.77), respectively; and for Patient Global Impression of Change-Balance, 1.21 points (95% CI = 1.66-0.77), 1.02 points (95% CI = 1.48-0.57), and 0.91 points (95% CI = 1.36-0.46), respectively. LIMITATIONS Groups were not matched for volume of physical therapy. CONCLUSIONS Six weeks of GroupCoreDIST improved balance and trunk control in the short and long terms compared with standard care in individuals who were ambulant and had MS. The intervention is an effective contribution to physical therapy for this population.
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Affiliation(s)
- Ellen Christin Arntzen
- Nordland Hospital Trust, Department of Physical Therapy, 8028 Bodø, Norway,Address all correspondence to Ms Arntzen at:
| | | | - Francis Odeh
- Nordland Hospital Trust, Department of Neurology; and Institute for Clinical Medicine, Faculty of Health Science, UiT The Arctic University of Norway, Tromsø, Norway
| | - Peter Feys
- Department of Biomed-Reva, University of Hasselt, Hasselt, Belgium
| | - Paolo Zanaboni
- National Center for E-Health Research, Future Journal, Tromsø, Norway
| | - Britt Normann
- Department of Health and Care Sciences, UiT The Arctic University of Norway; and Nordland Hospital Trust, Department of Physical Therapy
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Kasser SL, Kosma M. Social Cognitive Factors, Physical Activity, and Mobility Impairment in Adults with Multiple Sclerosis. Behav Med 2018; 44:306-313. [PMID: 28862920 DOI: 10.1080/08964289.2017.1368441] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Susan L Kasser
- a From the Department of Rehabilitation and Movement Science , University of Vermont , Burlington , VT
| | - Maria Kosma
- b School of Kinesiology , Louisiana State University , Baton Rouge , LA
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Veneri D, Gannotti M, Bertucco M, Fournier Hillman SE. Using the International Classification of Functioning, Disability, and Health Model to Gain Perspective of the Benefits of Yoga in Stroke, Multiple Sclerosis, and Children to Inform Practice for Children with Cerebral Palsy: A Meta-Analysis. J Altern Complement Med 2018; 24:439-457. [DOI: 10.1089/acm.2017.0030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Diana Veneri
- Department of Physical Therapy, Sacred Heart University, Fairfield, CT
| | - Mary Gannotti
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT
| | - Matteo Bertucco
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
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Sebastião E, McAuley E, Shigematsu R, Motl RW. Feasibility study design and methods for a home-based, square-stepping exercise program among older adults with multiple sclerosis: The SSE-MS project. Contemp Clin Trials Commun 2017; 7:200-207. [PMID: 29696187 PMCID: PMC5898480 DOI: 10.1016/j.conctc.2017.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/22/2017] [Accepted: 07/26/2017] [Indexed: 10/31/2022] Open
Abstract
We propose a randomized controlled trial (RCT) examining the feasibility of square-stepping exercise (SSE) delivered as a home-based program for older adults with multiple sclerosis (MS). We will assess feasibility in the four domains of process, resources, management and scientific outcomes. The trial will recruit older adults (aged 60 years and older) with mild-to-moderate MS-related disability who will be randomized into intervention or attention control conditions. Participants will complete assessments before and after completion of the conditions delivered over a 12-week period. Participants in the intervention group will have biweekly meetings with an exercise trainer in the Exercise Neuroscience Research Laboratory and receive verbal and visual instruction on step patterns for the SSE program. Participants will receive a mat for home-based practice of the step patterns, an instruction manual, and a logbook and pedometer for monitoring compliance. Compliance will be further monitored through weekly scheduled Skype calls. This feasibility study will inform future phase II and III RCTs that determine the actual efficacy and effectiveness of a home-based exercise program for older adults with MS.
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Affiliation(s)
- Emerson Sebastião
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, United States
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, United States
| | | | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, United States
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9
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Griffin N, Kehoe M. A questionnaire study to explore the views of people with multiple sclerosis of using smartphone technology for health care purposes. Disabil Rehabil 2017; 40:1434-1442. [PMID: 28322588 DOI: 10.1080/09638288.2017.1300332] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nicola Griffin
- Department of Physiotherapy, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Maria Kehoe
- Department of Health Service Executive Community Physiotherapy, Kildare/West Wicklow, Naas, Ireland
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10
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Pilutti LA, Motl RW, Edwards TA, Wilund KR. Rationale and design of a randomized controlled clinical trial of functional electrical stimulation cycling in persons with severe multiple sclerosis. Contemp Clin Trials Commun 2016; 3:147-152. [PMID: 29736463 PMCID: PMC5935873 DOI: 10.1016/j.conctc.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/27/2016] [Accepted: 05/11/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This randomized controlled trial (RCT) will examine the efficacy of supervised functional electrical stimulation (FES) cycling on walking performance and physiological function among persons with multiple sclerosis (MS) with severe mobility disability. METHODS/DESIGN This RCT will recruit 16 persons with MS that require unilateral or bilateral assistance for ambulation (i.e., Expanded Disability Status Scale (EDSS) score = 6.0-6.5). Participants will be randomized to one of two conditions: supervised FES cycling or passive cycling. The FES cycling condition will involve mild electrical stimulation that will generate an activation pattern that results in cycling the leg ergometer. The passive cycling condition will not provide any electrical stimulation, rather the movement of the pedals will be controlled by the electrical motor. Both conditions will be delivered 3 days/week for the same duration, over 6 months. Primary outcomes will include walking performance assessed as walking speed, endurance, and agility. Secondary outcomes will include physiological function assessed as cardiorespiratory fitness, muscular strength, and balance. Assessments will take place at baseline, mid-point (3-months), and immediately following the intervention (6-months). DISCUSSION This study will lay the foundation for the design of a future RCT by: (1) providing effect sizes that can be included in a power analysis for optimal sample size estimation; and (2) identifying cardiorespiratory fitness, muscular strength, and balance (i.e., physiological function) as mechanisms for the beneficial effects of FES cycling on walking performance. This trial will provide important information on a novel exercise rehabilitation therapy for managing walking impairment in persons with severe MS.
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Affiliation(s)
- Lara A Pilutti
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801, USA
| | - Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801, USA
| | - Thomas A Edwards
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801, USA
| | - Kenneth R Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801, USA
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11
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Motl RW, Pilutti LA. Is physical exercise a multiple sclerosis disease modifying treatment? Expert Rev Neurother 2016; 16:951-60. [DOI: 10.1080/14737175.2016.1193008] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Perceptions of Participants in a Group, Community, Exercise Programme for People with Multiple Sclerosis. Rehabil Res Pract 2015; 2015:123494. [PMID: 26491567 PMCID: PMC4600491 DOI: 10.1155/2015/123494] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 08/30/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. The purpose of this study was to explore the perceptions of people with multiple sclerosis of a community based, group exercise programme. Method. A pragmatic programme evaluation approach using qualitative research design was adopted. Focus groups were used to gather data from 14 participants who had taken part in a RCT of community based exercise interventions for PwMS who used at most a stick to walk outdoors. Data were transcribed verbatim and thematic analysis was used to first identify categories and then to group them into themes. Results. Three themes emerged, psychological benefits, physical benefits, and knowledge gained. The psychological benefits included the role of the group as a social and motivational factor, empowerment, confidence, hope, sense of achievement, and pride. Physical benefits were improved energy and reduced fatigue and improved ability and participation. Knowledge gained caused a shift from thoughts that exercise might do harm, to sufficient knowledge that would give participants confidence to exercise themselves. The role of the group was a key element in the positive outcomes. Conclusions. The qualitative analysis supports the findings of the main trial confirming positive effects of community exercise interventions by reducing the impact of MS and fatigue and improving participation.
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13
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Moradi M, Sahraian MA, Aghsaie A, Kordi MR, Meysamie A, Abolhasani M, Sobhani V. Effects of Eight-week Resistance Training Program in Men With Multiple Sclerosis. Asian J Sports Med 2015; 6:e22838. [PMID: 26448834 PMCID: PMC4592758 DOI: 10.5812/asjsm.6(2)2015.22838] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 11/08/2014] [Accepted: 11/20/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Muscle weakness and fatigue contribute to the reduction of daily activity in multiple sclerosis (MS) patients. Therapeutic strategies to promote improvements in muscle strength and endurance are limited in individuals with MS. Some evidence showed that exercise may improve and affect different aspects of the disease including quality of life, fatigue, motor and cognitive functions. OBJECTIVES To investigate the value of resistance training of moderate to high intensity on motor function, muscle strength, balance and perceived disability in male patients with multiple sclerosis compared to a control group. PATIENTS AND METHODS 20 male patients with MS (mean ± SD, age: 34.05 ± 7.8 y; Expanded Disability Status Scale (EDSS): 2.94 ± 1.5) were recruited and randomized either to the exercise (E) or control group (C). Group E participated in a three-time weekly individualized progressive resistance-training program (both upper and lower extremities) for eight weeks, while group C was advised not to change their physical activity habits. All initial measures (including EDSS, balance, muscle strength, and functional mobility) were re-evaluated at the end of the program. RESULTS Two patients of group E left the program. The other eight subjects completed the program with no MS-related exacerbations/complications. There was a significant change in 2 of 3 aspects of ambulatory function [Three minutes step test (P = 0.001), Timed Up and Go test (P = 0.009)], muscle strength (P = 0.000), and EDSS (P = 0.014). Comparing the two groups, we did not observe any significant change in "Balance" (P = 0.407). CONCLUSIONS The resistance training of moderate to high intensity was well-tolerated in MS patients and may be an effective intervention for improving muscle strength, functional ability and EDSS-based disease severity.
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Affiliation(s)
- Mahbubeh Moradi
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IR Iran
- Department of Sports Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, IR Iran
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IR Iran
- Sina MS Research Center, Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Aida Aghsaie
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IR Iran
- Sina MS Research Center, Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Reza Kordi
- Department of Sports Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, IR Iran
| | - Alipasha Meysamie
- Department of Community and Preventive Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Maryam Abolhasani
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IR Iran
- Department of Sports Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Maryam Abolhasani, Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188630228, Fax: +98-2166348570, E-mail:
| | - Vahid Sobhani
- Exercise Physiology Research Center, Baqyatallah University of Medical Sciences, Tehran, IR Iran
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14
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Motl RW, Dlugonski D, Pilutti LA, Klaren RE. Does the effect of a physical activity behavioral intervention vary by characteristics of people with multiple sclerosis? Int J MS Care 2015; 17:65-72. [PMID: 25892976 DOI: 10.7224/1537-2073.2014-016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Behavioral interventions have significantly increased physical activity in people with multiple sclerosis (MS). Nevertheless, there has been interindividual variability in the pattern and magnitude of change. This study documented the efficacy and variability of a behavioral intervention for changing physical activity and examined the possibility that efficacy varied by the characteristics of individuals with MS. METHODS Eighty-two people with MS were randomly assigned to one of two conditions: behavioral intervention (n = 41) or waitlist control (n = 41). We collected information before the study on MS type, disability status, weight status based on body-mass index, and current medications. Furthermore, all participants completed the Godin Leisure Time Exercise Questionnaire and the abbreviated International Physical Activity Questionnaire and wore an accelerometer for 1 week to measure minutes of moderate-to-vigorous physical activity before and after the 6-month intervention period. RESULTS Analysis of covariance (ANCOVA) indicated that participants in the behavioral intervention had significantly higher levels of physical activity than control participants after the 6-month period (P < .001). There was substantial interindividual variability in the magnitude of change, and ANCOVA indicated that MS type (relapsing vs. progressive) (P < .01), disability status (mild vs. moderate) (P < .01), and weight status (normal weight vs. overweight/obese) (P < .05) moderated the efficacy of the behavioral intervention. CONCLUSIONS The behavioral intervention was associated with improvements in physical activity, particularly for those with mild disability, relapsing-remitting MS, or normal weight status.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA (RWM, LAP, REK); and the Department of Kinesiology, East Carolina University, Greenville, NC, USA (DD)
| | - Deirdre Dlugonski
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA (RWM, LAP, REK); and the Department of Kinesiology, East Carolina University, Greenville, NC, USA (DD)
| | - Lara A Pilutti
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA (RWM, LAP, REK); and the Department of Kinesiology, East Carolina University, Greenville, NC, USA (DD)
| | - Rachel E Klaren
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA (RWM, LAP, REK); and the Department of Kinesiology, East Carolina University, Greenville, NC, USA (DD)
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15
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Relationships Among Physical Inactivity, Deconditioning, and Walking Impairment in Persons With Multiple Sclerosis. J Neurol Phys Ther 2015; 39:103-10. [DOI: 10.1097/npt.0000000000000087] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Yoga therapy and ambulatory multiple sclerosis Assessment of gait analysis parameters, fatigue and balance. J Bodyw Mov Ther 2015; 19:72-81. [DOI: 10.1016/j.jbmt.2014.04.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 02/27/2014] [Accepted: 03/03/2014] [Indexed: 12/18/2022]
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17
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Motl RW. Benefits, safety, and prescription of exercise in persons with multiple sclerosis. Expert Rev Neurother 2014; 14:1429-36. [DOI: 10.1586/14737175.2014.983904] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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18
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Tyler ME, Kaczmarek KA, Rust KL, Subbotin AM, Skinner KL, Danilov YP. Non-invasive neuromodulation to improve gait in chronic multiple sclerosis: a randomized double blind controlled pilot trial. J Neuroeng Rehabil 2014; 11:79. [PMID: 24885412 PMCID: PMC4017705 DOI: 10.1186/1743-0003-11-79] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 04/24/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study sought to examine the effect of targeted physical therapy with and without cranial nerve non-invasive neuromodulation (CN-NINM), on the walking ability of people with MS who exhibited a dysfunctional gait. We hypothesized that subjects who received electrical stimulation would have greater improvement than those who had a control device after a 14-week intervention. Gait disturbance is a common problem for people with multiple sclerosis (MS). Current management may include exercise, pharmacology, functional electrical stimulation, compensatory strategies, use of assistive devices, and implanted electrical devices. We have developed an effective rehabilitative strategy using neuromodulation of the cranial nerves via electrical stimulation of the tongue to enhance the plasticity of the brain. METHODS The study is a within-subject blinded randomized control design. Twenty chronic MS subjects with an identified gait disturbance were assigned to either an active or control group. Both groups completed a 14-week intervention program using a standardized combination of exercise and a device that provided electrical stimulation to the tongue. Those in the active group received electrical stimulation on the tongue that they could perceive. Those in the control group used a device that did not provide a physiologically significant stimulus and was not perceivable. Subjects were assessed with the Dynamic Gait Index (DGI). RESULTS The DGI scores improved for both groups. There were significant between-group differences, with the active group showing statistically greater improvement than the control group mean. CONCLUSION People with MS demonstrated improved gait with CN-NINM training in a pilot randomized controlled trial. This study suggests that tongue-based neurostimulation may amplify the benefits of exercise for improving gait in people with chronic MS.
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Affiliation(s)
- Mitchell E Tyler
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI 53706, USA
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Kurt A Kaczmarek
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Kathy L Rust
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Alla M Subbotin
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Kimberly L Skinner
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI 53706, USA
| | - Yuri P Danilov
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
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19
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Plow M, Finlayson M. Potential benefits of nintendo wii fit among people with multiple sclerosis: a longitudinal pilot study. Int J MS Care 2014; 13:21-30. [PMID: 24453702 DOI: 10.7224/1537-2073-13.1.21] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We examined the potential of Nintendo Wii Fit (Nintendo Co, Ltd, Kyoto, Japan) to increase physical activity (PA) behavior and health among people with multiple sclerosis (MS). The study consisted of a repeated-measures design with a baseline control period and involved 30 people with MS who had the ability to walk 25 feet with or without a cane (26 individuals were included in the analyses). Nintendo Wii was set up in the homes of participants, who were prescribed a Wii Fit exercise program lasting 14 weeks, 3 days a week. The Physical Activity and Disability Survey, Modified Fatigue Impact Scale, and 36-item Short Form Health Status Survey were administered three times before participants gained access to Wii Fit (control period, at 2-week intervals), and three times after they received Wii Fit (posttest 1: immediately after; posttest 2: 7 weeks after; posttest 3: 14 weeks after). Mobility, balance, strength, and weight were assessed at the first pretest, immediately prior to obtaining access to Wii Fit, and 7 weeks after obtaining access to Wii Fit. Results from the questionnaires indicated that PA significantly improved at week 7, but at week 14, PA levels declined relative to week 7 and the difference was no longer significant compared with the control period. Physical assessments indicated that balance and strength significantly improved at week 7. One adverse event was reported (repetitive knee injury). Physical assessments indicated that people with MS may be able to improve their fitness levels by using Wii Fit. Future studies should incorporate behavior change strategies to promote long-term use of Wii Fit, and explore whether individuals with more severe symptoms of MS can safely use Wii Fit.
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Affiliation(s)
- Matthew Plow
- Department of Biomedical Engineering and Department of Physical Medicine and Rehabilitation, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA (MP); and Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA (MF)
| | - Marcia Finlayson
- Department of Biomedical Engineering and Department of Physical Medicine and Rehabilitation, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA (MP); and Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA (MF)
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20
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Weikert M, Dlugonski D, Balantrapu S, Motl RW. Most common types of physical activity self-selected by people with multiple sclerosis. Int J MS Care 2014; 13:16-20. [PMID: 24453701 DOI: 10.7224/1537-2073-13.1.16] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The promotion of physical activity for people with multiple sclerosis (MS) would benefit from information about the common types of physical activity self-selected by this population. This study examined the most frequent types of physical activity self-reported by a large sample of people with MS. The data were collected as part of the baseline assessment of a longitudinal investigation of physical activity in relapsing-remitting MS (RRMS). The participants (N = 272) were sent a battery of questionnaires through the US Postal Service that included the Modifiable Activity Questionnaire for assessing types of physical activity performed during the previous year. Walking was ranked number 1 for both the first and second most common types of physical activity self-selected by people with MS, and it was ranked number 4 as the third most common type of self-selected physical activity. Collectively, 79% of the sample reported walking as a frequent form of self-selected physical activity in the previous year. Other notable types of physical activities self-selected by people with MS were gardening (44%), weight training (34%), bicycling (30%), and calisthenics (20%). This information may assist clinicians and practitioners in the development of physical activity programs and recommendations for people with MS.
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Affiliation(s)
- Madeline Weikert
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Deirdre Dlugonski
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Swathi Balantrapu
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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21
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Objectively quantified physical activity in persons with multiple sclerosis. Arch Phys Med Rehabil 2013; 94:2342-2348. [PMID: 23906692 DOI: 10.1016/j.apmr.2013.07.011] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/10/2013] [Accepted: 07/10/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To investigate levels of moderate-to-vigorous physical activity (MVPA) in a large sample of persons with multiple sclerosis (MS) and controls using accelerometry as a measure of physical activity, and to compare the rates of meeting public health guidelines for MVPA (ie, 30min/d) between persons with MS and controls. DESIGN Secondary analysis of a combined data set of persons with MS and healthy controls from 13 previous investigations of physical activity over a 8-year period (2005-2013). SETTING University. PARTICIPANTS Participants with MS (n=800) were recruited primarily within Illinois through multiple sources, including print and e-mail flyers and an online advertisement on the National Multiple Sclerosis Society website. Healthy controls (n=137) were recruited via public e-mail postings delivered across the university community. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Levels of MVPA and meeting public health guidelines for MVPA between persons with MS and controls. RESULTS After controlling for covariates (ie, age, sex, education, race, income), there was a moderate (d=.68) and statistically significant (F=47.2, P<.001) difference of 13.1 minutes of MVPA per day (95% confidence interval, 9.4-16.8) between MS and controls. There was a difference in the rates of meeting public health guidelines for MVPA (χ(2)=50.7, P<.001) between MS patients (20%) and controls (47%). Among those with MS, minutes of MVPA significantly differed as a function of education, employment status, clinical course, disease duration, and disability status. CONCLUSIONS We provide data using an objective physical activity measure and a large sample to indicate that only a small proportion of persons with MS are achieving adequate amounts of daily MVPA.
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22
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Plow M, Bethoux F, McDaniel C, McGlynn M, Marcus B. Randomized controlled pilot study of customized pamphlets to promote physical activity and symptom self-management in women with multiple sclerosis. Clin Rehabil 2013; 28:139-48. [DOI: 10.1177/0269215513494229] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Investigate the feasibility and potential efficacy of a customized print-based intervention to promote physical activity and symptom self-management in women with multiple sclerosis. Design: A randomly allocated two-group repeated measures design, with a delayed-treatment contact group serving as the control. Participants were randomized to receive the intervention immediately ( n =14) or receive it at week 12 ( n =16). Outcome measures were administered at weeks 1, 12, and 24. Setting: Community-based in metropolitan area. Subjects: Thirty women with multiple sclerosis. Intervention: Prescribing a home-exercise program and following up with customized pamphlets, which are matched to participants’ stage of readiness to change physical activity behavior and physical activity barriers (e.g. encouraging self-management of symptoms). Main Measures: Physical Activity and Disability Survey-revised, Godin Leisure-Time Exercise Questionnaire, SF-12, Symptoms of Multiple Sclerosis Scale, and 6-minute walk test. Results: Intent-to-treat analyses using mixed multivariate analysis of variance (MANOVA) were conducted on (1) physical activity levels and (2) health and function outcomes. The mixed MANOVAs for physical activity levels and health and function outcomes indicated significant improvements in the immediate group compared with the delayed group (i.e. condition by time interaction was significant, Wilks’ λ = 0.59, F2, 27 = 9.31, P = 0.001 and Wilks’ λ = 0.70, F4, 25 = 2.72, P = 0.052, respectively). The intervention had moderate to large effect sizes in improving physical activity levels (d = 0.63 to 0.89), perceptions of physical function (d = 0.63), and 6-minute walk test (d=0.86). Conclusion: This pilot study indicates that a customized print-based intervention shows promise in improving physical activity levels and health and function in women with multiple sclerosis.
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Affiliation(s)
- Matthew Plow
- Departments of Biomedical Engineering, and Physical Medicine and Rehabilitation, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Francois Bethoux
- Rehabilitation Services, Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Corey McDaniel
- Departments of Biomedical Engineering, and Physical Medicine and Rehabilitation, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Mark McGlynn
- Departments of Biomedical Engineering, and Physical Medicine and Rehabilitation, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Bess Marcus
- Department of Family and Preventive Medicine, University of California, San Diego, CA, USA
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23
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Motl RW, Pilutti LA, Sandroff BM, Klaren R, Balantrapu S, McAuley E, Sosnoff JJ, Fernhall B. Rationale and design of a randomized controlled, clinical trial investigating a comprehensive exercise stimulus for improving mobility disability outcomes in persons with multiple sclerosis. Contemp Clin Trials 2013; 35:151-8. [DOI: 10.1016/j.cct.2013.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 03/19/2013] [Accepted: 03/21/2013] [Indexed: 01/21/2023]
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24
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A Qualitative Study Exploring the Usability of Nintendo Wii Fit among Persons with Multiple Sclerosis. Occup Ther Int 2013; 21:21-32. [DOI: 10.1002/oti.1345] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 12/05/2012] [Accepted: 01/28/2013] [Indexed: 11/07/2022] Open
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25
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Sandroff BM, Sosnoff JJ, Motl RW. Physical fitness, walking performance, and gait in multiple sclerosis. J Neurol Sci 2013; 328:70-6. [PMID: 23522499 DOI: 10.1016/j.jns.2013.02.021] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/18/2013] [Accepted: 02/20/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Walking impairment is a prevalent, life-altering feature of multiple sclerosis (MS). There has been recent speculation that physiological deconditioning (i.e., reductions in aerobic capacity, balance, and muscular strength) contributes to walking and gait impairments in MS. OBJECTIVE This study examined the associations among aerobic capacity, balance, and lower-limb strength asymmetries, walking performance, and gait kinematics in 31 persons with MS and 31 matched controls. METHODS Participants underwent standard assessments of peak aerobic capacity, muscular strength (i.e., asymmetry between knee muscles), and balance. Walking performance was measured using the timed 25-ft walk (T25FW) and six-minute walk (6MW). Gait parameters were captured using a GaitRite™ electronic walkway. RESULTS Aerobic capacity, balance, and knee-extensor asymmetry were associated with walking performance and gait in persons with MS (r=.2-.6) and explained differences in walking and gait variables between MS and control groups (∆R(2)=.27-.34). Aerobic capacity and lower-limb strength asymmetries, but not balance, explained significant variance in walking performance and gait kinematics in the MS sample (R(2)=.32-.58). CONCLUSIONS Physiological deconditioning explains variability in walking disability in persons with MS and might represent a target of multimodal exercise training interventions for improving mobility outcomes in this population.
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Affiliation(s)
- Brian M Sandroff
- University of Illinois at Urbana-Champaign, Department of Kinesiology and Community Health, Urbana, IL 61801, USA
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26
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Plow M, Finlayson M. Potential Benefits of Nintendo Wii Fit Among People with Multiple Sclerosis. Int J MS Care 2013. [DOI: 10.7224/1537-2073-15.s1.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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27
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Dlugonski D, Pilutti LA, Sandroff BM, Suh Y, Balantrapu S, Motl RW. Steps per day among persons with multiple sclerosis: variation by demographic, clinical, and device characteristics. Arch Phys Med Rehabil 2013; 94:1534-9. [PMID: 23419331 DOI: 10.1016/j.apmr.2012.12.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 11/29/2012] [Accepted: 12/10/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify steps per day in a large sample of persons with multiple sclerosis (MS) and to describe variation by demographic and clinical characteristics and device type. DESIGN Cross-sectional design. SETTING General community. PARTICIPANTS Convenience sample of persons with multiple sclerosis (N=645) recruited from the general community who were ambulatory and relapse free for 30 days. Mean age ± SD of the participants was 46.3 ± 10.6 years old. Participants were mostly women (85%), white (93%), and employed (64%). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Step counts measured by a motion sensor during a 7-day period. RESULTS The average value for the entire sample was 5,903 ± 3,185 steps per day. This value varied by demographic and clinical characteristics, but not device type, and indicated that men, participants who were unemployed, had a high school education or less, progressive MS, a longer disease duration, and higher disability were less physically active based on the metric of steps per day. CONCLUSIONS This study provides an expected value for average steps per day among persons with MS. Such an expected value for this population is an important first step to help researchers and clinicians interested in improving the overall health of persons with MS through physical activity promotion.
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Affiliation(s)
- Deirdre Dlugonski
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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28
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Garrett M, Hogan N, Larkin A, Saunders J, Jakeman P, Coote S. Exercise in the community for people with multiple sclerosis--a follow-up of people with minimal gait impairment. Mult Scler 2012; 19:790-8. [PMID: 23132904 DOI: 10.1177/1352458512461390] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although there are many studies evaluating exercise interventions, few studies have evaluated the effect at follow-up. OBJECTIVES This paper presents follow-up data for participants who completed the exercise interventions in a large randomised controlled trial. METHODS One hundred twenty-one people with multiple sclerosis (MS) with minimal gait impairment who completed 10 weeks of community-based exercise interventions were evaluated by a blinded assessor 12 weeks after the intervention. The primary outcome measure was the Multiple Sclerosis Impact Scale-29 version 2 (MSIS-29,v2) physical component. Other outcomes were the MSIS-29 psychological component, the Modified Fatigue Impact Scale (MFIS) and the 6-minute walk test (6MWT) distance. RESULTS The positive effect on the physical impact of MS was not maintained from baseline to follow-up (-1.6, 95% CI -0.8, 4.0, p=0.189). The psychological impact and the impact of fatigue remained significantly improved (-3.5, 95% CI -6.1, -1.0, p = 0.006 and -4.68, 95% CI -6.9, -2.5, p < 0.001, respectively). There was no time effect for the 6MWT (f = 1.76, p = 0.179) although the trend suggests reversal of the benefits gained from the physiotherapist (PT)- and fitness instructor (FI)-led intervention. CONCLUSION The maintained benefit on the psychological impact of MS and fatigue may have important personal and socioeconomic consequences; however, it is important to find ways to maintain the physical benefits of exercise over the long term.
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Affiliation(s)
- Maria Garrett
- Department of Clinical Therapies, University of Limerick, Ireland.
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29
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Garrett M, Hogan N, Larkin A, Saunders J, Jakeman P, Coote S. Exercise in the community for people with minimal gait impairment due to MS: an assessor-blind randomized controlled trial. Mult Scler 2012; 19:782-9. [DOI: 10.1177/1352458512461966] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: While there is an increasing body of evidence supporting the efficacy of exercise in people with multiple sclerosis (MS), additional information on the effectiveness of combining aerobic and resistance training, and yoga is required. Objectives: This study evaluated the effectiveness of community exercise interventions for people with MS having minimal gait impairment. Methods: A multi-centred, block-randomised, assessor-blinded, controlled trial was conducted. Participants were randomised in groups of eight to physiotherapist (PT)-led exercise ( n = 80), yoga ( n = 77), fitness instructor (FI)-led exercise ( n = 86) and they took part in weekly community-based group exercise sessions. Those in the control group were asked not to change of their exercise habits ( n = 71). The primary outcome was the Multiple Sclerosis Impact Scale (MSIS) 29v2 physical component, measured before and after the 10-week intervention. Secondary outcomes were the MSIS 29v2 psychological component, the Modified Fatigue Impact Scale (MFIS) and the 6-Minute Walk Test (6MWT). Results: The group x time interaction approached significance for the MSIS-29v2 physical component ( f = 2.48, p = 0.061) and MFIS total ( f = 2.50, p = 0.06), and it was significant for the MFIS physical subscale ( f = 4.23, p = 0.006). All three exercise interventions led to a statistically significant improvement on the MSIS-29 psychological component and both the MFIS total and physical subscales, which were greater than the control ( p < 0.05). Only the PT-led and FI-led interventions significantly improved the MSIS-29 physical and 6MWT to levels greater than the control ( p < 0.05). Conclusions: This study provides evidence for the positive effect of exercise on the physical impact of MS and fatigue. The group nature of the classes may have contributed to the positive effects seen on the psychological impact of MS.
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Affiliation(s)
| | - N Hogan
- University of Limerick, Ireland
| | - A Larkin
- Multiple Sclerosis Society of Ireland, Galway, Ireland
| | | | | | - S Coote
- University of Limerick, Ireland
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30
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Plow M, Finlayson M, Motl RW, Bethoux F. Randomized controlled trial of a teleconference fatigue management plus physical activity intervention in adults with multiple sclerosis: rationale and research protocol. BMC Neurol 2012; 12:122. [PMID: 23072517 PMCID: PMC3495833 DOI: 10.1186/1471-2377-12-122] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 09/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic fatigue and inactivity are prevalent problems among individuals with multiple sclerosis (MS) and may independently or interactively have detrimental effects on quality of life and ability to participate in life roles. However, no studies to date have systematically evaluated the benefits of an intervention for both managing fatigue and promoting physical activity in individuals with MS. This study involves a randomized controlled trial to examine the effectiveness of a telehealth intervention that supports individuals with MS in managing fatigue and increasing physical activity levels. METHODS/DESIGN A randomly-allocated, three-parallel group, time-series design with a social support program serving as the control group will be used to accomplish the purpose of the study. Our goal is to recruit 189 ambulatory individuals with MS who will be randomized into one of three telehealth interventions: (1) a contact-control social support intervention, (2) a physical activity-only intervention, and (3) a physical activity plus fatigue management intervention. All interventions will last 12 weeks and will be delivered entirely over the phone. Our hypothesis is that, in comparison to the contact-control condition, both the physical activity-only intervention and the physical activity plus fatigue management intervention will yield significant increases in physical activity levels as well as improve fatigue and health and function, with the physical activity plus fatigue management intervention yielding significantly larger improvements. To test this hypothesis, outcome measures will be administered at Weeks 1, 12, and 24. Primary outcomes will be the Fatigue Impact Scale, the Godin Leisure-Time Exercise Questionnaire (GLTEQ), and Actigraph accelerometers. Secondary outcomes will include the SF-12 Survey, Mental Health Inventory, Multiple Sclerosis Impact Scale, the Community Participation Indicator, and psychosocial constructs (e.g., self-efficacy). DISCUSSION The proposed study is novel, in that it represents a multi-disciplinary effort to merge two promising lines of research on MS: fatigue management and physical activity promotion. Collectively, the proposed study will be the largest randomized controlled trial to examine the effects of a lifestyle physical activity intervention in people with MS. TRIAL REGISTRATION NCT01572714.
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Affiliation(s)
- Matthew Plow
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, 9500 Euclid Ave, ND-20, Cleveland, OH 44195, USA.
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Aubrey G, Demain S. Perceptions of group exercise in the management of multiple sclerosis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2012. [DOI: 10.12968/ijtr.2012.19.10.557] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Grace Aubrey
- Nottingham University Hospitals NHS Trust, Nottingham, UK; and
| | - Sara Demain
- Health Sciences, University of Southampton, UK
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Abstract
Multiple sclerosis (MS) is an immune-mediated disease characterized by inflammatory demyelination and neurodegeneration within the CNS. This damage of CNS structures leads to deficits of body functions, which, in turn, affect patient activities, such as walking, and participation. The pathogenesis and resulting consequences of MS have been described as concepts within the International Classification of Functioning, Disability and Health (ICF) model--an international standard to describe and measure health and disability. Evidence suggests that exercise training in people with MS has the potential to target and improve many of the components outlined in the ICF model. Although the body of research examining the effects of exercise training on depression, cognition and participatory outcomes is not sufficiently developed, some preliminary evidence is promising. Exercise training is proposed to affect inflammation, neurodegeneration, and CNS structures, but current evidence is limited. In this Review, we discuss evidence from clinical trials that suggests beneficial effects of exercise training on muscle strength, aerobic capacity and walking performance, and on fatigue, gait, balance and quality of life. Issues with current studies and areas of future research are highlighted.
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Dlugonski D, Joyce RJ, Motl RW. Meanings, motivations, and strategies for engaging in physical activity among women with multiple sclerosis. Disabil Rehabil 2012; 34:2148-57. [PMID: 22533641 DOI: 10.3109/09638288.2012.677935] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of the current study was to better understand the adoption and maintenance of physical activity from the perspective of women with multiple sclerosis (MS). METHODS Participants (N = 11) were women with MS who had low levels of disability and who engaged in varying levels of physical activity. Participants completed two semi-structured, audio taped interviews focusing on their beliefs, motivators, and experiences of physical activity. RESULTS Across all activity levels participants reported similar beliefs and motivations related to being physically active including the desire to be "normal", savoring current health, enjoyment of the activity, "feeling good" after activity, weight control, and maintenance of physical function. Active and inactive participants differed in the practical strategies they reportedly used to adopt and maintain physical activity, such as prioritizing and scheduling physical activity, managing disease-specific barriers, and building social support networks. CONCLUSIONS A consideration of these beliefs, motivations, and strategies may be useful for designing behavioral interventions to increase physical activity that are sensitive to the needs and preferences of women with MS.
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Affiliation(s)
- Deirdre Dlugonski
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, IL 61801, USA
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Kjølhede T, Vissing K, Dalgas U. Multiple sclerosis and progressive resistance training: a systematic review. Mult Scler 2012; 18:1215-28. [DOI: 10.1177/1352458512437418] [Citation(s) in RCA: 163] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Recently progressive resistance training (PRT) has been recognised as an effective tool in the rehabilitation of persons with multiple sclerosis (MS). The objective of this study was to systematically review the literature of PRT studies for persons with MS. A comprehensive literature search (PubMed, SveMed+, Embase, Cochrane, PEDro, SPORTDiscus and Bibliotek.dk) was conducted. Identified papers were rated according to the PEDro-scale. Sixteen studies were included and scored between 3 and 8 of 11 total points on the PEDro-scale, showing a general lack of blinding. Strong evidence regarding the beneficial effect of PRT on muscle strength was observed. Regarding functional capacity, balance and self-reported measures (fatigue, quality of life and mood) evidence is less strong, but the tendency is overall positive. Indications of an effect on underlying mechanisms such as muscle morphological changes, neural adaptations and cytokines also exist, but the studies investigating these aspects are few and inconclusive. PRT has a positive effect on muscle strength for persons with MS. Heterogeneous results exist regarding the effect on functional capacity and self-reported measures probably because of differences in training protocols, samples sizes, type and severity of MS. The area of underlying mechanisms deserves more attention in future research.
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Affiliation(s)
- T Kjølhede
- Section of Sport Science, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000 Aarhus C, Denmark
| | - K Vissing
- Section of Sport Science, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000 Aarhus C, Denmark
| | - U Dalgas
- Section of Sport Science, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000 Aarhus C, Denmark
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Accurate Prediction of Cardiorespiratory Fitness Using Cycle Ergometry in Minimally Disabled Persons With Relapsing-Remitting Multiple Sclerosis. Arch Phys Med Rehabil 2012; 93:490-5. [DOI: 10.1016/j.apmr.2011.08.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 08/16/2011] [Accepted: 08/24/2011] [Indexed: 11/24/2022]
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Internet-delivered behavioral intervention to increase physical activity in persons with multiple sclerosis: sustainability and secondary outcomes. PSYCHOL HEALTH MED 2012; 17:636-51. [PMID: 22313192 DOI: 10.1080/13548506.2011.652640] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Physical activity is associated with many benefits, but persons with multiple sclerosis (MS) are less physically active than the general population. There is a critical need for research on methods of increasing and sustaining the physical activity levels of this population. This randomized controlled trial examined the efficacy of an Internet-delivered and theory-based behavioral intervention that was supplemented with video coaching for increasing and sustaining physical activity over time in persons with MS. Physically inactive, ambulatory persons with MS (N = 45) were randomly assigned to intervention (n = 22) or control (n = 23) conditions and completed a battery of questionnaires before, after, and three months after a 12-week intervention period. Data analyses were conducted in PASW 18.0. Partial eta squared ([Formula: see text]) effect size indicated that there was a large, statistically significant condition-by-time interaction on physical activity ([Formula: see text]). Cohen's d effect sizes indicated that the intervention group had a large increase in physical activity after the 12-week trial (d = .98) that was sustained over a three-month follow-up (d = .79). The current study supports the efficacy of a behavioral intervention for increasing and sustaining physical activity in a sample of persons with MS.
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Abstract
The present study adopted an interrupted time-series design for identifying the possibility of behavioral reactivity and examining the effect of an Internet-delivered behavioral intervention for increasing self-reported and objectively-measured physical activity among persons with multiple sclerosis (MS). Participants (n = 18) wore an accelerometer for 7 days and completed a battery of questionnaires to measure physical activity at 3 time points (before and after a 3-month period of no treatment and again after a 3-month period of treatment). There was a small change in objectively-measured, but not self-reported, physical activity in the period of no treatment, whereas there was a large increase in self-reported and objectively-measured physical activity in the period of treatment. These findings both complement and extend previous research and further support the efficacy of the current Internet behavioral intervention for increasing physical activity in persons with MS.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
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Motl RW, Suh Y, Weikert M, Dlugonski D, Balantrapu S, Sandroff B. Fatigue, depression, and physical activity in relapsing-remitting multiple sclerosis: Results from a prospective, 18-month study. Mult Scler Relat Disord 2011; 1:43-8. [PMID: 25876450 DOI: 10.1016/j.msard.2011.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 08/16/2011] [Accepted: 08/18/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Fatigue, depression, and physical inactivity are common in multiple sclerosis (MS), but there is limited information on the bi-directional associations among those variables over a long period of time. OBJECTIVE This study examined the hypothesis that fatigue and depression would predict change in physical activity and that physical activity would predict changes in fatigue and depression over an 18-month period of time in persons with MS, even after controlling for disability status, disease duration, sex, and age. METHODS This longitudinal study collected data on fatigue, depression, physical activity, and confounding variables from the same sample of persons with relapsing-remitting MS on two occasions that were separated by 18 months. RESULTS The cross-lagged path coefficient between baseline fatigue and follow-up physical activity was statistically significant (path coefficient=-.26, p<.0001) as was the cross-lagged path coefficient between baseline physical activity and follow-up fatigue (path coefficient=-.11, p<.05). Those bi-directional associations were independent of depression, disability status, disease duration, sex, and age. There were no statistically significant cross-lagged path coefficients between depression and physical activity. CONCLUSIONS This study identified bi-directional associations between fatigue and physical activity over an 18-month period of time. The nature of such associations opens the door for research on fatigue management as an approach for sustaining or promoting physical activity over time.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 350 Freer Hall, Urbana, IL 61801, USA.
| | - Yoojin Suh
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 350 Freer Hall, Urbana, IL 61801, USA
| | - Madeline Weikert
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 350 Freer Hall, Urbana, IL 61801, USA
| | - Deirdre Dlugonski
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 350 Freer Hall, Urbana, IL 61801, USA
| | - Swathi Balantrapu
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 350 Freer Hall, Urbana, IL 61801, USA
| | - Brian Sandroff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 350 Freer Hall, Urbana, IL 61801, USA
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Lifestyle Physical Activity and Walking Impairment over Time in Relapsing-Remitting Multiple Sclerosis. Am J Phys Med Rehabil 2011; 90:372-9. [DOI: 10.1097/phm.0b013e31820f95e1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Broekmans T, Roelants M, Feys P, Alders G, Gijbels D, Hanssen I, Stinissen P, Eijnde BO. Effects of long-term resistance training and simultaneous electro-stimulation on muscle strength and functional mobility in multiple sclerosis. Mult Scler 2010; 17:468-77. [DOI: 10.1177/1352458510391339] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Resistance training studies in multiple sclerosis (MS) often use short intervention periods. Furthermore, training efficiency could be optimized by unilateral training and/or electrical stimulation. Objective: To examine the effect(s) of unilateral long-term (20 weeks) standardized resistance training with and without simultaneous electro-stimulation on leg muscle strength and overall functional mobility. Methods: A randomized controlled trial involving 36 persons with MS. At baseline (PRE) and after 10 (MID) and 20 (POST) weeks of standardized (ACSM) light to moderately intense unilateral leg resistance training (RESO, n = 11) only or resistance training with simultaneous electro-stimulation (RESE, n = 11, 100 Hz, biphasic symmetrical wave, 400 µs), maximal isometric strength of the knee extensors and flexors (45°, 90° knee angle) and dynamic (60–180°/s) knee-extensor strength was measured and compared with a control group (CON, n = 14). Functional mobility was evaluated using the Timed Get Up and Go, Timed 25 Foot Walk, Two-Minute Walk Test, Functional Reach and Rivermead Mobility Index. Results: Maximal isometric knee extensor (90°, MID: +10 ± 3%, POST: +10 ± 4%) in RESO and knee flexor (45°, POST: +7 ± 4%; 90°, POST: +9 ± 5%) in RESE strength increased ( p < 0.05) compared with CON but RESO and RESE did not differ. Also, impaired legs responded positively to resistance training (unilateral leg strength analysis) and functional reaching increased significantly in RESO (+18%) compared with CON. Dynamic muscle strength and the remaining functional mobility tests did not change. Conclusion: Long-term light to moderately intense resistance training improves muscle strength in persons with MS but simultaneous electro-stimulation does not further improve training outcome.
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Affiliation(s)
- Tom Broekmans
- REVAL Rehabilitation & Healthcare Research Center, Belgium
- Biomedical Research Institute, Hasselt University, Belgium
| | | | - Peter Feys
- REVAL Rehabilitation & Healthcare Research Center, Belgium
- Biomedical Research Institute, Hasselt University, Belgium
| | - Geert Alders
- REVAL Rehabilitation & Healthcare Research Center, Belgium
| | - Domien Gijbels
- REVAL Rehabilitation & Healthcare Research Center, Belgium
- Biomedical Research Institute, Hasselt University, Belgium
| | - Ine Hanssen
- REVAL Rehabilitation & Healthcare Research Center, Belgium
| | - Piet Stinissen
- Biomedical Research Institute, Hasselt University, Belgium
| | - Bert O Eijnde
- REVAL Rehabilitation & Healthcare Research Center, Belgium
- Biomedical Research Institute, Hasselt University, Belgium
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Motl RW, Weikert M, Suh Y, Dlugonski D. Symptom cluster and physical activity in relapsing-remitting multiple sclerosis. Res Nurs Health 2010; 33:398-412. [PMID: 20725947 DOI: 10.1002/nur.20396] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We compared the explanatory power of two symptom clusters that consisted of either three or five symptoms as correlates of physical activity in individuals with relapsing-remitting multiple sclerosis (RRMS; N = 218). The data were primarily analyzed using covariance modeling in Mplus 3.0. A symptom cluster of fatigue, depression, and pain had a moderate, negative relationship with physical activity, and this relationship was comparable in magnitude with a symptom cluster of fatigue, depression, pain, perceived cognitive dysfunction, and poor sleep quality. The relationships were attenuated after controlling for exercise history and neurological impairment. Such findings further support the consideration of a narrowly defined cluster of three symptoms as an independent correlate of physical activity in persons with RRMS.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
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