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Zheng P, Phillips SA, Duffecy J, DeJonge SR, DuBose NG, Motl RW. Remotely-delivered exercise training program for improving physical and cognitive functions among older adults with multiple sclerosis: Protocol for an NIH stage-I randomized controlled trial. Contemp Clin Trials 2024; 144:107636. [PMID: 39038700 DOI: 10.1016/j.cct.2024.107636] [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: 07/22/2023] [Revised: 04/14/2024] [Accepted: 07/17/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Older adults with multiple sclerosis (MS) present with low physical activity participation, cognitive and ambulatory dysfunctions, and compromised quality of life (QOL). OBJECTIVE We propose a NIH Stage-I, randomized controlled trial (RCT) that examines the feasibility and efficacy of a 16-week theory-based, remotely-delivered, exercise training program for improving cognitive and physical functions in older adults with MS who have moderate mobility disability without severe cognitive impairment. METHODS This Stage-I study utilizes a parallel-group RCT design. Participants (N = 50; age ≥ 50 years) will be randomly assigned into exercise training (combined aerobic and resistance exercise) or active control (flexibility and stretching) conditions. The conditions will be undertaken within a participant's home/community over a 16-week period, and monitored remotely and supported by Zoom-based chats guided by social cognitive theory (SCT) via a behavioral coach. Participants will receive training manuals and equipment, one-on-one behavioral coaching, action-planning calendars, self-monitoring logs, and SCT-based newsletters. The primary outcomes include feasibility (e.g., recruitment and retention rates), exercise behavior and physical activity; other outcomes include physical function (lower-extremity function, mobility, walking), cognition (processing speed, learning and memory, executive function), MS symptoms, QOL, and vascular function. We will collect outcome data at baseline (Week 0), post-intervention (Week 16), and follow-up (Week-32). Data analysis will follow intent-to-treat principles using linear mixed-effects models. DISCUSSION This Stage-I trial adopts an innovative approach for exercise training via telerehabilitation and is convenient and accessible for older adults with MS. If successful, the study will provide foundations for future research using remotely-delivered exercise intervention for managing the consequences of aging with MS. TRIAL REGISTRATION NUMBER NCT05930821.
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Affiliation(s)
- Peixuan Zheng
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States.
| | - Shane A Phillips
- Department of Physical Therapy, University of Illinois Chicago, Chicago, IL, United States
| | - Jennifer Duffecy
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, United States
| | - Sydney R DeJonge
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States
| | - Noah G DuBose
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States
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Jones CD, Kidwell-Chandler A, Cederberg KL, Sikes EM, Motl RW. Do fatigue and depression have a bivariate association with device-measured physical activity behavior in persons with multiple sclerosis? Disabil Rehabil 2024; 46:2522-2527. [PMID: 37350026 DOI: 10.1080/09638288.2023.2225876] [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: 08/13/2022] [Accepted: 06/10/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE This study examined the bivariate association between fatigue and depression symptoms and physical activity behavior in persons with multiple sclerosis (MS). METHODS The sample of adults with MS completed the Fatigue Severity Scale (FSS) and the Hospital Anxiety and Depression Scale (HADS) and wore a waist mounted accelerometer during waking hours for 7 days. We categorized participants as having elevated fatigue and depression based on cut-points for the FSS (i.e., 4+ as indicative of severe fatigue) and the HADS (i.e., 8+ as indicative of elevated depressive symptoms). We used a two-way multivariate analysis of variance (MANOVA) to examine the contribution of fatigue and depression to volume and pattern of sedentary, light (LPA) and moderate-to-vigorous physical activity (MVPA). RESULTS Results indicated no bivariate association between fatigue and depression and measures of physical activity behavior. The MANOVA indicated there was a significant association between fatigue and MVPA (F = 2.30, p = 0.032) and steps/day (F = 13.6, p < 0.001), independent of depression symptoms. There was no association between depression symptoms and physical activity behavior. CONCLUSIONS This study demonstrated an interrelation between fatigue symptoms and MVPA and steps/day in MS, independent of depression symptoms, and this should be considered in the future design and delivery of physical activity interventions in MS.IMPLICATIONS FOR REHABILIATIONFatigue and depression are prevalent and burdensome symptoms of multiple sclerosis (MS).These symptoms can collectively worsen psychological and functional outcomes in MS.Fatigue symptoms may impact ambulatory physical activity to a greater degree than depression symptom status in persons with MS.Fatigue is an important consideration when designing behavior change interventions targeted at promoting physical activity in persons with MS.
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Affiliation(s)
- C Danielle Jones
- Department of Physical Therapy, University of AL at Birmingham, Birmingham, AL, USA
| | | | - Katie L Cederberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - E Morghen Sikes
- Division of Occupational Therapy, Shenandoah University, Winchesterm, VA, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of IL Chicago, Chicago, IL, USA
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Fernández Ó, Sörensen PS, Comi G, Vermersch P, Hartung HP, Leocani L, Berger T, Van Wijmeersch B, Oreja-Guevara C. Managing multiple sclerosis in individuals aged 55 and above: a comprehensive review. Front Immunol 2024; 15:1379538. [PMID: 38646534 PMCID: PMC11032020 DOI: 10.3389/fimmu.2024.1379538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Multiple Sclerosis (MS) management in individuals aged 55 and above presents unique challenges due to the complex interaction between aging, comorbidities, immunosenescence, and MS pathophysiology. This comprehensive review explores the evolving landscape of MS in older adults, including the increased incidence and prevalence of MS in this age group, the shift in disease phenotypes from relapsing-remitting to progressive forms, and the presence of multimorbidity and polypharmacy. We aim to provide an updated review of the available evidence of disease-modifying treatments (DMTs) in older patients, including the efficacy and safety of existing therapies, emerging treatments such as Bruton tyrosine kinase (BTKs) inhibitors and those targeting remyelination and neuroprotection, and the critical decisions surrounding the initiation, de-escalation, and discontinuation of DMTs. Non-pharmacologic approaches, including physical therapy, neuromodulation therapies, cognitive rehabilitation, and psychotherapy, are also examined for their role in holistic care. The importance of MS Care Units and advance care planning are explored as a cornerstone in providing patient-centric care, ensuring alignment with patient preferences in the disease trajectory. Finally, the review emphasizes the need for personalized management and continuous monitoring of MS patients, alongside advocating for inclusive study designs in clinical research to improve the management of this growing patient demographic.
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Affiliation(s)
- Óscar Fernández
- Departament of Pharmacology, Faculty of Medicine; Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital of Malaga, Malaga, Spain
- Department of Pharmacology and Pediatry, Faculty of Medicine, University of Malaga, Malaga, Spain
| | - Per Soelberg Sörensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Copenhagen and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giancarlo Comi
- Department of Neurorehabilitation Sciences, Multiple Sclerosis Centre Casa di Cura Igea, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Patrick Vermersch
- Univ. Lille, Inserm U1172 LilNCog, CHU Lille, FHU Precise, Lille, France
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Brain and Mind Center, University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Palacky University Olomouc, Olomouc, Czechia
| | - Letizia Leocani
- Department of Neurorehabilitation Sciences, Multiple Sclerosis Centre Casa di Cura Igea, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Bart Van Wijmeersch
- University MS Centre, Hasselt-Pelt, Belgium
- Rehabilitation and Multiple Sclerosis (MS), Noorderhart Hospitals, Pelt, Belgium
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clínico Universitario San Carlos, IdISSC, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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Woelfle T, Bourguignon L, Lorscheider J, Kappos L, Naegelin Y, Jutzeler CR. Wearable Sensor Technologies to Assess Motor Functions in People With Multiple Sclerosis: Systematic Scoping Review and Perspective. J Med Internet Res 2023; 25:e44428. [PMID: 37498655 PMCID: PMC10415952 DOI: 10.2196/44428] [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: 11/18/2022] [Revised: 12/19/2022] [Accepted: 05/04/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Wearable sensor technologies have the potential to improve monitoring in people with multiple sclerosis (MS) and inform timely disease management decisions. Evidence of the utility of wearable sensor technologies in people with MS is accumulating but is generally limited to specific subgroups of patients, clinical or laboratory settings, and functional domains. OBJECTIVE This review aims to provide a comprehensive overview of all studies that have used wearable sensors to assess, monitor, and quantify motor function in people with MS during daily activities or in a controlled laboratory setting and to shed light on the technological advances over the past decades. METHODS We systematically reviewed studies on wearable sensors to assess the motor performance of people with MS. We scanned PubMed, Scopus, Embase, and Web of Science databases until December 31, 2022, considering search terms "multiple sclerosis" and those associated with wearable technologies and included all studies assessing motor functions. The types of results from relevant studies were systematically mapped into 9 predefined categories (association with clinical scores or other measures; test-retest reliability; group differences, 3 types; responsiveness to change or intervention; and acceptability to study participants), and the reporting quality was determined through 9 questions. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. RESULTS Of the 1251 identified publications, 308 were included: 176 (57.1%) in a real-world context, 107 (34.7%) in a laboratory context, and 25 (8.1%) in a mixed context. Most publications studied physical activity (196/308, 63.6%), followed by gait (81/308, 26.3%), dexterity or tremor (38/308, 12.3%), and balance (34/308, 11%). In the laboratory setting, outcome measures included (in addition to clinical severity scores) 2- and 6-minute walking tests, timed 25-foot walking test, timed up and go, stair climbing, balance tests, and finger-to-nose test, among others. The most popular anatomical landmarks for wearable placement were the waist, wrist, and lower back. Triaxial accelerometers were most commonly used (229/308, 74.4%). A surge in the number of sensors embedded in smartphones and smartwatches has been observed. Overall, the reporting quality was good. CONCLUSIONS Continuous monitoring with wearable sensors could optimize the management of people with MS, but some hurdles still exist to full clinical adoption of digital monitoring. Despite a possible publication bias and vast heterogeneity in the outcomes reported, our review provides an overview of the current literature on wearable sensor technologies used for people with MS and highlights shortcomings, such as the lack of harmonization, transparency in reporting methods and results, and limited data availability for the research community. These limitations need to be addressed for the growing implementation of wearable sensor technologies in clinical routine and clinical trials, which is of utmost importance for further progress in clinical research and daily management of people with MS. TRIAL REGISTRATION PROSPERO CRD42021243249; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=243249.
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Affiliation(s)
- Tim Woelfle
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Lucie Bourguignon
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Johannes Lorscheider
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Yvonne Naegelin
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
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Depression, Anxiety, and Physical Activity in Older Adults With Multiple Sclerosis. J Aging Phys Act 2023; 31:128-134. [PMID: 35926843 DOI: 10.1123/japa.2021-0447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/28/2022] [Accepted: 06/09/2022] [Indexed: 02/03/2023]
Abstract
This study examined levels of depression and anxiety symptoms (Hospital Anxiety and Depression Scale scores), and self-reported (Godin Leisure-Time Exercise Questionnaire), and accelerometer-measured physical activity in older adults with multiple sclerosis (n = 40) compared with age- and sex-matched healthy controls (n = 40). We observed differences in depression, anxiety, and physical activity between groups and further observed that minutes/day of moderate to vigorous physical activity partially accounted for group differences in depression scores. We provide preliminary support for research examining approaches for increasing moderate to vigorous physical activity and possibly reducing depression symptoms in older adults with multiple sclerosis.
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Motl RW, Baird JF. Health-Related Quality of Life and Physical Activity in Older Adults With Multiple Sclerosis. Int J MS Care 2023; 25:26-29. [PMID: 36711217 PMCID: PMC9881419 DOI: 10.7224/1537-2073.2021-136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND People with multiple sclerosis (MS) are living longer but not necessarily better lives, and this portends reduced health-related quality of life (HRQOL). Physical activity (PA) may be a correlate of HRQOL for people with MS. We examined differences in HRQOL and PA between older adults with and without MS to determine whether PA is associated with HRQOL and whether it accounts for group differences in HRQOL. METHODS Thirty-one older adults with MS and 30 age- and sex-matched controls without MS completed the 36-Item Short Form Health Survey (SF-36) and the Godin Leisure-Time Exercise Questionnaire (GLTEQ). Data were analyzed using the Baron and Kenny approach for examining PA via the GLTEQ as a mediator of group differences in HRQOL. RESULTS The MS group had significantly lower component scores on the SF-36 and the GLTEQ than the control group. The GLTEQ scores were correlated with SF-36 physical component scores (r = 0.52), whereas the correlation with mental component scores (r = 0.23) was small and nonsignificant. Group assignment initially explained 31% of the variance in physical component scores (β = 0.55) and adding GLTEQ to the model accounted for an additional 12% of the variance in physical component scores. Thus, group (β = 0.42) and GLTEQ (β = 0.37) were both significant correlates of physical component scores. The group effect was modestly attenuated with the addition of GLTEQ in step 2 (step 1 β = 0.55; step 2 β = 0.42) and indicated partial rather than full mediation. CONCLUSIONS These results provide cross-sectional support for future research examining approaches to increase PA to possibly improve the physical component of HRQOL in older adults with MS.
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Affiliation(s)
- Robert W. Motl
- From the Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA (RWM)
| | - Jessica F. Baird
- From the Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA (JFB)
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Huynh TLT, Silveira SL, Motl RW. Physical activity behavior in persons newly diagnosed with multiple sclerosis: Applying the Capability - Opportunity - Motivation - Behavior (COM-B) model. Mult Scler Relat Disord 2023; 69:104432. [PMID: 36470170 DOI: 10.1016/j.msard.2022.104432] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/03/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Physical activity (PA) research in multiple sclerosis (MS) typically has not focused on persons newly diagnosed with the disease. This is noteworthy as PA might be most amenable for change in the early stages of MS and further yield long-term benefits over the disease course. PURPOSE This study examined correlates of PA based on the Capability-Opportunity-Motivation-Behavior (COM-B) model in persons newly diagnosed with MS. METHODS Participants newly diagnosed with MS (i.e., ≤ 2 years; n = 152) completed an online Qualtrics survey that assessed PA levels and COM-B constructs. Multivariate Analysis of Variance and Discriminant Function Analysis identified the constructs that differentiated PA groups. RESULTS The results indicated that 39.5% and 34.2% of the sample were classified as Insufficiently Active and Not Regularly Active, respectively. The results further identified Intention, Action Control, Action Self-efficacy, Action Planning, Outcome Expectation, Goal Setting, and Recovery Self-efficacy, and Fatigue as the primary correlates of PA in persons newly diagnosed with MS. CONCLUSIONS Our results identified COM-B constructs in the Capability and Motivation domains as the primary correlates of physical activity in persons newly diagnosed with MS. Such research might inform interventions for changing physical activity in this MS subpopulation.
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Affiliation(s)
- Trinh L T Huynh
- Department of Physical Therapy, University of Alabama at Birmingham, CH19 Room 301, 933 19th Street South, Birmingham, AL 35205, USA.
| | - Stephanie L Silveira
- Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, TX, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
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Torchio A, Fusari G, Perini G, Crispiatico V, Grosso C, Cattaneo D, Pagliari C, Jonsdottir J. Objective and subjective measures of daily physical activity in persons with Multiple Sclerosis beginning a rehabilitation regime: A cross-sectional study. Mult Scler Relat Disord 2022; 68:104394. [PMID: 36544306 DOI: 10.1016/j.msard.2022.104394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/11/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Fatigue, and balance and gait disorders can impact on physical activity (PA) levels in persons with Multiple Sclerosis (pwMS). To date, several studies have examined PA in pwMS during daily life, but little is known about PA levels in pwMS during a rehabilitation period. The present study investigated PA levels (daily steps, light physical activity (LPA), and moderate-vigorous physical activity (MVPA)) in inpatient and outpatients with MS during their rehabilitation period and described the relationship between objectively measured PA and levels of disability, quality of life, fatigue, and self-efficacy. METHODS In this exploratory cross-sectional study, we examined 40 pwMS during their inpatient or outpatient rehabilitation regime. Participants included in the study (N = 34) wore a Fitbit Versa tracker for one week recording daily steps, minutes of LPA, and minutes of MVPA (primary outcomes). They underwent a clinical assessment of physical activity levels (Godin Leisure-Time Exercise Questionnaire(GLTEQ)), fatigue (Fatigue Severity Scale(FSS)), walking ability (10 Meter Walk Test(10MWT), 2-Min Walk Test(2MWT), 12-item Multiple Sclerosis Walking scale(MSWS-12)), quality of life (12-Item Short Form Survey (SF-12)), and self-efficacy (Self-Efficacy in Multiple Sclerosis scale (SEMS)) (secondary outcomes). Multiple linear regressions (MLR) models were used to test whether the demographic difference between the two groups influenced the estimation of objective variables measured by Fitbit. Finally, correlations between objectively measured physical activity and subjective clinical scales were estimated with Spearman correlations. RESULTS Our sample consisted of 21 females and 13 males with a mean (interquartile range) age of 52 (20) years and an Expanded Disability Status scale(EDSS) score of 6.0 (1.50) points; baseline characteristics of inpatients (N = 18) and outpatients (N = 16) differed statistically only in EDSS levels (p-value = 0.008) and use of assistive devices (p=0.007). The whole sample performed (mean±standard deviation) 3969±2190 steps per day, with no significant difference between inpatients (3318±1515) and outpatients (4660±2606). No statistical difference was found between the groups in LPA (p-value=0.064). A significant difference in MVPA (p-value < 0.001) was found between inpatients and outpatients, 1.52±3.98 and 14.69±11.56 min per day, respectively. Significant correlations were found between FSS and MVPA both in the whole sample (r(32)= -0.62, p < 0.001) and in the outpatients group (r(14) = -0.66, p = 0.005), and between 10MWT and daily steps (whole sample:(r(32) = 0.48, p = 0.005), outpatients:(r(14)= -0.51, p = 0.05)). CONCLUSIONS PwMS in our study overall engaged in reduced and less intense levels of daily PA with respect to the guidelines with inpatients performing almost no vigorous activities. Considering the importance of PA in improving physical and mental well-being, clinicians and researchers should develope strategies to increase daily PA of PwMS during their rehabilitation programs and daily life.
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Affiliation(s)
- Alessandro Torchio
- LaRiCE lab: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, Milan 20148, Italy
| | - Giulia Fusari
- LaRiCE lab: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, Milan 20148, Italy
| | - Gloria Perini
- LaRiCE lab: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, Milan 20148, Italy
| | - Valeria Crispiatico
- LaRiCE lab: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, Milan 20148, Italy
| | - Cristina Grosso
- LaRiCE lab: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, Milan 20148, Italy
| | - Davide Cattaneo
- LaRiCE lab: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, Milan 20148, Italy; Department of Physiopathology and Transplants, University of Milan, Milan, Italy
| | - Chiara Pagliari
- LaRiCE lab: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, Milan 20148, Italy
| | - Johanna Jonsdottir
- LaRiCE lab: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, IRCCS Fondazione Don Carlo Gnocchi Onlus, Via Capecelatro 66, Milan 20148, Italy.
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Polhemus A, Haag C, Sieber C, Sylvester R, Kool J, Gonzenbach R, von Wyl V. Methodological heterogeneity biases physical activity metrics derived from the Actigraph GT3X in multiple sclerosis: A rapid review and comparative study. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:989658. [PMID: 36518351 PMCID: PMC9742246 DOI: 10.3389/fresc.2022.989658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/01/2022] [Indexed: 11/10/2023]
Abstract
BACKGROUND Physical activity (PA) is reduced in persons with multiple sclerosis (MS), though it is known to aid in symptom and fatigue management. Methods for measuring PA are diverse and the impact of this heterogeneity on study outcomes is unclear. We aimed to clarify this impact by comparing common methods for deriving PA metrics in MS populations. METHODS First, a rapid review of existing literature identified methods for calculating PA in studies which used the Actigraph GT3X in populations with MS. We then compared methods in a prospective study on 42 persons with MS [EDSS 4.5 (3.5-6)] during a voluntary course of inpatient neurorehabilitation. Mixed-effects linear regression identified methodological factors which influenced PA measurements. Non-parametric hypothesis tests, correlations, and agreement statistics assessed overall and pairwise differences between methods. RESULTS In the rapid review, searches identified 421 unique records. Sixty-nine records representing 51 eligible studies exhibited substantial heterogeneity in methodology and reporting practices. In a subsequent comparative study, multiple methods for deriving six PA metrics (step count, activity counts, total time in PA, sedentary time, time in light PA, time in moderate to vigorous PA), were identified and directly compared. All metrics were sensitive to methodological factors such as the selected preprocessing filter, data source (vertical vs. vector magnitude counts), and cutpoint. Additionally, sedentary time was sensitive to wear time definitions. Pairwise correlation and agreement between methods varied from weak (minimum correlation: 0.15, minimum agreement: 0.03) to perfect (maximum correlation: 1.00, maximum agreement: 1.00). Methodological factors biased both point estimates of PA and correlations between PA and clinical assessments. CONCLUSIONS Methodological heterogeneity of existing literature is high, and this heterogeneity may confound studies which use the Actigraph GT3X. Step counts were highly sensitive to the filter used to process raw accelerometer data. Sedentary time was particularly sensitive to methodology, and we recommend using total time in PA instead. Several, though not all, methods for deriving light PA and moderate to vigorous PA yielded nearly identical results. PA metrics based on vertical axis counts tended to outperform those based on vector magnitude counts. Additional research is needed to establish the relative validity of existing methods.
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Affiliation(s)
- Ashley Polhemus
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Christina Haag
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
| | - Chloé Sieber
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
| | - Ramona Sylvester
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
| | - Jan Kool
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
| | - Roman Gonzenbach
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
| | - Viktor von Wyl
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
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Huynh TLT, Silveira SL, Motl RW. Systematic review of participant characteristics in theory-based behavior change interventions for physical activity in multiple sclerosis: are we missing those with the greatest potential for lifelong benefits? Disabil Rehabil 2022; 44:5784-5803. [PMID: 34334057 DOI: 10.1080/09638288.2021.1954705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 06/24/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study examined participant characteristics, particularly disease duration, in theory-based physical activity behavior change trials in multiple sclerosis (MS) and summarized theoretical frameworks and changes in physical activity outcomes. MATERIALS AND METHODS PubMed, CINAHL, Embase, and Scopus were searched to identify potential trials. One reviewer screened titles and abstracts, and two reviewers then independently screened full-text articles based on predetermined eligibility criteria. Data were extracted by one reviewer and checked by a second reviewer. RESULTS Among 33 trials reviewed, only one trial reported a mean disease duration of less than five years (i.e., 4.5 years) for the sample. The remaining trials included samples with a mean disease duration of 6.7 years or longer. The most common theories used were Social Cognitive Theory, Trans-theoretical Model, and Motivational Interviewing. The effects on physical activity were heterogeneous; device-measured outcomes increased in 41.4% of studies, self-reported outcomes improved in 72.4%. Adherence (≥80%) was reported in 34.5% of studies. CONCLUSIONS There is little focus on persons with MS in the early disease course in physical activity behavior change interventions. Future research should include comprehensive theoretical approaches for more homogeneous effects across outcome measures when targeting those in the early stage and all MS populations.IMPLICATIONS FOR REHABILITATIONTheory-based physical activity behavior change interventions have not included persons with multiple sclerosis (MS) in the early disease course (<5 years since diagnosis).Disease duration has not been a criterion used to include or exclude participants in the reviewed theory-based behavior change interventions for physical activity in people with MS.The theory-based behavior change interventions in this review positively affected short-term physical activity levels in people with MS.
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Affiliation(s)
- Trinh L T Huynh
- Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Robert W Motl
- Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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Jeng B, Šilić P, Huynh TLT, Motl RW. Sedentary Behavior and Lower-Extremity Physical Function across the Lifespan of Adults with Multiple Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12466. [PMID: 36231766 PMCID: PMC9566509 DOI: 10.3390/ijerph191912466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
One outcome of aging with multiple sclerosis (MS) involves the decline in physical function, including compromised balance, reduced walking speed, and lower-extremity strength. Sedentary behavior, the other end of the activity continuum, may be targeted for improvements in physical function among adults with MS, but less is known about the relationship between sedentary behavior and physical function with increasing age in MS. This study examined the associations between device-measured volume and pattern of sedentary behavior and physical function based on SPPB (Short Physical Performance Battery) of ambulatory persons with MS across the lifespan. We categorized participants (N = 216) into young (20-39 years), middle-aged (40-59 years), and older (60-79 years) age groups. Participants completed the SPPB during a single visit to the laboratory and wore an accelerometer for a 7-day period. The one-way analysis of variance indicated no differences in volume and pattern of sedentary behavior among the three age groups, except for average sedentary bout length. Spearman bivariate correlations indicated that pattern, but not volume, of sedentary behavior was associated with physical function in young, middle-aged, and older adults, and the magnitude of these associations varied by age group. Future interventions may reduce and break up prolonged periods of sedentary behavior for improvements in physical function and possibly other consequences in persons with MS.
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Affiliation(s)
- Brenda Jeng
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Petra Šilić
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Trinh L. T. Huynh
- Department of Physical Therapy, School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL 35223, USA
| | - Robert W. Motl
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
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12
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Sasaki JE, Bertochi GFA, Meneguci J, Motl RW. Pedometers and Accelerometers in Multiple Sclerosis: Current and New Applications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11839. [PMID: 36142112 PMCID: PMC9517119 DOI: 10.3390/ijerph191811839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
Pedometers and accelerometers have become commonplace for the assessment of physical behaviors (e.g., physical activity and sedentary behavior) in multiple sclerosis (MS) research. Current common applications include the measurement of steps taken and the classification of physical activity intensity, as well as sedentary behavior, using cut-points methods. The existing knowledge and applications, coupled with technological advances, have spawned new opportunities for using those motion sensors in persons with MS, and these include the utilization of the data as biomarkers of disease severity and progression, perhaps in clinical practice. Herein, we discuss the current state of knowledge on the validity and applications of pedometers and accelerometers in MS, as well as new opportunities and strategies for the improved assessment of physical behaviors and disease progression, and consequently, personalized care.
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Affiliation(s)
- Jeffer Eidi Sasaki
- Graduate Program in Physical Education, Federal University of Triangulo Mineiro, Uberaba 38025-180, MG, Brazil
| | | | - Joilson Meneguci
- Graduate Program in Physical Education, Federal University of Triangulo Mineiro, Uberaba 38025-180, MG, Brazil
| | - Robert W. Motl
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
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13
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Learmonth YC, Heritage B, Marck CH, Chen J, van der Mei I. Physical activity participation in Australians with multiple sclerosis: associations with geographical remoteness. Disabil Rehabil 2022:1-6. [PMID: 35666818 DOI: 10.1080/09638288.2022.2082564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Physical activity (PA) participation offers many benefits for persons with multiple sclerosis (MS). Persons with MS are significantly less active than the general population; however, there is insufficient evidence regarding the association between geographical remoteness and PA participation in persons with MS. We identify PA levels across levels of rurality in an Australian MS population. MATERIALS AND METHODS The Australian MS Longitudinal Study collects regular survey data from persons with MS in Australia, including demographic, clinical, and health behavioural data. Physical activity engagement was identified with the International Physical Activity Questionnaire-short form and geographical remoteness was identified from participants' postcode using the Access and Remoteness Index for Australia. Hurdle regression analysis examined the relationship between remoteness and PA participation, and level of PA, after controlling for confounding. RESULTS Data from 1260 respondents showed that 24% of persons with MS did not participate in any PA. Remoteness was not associated with the participation in any PA (OR 1.04; 89% highest density probability interval (HDPI) estimate 0.88, 1.22). Amongst those with any PA (n = 960), those living in more remote areas had, on average, higher levels of PA (RR 1.21; 89% HDPI estimate 1.11, 1.34). CONCLUSIONS Physical activity promotion does not need to differ based on geographical location. Implications for rehabilitationAlmost one quarter of persons with MS in our study recorded no participation in any physical activity (PA).Healthcare practitioners are encouraged to include the promotion of PA as part of MS management.Physical activity participation is similar for persons with MS across different geographical locations.Physical activity promotion does not need to differ based on geographical location.
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Affiliation(s)
- Yvonne C Learmonth
- Centre for Molecular Medicine and Innovative Therapeutics, and Centre for Healthy Aging, Health Futures Institute, Murdoch University, Murdoch, Australia.,Discipline of Exercise Science, Murdoch University, Murdoch, Australia.,Perron Institute for Neurological and Translational Science, Nedlands, Australia
| | - Brody Heritage
- Discipline of Psychology, Murdoch University, Murdoch, Australia
| | - Claudia H Marck
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jing Chen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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14
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Do device-measured physical activity and sedentary behavior differ by depression symptom status in persons with multiple sclerosis? Mult Scler Relat Disord 2022; 63:103889. [DOI: 10.1016/j.msard.2022.103889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/01/2022] [Accepted: 05/13/2022] [Indexed: 11/22/2022]
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15
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Motl RW, Sandroff BM, Benedict RH. Moderate-to-Vigorous Physical Activity is Associated with Processing Speed, but not Learning and Memory, in Cognitively Impaired Persons with Multiple Sclerosis. Mult Scler Relat Disord 2022; 63:103833. [DOI: 10.1016/j.msard.2022.103833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 01/08/2023]
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16
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Baird JF, Cutter GR, Motl RW. Do Physical Activity, Cardiorespiratory Fitness, and Subcortical Brain Structures Explain Reduced Walking Performance in Older Adults with Multiple Sclerosis? Mult Scler Relat Disord 2022; 60:103702. [DOI: 10.1016/j.msard.2022.103702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 01/04/2022] [Accepted: 02/19/2022] [Indexed: 10/19/2022]
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17
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Social cognitive theory variables are stronger correlates of moderate-to-vigorous physical activity than light physical activity in older adults with multiple sclerosis. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-021-00845-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Motl RW, Baird JF. Cardiorespiratory fitness and moderate-to-vigorous physical activity in older adults with multiple sclerosis. Mult Scler J Exp Transl Clin 2021; 7:20552173211057514. [PMID: 34868628 PMCID: PMC8640293 DOI: 10.1177/20552173211057514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/18/2021] [Indexed: 11/15/2022] Open
Abstract
Background Cardiorespiratory fitness (VO2peak) may be a modifiable indicator of health status and well-being in older adults with multiple sclerosis. Purpose We examined differences in VO2peak and moderate-to-vigorous physical activity between older adults with multiple sclerosis and healthy controls, and whether moderate-to-vigorous physical activity accounted for group differences in VO2peak. Methods Older adults with multiple sclerosis (n = 31) and healthy controls (n = 29) completed a cardiopulmonary exercise test and wore an accelerometer for measuring moderate-to-vigorous physical activity. The data were analyzed using the Baron and Kenny approach for examining moderate-to-vigorous physical activity as a mediator of group differences in VO2peak. Results The multiple sclerosis group had significantly lower VO2peak and moderate-to-vigorous physical activity than healthy controls. VO2peak had a large correlation with moderate-to-vigorous physical activity (r = .59). Group initially explained 8% of the variance in VO2peak (β = -0.29). The inclusion of moderate-to-vigorous physical activity accounted for an additional 27% of the variance in VO2peak, but only moderate-to-vigorous physical activity (β = 0.57) was a statistically significant correlate of VO2peak. The effect of Group was attenuated and non-significant with the addition of moderate-to-vigorous physical activity in Step 2 (Group β Step 1 = -0.29, Group β Step 2 = -0.05). Conclusions Our results provide initial support for targeting moderate-to-vigorous physical activity as an approach for improving VO2peak in older adults with multiple sclerosis.
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Affiliation(s)
- Robert W Motl
- University of Illinois Chicago, 1919 W Taylor St, Chicago, IL 60612, USA
| | - Jessica F Baird
- Department of Physical Therapy, University of Alabama at Birmingham, USA
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19
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Patti F, Penaherrera JN, Zieger L, Wicklein EM. Clinical characteristics of middle-aged and older patients with MS treated with interferon beta-1b: post-hoc analysis of a 2-year, prospective, international, observational study. BMC Neurol 2021; 21:324. [PMID: 34425763 PMCID: PMC8381478 DOI: 10.1186/s12883-021-02347-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/28/2021] [Indexed: 12/18/2022] Open
Abstract
Background Despite trends towards the increased age of patients living with multiple sclerosis (MS), little is known about the response of older adults with MS to disease-modifying therapies (DMTs). Thus, a post-hoc analysis was undertaken using data from a 2-year, international, non-interventional, prospective cohort study (NCT00787657; BEACON: BEtaferon prospective study on Adherence, COping and Nurse support) of patients above the age of 40 years with MS and starting interferon beta-1b (IFNB-1b) treatment within 6 months before study entry. Methods Middle-aged and older patients with MS were divided into two sub-groups: 41–50 years and > 50 years. Treatment with IFNB-1b started within 6 months before study entry. Patients were followed-up for a 2-year observation period. Assessments included disease history and course, annualised relapse rate (ARR), Expanded Disability Scale Score (EDSS), treatment adherence, Hospital Anxiety and Depression Scale (HADS), and adverse events (AE). Results At baseline, the intention-to-treat (ITT) population (n = 481) aged 41–50 years (n = 327) and > 50 years (n = 154), had mean (standard deviation [SD]) ages of 45.1 (2.8) and 56.2 (4.2) years, maximum age of 72 years, and duration of MS since onset of symptoms of 3.9 (5.2) and 5.9 (7.1) years, respectively. At baseline, the proportion of patients with relapsing–remitting MS (RRMS) was 96.3 and 94.9 %, and secondary progressive MS (SPMS) was 3.7 and 5.1 %, in the 41–50 and > 50 years sub-groups, respectively. The ARR in the 2 years before study start was 0.93 (0.48) and 0.86 (0.54) for the 41–50 and > 50 years groups, respectively, and decreased since study start to 0.20 (1.09) and 0.07 (0.37), respectively. The percentage of patients with anxiety and depression, as measured by HADS, were stable over the study period. Polypharmacy (five or more medications) was seen in 32.3 and 41.2 % of patients aged 41–50 and > 50 years. No unexpected AEs were reported. Conclusions This study provides observational data on patients between 40 and 72 years of age, suggesting that IFNB-1b can be an effective and well-tolerated treatment option in MS patients of advanced age. Trial registration ClinicalTrials.gov, NCT00787657.
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Affiliation(s)
- Francesco Patti
- Department of Medical and Surgical and Advanced Technologies, GF Ingrassia, Neuroscience Section, University of Catania, Catania, Italy.
| | | | - Lorissa Zieger
- Parexel Inc (at the time of this analysis), Berlin, Germany.,Current address: Freelance Biostatistician, Berlin, Germany
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20
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Motl RW, Cutter G, Bamman MM, Brown CJ, Rinker J. The Importance and Opportunity for Healthy Aging Through Lifestyle, Behavior Medicine Among Older Adults With Multiple Sclerosis: the Case Based on Physical Activity. Curr Treat Options Neurol 2021. [DOI: 10.1007/s11940-021-00680-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Silveira SL, Cederberg KLJ, Jeng B, Sikes EM, Sandroff BM, Jones CD, Motl RW. Symptom clusters and quality of life in persons with multiple sclerosis across the lifespan. Qual Life Res 2021; 30:1061-1071. [PMID: 33155152 PMCID: PMC8005422 DOI: 10.1007/s11136-020-02689-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE To describe symptom clusters based on severity of co-occurring symptoms among adults with multiple sclerosis (MS) by age groups and to further examine symptom clusters as a correlate of quality of life (QOL) by age groups. METHODS This cross-sectional study enrolled persons with MS between 20 and 79 years of age who completed measures of fatigue, depression, anxiety, sleep quality, and QOL using the 36-Item Short Form Health Survey. Bivariate correlation and partial correlation analyses examined associations among symptoms, QOL, and MS characteristics. K-means cluster analyses determined symptom clusters among the full sample and pre-determined age groups (i.e., 20-39, 40-59, and 60-79). One-way ANOVAs examined differences in QOL among clusters for the overall sample and by age groups. RESULTS Among the overall sample of 205 participants, symptoms were significantly correlated with QOL and three distinct clusters were identified and differentiated by the magnitude of symptom experience (i.e., mild, moderate, and severe). Results were consistent among young and middle-aged adults; however, among older adults two severe sleep problem clusters were identified that were distinguished by moderate versus severe fatigue, depression, and anxiety. ANOVAs among the overall sample indicated that the three symptom clusters varied significantly for both physical component scores, F(2, 202) = 12.03, p < .001, η2 = .10, and mental component scores, F(2, 202) = 137.92, p < .001, η2 = .58; severe symptom cluster was associated with worse QOL. Patterns in the age subgroup ANOVAs were consistent. CONCLUSIONS Given the strong association between severity of symptom clusters and QOL, approaches for targeting co-occurring symptoms are critically needed.
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Affiliation(s)
- Stephanie L Silveira
- Department of Physical Therapy, University of Alabama at Birmingham, 3810 Ridgeway Drive, Birmingham, AL, 35209, USA.
| | - Katie L J Cederberg
- Department of Physical Therapy, University of Alabama at Birmingham, 3810 Ridgeway Drive, Birmingham, AL, 35209, USA
| | - Brenda Jeng
- Department of Physical Therapy, University of Alabama at Birmingham, 3810 Ridgeway Drive, Birmingham, AL, 35209, USA
| | - E Morghen Sikes
- Department of Occupational Therapy, Shenandoah University, Winchester, VA, USA
| | - Brian M Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, 3810 Ridgeway Drive, Birmingham, AL, 35209, USA
| | - Catherine D Jones
- Department of Physical Therapy, University of Alabama at Birmingham, 3810 Ridgeway Drive, Birmingham, AL, 35209, USA
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, 3810 Ridgeway Drive, Birmingham, AL, 35209, USA
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22
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Examining Multilevel Environmental Correlates of Physical Activity Among Older Adults With Multiple Sclerosis. J Aging Phys Act 2020; 29:288-295. [PMID: 33049698 DOI: 10.1123/japa.2019-0495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/14/2020] [Accepted: 07/06/2020] [Indexed: 11/18/2022]
Abstract
Three hundred and sixty-three older adults with multiple sclerosis completed a cross-sectional study examining hierarchical correlates of physical activity using a social cognitive theory perspective within a social ecological model (i.e., built environment, social environment, and individual social cognitive theory variables). Hierarchical linear regression analyses were conducted, wherein significant associations were noted for built environment (i.e., land-use mix diversity and aesthetics) and physical activity in Step 1 (R2 = .09). Social and built environment were significant correlates in Step 2 (R2 = .15). Finally in Step 3, individual social cognitive theory variables (i.e., self-efficacy and outcome expectations) were the only significant correlates of total physical activity (R2 = .38). Results were comparable for health-promoting physical activity; however, self-efficacy was the only significant correlate in Step 3 (R2 = .36). This study provides guidance for researchers and practitioners on relevant targets for tailoring interventions for older adults with multiple sclerosis and supports an emphasis on self-efficacy as a primary predictor of health behavior change.
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Silveira SL, Baird JF, Motl RW. Rates, patterns, and correlates of fitness tracker use among older adults with multiple sclerosis. Disabil Health J 2020; 14:100966. [PMID: 32811785 DOI: 10.1016/j.dhjo.2020.100966] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/03/2020] [Accepted: 06/14/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Older adults with multiple sclerosis (MS) engage in alarmingly low levels of physical activity. Fitness trackers may be a promising approach for promoting and monitoring physical activity among older adults with MS. OBJECTIVE/HYPOTHESIS This study reports on the rates, patterns of fitness tracker use in adults with MS who are over 60 years of age. We hypothesized that older adults with MS who use fitness trackers "users" would report significantly more physical activity than those who don't "non-users." METHODS Participants across the United States completed an online survey that included self-reported demographic and clinical characteristics, fitness tracker use questionnaire, and Godin Leisure-Time Exercise Questionnaire (GLTEQ) for measuring total and health-promoting physical activity (GLTEQ-HCS). RESULTS Of the 440 participants who completed the full survey, 112 (28%) identified as fitness tracker users. The most common activity monitors were Fitbit®, Smartphone app, Apple® watch, and Garmin®. Fitness tracker users mostly reported having relapsing-remitting MS, less disability (i.e., lower Patient Determined Disability Steps), higher income, and higher rates of employment. There was a statistically significant difference in GLTEQ Total (t(438) = -3.8, p = .001) and GLTEQ-HCS (t(438) = -2.8, p = .006) scores between fitness tracker users and non-users. Self-reported step counts were strongly correlated with both GLTEQ Total (ρ = .50) and GLTEQ-HCS (ρ = 0.54) scores in fitness tracker users. CONCLUSIONS Further research is warranted investigating fitness tracker use and interests among older adults with MS and how technology may be applied as a behavioral tool to increase physical activity among this growing portion of the MS population.
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Affiliation(s)
- Stephanie L Silveira
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Jessica F Baird
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA; University of Alabama at Birmingham Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA; University of Alabama at Birmingham Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Baird JF, Silveira SL, Motl RW. Social Cognitive Theory and Physical Activity in Older Adults with Multiple Sclerosis. Int J MS Care 2020; 23:21-25. [PMID: 33658902 DOI: 10.7224/1537-2073.2019-071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background The expanding population of older adults with multiple sclerosis (MS) likely experiences many of the same benefits of physical activity (PA) as younger and middle-aged adults with MS. However, participation in PA is exceedingly low in this segment of the MS population. This study examined variables from social cognitive theory (SCT) as correlates of PA in older adults with MS to inform the subsequent development of behavioral interventions. Methods Older adults with MS (≥60 years of age, N = 180) completed an online survey including demographic and clinical characteristics, SCT variables (exercise self-efficacy, exercise goal setting, social support, and outcome expectations), and PA (total PA [TPA] and moderate-to-vigorous PA [MVPA]). Results Bivariate correlation analyses indicated that all SCT variables were significantly associated with TPA and MVPA (all P ≤ .001). Hierarchical linear regression analyses indicated that disability status was a significant correlate of TPA (β = -0.48, R2 = 0.23) and MVPA (β = -0.44, R2 = 0.19) in step 1; disability and self-efficacy were significant correlates of TPA (disability β = -0.20, self-efficacy β = 0.59, R2 = 0.50) and MVPA (disability β = -0.16, self-efficacy β = 0.60, R2 = 0.47) in step 2; and disability, self-efficacy, and exercise goal setting were significant correlates of TPA (disability β = -0.21, self-efficacy β = 0.50, exercise goal setting β = 0.14, R2 = 0.55) and MVPA (disability β = -0.17, self-efficacy β = 0.51, exercise goal setting β = 0.15, R2 = 0.51) in step 3. Conclusions These results suggest that behavioral interventions focusing on self-efficacy and exercise goal setting as targets from SCT may be appropriate for increasing PA in older adults with MS.
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Guicciardi M, Carta M, Pau M, Cocco E. The Relationships between Physical Activity, Self-Efficacy, and Quality of Life in People with Multiple Sclerosis. Behav Sci (Basel) 2019; 9:E121. [PMID: 31766489 PMCID: PMC6960862 DOI: 10.3390/bs9120121] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/19/2019] [Accepted: 11/19/2019] [Indexed: 01/15/2023] Open
Abstract
Regular physical activity (PA) can enhance the physical and mental health of people with Multiple Sclerosis (MS) because of its impact on muscular strength, mobility, balance, walking, fatigue, pain and health-related quality of life (HRQoL). Previous studies have hypothesized that the relationship between PA and HRQoL is mediated by self-efficacy. The aim of this research is to evaluate whether self-efficacy in goal setting and self-efficacy in the management of symptoms, mediate the relationship between PA and HRQoL, in a similar way to exercise self-efficacy. A sample of 28 participants with MS (18 females) and different levels of physical activity have been recruited and completed the following measures: a) physical activity (GLTEQ); b) health-related quality of life (SF-12); c) self-efficacy in the management of Multiple Sclerosis (SEMS) and, d) exercise self-efficacy (EXSE). The statistical analysis highlighted that self-efficacy in goal setting mediated the relationship between PA and mental health better than exercise self-efficacy. Our findings suggest that self-efficacy in goal setting can contribute to the adoption and maintenance of regular physical activity for long-lasting times, supporting and increasing the mental quality of life of people suffering from MS.
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Affiliation(s)
- Marco Guicciardi
- Department of Education, Psychology, Philosophy, University of Cagliari, 09123 Cagliari, Italy;
| | - Maria Carta
- Department of Education, Psychology, Philosophy, University of Cagliari, 09123 Cagliari, Italy;
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy;
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato (CA), Italy;
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26
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Cederberg KLJ, Jeng B, Sasaki JE, Braley TJ, Walters AS, Motl RW. Physical activity, sedentary behavior, and restless legs syndrome in persons with multiple sclerosis. J Neurol Sci 2019; 407:116531. [PMID: 31654833 DOI: 10.1016/j.jns.2019.116531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/20/2019] [Accepted: 10/10/2019] [Indexed: 12/11/2022]
Abstract
The present study examined the relationships among parameters (i.e., volume and pattern) of physical activity and sedentary behavior with the presence and severity of restless legs syndrome(RLS) in adults with multiple sclerosis(MS). Participants with MS (N = 253) wore an accelerometer for a 7-day period and completed the Cambridge-Hopkins Restless Legs Syndrome Questionnaire, the International Restless Legs Syndrome Study Group Scale (IRLS), and the Patient Determined Disease Steps scale. Sixty-six (26%) persons with MS had RLS (MS + RLS). There were no differences between the MS + RLS and MS group for parameters of physical activity or sedentary behavior. Among participants with IRLS scores in the mild range (n = 26), more time spent in light physical activity (rs = 0.39), fewer sedentary bouts per day (rs = 0.55), less time in sedentary bouts per day (rs = 0.51), and fewer breaks in sedentary time per day (rs = 0.57) were associated with lower RLS severity. This study represents the first step toward recognizing a relationship between physical activity, patterns of sedentary behavior, and RLS severity in MS and these results suggest that light physical activity and the pattern of sedentary behavior may be important targets for prospective behavioral interventions that target the management of RLS in persons with MS who have mild RLS severity.
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Affiliation(s)
- Katie L J Cederberg
- Department of Physical Therapy, University of Alabama at Birmingham, AL, USA(1).
| | - Brenda Jeng
- Department of Physical Therapy, University of Alabama at Birmingham, AL, USA(1)
| | - Jeffer E Sasaki
- Department of Sport Sciences, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
| | - Tiffany J Braley
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Arthur S Walters
- Department of Neurology, Vanderbilt University, Nashville, TN, USA
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, AL, USA(1)
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Baird JF, Cederberg KL, Sikes EM, Silveira SL, Jeng B, Sasaki JE, Sandroff BM, Motl RW. Physical activity and walking performance across the lifespan among adults with multiple sclerosis. Mult Scler Relat Disord 2019; 35:36-41. [DOI: 10.1016/j.msard.2019.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/12/2019] [Accepted: 07/04/2019] [Indexed: 11/28/2022]
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Bollaert RE, Motl RW. Physical and Cognitive Functions, Physical Activity, and Sedentary Behavior in Older Adults With Multiple Sclerosis. J Geriatr Phys Ther 2019; 42:304-312. [DOI: 10.1519/jpt.0000000000000163] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Baird JF, Cederberg KL, Sikes EM, Jeng B, Sasaki JE, Sandroff BM, Motl RW. Changes in Cognitive Performance With Age in Adults With Multiple Sclerosis. Cogn Behav Neurol 2019; 32:201-207. [PMID: 31517704 PMCID: PMC6750025 DOI: 10.1097/wnn.0000000000000200] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cognitive impairment is one of the most common consequences of multiple sclerosis (MS), yet there is a shortage of data regarding how cognition changes during the life span of individuals with MS. This information is of increasing importance given the growing proportion of older adults with MS. OBJECTIVE To study possible changes in cognitive function in correlation with increasing age in individuals with MS. METHODS Participants (N=129) were recruited and a priori allocated into one of three age groups (young, middle-aged, and older). All participants completed the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) during a single laboratory testing session. The BICAMS measures cognitive processing speed as well as verbal and visuospatial learning and memory. RESULTS A multivariate analysis of variance indicated that cognitive function significantly differed by age group, and these differences were not explained by amount of physical activity, years of education, years since diagnosis, or race. Older adults displayed significantly worse cognitive processing speed than young and middle-aged adults. The older and middle-aged adults also demonstrated significantly worse visuospatial learning and memory than the younger adults. Effect sizes indicated that cognitive processing speed and verbal learning and memory were more affected in late adulthood than early adulthood, whereas visuospatial learning and memory was affected similarly in early and late adulthood. CONCLUSIONS Older adults with MS demonstrated significant impairments in cognitive function compared to young and middle-aged adults with MS. Future studies should determine the predictors of cognitive decline in this age cohort.
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Affiliation(s)
- Jessica F. Baird
- Department of Physical Therapy, University of Alabama at Birmingham
- University of Alabama at Birmingham Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - E. Morghen Sikes
- Department of Physical Therapy, University of Alabama at Birmingham
| | - Brenda Jeng
- Department of Physical Therapy, University of Alabama at Birmingham
| | - Jeffer E. Sasaki
- Graduate Program in Physical Education, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Brian M. Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham
- University of Alabama at Birmingham Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert W. Motl
- Department of Physical Therapy, University of Alabama at Birmingham
- University of Alabama at Birmingham Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Aging With Multiple Sclerosis. TOPICS IN GERIATRIC REHABILITATION 2019. [DOI: 10.1097/tgr.0000000000000233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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31
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Sedentary Behavior in Persons With Multiple Sclerosis: Is the Time Ripe for Targeting a New Health Behavior? ACTA ACUST UNITED AC 2019. [DOI: 10.1123/kr.2018-0056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Shetty AK, Kodali M, Upadhya R, Madhu LN. Emerging Anti-Aging Strategies - Scientific Basis and Efficacy. Aging Dis 2018; 9:1165-1184. [PMID: 30574426 PMCID: PMC6284760 DOI: 10.14336/ad.2018.1026] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/30/2018] [Indexed: 12/11/2022] Open
Abstract
The prevalence of age-related diseases is in an upward trend due to increased life expectancy in humans. Age-related conditions are among the leading causes of morbidity and death worldwide currently. Therefore, there is an urgent need to find apt interventions that slow down aging and reduce or postpone the incidence of debilitating age-related diseases. This review discusses the efficacy of emerging anti-aging approaches for maintaining better health in old age. There are many anti-aging strategies in development, which include procedures such as augmentation of autophagy, elimination of senescent cells, transfusion of plasma from young blood, intermittent fasting, enhancement of adult neurogenesis, physical exercise, antioxidant intake, and stem cell therapy. Multiple pre-clinical studies suggest that administration of autophagy enhancers, senolytic drugs, plasma from young blood, drugs that enhance neurogenesis and BDNF are promising approaches to sustain normal health during aging and also to postpone age-related neurodegenerative diseases such as Alzheimer's disease. Stem cell therapy has also shown promise for improving regeneration and function of the aged or Alzheimer's disease brain. Several of these approaches are awaiting critical appraisal in clinical trials to determine their long-term efficacy and possible adverse effects. On the other hand, procedures such as intermittent fasting, physical exercise, intake of antioxidants such as resveratrol and curcumin have shown considerable promise for improving function in aging, some of which are ready for large-scale clinical trials, as they are non-invasive, and seem to have minimal side effects. In summary, several approaches are at the forefront of becoming mainstream therapies for combating aging and postponing age-related diseases in the coming years.
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Affiliation(s)
- Ashok K. Shetty
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, Texas 77843, USA
- Olin E. Teague Veterans’ Medical Center, Central Texas Veterans Health Care System, Temple, Texas 76504, USA
| | - Maheedhar Kodali
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, Texas 77843, USA
- Olin E. Teague Veterans’ Medical Center, Central Texas Veterans Health Care System, Temple, Texas 76504, USA
| | - Raghavendra Upadhya
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, Texas 77843, USA
- Olin E. Teague Veterans’ Medical Center, Central Texas Veterans Health Care System, Temple, Texas 76504, USA
| | - Leelavathi N. Madhu
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center College of Medicine, College Station, Texas 77843, USA
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Fakolade A, Finlayson M, Parsons T, Latimer-Cheung A. Correlating the Physical Activity Patterns of People with Moderate to Severe Multiple Sclerosis Disability and Their Family Caregivers. Physiother Can 2018; 70:373-381. [PMID: 30745723 DOI: 10.3138/ptc.2017-36.ep] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: People with multiple sclerosis (PwMS) and their family caregivers often react to the impact of the disease as an interdependent dyad. The aim of this exploratory study was to examine interdependence in the physical activity (PA) patterns of dyads affected by moderate to severe MS disability. Method: A total of 15 pairs of PwMS and their family caregivers wore accelerometers for 7 days. By collecting data simultaneously from both partners, we tested interdependence using the dyad as the unit of analysis. Results: PwMS and caregivers averaged 4,091.3 (SD 2,726.3) and 6,160.2 (SD 1,653.0) steps per day, respectively. The mean number of minutes per day of sedentary, light, and moderate to vigorous activity for PwMS was 566.3 (SD 97.7), 167.4 (SD 94.0), and 7.6 (SD 12.4), respectively, and 551.9 (SD 92.4), 199.6 (SD 63.4), and 21.4 (SD 18.2), respectively, for caregivers. Interdependence between dyads for sedentary, light, moderate to vigorous activity, and step count was low and non-significant (rs=0.20, 0.26, 0.13, and -0.27, respectively; p>0.05). Conclusions: Although our findings do not support the interdependence of PA between caregivers and care recipients with MS, they do show that both partners are not engaging in sufficient PA to achieve important health benefits. These findings are important because they indicate that the dyads are likely to benefit from interventions for changing PA behavior.
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Affiliation(s)
| | | | | | - Amy Latimer-Cheung
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ont
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Learmonth YC, Kinnett-Hopkins D, Motl RW. Capitalising on the opinions of persons with multiple sclerosis to inform the main trial – participant opinions from participation in a feasibility study, a qualitative extension study. Disabil Rehabil 2018; 41:3071-3078. [DOI: 10.1080/09638288.2018.1490823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Yvonne C. Learmonth
- Department of Psychology and Exercise Science, Murdoch University, Murdoch, Australia
| | - Dominique Kinnett-Hopkins
- Center for Education in Health Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Robert W. Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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35
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Ghai S, Ghai I. Effects of Rhythmic Auditory Cueing in Gait Rehabilitation for Multiple Sclerosis: A Mini Systematic Review and Meta-Analysis. Front Neurol 2018; 9:386. [PMID: 29942278 PMCID: PMC6004404 DOI: 10.3389/fneur.2018.00386] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/11/2018] [Indexed: 12/15/2022] Open
Abstract
Rhythmic auditory cueing has been shown to enhance gait performance in several movement disorders. The "entrainment effect" generated by the stimulations can enhance auditory motor coupling and instigate plasticity. However, a consensus as to its influence over gait training among patients with multiple sclerosis is still warranted. A systematic review and meta-analysis was carried out to analyze the effects of rhythmic auditory cueing in studies gait performance in patients with multiple sclerosis. This systematic identification of published literature was performed according to PRISMA guidelines, from inception until Dec 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Of 602 records, five studies (PEDro score: 5.7 ± 1.3) involving 188 participants (144 females/40 males) met our inclusion criteria. The meta-analysis revealed enhancements in spatiotemporal parameters of gait i.e., velocity (Hedge's g: 0.67), stride length (0.70), and cadence (1.0), and reduction in timed 25 feet walking test (-0.17). Underlying neurophysiological mechanisms, and clinical implications are discussed. This present review bridges the gaps in literature by suggesting application of rhythmic auditory cueing in conventional rehabilitation approaches to enhance gait performance in the multiple sclerosis community.
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Affiliation(s)
- Shashank Ghai
- Institute of Sports Science, Leibniz University Hanover, Hanover, Germany
| | - Ishan Ghai
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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36
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Physical Activity, Sedentary Behavior, and Physical Function in Older Adults With Multiple Sclerosis. J Aging Phys Act 2018; 26:177-182. [DOI: 10.1123/japa.2016-0358] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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37
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Sasaki JE, Sandroff B, Bamman M, Motl RW. Motion sensors in multiple sclerosis: Narrative review and update of applications. Expert Rev Med Devices 2017; 14:891-900. [PMID: 28956457 PMCID: PMC6291837 DOI: 10.1080/17434440.2017.1386550] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/27/2017] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The use of motion sensors for measuring physical activity in multiple sclerosis (MS) has evolved with increasing research particularly during the past decade. Areas covered: This manuscript reviews the literature regarding the application of motion sensors for measuring physical activity in MS. We first describe 'what is known' about their use in MS by examining the evidence generated between 1997 and 2012, including the psychometric properties of motion sensors in MS and the development of MS-specific accelerometer cut-points. We then evaluate 'what is new' based on research conducted between 2013 and 2017. This includes newer research on psychometric properties of motion sensors in MS, development of new MS-specific accelerometer and step-rate cut-points, sedentary behavior assessment, and research on fitness trackers and multisensors in MS. The final part presents a picture of 'what is next' for the applications of motion sensors in MS, especially pertaining new opportunities for testing and using fitness trackers in MS, and tracking disease and disability progression based on motion sensor output. Expert commentary: The use of motion sensors in MS has grown substantially over the years; however, a lot more can be done to explore the full potential and utility of these devices in MS.
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Affiliation(s)
- Jeffer Eidi Sasaki
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Brian Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Marcas Bamman
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL
- Department of Cell, Developmental & Integrative Biology, University of Alabama at Birmingham, Birmingham, AL
| | - Robert W. Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL
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38
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Zhang W, Becker H, Stuifbergen AK, Brown A. Predicting Health Promotion and Quality of Life With Symptom Clusters and Social Supports Among Older Adults With Multiple Sclerosis. J Gerontol Nurs 2017; 43:27-36. [PMID: 28399316 PMCID: PMC10838216 DOI: 10.3928/00989134-20170406-04] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 03/15/2017] [Indexed: 01/22/2024]
Abstract
Symptoms common among individuals with multiple sclerosis (MS) may influence health promotion and quality of life, especially among older adults, who often experience multiple chronic conditions. To identify and examine symptom clusters' effect on health promotion and quality of life, data from 215 adults with MS older than 60 (average years with diagnosis = 29) were analyzed. Correlations among symptoms ranged from 0.33 to 0.81. Factor analysis identified two symptom clusters: (a) physical/psychological/cognitive symptoms and (b) pain symptoms. In multiple hierarchical regressions, controlling for demographics and functional limitations, physical/psychological/cognitive symptoms significantly improved prediction on Health-Promoting Lifestyle Profile II interpersonal relations, stress management, and total scores; pain symptoms predicted nutrition scores. Both symptom clusters predicted spiritual growth and quality of life. Social support was a significant predictor of all outcomes. Symptom clusters, along with social support, should be considered in care and interventions for older adults with MS. [Journal of Gerontological Nursing, 43(10), 27-36.].
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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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40
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Fakolade A, Lamarre J, Latimer-Cheung A, Parsons T, Morrow SA, Finlayson M. Understanding leisure-time physical activity: Voices of people with MS who have moderate-to-severe disability and their family caregivers. Health Expect 2017; 21:181-191. [PMID: 28722772 PMCID: PMC5750693 DOI: 10.1111/hex.12600] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2017] [Indexed: 01/25/2023] Open
Abstract
Background Physical activity (PA) is beneficial for all people, yet people affected by multiple sclerosis (MS) find regular PA challenging. These people may include individuals with the disease who have moderate‐to‐severe disability and their family caregivers. For researchers and clinicians to effectively promote PA among caregiver/care‐recipient dyads with moderate‐to‐severe MS, a comprehensive understanding of the shared PA experiences of these dyads would be beneficial. Objective We explored shared experiences of caregiver/care‐recipient dyads affected by moderate‐to‐severe MS about PA and directions for intervention. Methods Six focus groups with 23 people with moderate‐to‐severe MS and 12 family caregivers were conducted. Data were analysed using a constant comparative approach. Results Three major themes emerged as follows: (i) PA is a continuum, (ii) cycle of disengagement and (iii) cycle of adjustment. The first theme captured the dyads understanding that PA falls along a continuum ranging from highly structured to unstructured activities. Cycle of disengagement captured the experiences of dyads engaging in little or no PA. These dyads perceived internal and external issues as drivers of the cycle of disengagement, while availability of supportive programmes and services or people helped the dyads to break out of the cycle. When the cycle of disengagement was broken, the dyads described moving towards the cycle of adjustment, where they were able to learn skills and take action to incorporate PA into daily routines. Conclusion This research highlights the need to adopt an integrative approach that acknowledges the caregiver/care‐recipient dyad with moderate‐to‐severe MS as a focus for PA intervention.
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Affiliation(s)
- Afolasade Fakolade
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Julie Lamarre
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Amy Latimer-Cheung
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Trisha Parsons
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Sarah A Morrow
- Multiple Sclerosis Clinic, University Hospital-London Health Services, London, ON, Canada
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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41
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Ketelhut NB, Kindred JH, Pimentel RE, Hess AM, Tracy BL, Reiser RF, Rudroff T. Functional factors that are important correlates to physical activity in people with multiple sclerosis: a pilot study. Disabil Rehabil 2017; 40:2416-2423. [DOI: 10.1080/09638288.2017.1336647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nathaniel B Ketelhut
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - John H Kindred
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Richard E Pimentel
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Ann M Hess
- Department of Statistics, Colorado State University, Fort Collins, CO, USA
| | - Brian L Tracy
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Raoul F Reiser
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Thorsten Rudroff
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
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Tedesco S, Barton J, O'Flynn B. A Review of Activity Trackers for Senior Citizens: Research Perspectives, Commercial Landscape and the Role of the Insurance Industry. SENSORS (BASEL, SWITZERLAND) 2017; 17:E1277. [PMID: 28587188 PMCID: PMC5492436 DOI: 10.3390/s17061277] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/31/2017] [Accepted: 05/31/2017] [Indexed: 12/18/2022]
Abstract
The objective assessment of physical activity levels through wearable inertial-based motion detectors for the automatic, continuous and long-term monitoring of people in free-living environments is a well-known research area in the literature. However, their application to older adults can present particular constraints. This paper reviews the adoption of wearable devices in senior citizens by describing various researches for monitoring physical activity indicators, such as energy expenditure, posture transitions, activity classification, fall detection and prediction, gait and balance analysis, also by adopting consumer-grade fitness trackers with the associated limitations regarding acceptability. This review also describes and compares existing commercial products encompassing activity trackers tailored for older adults, thus providing a comprehensive outlook of the status of commercially available motion tracking systems. Finally, the impact of wearable devices on life and health insurance companies, with a description of the potential benefits for the industry and the wearables market, was analyzed as an example of the potential emerging market drivers for such technology in the future.
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Affiliation(s)
- Salvatore Tedesco
- Tyndall National Institute, University College Cork/Lee Maltings, Prospect Row, Cork T12R5CP, Ireland.
| | - John Barton
- Tyndall National Institute, University College Cork/Lee Maltings, Prospect Row, Cork T12R5CP, Ireland.
| | - Brendan O'Flynn
- Tyndall National Institute, University College Cork/Lee Maltings, Prospect Row, Cork T12R5CP, Ireland.
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Roy S, Frndak S, Drake AS, Irwin L, Zivadinov R, Weinstock-Guttman B, Benedict RH. Differential effects of aging on motor and cognitive functioning in multiple sclerosis. Mult Scler 2016; 23:1385-1393. [PMID: 27885064 DOI: 10.1177/1352458516679036] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) patients are impaired in motor and cognitive performance, but the extent to which these deficits are magnified by aging is unknown. In one prior study, differences in cognitive processing speed between MS patients and healthy individuals were of similar magnitude across the lifespan. Here, we have improved on this work by expanding assessment to multiple cognitive domains and motor functioning. OBJECTIVE To determine whether the degree of cognitive and motor dysfunction in MS is magnified with increasing age. METHODS In all, 698 MS patients (aged 29-71 years) and 226 healthy controls (HCs; aged 18-72 years) completed neuroperformance tests covering ambulation, upper extremity function, information processing speed, and memory. RESULTS Linear regression models predicting cognitive and motor function revealed main effects of MS/HC diagnosis, age, and education across all measures. There was also an interaction between age and diagnosis on measures of motor function, but not on cognitive outcomes. CONCLUSION The progression of motor decline is amplified by aging in MS. However, the degree of cognitive impairment does not vary across the lifespan. Thus, evidence of accelerated cognitive impairment in older adults with MS may signal the presence of other age-related cognitive pathologies.
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Affiliation(s)
- Shumita Roy
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York (SUNY), Buffalo, NY, USA
| | - Seth Frndak
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York (SUNY), Buffalo, NY, USA
| | - Allison S Drake
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York (SUNY), Buffalo, NY, USA
| | - Lauren Irwin
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York (SUNY), Buffalo, NY, USA
| | - Robert Zivadinov
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York (SUNY), Buffalo, NY, USA/Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York (SUNY), Buffalo, NY, USA/MR Imaging Clinical Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York (SUNY), Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York (SUNY), Buffalo, NY, USA
| | - Ralph Hb Benedict
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York (SUNY), Buffalo, NY, USA/Department of Neurology, Buffalo General Hospital, Buffalo, NY, USA
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