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Leavitt VM, Tozlu C, Nelson KE, Boehme AK, Donnelly JE, Aguerre I, Spinner M, Riley CS, Stein J, Onomichi K. A randomized controlled trial of oral antipyretic treatment to reduce overheating during exercise in adults with multiple sclerosis. J Neurol 2024; 271:2207-2215. [PMID: 38413464 DOI: 10.1007/s00415-023-12147-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Some people with multiple sclerosis (pwMS) avoid exercise due to overheating. Evidence from a variety of cooling treatments shows benefits for pwMS. OBJECTIVE Conduct a randomized controlled trial of antipyretic treatment before exercise in pwMS. METHODS Adults over age 18 diagnosed with relapsing-remitting MS reporting heat sensitivity during exercise were randomly assigned to one of six sequences counterbalancing aspirin, acetaminophen, placebo. At each of three study visits separated by ≥ one week, participants received 650-millograms of aspirin, acetaminophen, or placebo before completing a maximal exercise test. Primary outcomes were body temperature change and total time-to-exhaustion (TTE), secondary outcomes were physiological and patient-reported outcomes (PROs). RESULTS Sixty participants were enrolled and assigned to treatment sequence; 37 completed ≥ one study visit. After controlling for order effects, we found that body temperature increase was reduced after aspirin (+ 0.006 ± 0.32 degrees Fahrenheit, p < 0.001) and after acetaminophen (+ 0.31 ± 0.35; p = 0.004) compared to placebo (+ 0.68 ± 0.35). TTE after aspirin (331.6 ± 76.6 s) and acetaminophen (578.2 ± 82.1) did not differ significantly from placebo (551.0 ± 78.4; p's > 0.05). Aspirin benefited all secondary outcomes compared to placebo (all p's < 0.001); acetaminophen showed broadly consistent benefits. CONCLUSION These results support antipyretic treatment as effective for reducing overheating during exercise in pwMS and failed to support antipyretics for increasing TTE in the context of a maximal exercise test. Benefits were shown for physiological markers of exercise productivity and PROs of fatigue, pain, and perceived exertion.
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Affiliation(s)
- Victoria M Leavitt
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Irving Medical Center, New York, NY, 10032, USA.
| | - Ceren Tozlu
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Katherine E Nelson
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, USA
- Center for Translational and Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, USA
| | - Amelia K Boehme
- Department of Neurology and Epidemiology, Columbia University Irving Medical Center, New York, USA
| | - Jaime E Donnelly
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, USA
| | - Ines Aguerre
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, USA
| | - Michael Spinner
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Claire S Riley
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, USA
- Center for Translational and Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, USA
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Kaho Onomichi
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, USA
- Center for Translational and Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, USA
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Silveira SL, Motl RW, Sandroff BM, Pilutti LA, Cutter GR. Randomized Controlled Trial of the Behavioral Intervention for Physical Activity in Multiple Sclerosis Project: Response Heterogeneity and Predictors of Change. Int J Behav Med 2024:10.1007/s12529-024-10265-7. [PMID: 38326673 DOI: 10.1007/s12529-024-10265-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND We reported that a social cognitive theory-based (SCT), Internet-delivered behavioral intervention increased device-measured minutes/day of moderate-to-vigorous physical activity (MVPA) over a 6-month period among persons with multiple sclerosis (MS). This paper examined the pattern and predictors of heterogeneity in change for MVPA. Based on previous research, we hypothesized that mild MS disability, fewer MS symptoms, lower baseline MVPA, and positive SCT characteristics (e.g., high exercise self-efficacy) would be associated with greater change in MVPA. METHOD Persons with MS (N = 318) were randomized into behavioral intervention (n = 159) or attention/social contact control (n = 159) conditions that were administered via Internet websites and supported with behavioral coaching. Demographic, clinical, symptom, behavioral, and SCT data were from before the 6-month period of delivering the conditions, and MVPA data were from before and after the 6-month period. We examined heterogeneity based on waterfall plots, box plots, and the Levene statistic. We identified predictors of MVPA change using bivariate correlation and multiple, linear regression analyses per condition. RESULTS The Levene statistic indicated statistically significant heterogeneity of variances for MVPA change between conditions (p = .003), and the waterfall plots and box plots indicated greater heterogeneity in MVPA change for the behavioral intervention. MVPA change score was correlated with baseline MVPA (r = - .33 and r = - .34, p = .0004 and p = .0001) in both conditions and walking impairment (r = - .188, p = .047) and race (r = .233, p = .014) in the behavioral intervention condition. The regression analysis indicated that baseline MVPA (Standardized B = - .449, p = .000002), self-reported walking impairment (Standardized B = - .310, p = .0008), and race (Standardized B = .215, p = .012) explained 25.6% of variance in MVPA change for the behavioral intervention condition. CONCLUSION We provide evidence for walking impairment, baseline MVPA, and race as predictors of the heterogeneity in the pattern of MVPA change with a behavioral intervention.
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Affiliation(s)
- Stephanie L Silveira
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX, 77030, USA.
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, USA
| | - Brian M Sandroff
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, USA
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
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Wilski M, Brola W, Koper M, Gabryelski J, Łuniewska M, Fudala M, Tomczak M. Relationship between physical activity and coping with stress in people with multiple sclerosis: A moderated mediation model with self-efficacy and disability level as variables. Int J Clin Health Psychol 2024; 24:100415. [PMID: 37840558 PMCID: PMC10568286 DOI: 10.1016/j.ijchp.2023.100415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
Abstract
Purpose An increasing number of studies support the beneficial relationship between physical activity and stress coping in people with multiple sclerosis (MS). However, there has been limited understanding of the variables that may influence the nature of this relationship. Therefore, based on the social-cognitive framework and previous research, we aimed to examine the association between the habitual physical activity of people with MS and their coping effectiveness. Furthermore, we sought to determine the extent to which self-efficacy acts as a mediator in this relationship, considering the level of disability as a moderator variable. Methods In this cross-sectional study, a total of 351 people with MS participated. The participants were asked to complete several assessment tools, including the Mini-COPE Inventory for Measurement-Coping with Stress, the Generalized Self-Efficacy Scale, and the Godin Leisure-Time Exercise Questionnaire. Additionally, a neurologist assessed the severity of the disease using the Expanded Disability Status Scale. Information on the demographic and clinical characteristics of the participants was collected via a self-report survey. Two moderated mediation analyses were conducted as part of the study. Results The study findings indicated a positive correlation between engagement in physical activity and self-efficacy among participants with high and medium disability levels. This, in turn, demonstrated a positive association with effective stress-coping strategies and a negative association with ineffective coping methods. In particular, a significant relationship was observed between involvement in physical activity and self-efficacy in participants with high disability, while it was not statistically significant in participants with low disability. Conclusion Physical activity was associated with improved psychosocial functioning in people with high levels of disability caused by MS. This association may be attributed to factors such as increased self-efficacy and improved stress coping. However, the relationship between physical activity and psychosocial functioning was less evident in people with low disability caused by MS.
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Affiliation(s)
- Maciej Wilski
- Department of Adapted Physical Activity, Poznań University of Physical Education, Poznan, Poland
| | - Waldemar Brola
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Magdalena Koper
- Department of Adapted Physical Activity, Poznań University of Physical Education, Poznan, Poland
| | - Jarosław Gabryelski
- Division of Rehabilitation Engineering, Institute of Combustion Engines and Transport, Faculty of Machines and Transport, Poznan University of Technology, Poznan, Poland
| | - Magdalena Łuniewska
- Department of Adapted Physical Activity, Poznań University of Physical Education, Poznan, Poland
| | - Małgorzata Fudala
- Department of Neurology, District Hospital Maria Skłodowska-Curie in Skarżysko, Kamienna, Poland
| | - Maciej Tomczak
- Department of Psychology, Poznań University of Physical Education, Poznan, Poland
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Motl RW, Kidwell-Chandler A, Sandroff BM, Pilutti LA, Cutter GR, Aldunate R, Bollaert RE. Randomized controlled trial of the behavioral intervention for physical activity in multiple sclerosis project: Social cognitive theory variables as mediators. Mult Scler Relat Disord 2023; 78:104933. [PMID: 37586313 DOI: 10.1016/j.msard.2023.104933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND We recently reported in a phase-III, randomized controlled trial that a behavioral intervention based on social cognitive theory (SCT) and delivered through the Internet using e-learning approaches increased device-measured minutes/day of moderate-to-vigorous physical activity (MVPA) over a 6-month period among persons with multiple sclerosis (MS). OBJECTIVE This planned tertiary outcome paper examined SCT variables as mediators of the behavioral intervention effect on change in device-measured minutes/day of MVPA. METHOD Persons with MS (N = 318) were randomized into behavioral intervention (n = 159) or attention/social contact control (n = 159) conditions. The conditions were administered over a 6-month period via an Internet website and supported with behavioral coaching by persons who were uninvolved in screening, recruitment, random assignment, and outcome assessments. We collected MVPA and SCT data before and after the 6-month period. The data analysis involved linear mixed modeling on MVPA and SCT outcomes followed by latent change score modeling for examining SCT variables as mediators of the intervention effect on change in MVPA. RESULTS The linear mixed model indicated statistically significant group by time interactions on device-measured minutes/day of MVPA and scores from SCT measures of exercise self-efficacy, barriers self-efficacy, goal setting, and planning. The effect of the intervention on device-measured minutes/day of MVPA was mediated by the SCT variable of exercise self-efficacy based on the statistical significance of the Wald z-score for the indirect effect in the latent change score model. CONCLUSIONS This study provides evidence for exercise self-efficacy as a SCT mediator of the behavioral intervention effect on device-measured minutes/day of MVPA in persons with MS.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, 506 J AHSB, Chicago, IL 60612, USA.
| | | | - Brian M Sandroff
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, USA
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, University of Ottawa, Canada
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | | | - Rachel E Bollaert
- Program in Exercise Science, Department of Physical Therapy, Marquette University, USA
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Yang T, Xiao H, Fan X, Zeng W. Exploring the effects of physical exercise on inferiority feeling in children and adolescents with disabilities: a test of chain mediated effects of self-depletion and self-efficacy. Front Psychol 2023; 14:1212371. [PMID: 37790224 PMCID: PMC10542406 DOI: 10.3389/fpsyg.2023.1212371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/16/2023] [Indexed: 10/05/2023] Open
Abstract
Objective The purpose of this study was to investigate the effects of physical exercise on inferiority feeling of children and adolescents with disabilities and its mechanism of action, as well as the mediating role of self depletion and self-efficacy. Methods The following scales were administered to 546 children and adolescents with disabilities (mean age 15.6 years): The Feelings of Inadequacy Scale, (FIS), the Self-Regulation Fatigue Scale (S-RFS), the General Self-Efficacy Scale (GSES), and the Physical Exercise Rating Scale. Results (1) Physical exercise can directly and negatively predict inferiority feeling, self-depletion, and can directly and positively predict self-efficacy; self-depletion can directly and negatively predict self-efficacy. Similarly, self-depletion positively predicts inferiority feeling; physical exercise and self-efficacy can also directly and negatively predict inferiority feeling. (2) The indirect effect of the path with self-depletion as the mediating variable was - 0.05, the indirect effect of the path with self-efficacy as the mediating variable was - 0.09, and the indirect effect of the path with self-depletion and self-efficacy as the mediating variables was - 0.04. (3) The sum of all indirect effects was - 0.18, and the three indirect effects accounted for 15.6%, 28.1%, and 12.5% of the total effect, with mediating effect was 56.2%. Conclusion Physical exercise can indirectly predict inferiority feeling in children and adolescents with disabilities through the independent mediation of self-depletion and self-efficacy, as well as through the chain mediation of both. This study supports that moderate physical exercise has a positive effect on the mental health of children and adolescents with disabilities, and that reducing self-depletion and improving self-efficacy are important ways to prevent inferiority feeling among children and adolescents with disabilities. It reveals the relationship between physical exercise and inferiority feeling and its mechanism of action, and further improves the research on the effect of physical exercise on inferiority feeling of children and adolescents with disabilities.
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Affiliation(s)
- Tongnian Yang
- School of Physical Education and Health, Jiangxi Science and Technology Normal University, Jiangxi, China
| | - Hui Xiao
- School of Physical Education and Health, Jiangxi Science and Technology Normal University, Jiangxi, China
| | - Xiaoyan Fan
- School of Physical Education and Health, Jiangxi Science and Technology Normal University, Jiangxi, China
| | - Wenping Zeng
- Nanchang Qiyin School (School for the Deaf and Dumb), Jiangxi, China
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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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Motl RW, Kidwell-Chandler A, Sandroff BM, Pilutti LA, Cutter GR, Aldunate R, Bollaert RE. Primary results of a phase-III, randomized controlled trial of the Behavioral Intervention for increasing Physical Activity in Multiple Sclerosis project. Mult Scler 2023; 29:415-426. [PMID: 36843446 DOI: 10.1177/13524585221146430] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
BACKGROUND We undertook a phase-III, randomized controlled trial (RCT) that examined the effectiveness of a behavioral intervention based on social cognitive theory (SCT) and delivered through the Internet using e-learning approaches for immediate and sustained increases in physical activity among persons with multiple sclerosis (MS). METHOD The study followed a parallel group RCT design. Persons with MS (N = 318) were randomized into either behavioral intervention (n = 159) or attention/social contact control (n = 159) conditions. The conditions were administered over a 6-month period by persons who were uninvolved in screening, recruitment, random assignment, and outcome assessment. There was a 6-month follow-up period without access of conditions. We collected outcome data every 6 months over the 12-month period. The primary outcome was device-measured minutes/day of moderate-to-vigorous physical activity (MVPA). The data analysis involved a modified intent-to-treat approach (i.e. those who received the allocated conditions) using a linear mixed model. RESULTS There was a significant group by time interaction on the primary outcome of device-measured minutes/day of MVPA (p < 0.005). MVPA was increased immediately after the 6-month period in the behavioral intervention compared with control, and this difference was sustained over the 6-month follow-up. CONCLUSION This study provides evidence for the effectiveness of a widely scalable approach for increasing MVPA in persons with MS.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | | | | | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Rachel E Bollaert
- Program in Exercise Science, Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
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Grunberg VA, Greenberg J, Mace RA, Bakhshaie J, Choi KW, Vranceanu AM. Fitbit Activity, Quota-Based Pacing, and Physical and Emotional Functioning Among Adults With Chronic Pain. THE JOURNAL OF PAIN 2022; 23:1933-1944. [PMID: 35914640 PMCID: PMC10226285 DOI: 10.1016/j.jpain.2022.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/14/2022] [Accepted: 07/11/2022] [Indexed: 11/20/2022]
Abstract
Physical activity can improve function in patients with chronic pain, however, adherence is low, in part due to inconsistent activity patterns. Smart wearable activity trackers, such as Fitbits, may help promote activity. In our program for chronic pain, we examined: 1) Fitbit activity patterns (ie, step count, moderate-to-vigorous physical activity (MVPA), sedentary behavior), and 2) whether achievement of weekly, individualized Fitbit step goals was associated with functional outcomes. We conducted a secondary analysis of Fitbit data from our 10-week mind-body activity program for chronic pain (GetActive-Fitbit arm, N = 41). Participants self-reported emotional and physical function and completed performance-based and accelerometer-based assessments. From week 1 to week 10, 30% of participants increased >800 steps; 32.5% increased MVPA; and 30% decreased sedentary behavior. Only step count significantly changed across time with mean steps peaking at week 8 (M = +1897.60, SD = 467.67). Fitbit step goal achievement was associated with improvements in anxiety (ß = -.35, CI [-2.80, -.43]), self-reported physical function (ß = -.34, CI [-5.17, 8.05]), and performance-based physical function (ß = .29, CI [-71.93, 28.38]), but not accelerometer-based physical function or depression. Adhering to individualized Fitbit step goals in the context of a mind-body activity program may improve anxiety and self-reported and performance-based physical function. PERSPECTIVE: We examine Fitbit activity patterns and the association between quota-based pacing and functional outcomes within a mind-body activity program for adults with chronic pain. Complementing quota-based pacing and coping skills with Fitbits may be a useful approach to promote activity engagement and behavior change in chronic pain populations.
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Affiliation(s)
- Victoria A Grunberg
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Division of Newborn Medicine, MassGeneral for Children, Boston, Massachusetts
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Ryan A Mace
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jafar Bakhshaie
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Karmel W Choi
- Psychiatric & Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Healy BC, Casady EC, Chitnis T, Weiner HL, Glanz BI. Estimating the Association between Physical Activity and Health-Related Quality of Life in Individuals with Multiple Sclerosis. Mult Scler Relat Disord 2022; 65:104006. [DOI: 10.1016/j.msard.2022.104006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/19/2022] [Accepted: 06/04/2022] [Indexed: 11/29/2022]
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Objectively assessed physiological, physical, and cognitive function along with patient-reported outcomes during the first 2 years of Alemtuzumab treatment in multiple sclerosis: a prospective observational study. J Neurol 2022; 269:4895-4908. [PMID: 35482080 DOI: 10.1007/s00415-022-11134-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In persons with multiple sclerosis (pwMS), little evidence exist on the effects of Alemtuzumab on physiological, physical, and cognitive function along with patient-reported outcomes, despite these domains are being rated as highly important. Therefore, our purpose was to perform a prospective observational study to examine these outlined outcomes during the first two years of Alemtuzumab treatment in pwMS. METHODS In n = 17 relapsing-remitting pwMS, physiological function [body composition; bone mineral content; muscle strength; aerobic capacity], physical function [6-min walk test (6MWT, primary outcome); timed 25 ft walk test (T25FWT); six spot step test (SSST); 9-step stair ascend (9SSA); timed up and go test (TUG); 5 × sit to stand test (5STS)], cognitive function [selective reminding test (SRT); symbol digit modalities test (SDMT)], and patient-reported outcomes [multiple sclerosis impact scale-29 (MSIS29); 12-item multiple sclerosis walking scale (MSWS12); modified fatigue impact scale (MFIS); hospital anxiety and depression scale (HADS)] were assessed prior to Alemtuzumab treatment initiation as well as 3, 6, 12, and 24 months into the treatment. RESULTS Improvements were observed at 24-month follow-up in T25FWT (+ 8%), SSST (+ 10%), SDMT (+ 5.2 points, 53% improved more than the clinical cut-off score) and SRT, whereas the primary outcome 6MWT, and all other remaining outcomes, remained stable throughout the Alemtuzumab treatment period. CONCLUSION The present findings suggest that Alemtuzumab treatment in relapsing-remitting pwMS can improve certain domains of physical function (short distance walking) and cognitive function (processing speed, memory), and furthermore stabilize physiological and physical function along with patient-reported outcomes. TRIAL REGISTRATION Registered at clinicaltrials.gov: NCT03806387.
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Khalil H, Rehan R, Al-Sharman A, Aburub AS, Darabseh MZ, Alomari MA, Aburub A, El-Salem K. Exercise capacity in people with Parkinson's disease: which clinical characteristics are important? Physiother Theory Pract 2022:1-9. [PMID: 35192419 DOI: 10.1080/09593985.2022.2042634] [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: 10/19/2022]
Abstract
BACKGROUND People with Parkinson's (PwP) are suffering from reduced exercise capacity. However, little information is known about clinical correlates of exercise capacity in this population. OBJECTIVE This study aimed to evaluate correlations between motor and non-motor symptoms with exercise capacity in PwP. METHODS A total of 50 individuals with Parkinson's disease participated in the study. Exercise capacity was measured by 6 minutes' walk test (6MWT). Besides, the Movement Disorder Society-Unified Parkinson's Disease Rating Scale-Part III used to evaluate disease motor severity, Berg Balance Scale to assess balance, Montréal Cognitive Assessment to evaluate cognitive status, hospital anxiety and depression scale to assess depression and anxiety, Modified Fatigue Impact scale to evaluate fatigue, and the Pittsburgh Sleep Quality Index to evaluate sleep quality. RESULTS The results showed that exercise capacity, when measured by the 6MWT, can be significantly predicted by balance, disease motor severity, anxiety, and age (R2 = 0.61 P < .0001). CONCLUSION These results suggest that exercise capacity in PwP is multifactorial and can potentially be predicted by balance, motor severity, anxiety, and age.
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Affiliation(s)
- Hanan Khalil
- College of Health Sciences, Department of Physical Therapy and Rehabilitation Sciences, Qatar University, Doha, Qatar
| | - Reem Rehan
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Alham Al-Sharman
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Ala' S Aburub
- Department of Physiotherapy, Isra University, Amman, Jordan
| | - Mohammad Z Darabseh
- Department of Allied Medical Sciences, Division of Physiotherapy, Aqaba University of Technology, Aqaba, Jordan.,Centre of Musculoskeletal Sciences and Sport Medicine, Manchester Metropolitan University, Manchester, UK
| | - Mahmoud A Alomari
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Aseel Aburub
- Department of Physiotherapy, Isra University, Amman, Jordan.,School of Health and Rehabilitation Sciences, Keele University, Newcastle Under Lyme, UK
| | - Khalid El-Salem
- Faculty of Medicine, Department of Neurosciences, Jordan University of Science and Technology, Irbid, Jordan
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12
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Young CA, Mills R, Langdon D, Sharrack B, Majeed T, Kalra S, Footitt D, Rog D, Harrower T, Nicholas R, Woolmore J, Thorpe J, Hanemann CO, Ford H, Paling D, Ellis C, Palace J, Constantinescu C, Tennant A. The four self-efficacy trajectories among people with multiple sclerosis: Clinical associations and implications. J Neurol Sci 2022; 436:120188. [DOI: 10.1016/j.jns.2022.120188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
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13
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Keller JL, Tian F, Fitzgerald KC, Mische L, Ritter J, Costello MG, Mowry EM, Zippunikov V, Zackowski KM. Using real-world accelerometry-derived diurnal patterns of physical activity to evaluate disability in multiple sclerosis. J Rehabil Assist Technol Eng 2022; 9:20556683211067362. [PMID: 35070348 PMCID: PMC8771734 DOI: 10.1177/20556683211067362] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 12/01/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
| | - Fan Tian
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Leah Mische
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jesse Ritter
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Ellen M. Mowry
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vadim Zippunikov
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathleen M. Zackowski
- Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, MD, USA
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14
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Maguire R, McKeague B, Kóka N, Coffey L, Maguire P, Desmond D. The role of expectations and future-oriented cognitions in quality of life of people with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2021; 56:103293. [PMID: 34624641 DOI: 10.1016/j.msard.2021.103293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/10/2021] [Accepted: 09/29/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Multiple Sclerosis (MS) is a highly variable condition characterised by uncertainty of disease course which can make formation of expectations about the future difficult. This systematic review aimed to examine associations between expectations, or Future Oriented Cognitions (FOCs), and Quality of Life (QOL) in people with MS (PwMS). METHODS Following PRISMA guidelines, literature up to October 2019 was searched using Medline, EMBASE, PsycINFO and Web of Science. Quantitative studies that investigated relationships between FOCs and QOL in PwMS (assessed using a standardised QOL assessment) were considered for inclusion. After data extraction, results were analysed using narrative synthesis, focusing on the valence of FOCs (positive, negative, unvalenced). Quality appraisal was conducted using the Mixed Methods Appraisal Tool (MMAT). All stages of the review were patient-led by a person with MS. RESULTS A total of 13 studies met the review inclusion criteria, with a combined sample size of 4,179. Of these studies, 11 involved measures of positive FOCs, most commonly self-efficacy, one measured a negative FOC, with one FOC unclassified. Nine studies found significant associations between QOL and self-efficacy. Although other positively valenced constructs were less frequently reported, significant associations with higher QOL were also evidenced. CONCLUSIONS Identifying ways to foster positive FOCs, particularly self-efficacy, may have beneficial effects on QOL. More research is needed to understand the impacts of negative FOCs on QOL to determine whether these processes could be meaningfully targeted in interventions.
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Affiliation(s)
- Rebecca Maguire
- Department of Psychology, Maynooth University; Assisting Living and Learning Institute, Maynooth University.
| | | | | | - Laura Coffey
- Department of Psychology, Maynooth University; Assisting Living and Learning Institute, Maynooth University
| | - Phil Maguire
- Department of Computer Science, Maynooth University
| | - Deirdre Desmond
- Department of Psychology, Maynooth University; Assisting Living and Learning Institute, Maynooth University
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15
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Eustis H, Plummer P. Self-efficacy training as an adjunct to exercise in a person with progressive multiple sclerosis: a case report. Physiother Theory Pract 2021; 38:3126-3135. [PMID: 34081567 DOI: 10.1080/09593985.2021.1934921] [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: 10/21/2022]
Abstract
Background: Increasing self-efficacy to exercise and minimizing disease-related barriers has been shown to improve physical activity levels and quality of life (QOL) in persons with multiple sclerosis (MS). Currently, little research has examined exercise self-efficacy in persons with more advanced MS. Purpose: Explore the effects of a self-efficacy plus exercise intervention on physical activity endurance and level, QOL, and fatigue in an individual with advanced MS and low self-efficacy.Methods: The participant was a 60-year-old, severely disabled female with secondary progressive MS and an Expanded Disability Status Score (EDSS) of 8. The 8-week intervention consisted of weekly discussions and MS-related education; four one-on-one sessions with a MS "mentor;" daily journal to record sleep quality, fatigue level, and physical activity. Outcomes included a modified 5-meter walk test (5MWT), MS Impact Scale (MSIS-29), Exercise Self-Efficacy Scale (EX-ES), Modified Fatigue Impact Scale (MFIS), MS Self-Efficacy Scale (MS-SES), Patient Health Questionnaire-9 (PHQ-9), and daily physical activity monitoring. Outcomes were assessed at baseline (week 0), post-intervention (week 8), and 8 weeks post intervention (week 16). The participant continued her regular exercise routine independently throughout the study period.Results: There were notable improvements in EX-ES, MFIS, PHQ-9, MSIS-29 psychological subscale, sleep quality, and morning fatigue ratings post intervention, some of which were retained at follow up.Conclusion: The findings illustrate that an 8-week self-efficacy intervention increased exercise self-efficacy, QOL, and reduced perceived fatigue in a severely disabled individual with progressive MS. Future research should examine self-efficacy interventions in a larger sample size of persons with progressive MS.
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Affiliation(s)
- Heather Eustis
- Department of Physical Therapy and Occupational Therapy, Duke University Hospital, Durham, NC, United States
| | - Prudence Plummer
- Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, United States
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16
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Stuart CM, Varatharaj A, Domjan J, Philip S, Galea I. Physical activity monitoring to assess disability progression in multiple sclerosis. Mult Scler J Exp Transl Clin 2020; 6:2055217320975185. [PMID: 33343919 PMCID: PMC7727071 DOI: 10.1177/2055217320975185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background Clinical outcome measurement in multiple sclerosis (MS) usually requires a physical visit. Remote activity monitoring (RAM) using wearable technology provides a rational alternative, especially desirable when distance is involved or in a pandemic setting. Objective To validate RAM in progressive MS using (1) traditional psychometric methods (2) brain atrophy. Methods 56 people with progressive MS participated in a longitudinal study over 2.5 years. An arm-worn RAM device measured activity over six days, every six months, and incorporated triaxial accelerometry and transcutaneous physiological variable measurement. Five RAM variables were assessed: physical activity duration, step count, active energy expenditure, metabolic equivalents and a composite RAM score incorporating all four variables. Other assessments every six months included EDSS, MSFC, MSIS-29, Chalder Fatigue Scale and Beck’s Depression Inventory. Annualized brain atrophy was measured using SIENA. Results RAM was tolerated well by people with MS; the device was worn 99.4% of the time. RAM had good convergent and divergent validity and was responsive, especially with respect to step count. Measurement of physical activity over one day was as responsive as six days. The composite RAM score positively correlated with brain volume loss. Conclusion Remote activity monitoring is a valid and acceptable outcome measure in MS.
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Affiliation(s)
- Charlotte M Stuart
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Aravinthan Varatharaj
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janine Domjan
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sheaba Philip
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ian Galea
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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17
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Kever A, Nelson KE, Aguerre IM, Riley CS, Boehme A, Lee NW, Strauss Farber R, Levin SN, Stein J, Leavitt VM. ASPIRE trial: study protocol for a double-blind randomised controlled trial of aspirin for overheating during exercise in multiple sclerosis. BMJ Open 2020; 10:e039691. [PMID: 33191260 PMCID: PMC7668379 DOI: 10.1136/bmjopen-2020-039691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The many benefits of exercise for persons with multiple sclerosis (MS) are well established, yet patients often refrain from exercise due to overheating and exhaustion. The present randomised controlled trial tests aspirin (acetylsalicylic acid (ASA)) as a convenient method to prevent overheating and improve exercise performance in persons with MS. The effects of ASA are compared with those of acetaminophen (APAP) and placebo. METHODS AND ANALYSIS Participants are seen for a laboratory maximal exercise test on 3 separate days separated by at least 1 week. At each session, body temperature is measured before oral administration of a standard adult dose (650 mg) of ASA, APAP or placebo. One hour after drug administration, participants perform a maximal ramp test on a cycle ergometer. Primary outcomes are (a) time to exhaustion (that is, time spent cycling to peak exertion) and (b) body temperature change. Crossover analyses will include tests for effects of treatment, period, treatment-period interaction (carryover effect) and sequence. ETHICS AND DISSEMINATION Ethical approval was granted by the institutional review board at Columbia University Irving Medical Center (reference: AAAS2529). Results of the trial will be published in peer-reviewed scientific journals and presented at national and international conferences. Neurologists, physiatrists, primary care physicians and physiotherapists are important stakeholders and will be targeted during dissemination. Positive trial results have the potential to promote aspirin therapy, an inexpensive and readily available treatment, to reduce overheating and allow more persons with MS to benefit from exercise. TRIAL REGISTRATION NUMBER NCT03824938.
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Affiliation(s)
- Anne Kever
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Katherine E Nelson
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Center for Translational & Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Ines M Aguerre
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Center for Translational & Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Claire S Riley
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Amelia Boehme
- Department of Neurology and Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Nancy W Lee
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vangelos College of Physicians and Surgeons, New York, NY, USA
| | - Rebecca Strauss Farber
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Seth N Levin
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vangelos College of Physicians and Surgeons, New York, NY, USA
| | - Victoria M Leavitt
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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18
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Neal WN, Cederberg KL, Jeng B, Sasaki JE, Motl RW. Is Symptomatic Fatigue Associated With Physical Activity and Sedentary Behaviors Among Persons With Multiple Sclerosis? Neurorehabil Neural Repair 2020; 34:505-511. [PMID: 32340521 PMCID: PMC8796123 DOI: 10.1177/1545968320916159] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Background. Fatigue is a debilitating symptom in multiple sclerosis (MS) that may be associated with reduced physical activity and increased sedentary behavior. Objective. This study examined the associations among fatigue and device-measured physical activity and sedentary behavior in people with MS. Methods. The participants (n = 252) completed the Patient Determined Disease Steps (PDDS) and Fatigue Severity Scale (FSS) and wore a waist-mounted accelerometer for 7 days. Participants were divided into 2 groups based on fatigue severity as measured by the FSS scale. We compared percentage of wear time spent in sedentary, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) between the 2 groups. Results. Persons in the fatigued group (FSS score ≥ 4) spent a greater percentage of time in sedentary behavior (P = .004) and a lower percentage of time in LPA (P = .035). Persons in the fatigued group further spent a lower percentage of time in nontransformed MVPA (P < .001) and square-root-transformed MVPA (P < .001) than persons in the nonfatigued group. When controlling for PDDS scores and years of education, there were no longer significant differences between groups in sedentary behavior, LPA, or transformed MVPA values; the difference in nontransformed MVPA was still statistically significant but likely the result of nonnormally distributed data. Conclusion. The present study suggests that factors other than fatigue might be associated with physical activity and sedentary behavior in MS, and this group might benefit from focal behavioral interventions that take into account mobility status in persons with MS who have fatigue.
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Affiliation(s)
- Whitney N. Neal
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Katie L. Cederberg
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brenda Jeng
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffer E. Sasaki
- Department of Sport Sciences, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Robert W. Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
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19
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Riemann-Lorenz K, Motl RW, Casey B, Coote S, Daubmann A, Heesen C. Possible determinants of long-term adherence to physical activity in multiple sclerosis—theory-based development of a comprehensive questionnaire and results from a German survey study. Disabil Rehabil 2020; 43:3175-3188. [DOI: 10.1080/09638288.2020.1731612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert W. Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bláthin Casey
- Health Behaviour Change Research Group, School of Medicine and School of Psychology, National University of Ireland, Galway, Ireland
| | - Susan Coote
- School of Allied Health and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne Daubmann
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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20
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Canning KL, Hicks AL. Physician referral improves adherence to the physical activity guidelines for adults with MS: A randomized controlled trial. Mult Scler Relat Disord 2020; 37:101441. [DOI: 10.1016/j.msard.2019.101441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/03/2019] [Accepted: 10/10/2019] [Indexed: 11/29/2022]
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21
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Jongen PJ, van Mastrigt GA, Heerings M, Visser LH, Ruimschotel RP, Hussaarts A, Duyverman L, Valkenburg-Vissers J, Cornelissen J, Bos M, van Droffelaar M, Donders R. Effect of an intensive 3-day social cognitive treatment (can do treatment) on control self-efficacy in patients with relapsing remitting multiple sclerosis and low disability: A single-centre randomized controlled trial. PLoS One 2019; 14:e0223482. [PMID: 31600271 PMCID: PMC6786633 DOI: 10.1371/journal.pone.0223482] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/20/2019] [Indexed: 11/19/2022] Open
Abstract
In patients with chronic disorders, control self-efficacy is the confidence with managing symptoms and coping with the demands of illness. Can do treatment (CDT) is an intensive, 3-day, social cognitive theory-based, multidisciplinary treatment that focuses on identification of stressors, goal setting, exploration of boundaries, and establishment of new boundaries. An uncontrolled study showed that patients with relapsing remitting multiple sclerosis (RRMS) and low-disability had improved control self-efficacy six months after CDT. Hence, in a 6-month, single-centre, randomized (1:1), unmasked, controlled trial in RRMS patients with Expanded Disability Status Scale (EDSS) score ≤4.0, we compared CDT with no intervention and the option to receive CDT after completion of study participation. Follow-up assessments were at one, three and six months. Primary endpoint was control self-efficacy (Multiple Sclerosis Self-Efficacy Scale Control [MSSES-C] (minimum 90, maximum 900) at six months. Secondary endpoints were functional self-efficacy (MSSES-F), participation and autonomy (Impact on Participation and Autonomy questionnaire [IPA]), health-related quality of life (MS Quality of Life-54 Items questionnaire [MSQoL-54]), anxiety, depression (Hospital Anxiety and Depression Scale [HADS]) and coping skills (Utrecht Coping List [UCL]) at six months. Tertiary endpoint was care-related strain on support partners (Caregiver Strain Index) at six months. Of the 158 patients that were included, 79 were assigned to CDT and 79 to the control group. Two CDT patients discontinued treatment prematurely. Sixty-one (77%) control patients chose to receive CDT after study participation. Intention-to-treat ANCOVA analyses were performed with follow-up values as dependent, and condition, baseline values, disease duration and gender as independent variables. The mean (standard deviation [SD]) MSSES-C score in the CDT group vs. control group at baseline was 468 (162) vs. 477 (136), and at six months 578 (166) vs. 540 (135) (p = 0.100). Secondary and tertiary endpoints did not differ between groups, except for the UCL palliative reaction score being slightly higher in the CDT group (p = 0.039). On post hoc analyses the MSSES-C score at one and three months was higher in the CDT vs. control group: 597 (114) vs. 491 (131) (p<0.0001) and 561 (160) vs. 514 (143) (p = 0.018), respectively; and at one month the MSSES-F, IPA Limitations, HADS Anxiety and Depression, and MSQoL-54 Mental and Physical scores were also in favour of the CDT group. We conclude that in low-disability RRMS patients, the intensive 3-day social cognitive theory-based CDT did not improve control self-efficacy at six months follow-up compared to waitlist controls. The absence of a between-group difference at six months relates to a gradual improvement in the control group. In all, this social cognitive theory-based approach for improving self-efficacy needs further investigation before being broadly applied in RRMS patients.
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Affiliation(s)
- Peter Joseph Jongen
- Department of Community & Occupational Medicine, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
- MS4 Research Institute, Nijmegen, the Netherlands
- * E-mail: ,
| | - Ghislaine A. van Mastrigt
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Marco Heerings
- National Multiple Sclerosis Foundation, Rotterdam, the Netherlands
| | - Leo H. Visser
- Department of Neurology, St. Elisabeth Hospital, Tilburg, the Netherlands
- University of Humanistic Studies, Utrecht, the Netherlands
| | | | | | - Lotte Duyverman
- Medical Psychiatric Centre PsyToBe, Rotterdam, the Netherlands
| | | | | | - Michel Bos
- Department of Neurology, St. Anna Hospital, Geldrop, the Netherlands
| | | | - Rogier Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
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22
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Vienne-Jumeau A, Oudre L, Moreau A, Quijoux F, Vidal PP, Ricard D. Comparing Gait Trials with Greedy Template Matching. SENSORS 2019; 19:s19143089. [PMID: 31336957 PMCID: PMC6679258 DOI: 10.3390/s19143089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/09/2019] [Accepted: 07/11/2019] [Indexed: 01/15/2023]
Abstract
Gait assessment and quantification have received an increased interest in recent years. Embedded technologies and low-cost sensors can be used for the longitudinal follow-up of various populations (neurological diseases, elderly, etc.). However, the comparison of two gait trials remains a tricky question as standard gait features may prove to be insufficient in some cases. This article describes a new algorithm for comparing two gait trials recorded with inertial measurement units (IMUs). This algorithm uses a library of step templates extracted from one trial and attempts to detect similar steps in the second trial through a greedy template matching approach. The output of our method is a similarity index (SId) comprised between 0 and 1 that reflects the similarity between the patterns observed in both trials. Results on healthy and multiple sclerosis subjects show that this new comparison tool can be used for both inter-individual comparison and longitudinal follow-up.
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Affiliation(s)
- Aliénor Vienne-Jumeau
- COGNAC-G (UMR 8257), CNRS Service de Santé des Armées University Paris Descartes, 75006 Paris, France
| | - Laurent Oudre
- COGNAC-G (UMR 8257), CNRS Service de Santé des Armées University Paris Descartes, 75006 Paris, France.
- L2TI, University Paris 13, 93430 Villetaneuse, France.
- CMLA (UMR 8536), CNRS ENS Paris-Saclay, 94235 Cachan, France.
| | - Albane Moreau
- COGNAC-G (UMR 8257), CNRS Service de Santé des Armées University Paris Descartes, 75006 Paris, France
| | - Flavien Quijoux
- COGNAC-G (UMR 8257), CNRS Service de Santé des Armées University Paris Descartes, 75006 Paris, France
- ORPEA Group, 92813 Puteaux, France
| | - Pierre-Paul Vidal
- COGNAC-G (UMR 8257), CNRS Service de Santé des Armées University Paris Descartes, 75006 Paris, France
- Hangzhou Dianzi University, 310005 Hangzhou, China
| | - Damien Ricard
- COGNAC-G (UMR 8257), CNRS Service de Santé des Armées University Paris Descartes, 75006 Paris, France
- Service de Neurologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, 92190 Clamart, France
- Ecole du Val-de-Grâce, Ecole de Santé des Armées, 75005 Paris, France
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23
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Silveira SL, Motl RW. Do Social Cognitive Theory constructs explain response heterogeneity with a physical activity behavioral intervention in multiple sclerosis? Contemp Clin Trials Commun 2019; 15:100366. [PMID: 31193266 PMCID: PMC6525323 DOI: 10.1016/j.conctc.2019.100366] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/10/2019] [Accepted: 04/17/2019] [Indexed: 11/22/2022] Open
Abstract
Background Behavioral interventions based on Social Cognitive Theory (SCT) are efficacious for increasing both objectively-measured and self-reported physical activity in people with multiple sclerosis (MS). Purpose This study involved a secondary analysis of data focused on SCT constructs as correlates of individual-level changes (i.e., response heterogeneity) following a behavioral intervention. Method Twenty-two persons with MS who completed a 6-month SCT-based behavioral intervention for increasing physical activity were included in analyses. The intervention consisted of two primary components, namely a dedicated Internet website and one-on-one video chats with a behavioral coach. Outcomes included objectively-measured moderate-vigorous physical activity (MVPA) using Actigraph model GT3X+ accelerometers and self-reported physical activity using the Godin Leisure-Time Exercise Questionnaire (GLTEQ) as well as SCT variables of exercise self-efficacy, barriers self-efficacy, outcome expectations, goal setting and planning and facilitators/impediments. Results There was individual variability in physical activity change following the intervention. For example, 4/22 participants demonstrated a reduction in MVPA, 1/22 participants had no change, 9/22 participants had less than 0.5 standard deviation (SD) increase in MVPA, and 8/22 participants had an increase in MVPA of more than 0.5 SD. Baseline SCT variables, particularly outcome expectations, goal setting, planning, and barriers self-efficacy, correlated with increased physical activity. Conclusions This study indicates that SCT variables correlate with the response heterogeneity associated with physical activity behavioral interventions, and this might inform the delivery of interventions consistent with Bandura's stepwise implementation model for optimizing the “fit” of an intervention based on SCT for maximizing treatment efficacy in MS.
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Affiliation(s)
- Stephanie L Silveira
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, USA
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, USA
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24
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Motl RW, Sandroff BM, McAuley E. Naturally occurring change in Multiple Sclerosis Walking Scale-12 scores over time in multiple sclerosis. Neurodegener Dis Manag 2018; 8:315-322. [PMID: 30226109 DOI: 10.2217/nmt-2018-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM This study examined the trajectory and pattern of naturally occurring change in perceived walking impairment over a 30-month period in relapsing-remitting multiple sclerosis (RRMS). PATIENTS & METHODS Two hundred and sixty-nine persons with RRMS completed the 12-item Multiple Sclerosis Walking Scale (MSWS-12) every 6 months over a 30-month period. Data were analyzed using latent growth curve modeling and latent class growth curve modeling. RESULTS Latent growth curve modeling demonstrated that a linear trajectory adequately described the group-level pattern of change in MSWS-12 scores over time. Latent class growth curve modeling supported a three-class model for describing the heterogeneity of changes in MSWS-12 scores over time. CONCLUSION Walking impairment does change over time in RRMS, and this can be described by three patterns of change trajectories that differed based on initial status of walking impairment.
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Affiliation(s)
- Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA 35294
| | - Brian M Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA 35294
| | - Edward McAuley
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA 61801
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Kalina JT, Hinojosa J, Strober L, Bacon J, Donnelly S, Goverover Y. Randomized Controlled Trial to Improve Self-Efficacy in People With Multiple Sclerosis: The Community Reintegration for Socially Isolated Patients (CRISP) Program. Am J Occup Ther 2018; 72:7205205030p1-7205205030p8. [PMID: 30157015 DOI: 10.5014/ajot.2018.026864] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We examined the efficacy of a 12-wk educational socialization program, Community Reintegration for Socially Isolated Patients (CRISP), in improving self-efficacy for people with multiple sclerosis (MS). We also examined whether participants in the experimental group with increased self-efficacy experienced reduced loneliness and depression. METHOD This randomized controlled group design included 91 participants with MS (experimental group, n = 51; control group, n = 40). Participants were between ages 20 and 68 yr, and the majority experienced a relapsing-remitting MS course (86%) and mild to moderate disability. Participants completed baseline and posttreatment assessments, including questionnaires assessing self-efficacy, loneliness, and depression. RESULTS Experimental group participants significantly improved in self-efficacy compared with control group participants. Experimental group participants who demonstrated improved self-efficacy reported reduced perceptions of loneliness but not depressive symptoms. CONCLUSION CRISP is a promising intervention to improve self-efficacy for people with MS. However, results need to be treated with caution given the study's limitations.
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Affiliation(s)
- J Tamar Kalina
- J. Tamar Kalina, PhD, MSCS, OTR/L, is Medical Science Liaison, Biogen Idec, Weston, MA. At the time of the study, she was Director of Rehabilitation Services, Senior Manager Rehabilitation and Research, and Assistant Professor in Neurology, New York University, New York, NY;
| | - Jim Hinojosa
- Jim Hinojosa, PhD, OT, FAOTA, is Professor Emeritus, New York University, New York, NY
| | - Lauren Strober
- Lauren Strober, PhD, is Senior Research Scientist, Kessler Foundation, West Orange, NJ
| | - Joshua Bacon
- Joshua Bacon, PhD, is Clinical Psychologist and Assistant Professor, New York School of Medicine, New York, NY
| | - Seamus Donnelly
- Seamus Donnelly, PhD, is Student, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Yael Goverover
- Yael Goverover, PhD, OTR/L, is Associate Professor, New York University, New York, NY
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26
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Motl RW, Sandroff BM, Wingo BC, McCroskey J, Pilutti LA, Cutter GR, Bollaert RE, McAuley E. Phase-III, randomized controlled trial of the behavioral intervention for increasing physical activity in multiple sclerosis: Project BIPAMS. Contemp Clin Trials 2018; 71:154-161. [PMID: 29959105 DOI: 10.1016/j.cct.2018.06.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND We propose a phase-III, randomized controlled trial (RCT) that examines the effectiveness of a behavioral intervention based on social cognitive theory (SCT) and delivered through the Internet using e-learning approaches for increasing physical activity and secondary outcomes (e.g., symptoms) in a large sample of people with multiple sclerosis (MS) residing throughout the United States. METHODS/DESIGN The proposed phase-III trial will use a parallel group, RCT design that examines the effect of a 6-month behavioral intervention for increasing physical activity and secondarily improving mobility, cognition, symptoms, and quality of life (QOL) in persons with MS. The primary outcome is accelerometer-measured moderate-to-vigorous physical activity (MVPA). The secondary outcomes include self-report measures of physical activity, walking impairment, cognition, fatigue, depression, anxiety, pain, sleep quality, and QOL. The tertiary outcomes are mediator variables based on SCT. Participants (N = 280) will be randomized into behavioral intervention (n = 140) or attention and social contact control (n = 140) conditions using computerized random numbers with concealed allocation. The conditions will be administered over 6-months by persons who are uninvolved in screening, recruitment, random assignment, and outcome assessment. There will be a 6-month follow-up without intervention access/content. We will collect primary, secondary, and tertiary outcome data every 6 months over the 12-month period. Data analysis will involve intent-to-treat principles and latent growth modeling (LGM). DISCUSSION The proposed research will provide evidence for the effectiveness of a novel, widely scalable approach for increasing lifestyle physical activity and improving secondary outcomes and QOL in persons with MS.
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Affiliation(s)
- Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, USA.
| | - Brian M Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, USA
| | - Brooks C Wingo
- Department of Occupational Therapy, University of Alabama at Birmingham, USA
| | - Justin McCroskey
- Department of Physical Therapy, University of Alabama at Birmingham, USA
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, University of Ottawa, Canada
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | - Rachel E Bollaert
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, USA
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, USA
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27
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Motl RW. Promotion of physical activity and exercise in multiple sclerosis: Importance of behavioral science and theory. Mult Scler J Exp Transl Clin 2018; 4:2055217318786745. [PMID: 30090642 PMCID: PMC6077908 DOI: 10.1177/2055217318786745] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/07/2018] [Accepted: 05/30/2018] [Indexed: 12/29/2022] Open
Abstract
There is an obvious disconnect between evidence of benefits and rates of participation in exercise and physical activity among people living with multiple sclerosis (MS). We propose that the problem with exercise behavior in MS (i.e. lack of broad or increasing participation by people with MS despite evidence of meaningful benefits) might be ameliorated through the inclusion of behavior change theory in the design of exercise programs and promotion efforts, as has been undertaken in other populations such as breast cancer survivors. This paper reviews Social Cognitive Theory as an example approach for informing interventions for increasing exercise and physical activity behavior outside of MS and provides an overview of current knowledge regarding the application of this theory for physical activity in MS. We then outline future research necessary for informing trials that design, implement, and test theory-based interventions for physical activity promotion in MS. If theories of behavior change are adopted for informing exercise and physical activity research in MS, we can take a major step forward in addressing the problem of exercise and physical activity participation that has plagued the field for more than 25 years.
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Affiliation(s)
- Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, 336 SHPB, 1720 2nd Ave. S., Birmingham, AL 35294, USA.
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28
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Casey B, Coote S, Galvin R, Donnelly A. Objective physical activity levels in people with multiple sclerosis: Meta-analysis. Scand J Med Sci Sports 2018; 28:1960-1969. [DOI: 10.1111/sms.13214] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 12/23/2022]
Affiliation(s)
- B. Casey
- Faculty of Education and Health Sciences; School of Allied Health; University of Limerick; Limerick Ireland
| | - S. Coote
- Faculty of Education and Health Sciences; School of Allied Health; University of Limerick; Limerick Ireland
| | - R. Galvin
- Faculty of Education and Health Sciences; School of Allied Health; University of Limerick; Limerick Ireland
| | - A. Donnelly
- Faculty of Education and Health Sciences; Department of Physical Education and Sport Sciences; University of Limerick; Limerick Ireland
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29
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Uszynski MK, Casey B, Hayes S, Gallagher S, Purtill H, Motl RW, Coote S. Social Cognitive Theory Correlates of Physical Activity in Inactive Adults with Multiple Sclerosis. Int J MS Care 2018; 20:129-135. [PMID: 29896049 PMCID: PMC5991504 DOI: 10.7224/1537-2073.2016-111] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is a growing body of evidence that physical activity (PA) improves symptoms of multiple sclerosis (MS). Despite the benefits of PA, people with MS are relatively inactive compared with their healthy counterparts. This study investigated associations between social cognitive theory (SCT) constructs and energy expenditure (EE) as an objective measure of PA in a sample of inactive people with MS. METHODS Participants (n = 65) completed several questionnaires and were assessed using standardized outcome measures as part of a cross-sectional analysis of baseline data from a randomized controlled trial (Step it Up). RESULTS The bivariate correlation analysis indicated that of all SCT constructs, only exercise self-efficacy was significantly correlated with EE (r = 0.297, P = .022). Multiple linear regression analysis found that exercise self-efficacy independently explained 9% of the variance in EE (R2 = 0.088). A model including exercise self-efficacy, exercise goal setting, exercise planning, and exercise benefits explained 17% of the variance in EE (F4,54 = 2.741, P = .038, R2 = 0.169). In this model, only exercise self-efficacy was significantly associated with EE scores (Exercise Self-Efficacy Scale β = .320, P = .016). CONCLUSIONS The constructs of SCT explained little of the variance of objectively measured PA in a sample of inactive people with MS who volunteered for an exercise trial. The only significant variable was exercise self-efficacy, which confirms the importance of enhancing it through PA interventions.
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Anens E, Zetterberg L, Urell C, Emtner M, Hellström K. Self-reported physical activity correlates in Swedish adults with multiple sclerosis: a cross-sectional study. BMC Neurol 2017; 17:204. [PMID: 29191168 PMCID: PMC5710131 DOI: 10.1186/s12883-017-0981-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022] Open
Abstract
Background The benefits of physical activity in persons with Multiple Sclerosis (MS) are considerable. Knowledge about factors that correlate to physical activity is helpful in order to develop successful strategies to increase physical activity in persons with MS. Previous studies have focused on correlates to physical activity in MS, however falls self-efficacy, social support and enjoyment of physical activity are not much studied, as well as if the correlates differ with regard to disease severity. The aim of the study was to examine associations between physical activity and age, gender, employment, having children living at home, education, disease type, disease severity, fatigue, self-efficacy for physical activity, falls self-efficacy, social support and enjoyment of physical activity in a sample of persons with MS and in subgroups with regard to disease severity. Methods This is a cross-sectional survey study including Swedish community living adults with MS, 287 persons, response rate 58.2%. The survey included standardized self-reported scales measuring physical activity, disease severity, fatigue, self-efficacy for physical activity, falls self-efficacy, and social support. Physical activity was measured by the Physical Activity Disability Survey – Revised. Results Multiple regression analyzes showed that 59% (F(6,3) = 64.9, p = 0.000) of the variation in physical activity was explained by having less severe disease (β = −0.30), being employed (β = 0.26), having high falls self-efficacy (β = 0.20), having high self-efficacy for physical activity (β = 0.17), and enjoying physical activity (β = 0.11). In persons with moderate/severe MS, self-efficacy for physical activity explained physical activity. Conclusions Consistent with previous research in persons with MS in other countries this study shows that disease severity, employment and self-efficacy for physical activity are important for physical activity. Additional important factors were falls self-efficacy and enjoyment. More research is needed to confirm this and the subgroup differences.
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Affiliation(s)
- Elisabeth Anens
- Department of Neuroscience, Section for Physiotherapy, Box 593 Uppsala University, 751 24, Uppsala, Sweden.
| | - Lena Zetterberg
- Department of Neuroscience, Section for Physiotherapy, Box 593 Uppsala University, 751 24, Uppsala, Sweden
| | - Charlotte Urell
- Department of Neuroscience, Section for Physiotherapy, Box 593 Uppsala University, 751 24, Uppsala, Sweden
| | - Margareta Emtner
- Department of Neuroscience, Section for Physiotherapy, Box 593 Uppsala University, 751 24, Uppsala, Sweden
| | - Karin Hellström
- Department of Neuroscience, Section for Physiotherapy, Box 593 Uppsala University, 751 24, Uppsala, Sweden
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31
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Dalgas U. Exercise therapy in multiple sclerosis and its effects on function and the brain. Neurodegener Dis Manag 2017; 7:35-40. [DOI: 10.2217/nmt-2017-0040] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Exercise therapy is a promising nonpharmacological therapy in people with multiple sclerosis (MS). Although exercise training may induce a transient worsening of symptoms in some MS patients, it is generally considered safe and does not increase the risk of relapses. Exercise training can lead to clinically relevant improvements in physical function, but should be considered an adjunct to specific task-based training. Exercise has also shown positive effects on the brain, including improvements in brain volume and cognition. In summary, exercise therapy is a safe and potent nonpharmacological intervention in MS, with beneficial effects on both functional capacity and the brain.
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Affiliation(s)
- Ulrik Dalgas
- Department of Public Health, Section of Sport Science, Aarhus University, Denmark
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32
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Yousef A, Jonzzon S, Suleiman L, Arjona J, Graves JS. Biosensing in multiple sclerosis. Expert Rev Med Devices 2017; 14:901-912. [PMID: 28975814 DOI: 10.1080/17434440.2017.1388162] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The goal of using wearable biosensors in multiple sclerosis (MS) is to provide outcome metrics with higher sensitivity to deficits and better inter-test and inter-rater reliability than standard neurological exam bedside maneuvers. A wearable biosensor not only has the potential to enhance physical exams, but also offers the promise of remote evaluations of the patient either at home or with local non-specialist providers. Areas covered: We performed a structured literature review on the use of wearable biosensors in studies of multiple sclerosis. This included accelerometers, gyroscopes, eye-trackers, grip sensors, and multi-sensors. Expert commentary: Wearable sensors that are sensitive to change in function over time have great potential to serve as outcome metrics in clinical trials. Key features of generalizability are simplicity in the application of the device and delivery of data to the provider. Another important feature to establish is best sampling rate. Having too high of a sampling rate can lead to over-interpretation of noisy data On the other hand, a low sampling rate can result in an insensitive test thus missing subtle changes of clinical interest. Of most importance is to establish metrics derived from wearable devices that provide meaningful data in longitudinal studies.
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Affiliation(s)
- Andrew Yousef
- a Department of Neurology , University of California , San Francisco , CA , USA
| | - Soren Jonzzon
- a Department of Neurology , University of California , San Francisco , CA , USA
| | - Leena Suleiman
- a Department of Neurology , University of California , San Francisco , CA , USA
| | - Jennifer Arjona
- a Department of Neurology , University of California , San Francisco , CA , USA
| | - Jennifer S Graves
- a Department of Neurology , University of California , San Francisco , CA , USA
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33
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Motl RW. Randomized controlled trial of an e-learning designed behavioral intervention for increasing physical activity behavior in multiple sclerosis. Mult Scler J Exp Transl Clin 2017; 3:2055217317734886. [PMID: 29051831 PMCID: PMC5637983 DOI: 10.1177/2055217317734886] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/10/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Internet-delivered, behavioral interventions represent a cost-effective, broadly disseminable approach for teaching persons with multiple sclerosis (MS) the theory-based skills, techniques, and strategies for changing physical activity. OBJECTIVES This pilot, randomized controlled trial examined the efficacy of a newly developed Internet website based on e-learning approaches that delivered a theory-based behavior intervention for increasing physical activity and improving symptoms, walking impairment, and neurological disability. METHODS Participants with MS (N = 47) were randomly assigned into behavioral intervention (n = 23) or waitlist control (n = 24) conditions delivered over a six-month period. Outcomes were administered before and after the six-month period using blinded assessors, and data were analyzed using analysis of covariance in SPSS. RESULTS There was a significant, positive intervention effect on self-reported physical activity (P = 0.05, [Formula: see text] = 0.10), and non-significant improvement in objectively measured physical activity (P = 0.24, [Formula: see text] = 0.04). There were significant, positive effects of the intervention on overall (P = 0.018, [Formula: see text] = 0.13) and physical impact of fatigue (P = 0.003, [Formula: see text] = 0.20), self-reported walking impairment (P = 0.047, [Formula: see text] = 0.10), and disability status (P = 0.033, [Formula: see text] = 0.11). There were non-significant improvements in fatigue severity (P = 0.10, [Formula: see text] = 0.06), depression (P = 0.10, [Formula: see text] = 0.07) and anxiety (P = 0.06, [Formula: see text] = 0.09) symptoms, and self-reported disability (P = 0.10, [Formula: see text] = 0.07). CONCLUSIONS We provide evidence for the efficacy of an Internet-based behavioral intervention with content delivered through interactive video courses grounded in e-learning principles for increasing physical activity and possibly improving secondary outcomes of fatigue, depression, anxiety, and walking impairment/disability in persons with MS.
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Affiliation(s)
- Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, USA
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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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35
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Sources of Variability in Physical Activity Among Inactive People with Multiple Sclerosis. Int J Behav Med 2017; 25:259-264. [PMID: 28695416 DOI: 10.1007/s12529-017-9674-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Evidence supports that physical activity (PA) improves symptoms of multiple sclerosis (MS). Although application of principles from Social Cognitive Theory (SCT) may facilitate positive changes in PA behaviour among people with multiple sclerosis (pwMS), the constructs often explain limited variance in PA. This study investigated the extent to which MS symptoms, including fatigue, depression, and walking limitations combined with the SCT constructs, explained more variance in PA than SCT constructs alone among pwMS. METHOD Baseline data, including objectively assessed PA, exercise self-efficacy, goal setting, outcome expectations, 6-min walk test, fatigue and depression, from 65 participants of the Step It Up randomized controlled trial completed in Ireland (2016), were included. Multiple regression models quantified variance explained in PA and independent associations of (1) SCT constructs, (2) symptoms and (3) SCT constructs and symptoms. RESULTS Model 1 included exercise self-efficacy, exercise goal setting and multidimensional outcomes expectations for exercise and explained ~14% of the variance in PA (R 2=0.144, p < 0.05). Model 2 included walking limitations, fatigue and depression and explained 20% of the variance in PA (R 2=0.196, p < 0.01). Model 3 combined models 1 and 2 and explained variance increased to ~29% (R 2=0.288; p<0.01). In Model 3, exercise self-efficacy (β=0.30, p < 0.05), walking limitations (β=0.32, p < 0.01), fatigue (β = -0.41, p < 0.01) and depression (β = 0.34, p < 0.05) were significantly and independently associated with PA. CONCLUSION Findings suggest that relevant MS symptoms improved by PA, including fatigue, depression and walking limitations, and SCT constructs together explained more variance in PA than SCT constructs alone, providing support for targeting both SCT constructs and these symptoms in the multifactorial promotion of PA among pwMS.
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Casey B, Coote S, Shirazipour C, Hannigan A, Motl R, Martin Ginis K, Latimer-Cheung A. Modifiable Psychosocial Constructs Associated With Physical Activity Participation in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2017; 98:1453-1475. [DOI: 10.1016/j.apmr.2017.01.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/09/2017] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
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37
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Coote S, Uszynski M, Herring MP, Hayes S, Scarrott C, Newell J, Gallagher S, Larkin A, Motl RW. Effect of exercising at minimum recommendations of the multiple sclerosis exercise guideline combined with structured education or attention control education - secondary results of the step it up randomised controlled trial. BMC Neurol 2017. [PMID: 28646860 PMCID: PMC5483256 DOI: 10.1186/s12883-017-0898-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent exercise guidelines for people with multiple sclerosis (MS) recommend a minimum of 30 min moderate intensity aerobic exercise and resistance exercise twice per week. This trial compared the secondary outcomes of a combined 10-week guideline based intervention and a Social Cognitive Theory (SCT) education programme with the same exercise intervention involving an attention control education. METHODS Physically inactive people with MS, scoring 0-3 on Patient Determined Disease Steps Scale, with no MS relapse or change in MS medication, were randomised to 10-week exercise plus SCT education or exercise plus attention control education conditions. Outcomes included fatigue, depression, anxiety, strength, physical activity, SCT constructs and impact of MS and were measured by a blinded assessor pre and post-intervention and 3 and 6 month follow up. RESULTS One hundred and seventy-four expressed interest, 92 were eligible and 65 enrolled. Using linear mixed effects models, the differences between groups on all secondary measures post-intervention and at follow-up were not significant. Post-hoc, exploratory, within group analysis identified improvements in both groups post intervention in fatigue (mean ∆(95% CI) SCT -4.99(-9.87, -0.21), p = 0.04, Control -7.68(-12.13, -3.23), p = 0.00), strength (SCT -1.51(-2.41, -0.60), p < 0.01, Control -1.55(-2.30, -0.79), p < 0.01), physical activity (SCT 9.85(5.45, 14.23), p < 0.01, Control 12.92(4.69, 20.89), goal setting (SCT 7.30(4.19, 10.4), p < 0.01, Control 5.96(2.92, 9.01), p < 0.01) and exercise planning (SCT 5.88(3.37, 8.39), p < 0.01, Control 3.76(1.27, 6.25), p < 0.01) that were maintained above baseline at 3 and 6 month follow up (all p < 0.05). Only the SCT group improved at 3 and 6 month follow up in physical impact of MS(-4.45(-8.68, -0.22), -4.12(-8.25, 0.01), anxiety(-1.76(-3.20, -0.31), -1.99(-3.28, -0.71), depression(-1.51(-2.89, -0.13), -1.02(-2.05, 0.01)) and cognition(5.04(2.51, 7.57), 3.05(0.81, 5.28), with a medium effect for cognition and fitness (Hedges' g 0.75(0.24, 1.25), 0.51(0.01, 1.00) at 3 month follow up. CONCLUSIONS There were no statistically significant differences between groups for the secondary outcomes once age, gender, time since diagnosis and type of MS were accounted for. However, within the SCT group only there were improvements in anxiety, depression, cognition and physical impact of MS. Exercising at the minimum guideline amount has a positive effect on fatigue, strength and PA that is sustained at 3 and 6 months following the cessation of the program. TRIAL REGISTRATION ClinicalTrials.gov, NCT02301442 , retrospectively registered on November 13th 2014.
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Affiliation(s)
- Susan Coote
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland. .,Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Marcin Uszynski
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.,Multiple Sclerosis Society of Ireland, Western office, Galway, Ireland
| | - Matthew P Herring
- Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Physical Education and Sports Science, University of Limerick, Limerick, Ireland
| | - Sara Hayes
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Carl Scarrott
- HRB Clinical Research Facility, National University of Ireland, Galway, Ireland.,School of Mathematics and Statistics, University of Canterbury, Christchurch, New Zealand
| | - John Newell
- HRB Clinical Research Facility, National University of Ireland, Galway, Ireland.,School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland
| | - Stephen Gallagher
- Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Psychology, University of Limerick, Limerick, Ireland
| | - Aidan Larkin
- Multiple Sclerosis Society of Ireland, Western office, Galway, Ireland
| | - Robert W Motl
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, USA
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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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Meaning of Self in Multiple Sclerosis: Implications for Treatment and Rehabilitation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 958:43-55. [DOI: 10.1007/978-3-319-47861-6_4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Block VJ, Lizée A, Crabtree-Hartman E, Bevan CJ, Graves JS, Bove R, Green AJ, Nourbakhsh B, Tremblay M, Gourraud PA, Ng MY, Pletcher MJ, Olgin JE, Marcus GM, Allen DD, Cree BAC, Gelfand JM. Continuous daily assessment of multiple sclerosis disability using remote step count monitoring. J Neurol 2016; 264:316-326. [PMID: 27896433 DOI: 10.1007/s00415-016-8334-6] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 11/25/2022]
Abstract
Disability measures in multiple sclerosis (MS) rely heavily on ambulatory function, and current metrics fail to capture potentially important variability in walking behavior. We sought to determine whether remote step count monitoring using a consumer-friendly accelerometer (Fitbit Flex) can enhance MS disability assessment. 99 adults with relapsing or progressive MS able to walk ≥2-min were prospectively recruited. At 4 weeks, study retention was 97% and median Fitbit use was 97% of days. Substudy validation resulted in high interclass correlations between Fitbit, ActiGraph and manual step count tally during a 2-minute walk test, and between Fitbit and ActiGraph (ICC = 0.76) during 7-day home monitoring. Over 4 weeks of continuous monitoring, daily steps were lower in progressive versus relapsing MS (mean difference 2546 steps, p < 0.01). Lower average daily step count was associated with greater disability on the Expanded Disability Status Scale (EDSS) (p < 0.001). Within each EDSS category, substantial variability in step count was apparent (i.e., EDSS = 6.0 range 1097-7152). Step count demonstrated moderate-strong correlations with other walking measures. Lower average daily step count is associated with greater MS disability and captures important variability in real-world walking activity otherwise masked by standard disability scales, including the EDSS. These results support remote step count monitoring as an exploratory outcome in MS trials.
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Affiliation(s)
- V J Block
- Department of Physical Therapy and Rehabilitation, University of California, San Francisco and San Francisco State University, San Francisco, CA, USA
| | - A Lizée
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - E Crabtree-Hartman
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - C J Bevan
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - J S Graves
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - R Bove
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - A J Green
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - B Nourbakhsh
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - M Tremblay
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - P-A Gourraud
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - M Y Ng
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - M J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - J E Olgin
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - G M Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - D D Allen
- Department of Physical Therapy and Rehabilitation, University of California, San Francisco and San Francisco State University, San Francisco, CA, USA
| | - B A C Cree
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA
| | - J M Gelfand
- Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, Box 3206, San Francisco, CA, 94158, USA.
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Prince SA, Reed JL, Martinello N, Adamo KB, Fodor JG, Hiremath S, Kristjansson EA, Mullen KA, Nerenberg KA, Tulloch HE, Reid RD. Why are adult women physically active? A systematic review of prospective cohort studies to identify intrapersonal, social environmental and physical environmental determinants. Obes Rev 2016; 17:919-44. [PMID: 27465602 DOI: 10.1111/obr.12432] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/13/2016] [Accepted: 04/27/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study aims to systematically review available evidence from prospective cohort studies to identify intrapersonal, social environmental and physical environmental determinants of moderate-to-vigorous intensity physical activity (MVPA) among working-age women. METHODS Six databases were searched to identify all prospective cohort studies that reported on intrapersonal (e.g. self-efficacy and socioeconomic status [SES]), social (e.g. crime, area SES and social support) and/or physical (e.g. weather, work and recreation) environmental determinants of MVPA in working-age (mean 18-65 years) women. A qualitative synthesis including harvest plots was completed. PROSPERO CRD42014009750 RESULTS: Searching identified 17,387 potential articles; 97 were used in the analysis. The majority (n = 87 studies) reported on ≥1 intrapersonal determinant. Very few (n = 34) examined factors in the social or physical environments, and none looked at social policy. Positive and consistent influencers included higher self-efficacy (n = 18/23), self-rated health (n = 8/13) and intentions (n = 10/11) and perceived behavioural control (n = 5/7) to be physically active. Having children in the household was negatively related to MVPA (n = 9/15). CONCLUSIONS Physical activity intervention studies should consider a woman's level of self-efficacy and perceived behavioural control to be physically active. Additional studies are needed on the impact of children in the household, having a spouse/partner and using group goal setting. More evidence is needed to evaluate the impact of environmental factors.
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Affiliation(s)
- S A Prince
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada.
| | - J L Reed
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - N Martinello
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada.,Population Health PhD Program, University of Ottawa, Ottawa, ON, Canada
| | - K B Adamo
- School of Human Kinetics, University of Ottawa, Faculty of Health Sciences, Ottawa, ON, Canada.,Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Pediatrics, University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada
| | - J G Fodor
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - S Hiremath
- Division of Nephrology, The Ottawa Hospital, Riverside Campus, Ottawa, ON, Canada
| | | | - K A Mullen
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - K A Nerenberg
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - H E Tulloch
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - R D Reid
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Relative Importance of Baseline Pain, Fatigue, Sleep, and Physical Activity: Predicting Change in Depression in Adults With Multiple Sclerosis. Arch Phys Med Rehabil 2016; 97:1309-15. [DOI: 10.1016/j.apmr.2016.02.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/17/2016] [Accepted: 02/28/2016] [Indexed: 10/22/2022]
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Ensari I, Adamson BC, Motl RW. Longitudinal association between depressive symptoms and walking impairment in people with relapsing-remitting multiple sclerosis. J Health Psychol 2016; 21:2732-2741. [DOI: 10.1177/1359105315584837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Worsening depressive symptoms and walking impairment are significant burdens in multiple sclerosis. We explored the reciprocal relationship between depressive symptoms and walking impairment in a cohort of 269 people with relapsing-remitting multiple sclerosis over 2 years. The data were examined using longitudinal panel analysis in Mplus. Baseline depressive symptoms predicted change in walking impairment at 1-year follow-up (path coefficient = .074), and change in walking impairment at 1-year follow-up predicted change in depressive symptoms at 2-year follow-up (path coefficient = .177). Our study provides preliminary evidence for initiation of a reciprocal relationship between depressive symptoms and walking impairment in relapsing-remitting multiple sclerosis.
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Affiliation(s)
- Ipek Ensari
- University of Illinois at Urbana–Champaign, USA
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Chard S. Qualitative perspectives on aquatic exercise initiation and satisfaction among persons with multiple sclerosis. Disabil Rehabil 2016; 39:1307-1312. [PMID: 27346481 DOI: 10.1080/09638288.2016.1194897] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To identify the individual and social experiences underlying the initiation and satisfaction with aquatic exercise among persons with MS. METHODS A convenience sample (n = 45) of persons aged ≥18 with MS who had engaged in water-based exercise within the previous six months completed a 60-90 min semi-structured telephone interview regarding their aquatic exercise experiences. RESULTS An aquatic exercise history was not a prerequisite for the adoption of aquatic exercise. Rather, participants described aquatic exercise routines as stemming from recognition of a decline in physical function combined with encouragement and invitations to join aquatic programs. Despite regular visits, health care providers were not a common source of information regarding the feasibility of aquatic exercise. Participants' aquatic activities included MS-specific and generalized aquatics courses, with class satisfaction resting on the instructor, class "fit" and a feeling of acceptance. CONCLUSION Communication regarding local aquatic opportunities is critical for ensuring aquatics engagement among persons with MS. Providers could play a stronger role in emphasizing the feasibility and benefits of aquatic programs. In addition, persons with MS should be encouraged to try local MS and more generalized aquatic programs in order to identify a program matching their social and physical goals. Implications for Rehabilitation Directed communication regarding aquatic opportunities is essential to prompting the initiation of aquatic exercise Both MS-specific and general aquatics classes can provide positive exercise experiences for persons with MS A history of regular exercise or aquatic experiences is not a prerequisite for the initiation of aquatic exercise among persons with MS Health care provider visits may represent missed opportunities for promoting aquatics; providers should consider the suitability of aquatics for all patients with MS, regardless of the patient's exercise history.
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Affiliation(s)
- Sarah Chard
- a Department of Sociology and Anthropology , UMBC , Baltimore , MD , USA
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Block VAJ, Pitsch E, Tahir P, Cree BAC, Allen DD, Gelfand JM. Remote Physical Activity Monitoring in Neurological Disease: A Systematic Review. PLoS One 2016; 11:e0154335. [PMID: 27124611 PMCID: PMC4849800 DOI: 10.1371/journal.pone.0154335] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/11/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To perform a systematic review of studies using remote physical activity monitoring in neurological diseases, highlighting advances and determining gaps. METHODS Studies were systematically identified in PubMed/MEDLINE, CINAHL and SCOPUS from January 2004 to December 2014 that monitored physical activity for ≥24 hours in adults with neurological diseases. Studies that measured only involuntary motor activity (tremor, seizures), energy expenditure or sleep were excluded. Feasibility, findings, and protocols were examined. RESULTS 137 studies met inclusion criteria in multiple sclerosis (MS) (61 studies); stroke (41); Parkinson's Disease (PD) (20); dementia (11); traumatic brain injury (2) and ataxia (1). Physical activity levels measured by remote monitoring are consistently low in people with MS, stroke and dementia, and patterns of physical activity are altered in PD. In MS, decreased ambulatory activity assessed via remote monitoring is associated with greater disability and lower quality of life. In stroke, remote measures of upper limb function and ambulation are associated with functional recovery following rehabilitation and goal-directed interventions. In PD, remote monitoring may help to predict falls. In dementia, remote physical activity measures correlate with disease severity and can detect wandering. CONCLUSIONS These studies show that remote physical activity monitoring is feasible in neurological diseases, including in people with moderate to severe neurological disability. Remote monitoring can be a psychometrically sound and responsive way to assess physical activity in neurological disease. Further research is needed to ensure these tools provide meaningful information in the context of specific neurological disorders and patterns of neurological disability.
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Affiliation(s)
- Valerie A. J. Block
- Graduate Program in Physical Therapy, University of California San Francisco/ San Francisco State University, San Francisco, California, United States of America
| | - Erica Pitsch
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, California, United States of America
| | - Peggy Tahir
- University of California San Francisco Library, San Francisco, California, United States of America
| | - Bruce A. C. Cree
- Multiple Sclerosis and Neuroinflammation Center, Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
| | - Diane D. Allen
- Graduate Program in Physical Therapy, University of California San Francisco/ San Francisco State University, San Francisco, California, United States of America
| | - Jeffrey M. Gelfand
- Multiple Sclerosis and Neuroinflammation Center, Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
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46
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Feasibility study design and methods for Project GEMS: Guidelines for Exercise in Multiple Sclerosis. Contemp Clin Trials 2016; 47:32-9. [DOI: 10.1016/j.cct.2015.12.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/23/2015] [Accepted: 12/03/2015] [Indexed: 12/19/2022]
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Streber R, Peters S, Pfeifer K. Systematic Review of Correlates and Determinants of Physical Activity in Persons With Multiple Sclerosis. Arch Phys Med Rehabil 2016; 97:633-645.e29. [PMID: 26751247 DOI: 10.1016/j.apmr.2015.11.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/16/2015] [Accepted: 11/20/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To review the current evidence regarding correlates and determinants of physical activity (PA) in persons with multiple sclerosis (pwMS). DATA SOURCES PubMed and Scopus (1980 to January 2015) and reference lists of eligible studies. STUDY SELECTION Eligible studies include adults with multiple sclerosis; have a cross-sectional or prospective observational design; or examine the effect of a theory-based intervention trial on PA, including a mediation analysis. Eligible studies also apply a quantitative assessment of PA and correlates or proposed mediators and are published in English or German language. DATA EXTRACTION Two reviewers independently evaluated the risk of bias, extracted data, and categorized variables according to the International Classification of Functioning, Disability and Health. DATA SYNTHESIS Consistency and the direction of associations were evaluated with a semiquantitative approach. Fifty-six publications with data from observational studies and 2 interventional studies provided evidence for 86 different variables. Consistent correlates of PA were the disability level, walking limitations in particular, PA-related self-efficacy, self-regulation constructs, employment status, and educational level. One interventional study provided evidence for a causal relation between self-regulation and PA. However, 59 of the 86 investigated variables in observational studies are based on 1 or 2 study findings, and most results stem from cross-sectional designs. CONCLUSIONS Beside the importance of the general disability level and walking limitations, the results highlight the importance of personal factors (eg, PA-related self-efficacy, self-regulatory constructs, sociodemographic factors). Limitations and implications of the current review are discussed. Research that is more rigorous is needed to better understand what affects PA in pwMS.
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Affiliation(s)
- René Streber
- Institute of Sport Science and Sport, Division Exercise and Health, Department Psychology and Sport Science, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Peters
- Institute of Sport Science and Sport, Division Exercise and Health, Department Psychology and Sport Science, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Klaus Pfeifer
- Institute of Sport Science and Sport, Division Exercise and Health, Department Psychology and Sport Science, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
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48
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Learmonth YC, Motl RW. Physical activity and exercise training in multiple sclerosis: a review and content analysis of qualitative research identifying perceived determinants and consequences. Disabil Rehabil 2015; 38:1227-42. [PMID: 26314587 DOI: 10.3109/09638288.2015.1077397] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE This systematic review was conducted to provide rich and deep evidence of the perceived determinants and consequences of physical activity and exercise based on qualitative research in multiple sclerosis (MS). METHOD Electronic databases and article reference lists were searched to identify qualitative studies of physical activity and exercise in MS. Studies were included if they were written in English and examined consequences/determinants of physical activity in persons with MS. Content analysis of perceived determinants and consequences of physical activity and exercise was undertaken using an inductive analysis guided by the Physical Activity for people with Disabilities framework and Social Cognitive Theory, respectively. RESULTS Nineteen articles were reviewed. The most commonly identified perceived barriers of physical activity and exercise were related to the environmental (i.e. minimal or no disabled facilities, and minimal or conflicting advice from healthcare professionals) and related to personal barriers (i.e. fatigue, and fear and apprehension). The most commonly identified perceived facilitators of physical activity were related to the environment (i.e. the type of exercise modality and peer support) and related to personal facilitators (i.e. appropriate exercise and feelings of accomplishment). The most commonly identified perceived beneficial consequences of physical activity and exercise were maintaining physical functions, increased social participation and feelings of self-management and control. The most commonly identified perceived adverse consequences were increased fatigue and feelings of frustration and lost control. CONCLUSIONS Results will inform future research on the perceived determinants and consequences of physical activity and exercise in those with MS and can be adopted for developing professional education and interventions for physical activity and exercise in MS. IMPLICATIONS FOR REHABILITATION Physical activity and exercise behaviour in people with multiple sclerosis (MS) is subject to a number of modifiable determinants. Healthcare professionals working to promote physical activity and exercise in those with MS should choose to endorse the positive benefits of participation. Future physical activity interventions for those with MS may be improved by incorporating behavioural management strategies.
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Affiliation(s)
- Yvonne C Learmonth
- a Department of Kinesiology and Community Health , University of Illinois at Urbana-Champaign , Urbana , IL , USA
| | - Robert W Motl
- a Department of Kinesiology and Community Health , University of Illinois at Urbana-Champaign , Urbana , IL , USA
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Motl RW, Learmonth YC, Pilutti LA, Gappmaier E, Coote S. Top 10 research questions related to physical activity and multiple sclerosis. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2015; 86:117-129. [PMID: 25874730 DOI: 10.1080/02701367.2015.1023099] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
An estimated 2.5 million people worldwide are living with multiple sclerosis (MS), and this disease may be increasing in prevalence. MS is a disease of the central nervous system that is associated with heterogeneous symptoms and functional consequences, and the current first-line disease-modifying therapies often become ineffective later in the disease. There is increasing evidence for the benefits of physical activity (PA) in people with MS, but this population is generally physically inactive and sedentary. We proposed 10 research questions to guide future research on PA and MS: (1) Is PA an MS disease-modifying behavior? (2) What are the benefits of PA among people with MS? (3) What is the optimal PA prescription for people with MS? (4) What are the safety issues with PA in people with MS? (5) What characteristics of people with MS modify the benefits of PA? (6) What variables explain participation in PA among people with MS? (7) What are effective behavioral interventions for PA change in people with MS? (8) How do we translate PA research into clinical MS practice? (9) What is the role of sedentary behavior in people with MS? And (10) what is the optimal measurement of PA in people with MS? These questions are critical for informing our understanding of the short- and long-term consequences of PA in MS as well as for identifying approaches for promoting and sustaining PA in MS. Addressing these questions may greatly improve the lives of people with this chronic disease.
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50
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Fritz NE, Newsome SD, Eloyan A, Marasigan RER, Calabresi PA, Zackowski KM. Longitudinal relationships among posturography and gait measures in multiple sclerosis. Neurology 2015; 84:2048-56. [PMID: 25878185 DOI: 10.1212/wnl.0000000000001580] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/22/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Gait and balance dysfunction frequently occurs early in the multiple sclerosis (MS) disease course. Hence, we sought to determine the longitudinal relationships among quantitative measures of gait and balance in individuals with MS. METHODS Fifty-seven ambulatory individuals with MS (28 relapsing-remitting, 29 progressive) were evaluated using posturography, quantitative sensorimotor and gait measures, and overall MS disability with the Expanded Disability Status Scale at each session. RESULTS Our cohort's age was 45.8 ± 10.4 years (mean ± SD), follow-up time 32.8 ± 15.4 months, median Expanded Disability Status Scale score 3.5, and 56% were women. Poorer performance on balance measures was related to slower walking velocity. Two posturography measures, the anterior-posterior sway and sway during static eyes open, feet apart conditions, were significant contributors to walk velocity over time (approximate R(2) = 0.95), such that poorer performance on the posturography measures was related to slower walking velocity. Similarly, the anterior-posterior sway and sway during static eyes closed, feet together conditions were also significant contributors to the Timed 25-Foot Walk performance over time (approximate R(2) = 0.83). CONCLUSIONS This longitudinal cohort study establishes a strong relationship between clinical gait measures and posturography. The data show that increases in static posturography and reductions in dynamic posturography are associated with a decline in walk velocity and Timed 25-Foot Walk performance over time. Furthermore, longitudinal balance measures predict future walking performance. Quantitative walking and balance measures are important additions to clinical testing to explore longitudinal change and understand fall risk in this progressive disease population.
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Affiliation(s)
- Nora E Fritz
- From the Kennedy Krieger Institute (N.E.F., R.E.R.M., K.M.Z.), Baltimore; and Departments of Physical Medicine and Rehabilitation (N.E.F., K.M.Z.), Neurology (S.D.N., P.A.C., K.M.Z.), and Biostatistics (A.E.), Johns Hopkins University, Baltimore, MD.
| | - Scott D Newsome
- From the Kennedy Krieger Institute (N.E.F., R.E.R.M., K.M.Z.), Baltimore; and Departments of Physical Medicine and Rehabilitation (N.E.F., K.M.Z.), Neurology (S.D.N., P.A.C., K.M.Z.), and Biostatistics (A.E.), Johns Hopkins University, Baltimore, MD
| | - Ani Eloyan
- From the Kennedy Krieger Institute (N.E.F., R.E.R.M., K.M.Z.), Baltimore; and Departments of Physical Medicine and Rehabilitation (N.E.F., K.M.Z.), Neurology (S.D.N., P.A.C., K.M.Z.), and Biostatistics (A.E.), Johns Hopkins University, Baltimore, MD
| | - Rhul Evans R Marasigan
- From the Kennedy Krieger Institute (N.E.F., R.E.R.M., K.M.Z.), Baltimore; and Departments of Physical Medicine and Rehabilitation (N.E.F., K.M.Z.), Neurology (S.D.N., P.A.C., K.M.Z.), and Biostatistics (A.E.), Johns Hopkins University, Baltimore, MD
| | - Peter A Calabresi
- From the Kennedy Krieger Institute (N.E.F., R.E.R.M., K.M.Z.), Baltimore; and Departments of Physical Medicine and Rehabilitation (N.E.F., K.M.Z.), Neurology (S.D.N., P.A.C., K.M.Z.), and Biostatistics (A.E.), Johns Hopkins University, Baltimore, MD
| | - Kathleen M Zackowski
- From the Kennedy Krieger Institute (N.E.F., R.E.R.M., K.M.Z.), Baltimore; and Departments of Physical Medicine and Rehabilitation (N.E.F., K.M.Z.), Neurology (S.D.N., P.A.C., K.M.Z.), and Biostatistics (A.E.), Johns Hopkins University, Baltimore, MD
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