Exercise in Multiple Sclerosis: Knowing is Not Enough-The Crucial Role of Intention Formation and Intention Realization

Translation and validation of the Persian version of Godin Leisure-Time Exercise Questionnaire in patients with multiple sclerosis

Study Design

Psychometric study.

Objective

The purpose of this study is to translate, culturally adapt and evaluate the validity and reliability of the Persian (Farsi) version of GLTEQ in patients with multiple sclerosis.

Methods

This study had three phases, including translation of the questionnaire into Persian and making cultural adaptation, evaluation of pre-final version of questionnaire’s comprehensibility in a pilot study, and investigation of reliability and validity of the final version of the translated questionnaire. Content validity, and convergent validity (correlations among the Persian version of GLTEQ and Global physical activity questionnaire (GPAQ), and international physical activity questionnaire (IPAQ)) and after all test-retest reliability were studied.

Results

The subjects were 87 MS patients. The Persian version demonstrated moderate to good convergent validity; the correlation coefficient between the Persian version and GPAQ was r=0.64 (p<0.001), and between the Persian version and IPAQ was r=0.59 (p<0.001). The test-retest reliability was strong (Intra-class Correlation (ICC) value ranged between 0.908 and 0.992). Besides, its face validity and content validity were acceptable.

Conclusions

The Persian version of GLTEQ is a valid and reliable instrument to assess physical activity in patients with MS. This questionnaire can be a step toward standardization of physical activity measurement in patients with MS. Also, in research, it provides the possibilities to carry on a comparative study across cultures using the same outcome measure.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-021-02465-5.

A Mobile App for Measuring Real Time Fatigue in Patients with Multiple Sclerosis: Introducing the Fimo Health App

Although fatigue is one of the most disabling symptoms of MS, its pathogenesis is not well understood yet. This study aims to introduce a new holistic approach to measure fatigue and its influencing factors via a mobile app. Fatigue is measured with different patient-reported outcome measures (Visual Analog Scale, Fatigue Severity Scale) and tests (Symbol Digit Modalities Test). The influencing vital and environmental factors are captured with a smartwatch and phone sensors. Patients can track these factors within the app. To individually counteract their fatigue, a fatigue course, based on the current treatment guidelines, was implemented. The course implies knowledge about fatigue and MS, exercises, energy-conservation management, and cognitive behavioral therapy. Based on the Transtheoretical Model of Behavior Change, the design of the Fimo health app follows the ten strategies of the process of change, which is a proven approach to designing health intervention programs. By monitoring fatigue and individual influencing factors, patients can better understand and manage their fatigue. They can share their data and insights about fatigue and its influencing factors with their doctors. Thus, they can receive individualized therapies and drug plans.

"How Come You Sent Me the Canadian One?" Application and Uptake of the Canadian Physical Activity Guidelines for Adults With Multiple Sclerosis in the United States

The uptake and benefits of the Canadian Physical Activity Guidelines for Adults with Multiple Sclerosis (PAGs) have been validated, but there is limited understanding regarding the knowledge, needs, and preferences of people with multiple sclerosis (MS) for implementing the PAGs outside of clinical research. The authors conducted online, semistructured interviews with 40 persons with MS from across the United States seeking information on awareness of and potential approaches for increasing the uptake of the PAGs. They identified first impressions and potential approaches for increasing the uptake of the PAGs through inductive, semantic thematic analysis. Participants perceived the PAGs as a good introduction for structured exercise but desired more information on how to meet the PAGs. Participants further believed that modifying the PAGs for inclusivity and applying a multifaceted approach for dissemination and implementation may increase uptake of exercise behavior. Physical activity research in MS should include both analyzing the effects of exercise and the unique challenges faced by persons with MS in putting the PAGs into practice.

The Role of Perceived Energy and Self-Beliefs for Physical Activity and Sports Activity of Patients With Multiple Sclerosis and Chronic Stroke

Physical activity counteracts some of the negative consequences associated with chronic neurological diseases. Here, we describe the levels of physical activity (PA) and sports activity (Sport) in patients with multiple sclerosis (pMS, n = 59) and chronic stroke (pStroke, n = 67) and test compliance with the recommendation for health-promoting physical activity of the World-Health Organization (WHO). Secondly, we tested for differences between the groups of patients, and thirdly, we examined relationships between PA and Sport with psychological indicators of perceived energy (fatigue and vitality) and self-beliefs (self-efficacy and self-control). Psychological constructs were assessed with validated measures from different disciplines in Psychology. A statistical aim was to describe interpretations gained by (non-) parametric Bayesian and Null-Hypothesis-Significance Testing statistics (NHST) on the example of the conducted tests for differences and relationships. Descriptive analyses revealed that pMS and pStroke complied with recommendations of the WHO, but with large variance indicating that patient groups are not homogenous. Tests for differences showed that the PA difference between pMS and pStroke can be attributed to the higher proportion of women in the pMS sample as they engage more in household chores (important part of PA). Tests for relationships showed that for pStroke, vitality, self-control, and self-efficacy were positively related to the level of sports activity. Furthermore, pStroke who were sport active had lower fatigue and higher self-control and self-efficacy scores than sport inactive people. Although they address slightly different questions, the Bayesian and the NHST approach led to similar general conclusions.

Implicit Theories about Athletic Ability Modulate the Effects of If-Then Planning on Performance in a Standardized Endurance Task

Muscular strength has a strong positive impact on cardiometabolic health and fitness. However, building up strength endurance requires effortful exercises. From a health perspective, it is important to understand which psychological strategies help people deal with straining exercise. Self-regulation strategies like if-then planning (also known as implementation intentions) appear particularly promising because they might directly alter how people deal with exercise-induced sensations. However, research on the effects of if-then planning on exercise performance has yielded mixed results so far. One possible reason for these inconsistent results is the lack of tailored interventions and the neglect of potential moderators. To address this, we investigated the efficacy of if-then plans that were tailored to perceived limits of endurance performance (i.e., perceptions of exertion versus pain). In addition, we investigated the effects of these tailored if-then plans while taking into account the potentially moderating effects of individual differences in implicit theories. Specifically, we were interested in the role of implicit theories about athletic performance (i.e., entity versus incremental beliefs) and about the limitation of athletic performance by mental versus physical factors (i.e., mind-over-body beliefs). N = 66 male students (age: M = 25.8 years, SD = 3.2) performed a static muscular endurance task twice (measurement: baseline task vs. main task) and were randomly assigned to a goal or an implementation intention condition. They were instructed to hold two intertwined rings for as long as possible while avoiding contacts between them (measure of performance: time-to-failure and errors). After the baseline task, participants were either given an implementation intention or were simply asked to rehearse the task instructions. The content of the instruction depended on whether they ascribed ultimate baseline task termination to perceptions of exertion or pain. After the main task, implicit theories on athletic ability were assessed. No differences in performance emerged between conditions. In the implementation intention condition, however, stronger entity beliefs were associated with increasing time-to-failure when participants planned to ignore exertion but with decreasing time-to-failure when they planned to ignore pain. This pattern of results was reversed with regard to mind-over-body beliefs. These findings indicate that the efficacy of psychological strategies hinges on recreational athletes' beliefs regarding athletic performance.