Worsening of symptoms is associated with lower physical activity levels in individuals with multiple sclerosis

Neuromuscular Electrical Stimulation Does Not Influence Spinal Excitability in Multiple Sclerosis Patients

(1) Background: Neuromuscular electrical stimulation (NMES) has beneficial effects on physical functions in Multiple sclerosis (MS) patients. However, the neurophysiological mechanisms underlying these functional improvements are still unclear. This study aims at comparing acute responses in spinal excitability, as measured by soleus Hoffmann reflex (H-reflex), between MS patients and healthy individuals, under three experimental conditions involving the ankle planta flexor muscles: (1) passive NMES (pNMES); (2) NMES superimposed onto isometric voluntary contraction (NMES+); and (3) isometric voluntary contraction (ISO). (2) Methods: In total, 20 MS patients (MS) and 20 healthy individuals as the control group (CG) took part in a single experimental session. Under each condition, participants performed 15 repetitions of 6 s at 20% of maximal voluntary isometric contraction, with 6 s of recovery between repetitions. Before and after each condition, H-reflex amplitudes were recorded. (3) Results: In MS, H-reflex amplitude did not change under any experimental condition (ISO: p = 0.506; pNMES: p = 0.068; NMES+: p = 0.126). In CG, H-reflex amplitude significantly increased under NMES+ (p = 0.01), decreased under pNMES (p < 0.000) and was unaltered under ISO (p = 0.829). (4) Conclusions: The different H-reflex responses between MS and CG might reflect a reduced ability of MS patients in modulating spinal excitability.

Leveraging Emerging Technologies to Expand Accessibility and Improve Precision in Rehabilitation and Exercise for People with Disabilities

Physical rehabilitation and exercise training have emerged as promising solutions for improving health, restoring function, and preserving quality of life in populations that face disparate health challenges related to disability. Despite the immense potential for rehabilitation and exercise to help people with disabilities live longer, healthier, and more independent lives, people with disabilities can experience physical, psychosocial, environmental, and economic barriers that limit their ability to participate in rehabilitation, exercise, and other physical activities. Together, these barriers contribute to health inequities in people with disabilities, by disproportionately limiting their ability to participate in health-promoting physical activities, relative to people without disabilities. Therefore, there is great need for research and innovation focusing on the development of strategies to expand accessibility and promote participation in rehabilitation and exercise programs for people with disabilities. Here, we discuss how cutting-edge technologies related to telecommunications, wearables, virtual and augmented reality, artificial intelligence, and cloud computing are providing new opportunities to improve accessibility in rehabilitation and exercise for people with disabilities. In addition, we highlight new frontiers in digital health technology and emerging lines of scientific research that will shape the future of precision care strategies for people with disabilities.

An Internet- and Kinect-Based Multiple Sclerosis Fitness Intervention Training With Pilates Exercises: Development and Usability Study

BACKGROUND

Balance impairments are common in people with multiple sclerosis (MS), with reduced ability to maintain position and delayed responses to postural adjustments. Pilates is a popular alternative method for balance training that may reduce the rapid worsening of symptoms and the increased risk of secondary conditions (eg, depression) that are frequently associated with physical inactivity.

OBJECTIVE

In this paper, we aimed to describe the design, development, and usability testing of MS Fitness Intervention Training (MS-FIT), a Kinect-based tool implementing Pilates exercises customized for MS.

METHODS

MS-FIT has been developed using a user-centered design approach (design, prototype, user feedback, and analysis) to gain the target user's perspective. A team composed of 1 physical therapist, 2 game programmers, and 1 game designer developed the first version of MS-FIT that integrated the knowledge and experience of the team with MS literature findings related to Pilates exercises and balance interventions based on exergames. MS-FIT, developed by using the Unity 3D (Unity Technologies) game engine software with Kinect Sensor V2 for Windows, implements exercises for breathing, posture, and balance. Feedback from an Italian panel of experts in MS rehabilitation (neurologists, physiatrists, physical therapists, 1 statistician, and 1 bioengineer) and people with MS was collected to customize the tool for use in MS. The context of MS-FIT is traveling around the world to visit some of the most important cities to learn the aspects of their culture through pictures and stories. At each stay of the travel, the avatar of a Pilates teacher shows the user the exercises to be performed. Overall, 9 people with MS (n=4, 44% women; mean age 42.89, SD 11.97 years; mean disease duration 10.19, SD 9.18 years; Expanded Disability Status Scale score 3.17, SD 0.75) were involved in 3 outpatient user test sessions of 30 minutes; MS-FIT's usability was assessed through an ad hoc questionnaire (maximum value=5; higher the score, higher the usability) evaluating easiness to use, playability, enjoyment, satisfaction, and acceptance.

RESULTS

A user-centered design approach was used to develop an accessible and challenging tool for balance training. All people with MS (9/9, 100%) completed the user test sessions and answered the ad hoc questionnaire. The average score on each item ranged from 3.78 (SD 0.67) to 4.33 (SD 1.00), which indicated a high usability level. The feedback and suggestions provided by 64% (9/14) of people with MS and 36% (5/14) of therapists involved in the user test were implemented to refine the first prototype to release MS-FIT 2.0.

CONCLUSIONS

The participants reported that MS-FIT was a usable tool. It is a promising system for enhancing the motivation and engagement of people with MS in performing exercise with the aim of improving their physical status.

Influence of Transcranial Direct Current Stimulation and Exercise on Physical Capacity and Gait in Multiple Sclerosis: A Cross-Over Pilot Study

Physical capacity provides a link between disease or impairment and limitations in activity; in multiple sclerosis (MS), it is limited and decreased. The aim of this study was to study the effects of exercise and transcranial direct current stimulation (tDCS) on the left dorsolateral prefrontal cortex area in MS patients with fatigue and an impaired gait ability. A cross-over design was carried out on fifteen patients with two disability associations, but three were excluded. Before and after each intervention, the 6 min walk test (6MWT) and the 2 min walk test (2MWT) were used to assess walking ability and the Modified Fatigue Impact Scale (MFIS) was used to assess fatigue. A total of twelve patients were enrolled (48.0 median age, Kurtzke Disability Scale (EDSS) 3.66 ± 1.3): five females and seven males. After the application of the exercise program, significant improvements were observed in the 6MWT (p < 0.001, g = 0.159) and 2MWT (p < 0.001, g = 0.182). Furthermore, fatigue was significantly reduced after the application of the exercise program (p < 0.05, g = 0.742) and after tDCS (p < 0.05, g = 0.525). We could consider therapeutic exercise in the future to improve the walking ability and fatigue in MS patients. Furthermore, tDCS did not exert a significant improvement in walking ability, but it appeared to influence fatigue. Clinical trial registration code: ACTRN12622000264785.

Higher diet quality is associated with short and long-term benefits on SF-6D health state utilities: a 5-year cohort study in an international sample of people with multiple sclerosis

BACKGROUND/PURPOSE

Health state utilities (HSU) are a subjective measure of an individual's health-related quality of life (HRQoL), adjusted by societal or patient relative preference weights for living in different states of health-related quality of life (HRQoL), derived from patient-reported responses to multi-attribute utility instrument (MAUI), and can be used as inputs for cost-utility analyses and in clinical assessment. This research assessed associations of diet with subsequent HSU in a large international cohort of people living with multiple sclerosis (MS), a progressive autoimmune condition of the central nervous system.

METHODS

HSUs were generated from responses to Short-Form Six-Dimension (SF-6D) MAUI, and quality-of-the-diet by Diet Habits Questionnaire (DHQ). Cross-sectional, and short- and long-term prospective associations of DHQ with HSU evaluated by linear regression at 2.5- and 5-years. Pooled prospective associations between DHQ and HSU evaluated using linear and quantile regression. Analyses adjusted for relevant demographic and clinical covariates.

RESULTS

Among 839 participants, baseline DHQ scores showed short- and long-term associations with subsequent HSU, each 10-unit increase in total DHQ score associated with 0.008-0.012 higher HSU (out of 1.00). These associations were dose-dependent, those in the top two quartiles of baseline DHQ scores having 0.01-0.03 higher HSU at follow-up, 0.03 being the threshold for a minimally clinically important difference. Fat, fiber, and fruit/vegetable DHQ subscores were most strongly and consistently associated with better HSU outcomes. However, baseline meat and dairy consumption were associated with 0.01-0.02 lower HSU at subsequent follow-up.

CONCLUSIONS

A higher quality-of-the-diet showed robust prospective relationships with higher HSUs 2.5- and 5-years later, substantiating previous cross-sectional relationships in this cohort. Subject to replication, these results suggest interventions to improve the quality-of-the-diet may be effective to improve HRQoL in people living with MS.

The role of worry in exercise and physical activity behavior of people with multiple sclerosis

Purpose:

This study is a secondary analysis of data from a mixed methods exploration of fatigue in people with multiple sclerosis (MS), a chronic autoimmune disease affecting the central nervous system. During initial analysis, worry emerged during discussions of the fatigue experience. The purpose of this study is to explore worry in relationship to exercise and physical activity behavior.

Methods:

Mixed methods were used to address the research question. 55 people with MS provided demographic and survey data (habitual physical activity, body perception, functioning). 35 participated in semi-structured interviews on the topics of fatigue, body sensations, emotions, and their effects on physical activity. Qualitative data were analyzed utilizing constructivist grounded theory. Quantitative data were analyzed utilizing multiple regression.

Results:

Qualitative theory described participants’ thoughts and experiences regarding the consequences of fatigue during activity, and how they appear to influence subsequent actions. Worry played a critical role in thought processes regarding physical activity. Aspects of body perception were weak quantitative predictors of physical activity behavior after control of physical functionality.

Conclusions:

The most significant finding of this study was the description and dialogue about worry as a factor that shapes perceptions of the benefits and value of exercise and physical activity. Physical activity practitioners could benefit from seeking to understand physical-activity-related worry when examining physical activity behavior and designing programming.

Influence of Transcranial Direct Current Stimulation and Exercise on Fatigue and Quality of Life in Multiple Sclerosis

BACKGROUND

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that leads to a great deterioration in the quality of life.

OBJECTIVE

We aimed to assess the effectiveness of two individual programs, one based on transcranial direct current stimulation (tDCS) and another based on the effect of physical exercise on fatigue and quality of life in patients with MS.

METHODS

A total of 12 patients with relapsing-remitting and progressive secondary MS participated. Fatigue and quality of life were assessed before and after intervention. The exercise program and tDCS were carried out over a 4-week period, with a washout period of 5 months.

RESULTS

The results show significant improvements in the different quality of life subscales after the application of tDCS, activities of daily living (r = 0.625; p = 0.037) (g = 0.465), psychological well-being (r = 0.856; p = 0.004) (g = 0.727) and coping (r = 0.904; p = 0.18) (g = 0.376), and in those after the application of exercise, activities of daily living (r = 0.853; p = 0.003) (g = 0.570) and psychological well-being (r = 0.693; p = 0.041) (g = 0.417). After the application of both therapies, more than 50% of the subjects did not have a positive fatigue score on the MFIS scale.

CONCLUSION

The major findings suggest that the application of both therapies produces a beneficial effect with significant improvements in the quality of life of this sample.

Fragmentation, circadian amplitude, and fractal pattern of daily-living physical activity in people with multiple sclerosis: Is there relevant information beyond the total amount of physical activity?

BACKGROUND

Physical activity is lower in people with multiple sclerosis (pwMS) compared to healthy controls. Previous work focused on studying activity levels or activity volume, but studies of daily-living rest-activity fragmentation patterns, circadian rhythms, and fractal regulation in pwMS are limited. Based on findings in other cohorts, one could suggest that these aspects of daily-living physical activity will provide additional information about the health and well-being of pwMS. Therefore, here, we aimed to (1) identify which fragmentation, fractal, and circadian amplitude measures differ between pwMS and healthy controls, (2) evaluate the relationship between fragmentation, fractal, and circadian amplitude measures and disease severity, and (3) begin to evaluate the added value of those measures, as compared to more conventional measures of physical activity (e.g., mean signal vector magnitude (SVM). A global measure of the overall volume of physical activity).

METHODS

132 people with relapsing-remitting MS (47±11 yrs, 69.7% female, Expanded Disability Status Scale, EDSS, median (IQR): 3 (2-4)) and 90 healthy controls (46±11 yrs, 47.8% female) were asked to wear a 3D accelerometer on their lower back for 7 days. Rest-activity fragmentation, circadian amplitude, fractal regulation, and mean SVM metrics were extracted. PwMS and healthy controls were compared using independent samples t-tests and linear regression, including comparisons adjusted for mean SVM to control for the effect of physical activity volume. Spearman correlations between measures and logistic regressions were used to identify the clinical condition based on the measures that differed significantly after adjusting for SVM. All analyses included adjustments for demographic and clinical parameters (e.g., age, sex).

RESULTS

Multiple measures of activity fragmentation significantly differed between pwMS and healthy controls, reflecting a more fragmented active behavior in pwMS. PwMS had a lower circadian rhythm amplitude, indicating a smaller amplitude in the circadian changes of daily activity, and weaker temporal correlations as based on the fractal analysis. When taking into account physical activity volume, one circadian amplitude measure and one fractal measure remained significantly different in pwMS and controls. Fragmentation measures and circadian amplitude measures were significantly associated with disability level as measured by the EDSS; the association with circadian amplitude remained significant, even after adjusting for the mean SVM.

CONCLUSION

The physical activity patterns of pwMS differ from those of healthy individuals in rest-activity fragmentation, the amplitude of the circadian rhythm, and fractal regulation. Measures describing these aspects of activity provide information that is not captured in the total volume of physical activity and could, perhaps, augment the monitoring of disease progression and evaluation of the response to interventions.

Objective and subjective measures of daily physical activity in persons with Multiple Sclerosis beginning a rehabilitation regime: A cross-sectional study

INTRODUCTION

Fatigue, and balance and gait disorders can impact on physical activity (PA) levels in persons with Multiple Sclerosis (pwMS). To date, several studies have examined PA in pwMS during daily life, but little is known about PA levels in pwMS during a rehabilitation period. The present study investigated PA levels (daily steps, light physical activity (LPA), and moderate-vigorous physical activity (MVPA)) in inpatient and outpatients with MS during their rehabilitation period and described the relationship between objectively measured PA and levels of disability, quality of life, fatigue, and self-efficacy.

METHODS

In this exploratory cross-sectional study, we examined 40 pwMS during their inpatient or outpatient rehabilitation regime. Participants included in the study (N = 34) wore a Fitbit Versa tracker for one week recording daily steps, minutes of LPA, and minutes of MVPA (primary outcomes). They underwent a clinical assessment of physical activity levels (Godin Leisure-Time Exercise Questionnaire(GLTEQ)), fatigue (Fatigue Severity Scale(FSS)), walking ability (10 Meter Walk Test(10MWT), 2-Min Walk Test(2MWT), 12-item Multiple Sclerosis Walking scale(MSWS-12)), quality of life (12-Item Short Form Survey (SF-12)), and self-efficacy (Self-Efficacy in Multiple Sclerosis scale (SEMS)) (secondary outcomes). Multiple linear regressions (MLR) models were used to test whether the demographic difference between the two groups influenced the estimation of objective variables measured by Fitbit. Finally, correlations between objectively measured physical activity and subjective clinical scales were estimated with Spearman correlations.

RESULTS

Our sample consisted of 21 females and 13 males with a mean (interquartile range) age of 52 (20) years and an Expanded Disability Status scale(EDSS) score of 6.0 (1.50) points; baseline characteristics of inpatients (N = 18) and outpatients (N = 16) differed statistically only in EDSS levels (p-value = 0.008) and use of assistive devices (p=0.007). The whole sample performed (mean±standard deviation) 3969±2190 steps per day, with no significant difference between inpatients (3318±1515) and outpatients (4660±2606). No statistical difference was found between the groups in LPA (p-value=0.064). A significant difference in MVPA (p-value < 0.001) was found between inpatients and outpatients, 1.52±3.98 and 14.69±11.56 min per day, respectively. Significant correlations were found between FSS and MVPA both in the whole sample (r(32)= -0.62, p < 0.001) and in the outpatients group (r(14) = -0.66, p = 0.005), and between 10MWT and daily steps (whole sample:(r(32) = 0.48, p = 0.005), outpatients:(r(14)= -0.51, p = 0.05)).

CONCLUSIONS

PwMS in our study overall engaged in reduced and less intense levels of daily PA with respect to the guidelines with inpatients performing almost no vigorous activities. Considering the importance of PA in improving physical and mental well-being, clinicians and researchers should develope strategies to increase daily PA of PwMS during their rehabilitation programs and daily life.

Physical activity and risk of multiple sclerosis: A Mendelian randomization study

Multiple evidence from epidemiological studies has suggested association between physical activity and risk of multiple sclerosis (MS). However, the conclusion was still controversial between studies, and whether the association was causal or confounded is elusive. To evaluate the role of physical activity with different intensities in the risk of MS, we first estimated their genetic correlation, and then conducted two-sample and multivariable Mendelian randomization analyses based on summary statistics from previous large genome-wide association studies. A significant genetic correlation was identified between moderate physical activity and the risk of MS (genetic correlation: -0.15, SE=0.05, P=2.9E-03). Meanwhile, higher moderate physical activity was significantly associated with a reduced risk of MS (OR:0.87, 95% CI:0.80-0.96, P=3.45E-03). Such association was further verified using summary statistics from another study on overall physical activity (OR:0.36, 95% CI:0.17-0.76, P=6.82E-03). The results were robust under all sensitivity analyses. Current results suggested moderate physical activity could reduce the risk of MS. These findings help better understand the role of physical activity in MS, and provide some lifestyle recommendations for individuals susceptible to MS.

A crossover pilot trial of the feasibility, acceptability, and effectiveness of LoveYourBrain Yoga for community-dwelling adults with multiple sclerosis

BACKGROUND AND PURPOSE

Among people with multiple sclerosis (MS), yoga has potential to improve fatigue and other symptoms that undermine quality of life. The aim of this study was to assess the feasibility, acceptability, and effectiveness of LoveYourBrain Yoga, a six-week yoga with psychoeducation program, on fatigue and other health-related outcomes among people with MS in a rural, community-based setting in the United States.

METHODS

This non-randomized 2x2 crossover pilot trial compared LoveYourBrain Yoga to a control among 15 people with MS. People were eligible if they were adults with MS (EDSS score ≤6), English-speaking, and ambulatory. Paired t-tests and Wilcoxon signed rank sum analyses assessed mean differences in PROMIS-Fatigue_MS, Multiple Sclerosis Impact Scale, Symbol Digit Modalities Test, NIH Neuro-QoL measures, and Liverpool Self-Efficacy scale. We assessed feasibility using recruitment and retention rates, mean attendance, fidelity, and acceptability using satisfaction measures.

RESULTS

Significant improvements in fatigue (MD -4.34, SD 5.26, p = 0.012), positive affect and wellbeing (MD 2.76, SD 3.99, p = 0.028), and anxiety (MD -4.42, SD 5.36, p = 0.012) were found after LoveYourBrain Yoga compared to the control. Participants reported high satisfaction (M 9.5, SD 1.4) and a majority (92.3%) reported 'Definitely, yes' to recommending it to a friend or family.

CONCLUSION

LoveYourBrain Yoga is feasible and acceptable when implemented in a rural, community-based setting for people with MS. It may improve a range of MS symptoms and offer a means for acquiring new skills for stress reduction, anxiety management, and overall wellbeing.

Validity and reliability of the Persian version of the exercise self-efficacy scale in people with multiple sclerosis

BACKGROUND

Exercise self-efficacy has been identified as one of the primary determinants of physical activity in people with multiple sclerosis (MS). Therefore, assessment of exercise self-efficacy is important to be measured with valid and reliable scale to provide tailored interventions.

MATERIALS AND METHODS

The English version of the exercise self-efficacy scale was translated into Persian using a forward-backward translation approach. Factorial validity was conducted using the expletory factor analysis (EFA) and the confirmatory factor analysis (CFA). In addition, construct validity was performed using convergent and known-group validity. Reliability was evaluated by internal consistency and test-retest reliability. Participants were recruited from two hospitals (MS clinics).

RESULTS

Expletory factor analysis identified a single factor structure which explained 64.7% variance in exercise self-efficacy scale (EXSE). CFA supported a single factor structure with a good model fit. Average variance extracted = 0.60 and composite reliability = 0.93 values confirmed the convergent validity. The known-group validity was verified with significant differences between subgroups. The Cronbach's alpha coefficient = 0.93 and intraclass correlation coefficient = 0.85 supported reliability of EXSE scale.

CONCLUSIONS

Our findings provided sufficient evidence of validity and reliability for EXSE scale in people with MS. This measure can utilize by researchers and health-care providers in studies and clinical practice as a robust measure to assess exercise self-efficacy and to develop interventions in people with MS.

Aspectos del estilo de vida en personas con esclerosis múltiple antes y durante la pandemia COVID-19: resultado de una encuesta en Argentina

Introducción

Un estilo de vida poco saludable tendría influencia negativa en la evolución de la esclerosis múltiple (EM). La pandemia de COVID-19 ha producido cambios que podrían haber modificado el mismo. Los objetivos fueron evaluar aspectos del estilo de vida de personas con EM (pcEM) integrantes de una asociación de pacientes de Argentina, previo y durante la pandemia, las causas de este y si recibieron consejos médicos sobre el tema.

Sujetos y métodos

Estudio observacional, las pcEM fueron convocadas a través de una asociación de pacientes para responder encuestas on line en noviembre de 2019 y octubre de 2020. Se recolectaron datos demográficos, de la enfermedad, talla, peso, tabaquismo, alimentación, actividad física, consumo de alcohol y sobre la atención médica.

Resultados

208 pcEM. Mujeres: 76,4%. 43,76 años (± 10,7). Cumple con la actividad física recomendada el 40,4%, 5 porciones de frutas y verduras diarias el 13,9%, tabaquismo el 24,5%, consumo de alcohol de riesgo el 12,5%, sobrepeso + obesidad el 53,4%. En pandemia disminuyó el tabaquismo (24,9% vs 20%; p = 0,004), aumentó el peso (BMI = 26,1 vs 27,4; p = 0,001) y disminuyó la actividad física (39,3% vs 31,5%; p = 0,016). Recibieron regularmente consejos sobre ejercicio físico el 54,3%, sobre dieta saludable el 32,4% y sobre cesación tabáquica el 33,3%.

Conclusiones

Un importante porcentaje de las pcEM presentan aspectos del estilo de vida no saludables. En pandemia se observó: aumento de peso, aumento del sedentarismo y disminución del tabaquismo. No se realizaron frecuentemente los consejos sobre estilo de vida. Son necesarios nuevos estudios para evaluar cómo mejorar el estilo de vida y su implicancia en la evolución y la calidad de vida.

Motivation for Physical Activity in Adults with Multiple Sclerosis: A Self-determination Theory–Based Approach

Background: Despite the benefits of regular physical activity (PA), most adults with multiple sclerosis (MS) are insufficiently active. Identifying the motivational correlates of PA is necessary to facilitate health behavior change. The extent to which the constructs of psychological need satisfaction and motivational regulations associate with self-determined PA in adults with the disease was examined.

Methods: Individuals with MS were provided a link to a web-based survey. There were 290 respondents: 242 women and 48 men aged 22 to 71 (mean ± SD, 49.50 ± 12.05) years with primarily mild-to-moderate mobility impairment who completed the Psychological Need Satisfaction in Exercise scale, the Behavioral Regulation in Exercise Questionnaire, and the International Physical Activity Questionnaire.

Results: Path analysis revealed that PA was best predicted by integrated regulation, competence, and mobility, explaining 28% of the variance in PA behavior. All three need satisfaction variables (relatedness, competence, and autonomy) and mobility impairment accounted for 43% of the variance in integrated regulation.

Conclusions: Increasing satisfaction of the need for relatedness, competence, and autonomy can lead to more integrated and internally motivated PA engagement in adults with MS.

Do physical activity and social cognitive theory variable scores differ across symptom cluster severity groups in multiple sclerosis?

BACKGROUND

Persons with multiple sclerosis (MS) experience co-occurring symptoms termed "symptom clusters" that can be distinguished based on mild, moderate, or severe symptom severity termed "symptom cluster severity." Physical activity (PA) may be an approach for improving co-occurring symptoms.

OBJECTIVE

To examined if PA and social cognitive theory (SCT) variables differed by symptom cluster groups, and if associations between SCT variables and PA were moderated by symptom cluster groups.

METHODS

Secondary analysis of participants with MS (N = 205) enrolled in a cross-sectional study. Trend analyses were conducted to determine if device-measured and self-reported PA and SCT variables (i.e., social support, self-efficacy, outcome expectations, goal setting, planning, and impediments) decreased with increased symptom cluster severity. Spearman rho rank-order correlations were conducted between PA measures and SCT variables within each symptom cluster group.

RESULTS

Linear trend analyses indicated that self-reported PA declined with increased symptom cluster severity groups (F = 4.90,p = 0.03). Linear trend analyses indicated significant differences among symptom cluster severity groups in social support (F = 31.43,p = 0.001), exercise self-efficacy (F = 22.55,p = 0.001), barrier self-efficacy (F = 11.48,p = 0.001), outcome expectations (F = 6.98,p = 0.009), and impediments (F = 34.41,p = 0.001). There were differential associations of moderate magnitude in correlations, such that three SCT variables were associated with PA in the mild group (i.e., self-efficacy, goal setting and planning), two in the moderate group (i.e., social support and goal setting), and four in the severe group (i.e., self-efficacy, outcome expectations, planning, and social support).

CONCLUSIONS

Further research is warranted examining the use of SCT-based behavior change techniques for promoting PA and improving symptom clusters in persons with MS.

High-intensity interval training and energy management education, compared with moderate continuous training and progressive muscle relaxation, for improving health-related quality of life in persons with multiple sclerosis: study protocol of a randomized controlled superiority trial with six months' follow-up

Background

Persons with multiple sclerosis (PwMS) often have reduced aerobic capacity and report fatigue as the most disabling symptom impacting their health-related quality of life (HRQoL). A multidisciplinary rehabilitation approach is recommended for successful management of symptoms, although there is little supporting evidence. The aim of this study is to evaluate the effect of a multimodal therapy approach, including endurance training and patient education, during a three-week inpatient rehabilitation stay, on HRQoL in PwMS at six months follow-up. Inpatient energy management education (IEME) + high-intensity interval training (HIIT) will be compared with progressive muscle relaxation (PMR) + moderate continuous training (MCT).

Methods

This study has a two-armed single-blind randomized controlled superiority trial design. One hundred six PwMS-related fatigue (relapsing-remitting or chronic progressive phenotypes; Expanded Disability Status Scale (EDSS) ≤ 6.5) will be recruited at the Valens clinic, Switzerland, and randomized into either an experimental (EG) or a control group (CG). EG: participants will perform IEME twice and HIIT three times per week during the three-week rehabilitation stay. IEME is a group-based intervention, lasting for 6.5 h over three weeks. HIIT contains of five 1.5-min high-intensive exercise bouts on a cycle ergometer at 95–100% of peak heart rate (HR_peak), followed by active breaks of unloaded pedalling for 2 min to achieve 60% of HR_peak. CG: participants will perform PMR twice and MCT three times per week during the three-week rehabilitation stay, representing local usual care. PMR consists of six 1-h relaxation group sessions. MCT consists of 24-min continuous cycling at 65% of HR_peak. The primary outcome is HRQoL (Physical and Mental Component Summaries of the Medical Outcome Study 36-item Short Form Health Survey; SF-36), measured at entry to the clinic (baseline, T₀), three weeks after T₀ (T₁) and at four (T₂) and six (T₃) months after T₀. Secondary outcomes comprise cardiorespiratory fitness, inflammatory markers (measured at T₀ and T₁), fatigue, mood, self-efficacy, occupational performance, physical activity (measured at T₀, T₁, T₂ and T₃) and behaviour changes in energy management (measured at T₂ and T₃).

Discussion

This study will provide detailed information on a multimodal therapy approach to further improve rehabilitation for PwMS.

Trial registration

This trial was prospectively registered at ClinicalTrials.gov (NCT04356248; 22 April 2020).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-021-02084-0.

Examining Multilevel Environmental Correlates of Physical Activity Among Older Adults With Multiple Sclerosis

Three hundred and sixty-three older adults with multiple sclerosis completed a cross-sectional study examining hierarchical correlates of physical activity using a social cognitive theory perspective within a social ecological model (i.e., built environment, social environment, and individual social cognitive theory variables). Hierarchical linear regression analyses were conducted, wherein significant associations were noted for built environment (i.e., land-use mix diversity and aesthetics) and physical activity in Step 1 (R2 = .09). Social and built environment were significant correlates in Step 2 (R2 = .15). Finally in Step 3, individual social cognitive theory variables (i.e., self-efficacy and outcome expectations) were the only significant correlates of total physical activity (R2 = .38). Results were comparable for health-promoting physical activity; however, self-efficacy was the only significant correlate in Step 3 (R2 = .36). This study provides guidance for researchers and practitioners on relevant targets for tailoring interventions for older adults with multiple sclerosis and supports an emphasis on self-efficacy as a primary predictor of health behavior change.

Daily Temporal Associations Between Physical Activity and Symptoms in Multiple Sclerosis

Background

Symptom severity is negatively associated with physical activity in multiple sclerosis (MS). However, it is unclear how physical activity and symptoms correlate on a day-to-day basis in persons with MS.

Purpose

To determine the temporal within-person associations of pain, fatigue, depressed mood, and perceived cognitive function with physical activity in MS.

Methods

Ambulatory adults with MS (N = 107) completed 7 days of home monitoring. Continuous physical activity data (assessed via wrist-worn accelerometer) and concurrent ecological momentary assessment (5X/day) of pain, fatigue, depressed mood, and perceived cognitive function were collected. Data were analyzed using multilevel mixed modeling.

Results

Fatigue and depressed mood demonstrated bidirectional associations with physical activity, whereas pain and cognitive function did not. Higher than usual fatigue (B = -5.83, p = .001) and depressed mood (B = -4.12, p = .03) were followed by decreased physical activity. In contrast, higher than usual physical activity was associated with subsequent decline in fatigue (B = -0.001, p = .02) and depressed mood (B = -0.0007, p = .02); however, the association between physical activity and fatigue varied across the day.

Conclusions

Physical activity is dynamically related to fatigue and mood on a moment-to-moment basis in MS. Efforts to increase physical activity in MS must incorporate a focus on how symptoms affect and are affected by activity.

[Comorbid pathology of the cardiovascular system in young patients with relapsing-remitting multiple sclerosis]

AIM

To study the state of the cardiovascular system and peripheral microcirculation in young patients with relapsing-remitting multiple sclerosis (MS).

MATERIAL AND METHODS

The study included 45 MS patients (17 men and 28 women, age 28 [24; 32] years, disease duration 5.5 [2; 7] years). The control group included healthy controls (age 30 [25; 33] years). Neurological and cardiologic examinations included 24-hour Holter ECG monitoring and 24-hour blood pressure monitoring with determination of the daily arterial vascular stiffness, echocardiography, laser doppler flowmetry followed by an occlusive test to assess the state of microvasculation, levels of serum vascular cellular adhesion molecule-1 (VCAM-1).

RESULTS

In MS group, the results of 24-hour blood pressure monitoring showed that the variability of systolic blood pressure and diastolic blood pressure during daytime hours was reduced compared to the control group (p<0.026 and p<0.002, respectively). The indicators of daily arterial stiffness in MS group were significantly increased (p<0.001). According to the results of Holter ECG monitoring, no heart rhythm disorder was detected in both groups, except an increase in the number of supraventricular extrasystoles in MS patients compared to the control group (p<0.005). There were no between group differences in echocardiography indicators. The level of VCAM-1 was significantly increased in MS group compared to controls (p<0.001).

CONCLUSION

Young MS patients are at risk of cardiovascular diseases associated with the variability of blood pressure and indexes of daily arterial vascular stiffness.

Safety and Feasibility of Various Functional Electrical Stimulation Cycling Protocols in Individuals With Multiple Sclerosis Who Are Nonambulatory

Objective

To examine the safety, feasibility, and response to functional electrical stimulation (FES) cycling protocols requiring differing levels of effort in people with multiple sclerosis (MS) who are nonambulatory.

Design

Pilot study with pre-post intervention testing.

Setting

Outpatient clinic setting of a long-term acute care hospital.

Participants

Individuals (N=10) with MS (6 men; mean age 58.6±9.86y) who use a wheelchair for community mobility. Participants’ Expanded Disability Status Scale score ranged from 6.5 to 8.5 (median 7.5).

Intervention

Participants performed 3 or 4 FES cycling protocols requiring different levels of volitional effort during 6-8 testing sessions.

Main Outcome Measures

The primary outcome was safety, measured by adverse events and increase in MS symptoms, all assessed throughout, immediately post- and 1 day postsession. FES cycling performance for each protocol was also recorded. Exploratory outcome measures collected before and after all testing sessions included functional assessment of MS, MS Impact Scale, Exercise Self Efficacy Scale, Patient Health Questionnaire-9 item, and the Zarit Caregiver Burden Scale.

Results

All participants (4 women, 6 men) completed all testing sessions. There were no serious adverse events or differences in vitals or symptoms between protocols. Two participants had an isolated episode of mild hypotension. Changes in pain, spasticity, and fatigue were minimal. Five participants were able to cycle for 30 minutes and completed interval training protocols requiring increasing difficulty. The remainder cycled for <3 minutes and completed a rest interval protocol. There was modest improvement on the exploratory outcome measures.

Conclusions

People with MS who use a wheelchair for community mobility can safely perform FES cycling requiring more effort than previously reported research. Therefore, the individuals may experience greater benefits than previously reported. Further study is required to better understand the potential benefits for optimizing function and improving health in people with MS.

•

People with multiple sclerosis who are nonambulatory can safely perform functional electrical stimulation (FES) cycling using parameters requiring more effort.

•

FES cycling may offer an opportunity for increased exercise stimulus or neuromuscular training if individuals are adequately challenged using an appropriate cycling protocol.

Ecological validity of walking capacity tests following rehabilitation in people with multiple sclerosis

Background

Walking capacity tests are commonly used to evaluate interventions aiming at reducing walking impairment in people with multiple sclerosis (pwMS). However, their ecological validity has recently been questioned. The aim of the present study was to investigate the ecological validity of the 2- and 6-minutes walking tests (2MWT and 6MWT) and the timed 25-foot walk (T25FW) after 28 days of multidisciplinary inpatient rehabilitation (MIR) in pwMS using accelerometry.

Methods

PwMS wore an accelerometer on 7 consecutive days within a 14-day period prior to MIR, performed 2/6MWT and T25FW at the beginning and at the end of MIR, followed by another 7 consecutive days of accelerometry.

Results

Significant improvements in 2/6MWT and T25FW after MIR in a cohort of 76 pwMS (mean age = 47.9, SD 8.3 years) were overall correlated to a significant gain in everyday life mobility (total steps/day). However, the correlation was strongly dependent on pre-existing walking disability defined by EDSS and only pwMS with “mild” walking impairment (EDSS 2–3.5) were able to transfer benefits measurable by walking capacity tests into improved everyday life mobility, while pwMS with “moderate to severe” walking disability (EDSS 4–6.5) were not.

Conclusion

Ecological validity of changes in walking capacity tests following MIR is strongly dependent on pre-existing walking impairment.

The effectiveness of interventions targeting physical activity and/or sedentary behaviour in people with Multiple Sclerosis: a systematic review

Background: Remaining physically active is important to maintain functional ability and reduce the incidence of co-morbidities in people with Multiple Sclerosis. The aim of this review was to evaluate the effectiveness of interventions on physical activity or sedentary behaviour in people with Multiple Sclerosis.Methods: A systematic search was conducted in May 2018 of the following databases: Web of Science Core Collections, Embase and Medline. Included studies were randomised controlled trials involving people with Multiple Sclerosis who completed an intervention, compared to any comparator. Outcomes included subjective or objective measures of physical activity or sedentary behaviour. Quality assessment was performed using the Physiotherapy Evidence Database scale.Results: Twenty-five trials were included covering 1697 participants, the majority of which had mild-moderate disability (average Physiotherapy Evidence Database score 6.2 ± 1.5). Experimental interventions included exercise prescription (n = 5), behaviour change interventions (n = 10), combined exercise, and behaviour change techniques (n = 7) and education (n = 3). Generally, subjective but not objective physical activity improved in those with mild-moderate disability. Insufficient data existed on the effectiveness on sedentary behaviour.Conclusions: A discrepancy seems to exists between the effectiveness of physical activity interventions in people with Multiple Sclerosis depending on whether physical activity was assessed objectively or subjectively, with the latter indicating effects. Effects on sedentary behaviour remain to be elucidated.Implications for RehabilitationRemaining physically active is important to maintain functional ability, independence, quality of life, and to reduce the incidence of co-morbidity.Exercise prescription, behaviour change interventions, combined exercise and behaviour change interventions, and health promotion education appear to subjectively improve physical activity in people with Multiple Sclerosis with mild-moderate disability, yet this is often not the case when measured objectively.There is a lack of evidence to support the effectiveness of these interventions on sedentary behaviour.

A systematic critical review of physical activity aspects in clinical guidelines for multiple sclerosis

OBJECTIVE

This paper aims to evaluate the quality of clinical guidelines (CGs) for MS and to critically appraise physical activity-related recommendations.

DATA SOURCES

Medical databases (MEDLINE, TRIP), clearinghouses, and guideline developers. An expert was asked to confirm if the list of CGs was complete.

STUDY SELECTION

Evidence-based CGs specific to MS with recommendations including aspects of rehabilitation or physical activity were included.

DATA EXTRACTION

Two reviewers independently first assessed the methodological quality of the CGs based on the 23 items of the Appraisal of Guidelines for Research and Evaluation Instrument version two (AGREE II) and second evaluated the physical activity-related content quality using an instrument containing 14 items that was used for the development of the National Recommendations for Physical Activity in Germany.

DATA SYNTHESIS

For the AGREE II domains and the criteria for content quality, standardized domain scores were calculated.

RESULTS

Three CGs were included. The average scores for the methodological quality of the domains were: scope and purpose (91%), stakeholder involvement (81%), rigor of development (78%), clarity of presentation (93%), applicability (53%), and editorial independence (83%). The mean scores for physical activity-related content quality did not exceed 56% for any criteria.

CONCLUSIONS

Overall, this critical review shows that the methodological quality of CGs were moderate to good but physical activity-related content quality was heterogeneous and low. Results emphasize the need for more specific physical activity recommendations that incorporate multiple aspects of physical activity prescription.

Changing physical activity behaviour for people with multiple sclerosis: protocol of a randomised controlled feasibility trial (iStep-MS)

INTRODUCTION

Although physical activity may reduce disease burden, fatigue and disability, and improve quality of life among people with multiple sclerosis (MS), many people with MS are physically inactive and spend significant time in sedentary behaviour. Behaviour change interventions may assist people with MS to increase physical activity and reduce sedentary behaviour. However, few studies have investigated their effectiveness using objective measures of physical activity, particularly in the long term. Further, interventions that have proven effective in the short term may not be feasible in clinical practice because of the large amount of support provided. The iStep-MS trial aims to determine the safety, feasibility and acceptability of a behaviour change intervention to increase physical activity and reduce sedentary behaviour among people with MS.

METHODS AND ANALYSIS

Sixty people with MS will be randomised (1:1 ratio) to receive a 12-week intervention or usual care only. The intervention consists of four physical activity consultations with a physiotherapist supported by a handbook and pedometer. Outcomes assessed at baseline, 12 weeks and 9 months are physical activity (ActiGraph wGT3X-BT accelerometer), sedentary behaviour (activPAL3µ), self-reported activity and sitting time, walking capability, fatigue, self-efficacy, participation, quality of life and health service use. The safety of the intervention will be determined by assessing change in pain and fatigue and the incidence of adverse events during the follow-up period. A parallel process evaluation will assess the feasibility and acceptability of the intervention through assessment of fidelity to the programme and semistructured interviews exploring participants' and therapists' experiences of the intervention. The feasibility of conducting an economic evaluation will be determined by collecting data on quality of life and resource use.

ETHICS AND DISSEMINATION

Research ethics committee approval has been granted from Brunel University London. Results of the trial will be submitted for publication in journals and distributed to people with MS and physiotherapists.

TRIAL REGISTRATION NUMBER

ISRCTN15343862 (doi 10.1186/ISRCTN15343862). Protocol version: 1.0; Pre-results.

Biosensing in multiple sclerosis

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.

An exploration of fall-related, psychosocial variables in people with multiple sclerosis who have fallen

Introduction

Psychosocial contributors to fall risk for people with multiple sclerosis are often overlooked in falls prevention practice. This study explored several fall-related, psychosocial variables and their association with falls self-efficacy in a sample of people with multiple sclerosis reporting a fall.

Method

A cross-sectional, structured telephone survey was employed. The survey explored socio-demographics, multiple sclerosis characteristics, and fall-related psychosocial variables. Multiple linear regression was employed to investigate associations with Falls Efficacy Scale – International scores.

Results

The mean Falls Efficacy Scale – International score for 140 participants was 38.14(SD = 10.16), and the mean Falls Control Scale score was 5.38(SD = 2.22). Fear of falling was expressed by 129 (92%) participants, with 111 (79%) reporting associated activity curtailment. A regression model including six predictors explained 47% of the variance in the Falls Efficacy Scale – International scores. Results of the multiple linear regression showed that fear of falling, associated activity curtailment, balance interference, falls control, and health status were associated with falls self-efficacy.

Conclusion

Fear of falling and associated activity curtailment, low falls self-efficacy, and compromised falls control are common among people with multiple sclerosis who have fallen. These fall-related psychosocial variables are distinct and each warrants attention during assessment. Findings suggest that falls self-efficacy among people with multiple sclerosis who have fallen is a complex construct associated with physical and psychosocial factors.

The Effects of Gain- versus Loss-Framed Messages Following Health Risk Information on Physical Activity in Individuals With Multiple Sclerosis

Few people with multiple sclerosis engage in physical activity. Messaging interventions may motivate more physical activity among these individuals. The purpose of this online study was to evaluate an intervention presenting participants with multiple sclerosis (N = 237) with risk information (i.e., information demonstrating people with multiple sclerosis are more likely to experience certain health issues) or no risk information followed by gain- or loss-framed physical activity messages. Participants completed questionnaires on Days 1, 6, and 28 and received information material on Days 2-5. The dependent variables were as follows: physical activity intentions and behavior, response and task efficacy, perceived threat (i.e., perception of threat to health issues relevant to people with multiple sclerosis), and avoidance (i.e., avoiding thinking about/doing something about the health issues presented in the messages). Analyses indicated physical activity and response efficacy increased over time. Also, participants receiving risk information had higher levels of physical activity and perceived threat. However, manipulation checks showed no differences between participants regarding perceptions of risk information or gain/loss-framed messages. Despite the lack of impact of the framing intervention, this study suggests that a brief informational intervention can positively influence physical activity and certain correlates of physical activity among people with multiple sclerosis.

Upper limb movement analysis during gait in multiple sclerosis patients

PURPOSE

Gait disorders in multiple sclerosis (MS) are well studied; however, no previous study has described upper limb movements during gait. However, upper limb movements have an important role during locomotion and can be altered in MS patients due to direct MS lesions or mechanisms of compensation. The aim of this study was to describe the arm movements during gait in a population of MS patients with low disability compared with a healthy control group.

METHODS

In this observational study we analyzed the arm movements during gait in 52 outpatients (mean age: 39.7±9.6years, female: 40%) with relapsing-remitting MS with low disability (mean EDSS: 2±1) and 25 healthy age-matched controls using a 3-dimension gait analysis.

RESULTS

MS patients walked slower, with increased mean elbow flexion and decreased amplitude of elbow flexion (ROM) compared to the control group, whereas shoulder and hand movements were similar to controls. These differences were not explained by age or disability.

CONCLUSION

Upper limb alterations in movement during gait in MS patients with low disability can be characterized by an increase in mean elbow flexion and a decrease in amplitude (ROM) for elbow flexion/extension. This upper limb movement pattern should be considered as a new component of gait disorders in MS and may reflect subtle motor deficits or the use of compensatory mechanisms.

Commitment to physical activity and health: a case study of a Paralympic Gold medallist

BACKGROUND

Physical activity has been documented as both beneficial and detrimental for individuals with multiple sclerosis (MS). The varied experience highlights challenges associated with physical activity and MS, requiring a greater understanding of the experiences of exercise for individuals with MS.

OBJECTIVE

The purpose of this study was to explore how physical activity played a role in the life of a Paralympic Gold medallist. Carol was diagnosed with MS and went onto achieve the highest accolade in Paralympic sport.

METHODS

Narrative inquiry, within a single-case design, explored how physical activity played a role in Carol's life. The narrative was analysed through the lens of a salutogenic framework, which explores how individuals create health despite adverse circumstances.

FINDINGS

Carol's physical activity pathway explores life before and after her diagnosis, motivations to return to exercise and pathway to Paralympic Gold. Carol's experiences highlight how physical activity played a role during various stages of her life. Exercise had a significant role in Carol's life prior to diagnosis, it assisted in the management of MS and she cycled the elite level, winning a Paralympic Gold medal in para-cycling. Implications for Rehabilitation Physical activity has been reported as beneficial for multiple sclerosis management; however, there can be a fine line between the benefits and an overload that can harm. An elite athlete with multiple sclerosis maintained and sustained physical activity to the highest level in elite sport, incorporating a positive health outlook throughout different stages of her life. The case highlights how commitment and self-awareness of capabilities and limits may be useful self-management tools in increasing physical activity for individuals living with multiple sclerosis.

Subjective and objective assessment of physical activity in multiple sclerosis and their relation to health-related quality of life

Background

Physical activity (PA) is frequently restricted in people with multiple sclerosis (PwMS) and aiming to enhance PA is considered beneficial in this population. We here aimed to explore two standard methods (subjective plus objective) to assess PA reduction in PwMS and to describe the relation of PA to health-related quality of life (hrQoL).

Methods

PA was objectively measured over a 7-day period in 26 PwMS (EDSS 1.5–6.0) and 30 matched healthy controls (HC) using SenseWear mini® armband (SWAmini) and reported as step count, mean total and activity related energy expenditure (EE) as well as time spent in PA of different intensities. Measures of EE were also derived from self-assessment with IPAQ (International Physical Activity Questionnaire) long version, which additionally yielded information on the context of PA and a classification into subjects’ PA levels. To explore the convergence between both types of assessment, IPAQ categories (low, moderate, high) were related to selected PA parameters from objective assessment using ANOVA. Group differences and associated effect sizes for all PA parameters as well as their relation to clinical and hrQoL measures were determined.

Results

Both, SWAmini and IPAQ assessment, captured differences in PA between PwMS and HC. IPAQ categories fit well with common cut-offs for step count (p = 0.002) and mean METs (p = 0.004) to determine PA levels with objective devices. Correlations between specifically matched pairs of IPAQ and SWAmini parameters ranged between r .288 and r .507. Concerning hrQoL, the lower limb mobility subscore was related to four PA measures, while a relation with patients’ report of general contentment was only seen for one.

Conclusions

Both methods of assessment seem applicable in PwMS and able to describe reductions in daily PA at group level. Whether they can be used to track individual effects of interventions to enhance PA levels needs further exploration. The relation of PA measures with hrQoL seen with lower limb mobility suggests lower limb function not only as a major target for intervention to increase PA but also as a possible surrogate for PA changes.

Electronic supplementary material

The online version of this article (doi:10.1186/s12883-016-0783-0) contains supplementary material, which is available to authorized users.

Validity and Reliability of the Persian Practice Environment Scale of Nursing Work Index

Background:

The practice environment pivotal role in patients and nurses better outcomes is evident. Practice Environment Scale of Nursing Work Index (PES-NWI) is widely utilized to assess nursing work environments. The present study was conducted to demonstrate the validity and reliability of the Persian version of PES-NWI.

Materials and Methods:

The instrument was translated and its psychometrics were investigated by content, construct validity (factor analysis), and homogeneity (internal consistency and intraclass correlation) on a sample of 350 nurses at educational hospitals in East Azerbaijan, Iran.

Results:

The 30 items loaded onto 4 factors explained 34.95–50.06% of the variance. The items across the factors differed slightly from those reported by the original author of the PES-NWI. Cronbach's alpha and Pearson coefficient for the entire instrument and also for extracted factors was 0.70–0.96.

Conclusions:

The Persian version of PES-NWI has an appropriate level of validity and reliability in the Iranian setting for nurses. The subscale of Nursing Foundations for quality care needs modification.

Symptom variability, affect and physical activity in ambulatory persons with multiple sclerosis: Understanding patterns and time-bound relationships

BACKGROUND

Individuals with multiple sclerosis (MS) experience a clinical course that is highly variable with daily fluctuations in symptoms significantly affecting functional ability and quality of life. Yet, understanding how MS symptoms co-vary and associate with physical and psychological health is unclear.

OBJECTIVE

The purpose of the study was to explore variability patterns and time-bound relationships across symptoms, affect, and physical activity in individuals with MS.

METHODS

The study employed a multivariate, replicated, single-subject repeated-measures (MRSRM) design and involved four individuals with MS. Mood, fatigue, pain, balance confidence, and losses of balance were measured daily over 28 days by self-report. Physical activity was also measured daily over this same time period via accelerometry. Dynamic factor analysis (DFA) was used to determine the dimensionality and lagged relationships across the variables.

RESULTS

Person-specific models revealed considerable time-dependent co-variation patterns as well as pattern variation across subjects. Results also offered insight into distinct variability structures at varying levels of disability.

CONCLUSION

Modeling person-level variability may be beneficial for addressing the heterogeneity of experiences in individuals with MS and for understanding temporal and dynamic interrelationships among perceived symptoms, affect, and health outcomes in this group.

Increasing Physical Activity and Participation in People With Multiple Sclerosis: A Review

Multiple sclerosis (MS) is a chronic progressive disease of the central nervous system (CNS) affecting >2.5 million people worldwide. Damage to neurons in the CNS causes various sensorimotor and cognitive symptoms, such as fatigue, pain, spasticity, memory deficits, and impairment of mobility. Until the late 1990s, it was believed that symptoms of MS would be worsened with physical exertion and people with MS were encouraged to limit physical activity and exertion. Not only has emerging evidence suggested that physical activity, including exercise, is safe for people with MS, there is also evidence that at least some of the disability that occurs after MS is due to secondary deconditioning from the sedentary lifestyle adopted because of the symptoms of MS, not just CNS damage alone. Therefore, not only is physical activity safe, it is also required for maintaining function and health in people with MS. The purpose of this article is to review the unique physical and social barriers to physical activity in people with MS, including those with moderate to severe disability who use a wheelchair or scooter for mobility. We will discuss how existing guidelines for physical activity may not meet the needs of people with MS and present evidence-based considerations for promoting physical activity in people with MS. Ultimately, the goal is to overcome the barriers to physical activity and improve health, participation, and quality of life in people with MS.

Multidisciplinary rehabilitation and steroids in the management of multiple sclerosis relapses: a randomized controlled trial

INTRODUCTION

Periodic relapses are one of the main characteristics of multiple sclerosis (MS), from which recovery is often incomplete despite high-dose methylprednisolone (HDMP) treatment. The aim of our study was to evaluate the potential benefits of short-term HDMP combined with multidisciplinary rehabilitation (MDR) in persons with MS in relapse in order to assess whether combination of steroid therapy with MDR is more beneficial than steroid therapy alone.

MATERIAL AND METHODS

This investigation was conducted as a randomized controlled trial. The MS patients were eligible if they had an established diagnosis and relapse requiring application of HDMP. Forty-nine patients were included in the study and randomized to control and treatment groups, and 37 completed the study. High-dose methylprednisolone was administered to all patients. The treatment group additionally underwent an MDR program over a 3-week period. All outcome measures were completed at baseline and 1 and 3 months later.

RESULTS

The Expanded Disability Status Scale (EDSS) and Functional Independence Measure (FIM) motor scores improved statistically significantly 1 month after HDMP, in both treatment and control groups. During the study period, in the treatment group, a sustained large effect size (ES) was found for both physical and mental composite scores of Multiple Sclerosis Quality of Life-54 (MSQoL-54), while in the controls, a sustained moderate ES was demonstrated only for physical composite score.

CONCLUSIONS

Our findings suggest that MDR improves MS relapse outcome.

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

OBJECTIVE

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

DATA SOURCES

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

STUDY SELECTION

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

DATA EXTRACTION

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

DATA SYNTHESIS

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

CONCLUSIONS

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

Step-rate cut-points for physical activity intensity in patients with multiple sclerosis: The effect of disability status

BACKGROUND

Evaluating the relationship between step-rate and rate of oxygen uptake (VO2) may allow for practical physical activity assessment in patients with multiple sclerosis (MS) of differing disability levels.

AIMS

To examine whether the VO2 to step-rate relationship during over-ground walking differs across varying disability levels among patients with MS and to develop step-rate thresholds for moderate- and vigorous-intensity physical activity.

MATERIALS AND METHODS

Adults with MS (N=58; age: 51 ± 9 years; 48 women) completed one over-ground walking trial at comfortable speed, one at 0.22 m · s(-1) slower, and one at 0.22 m · s(-1) faster. Each trial lasted 6 min. VO2 was measured with portable spirometry and steps with hand-tally. Disability status was classified as mild, moderate, or severe based on Expanded Disability Status Scale scores.

RESULTS

Multi-level regression indicated that step-rate, disability status, and height significantly predicted VO2 (p<0.05). Based on this model, we developed step-rate thresholds for activity intensity that vary by disability status and height. A separate regression without height allowed for development of step-rate thresholds that vary only by disability status.

CONCLUSION

The VO2 during over-ground walking differs among ambulatory patients with MS based on disability level and height, yielding different step-rate thresholds for physical activity intensity.

Impact of 24 Weeks of Resistance and Endurance Exercise on Glucose Tolerance in Persons with Multiple Sclerosis

BACKGROUND

Recently, the authors reported an elevated prevalence of impaired glucose tolerance in individuals with multiple sclerosis (MS), compared with matched healthy controls, indicating metabolic defects that may increase comorbidity. MS also leads to a more inactive lifestyle, increasing the likelihood to develop fat accumulation, muscle wasting/weakness, and exercise intolerance. In other populations, these health complications can partly be reversed by physical exercise.

OBJECTIVE

The aim of this study was to determine the impact of a mild-to-moderate-intensity exercise program on glucose tolerance, ranging between normal and impaired, in persons with MS.

DESIGN

Persons with MS (mean expanded disability status scale, 3.3 ± 0.2; mean age, 48 ± 15 yrs) were randomized to an exercise group (n = 29) or a nonexercise control group (n = 15). Glucose tolerance, as well as muscle strength, exercise tolerance, and body composition to validate the applied exercise program, was determined in both groups at baseline and after 6, 12, and 24 wks of mild-to-moderate-intensity combined endurance and resistance training.

RESULTS

No effects on blood glucose and serum insulin were detected. However, 6 mos of exercise improved muscle strength, exercise tolerance, and lean tissue mass within the intervention group as compared with baseline. In the control group, no changes were detected.

CONCLUSION

Twenty-four weeks of mild-to-moderate-intensity combined endurance and resistance training was not able to improve glycemic control in this cohort of persons with MS. Future research is warranted to investigate the influence of higher exercise intensities on glucose tolerance, in an attempt to remediate metabolic deficits and to decrease the prevalence of comorbidities in MS.

Prior regular exercise improves clinical outcome and reduces demyelination and axonal injury in experimental autoimmune encephalomyelitis

Although previous studies have shown that forced exercise modulates inflammation and is therapeutic acutely for experimental autoimmune encephalomyelitis (EAE), the long-term benefits have not been evaluated. In this study, we investigated the effects of preconditioning exercise on the clinical and pathological progression of EAE. Female C57BL/6 mice were randomly assigned to either an exercised (Ex) or unexercised (UEx) group and all of them were induced for EAE. Mice in the Ex group had an attenuated clinical score relative to UEx mice throughout the study. At 42 dpi, flow cytometry analysis showed a significant reduction in B cells, CD4(+) T cells, and CD8(+) T cells infiltrating into the spinal cord in the Ex group compared to UEx. Ex mice also had a significant reduction in myelin damage with a corresponding increase in proteolipid protein expression. Finally, Ex mice had a significant reduction in axonal damage. Collectively, our study demonstrates for the first time that a prolonged and forced preconditioning protocol of exercise improves clinical outcome and attenuates pathological hallmarks of EAE at chronic disease. In this study, we show that a program of 6 weeks of preconditioning exercise promoted a significant reduction of cells infiltrating into the spinal cord, a significant reduction in myelin damage and a significant reduction in axonal damage in experimental autoimmune encephalomyelitis (EAE) mice at 42 dpi. Collectively, our study demonstrates for the first time that a preconditioning protocol of exercise improves clinical outcome and attenuates pathological hallmarks of EAE at chronic disease.

Use of Accelerometers to Measure Real-Life Physical Activity in Ambulatory Individuals with Multiple Sclerosis: A Pilot Study

BACKGROUND

Multiple sclerosis (MS) may negatively affect individuals' participation in physical activity (PA). We used accelerometers to determine PA level in individuals with MS with varying degrees of disability as measured by the Expanded Disability Status Scale (EDSS) during regular daily activities.

METHODS

Participants wore an accelerometer from 8 a.m. to 9 p.m. for 7 consecutive days. Activity counts recorded during this period were analyzed in 1-minute epochs and categorized into one of four PA levels: light, moderate, hard, and very hard.

RESULTS

The study cohort comprised 13 patients with MS and 12 controls. There were significant negative correlations for minutes spent in PA and EDSS measures on weekdays (r = -0.61), weekend (r = -0.64), and full week (r = -0.61) and number of steps taken on weekdays (r = -0.56), weekend (r = -0.80), and full-week average (r = -0.68). Significant positive correlations were found for minutes spent in light PA and EDSS score (r = 0.69). Significant negative correlations were found for minutes spent in moderate and hard PA and EDSS score. No significant difference was seen between the MS group and controls on any parameters (P > .05).

CONCLUSIONS

This study showed that accelerometers can be used to objectively quantify PA levels in individuals with MS with different disability levels. This cohort demonstrated that the amount of PA is inversely proportional to the degree of physical disability. Collected data revealed not only the amount but also the intensity of PA performed in real-life circumstances.

Effectiveness of Group Versus Individual Yoga Exercises on Fatigue of Patients with Multiple Sclerosis

Background:

Multiple sclerosis disorders poses heavy physical and emotional effect on patients who are associated with the disease.

Aim:

This study aimed to compare the effectiveness of individual versus group exercises on fatigue on patients with multiple sclerosis.

Materials and Methods:

In this clinical trial, 85 patients with multiple sclerosis were divided in two groups of individualized exercise and team exercise. The intervention was conducted for 6 weeks and comprised of mild stretching and basic yoga exercises twice a day. The data were collected through demographic questionnaire, standard fatigue scale and self-reported checklist. Data analysis was performed by SPSS software.

Results:

The mean levels of fatigue perception after the intervention in group exercise was 27.9 ± 15.9 and 27.1 ± 17.2 in individual exercise. There was no significant difference between the two groups (P > 0.05). Statistically significant difference was observed in the mean level of perceived fatigue in triplicate measurements (P = 0.013) among patients who completed individual exercise. However, this difference was not significant in the group exercise.

Conclusion:

Performing mild stretching exercises and basic yoga are recommended as a cost-effective method which is easy to perform among patients with mild to moderate disabilities.

Physical activity and associated levels of disability and quality of life in people with multiple sclerosis: a large international survey

BACKGROUND

Multiple Sclerosis (MS) is a common neurodegenerative disease, which often has a devastating effect on physical and emotional wellbeing of people with MS (PwMS). Several studies have shown positive effects of physical activity (PA) on disability, health related quality of life (HRQOL), and other outcomes. However, many studies include only people with mild disability making it difficult to generalize findings to those with moderate or severe disability. This study investigated the associations between PA and HRQOL, relapse rate (RR), disability, and demographic variables in PwMS with varying disability.

METHODS

Through online platforms this large international survey recruited 2232 participants with MS who completed items regarding PA, MS and other health characteristics.

RESULTS

PwMS who were younger (p < .001), male (p = 0.006), and with lower body mass index (BMI) (p < .001) undertook more PA, which was associated with decreased disability (p < 0.001) and increased HRQOL measures (all p < 0.001). For the subsample of people with relapsing-remitting MS, PA was associated with a decreased RR (p = 0.009). Regression analyses showed that increased PA predicted clinically significant improvements in HRQOL while controlling for level of disability, age and gender. More specifically, increasing from low to moderate and to high PA increased estimated mean physical health composite from 47.7 to 56.0 to 59.9 respectively (25.6% change), mental health composite from 60.6 to 67.0 to 68.8 (13.5% change), energy subscale from 35.9 to 44.5 to 49.8 (38.7% change), social function subscale from 57.8 to 66.1 to 68.4 (18.3% change), and overall QOL subscale from 58.5 to 64.5 to 67.7 (15.7% change).

CONCLUSIONS

For PwMS, regardless of disability level, increased PA is related to better HRQOL in terms of energy, social functioning, mental and physical health. These are important findings that should be taken into consideration by clinicians treating PwMS.