Preferences for exercise among black individuals with multiple sclerosis

A Qualitative Inquiry of Exercise Preferences among Hispanic Adults with Multiple Sclerosis

This study aimed to identify the components of an ideal exercise training program for Hispanics with multiple sclerosis (MS), cultural adaptations, and avenues for dissemination of information to this population. Online, semi-structured interviews were conducted with 27 adults with MS who identified as Hispanic. A deductive content analysis approach was applied for assessing necessary and desired components of an exercise program. Participants articulated preferences for "what," "when," "where," and "who" of exercise programs. All participants expressed an interest in aerobic training (n = 27) and need for resistance (n = 14), flexibility (n = 8), and neuromotor components (n = 10; what). The most commonly mentioned exercise frequency was 3-5 times per week (n = 21; when). The locations included home- or community-based exercise (where), supported through coaching (n = 13) or group (n = 14) delivery with a minority preferring autonomous exercise (n = 5) (who). Cultural adaptations for Hispanics included language, cultural norms, priorities, music/dance, and instructor characteristics. Further, participants provided suggestions for future advertising of exercise programs and resources such as MS-specific websites and health care providers. This study provides guidance for creating a culturally tailored, structured exercise programs for Hispanics with MS that may fill a significant gap in available rehabilitation resources for the subgroup.

Factors influencing adherence to Physical Exercise in patients with multiple sclerosis: a systematic review focusing on Exercise over General Physical Activity

BACKGROUND

While the barriers and facilitators of physical activity adherence are well-defined, there is a limited number of studies focusing specifically on exercise adherence, which is crucial to identify in patients with multiple sclerosis (MS) due to its known disease-modifying effect.

OBJECTIVE

To investigate the factors affecting adherence to physical exercise in MS patients.

METHODS

Literature search was conducted in PubMed, Cochrane, Web of Science, and Scopus electronic databases up to the current date. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) for quantitative studies and the McMaster Critical Appraisal Tool for qualitative studies, with evidence synthesis conducted using the Modified Bakker Scale.

RESULTS

The systematic review incorporated thirteen studies, consisting of seven qualitative and six quantitative ones. These studies' methodological quality was high; 12 were high, and the other was medium (unclear). In all reviewed studies, the primary patient-related and environmental barriers with high levels of evidence regarding exercise adherence included fatigue (38%), false beliefs (18%), cost (18%), and lack of time (15%). Barriers identified in very few studies included cognitive problems (3%), bladder-bowel problems (3%), and family support and advice (3%), indicating a necessity for further research to reveal their impact on exercise adherence.

CONCLUSION

The scarcity of studies on exercise barriers in MS is partly due to the absence of reliable assessment methods for evaluating exercise adherence, along with the prevalent emphasis on physical activity. Future research should prioritize the development of adherence scales tailored to physical exercise and shifting focus towards less explored barriers.

Randomized Controlled Trial of the Behavioral Intervention for Physical Activity in Multiple Sclerosis Project: Response Heterogeneity and Predictors of Change

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.

The effects of race/ethnicity and physician recommendation for physical activity on physical activity levels and arthritis symptoms among adults with arthritis

BACKGROUND

Among U.S. adults with physician-diagnosed arthritis, we examined the association of 1) participant race/ethnicity with meeting physical activity guidelines and arthritis symptoms, and 2) the association of receipt of a physician exercise recommendation with physical activity levels and arthritis symptoms, and whether race/ethnicity moderates these associations.

METHODS

Retrospective, cross-sectional study of National Health Interview Survey pooled data from 2002, 2006, 2009, and 2014 from 27,887 U.S. adults aged ≥18 years with arthritis. Outcomes were meeting aerobic (yes/no) and strengthening guidelines (yes/no), arthritis-associated activity limitations (yes/no) and arthritis-related pain (0-10; higher score = more pain). Predictors were race/ethnicity (White, African American, Latino, and Asian) and receipt of physician recommendation for exercise (yes/no). Covariates included demographic and health characteristics.

RESULTS

Adjusting for covariates, African Americans were more likely (AOR = 1.27; 95% CI 1.12, 1.43) and Asians were less likely (AOR = 0.75; 95% CI 0.61, 0.92) than Whites to meet muscle strengthening activity guidelines. Compared to Whites, African Americans (B = 0.48; 95% CI 0.24, 0.72) and Latinos (B = 0.44; 95% CI 0.15, 0.72) reported more severe, while Asians reported less severe (B = -0.68; 95% CI -1.22, - 0.14) joint pain. Controlling for covariates, physician exercise recommendation was associated with meeting aerobic (AOR = 1.20; 95% CI 1.11, 1.30) and strengthening (AOR = 1.21; 95% CI 1.11, 1.33) guidelines, regardless of race/ethnicity except for a weak negative association with meeting strengthening guidelines (AOR = 0.85; CI 0.74-0.99) among Latinos.

CONCLUSIONS

Disparities in pain exist for African Americans and Latinos with arthritis. Physician exercise recommendation is critical among patients with arthritis to relieve symptom burden.