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Wanitschek A, Seebacher B, Muehlbacher A, Brenneis C, Ehling R. Comparison of patient-reported outcomes of physical activity and accelerometry in people with multiple sclerosis and ambulatory impairment: A cross-sectional study. Mult Scler Relat Disord 2024; 85:105532. [PMID: 38452648 DOI: 10.1016/j.msard.2024.105532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/29/2023] [Accepted: 02/29/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Accelerometers and patient-reported outcomes (PRO) are used to assess physical activity (PA) in people with multiple sclerosis (pwMS). So far it is unknown, however, whether these assessments represent mobility limitations in pwMS with mild and moderate to severe disability alike. The primary aim of the study was to assess the correlation between accelerometry and International Physical Activity Questionnaire (IPAQ) scores in pwMS with different degrees of ambulatory impairment. Taken its frequent use into account, the Godin Leisure Time Exercise Questionnaire (GLTEQ) was investigated as additional PRO. METHODS In a prospective cohort of pwMS, correlational analyses were performed between the number of daily steps, time spent in light, moderate to vigorous PA (MVPA) and time spent sitting as assessed using accelerometry (ActiGraph®-GT3X), and the respective IPAQ and GLTEQ scores. Additionally, associations of PA with disease-specific characteristics, aerobic capacity (VO2peak), walking assessments (Timed 25-Foot Walk, T25FW; 2-Minute Walk Test, 2MWT) and walking perception (Multiple Sclerosis Walking Scale-12; MSWS-12) were explored. Patient subgroups with mild (Expanded Disability Status Scale; EDSS score <4.0) and moderate to severe disability (EDSS ≥4.0) were analysed for the impact of ambulatory impairment on PA. Multiple linear regression was used to determine predictors of PA. RESULTS A total of 56 pwMS completed the study, with a mean (standard deviation, SD) age of 48.4 (10.3) years, disease duration of 14.8 (9.6) years and median (interquartile range) EDSS score of 3.5 (2.0 - 4.4). Moderate to weak correlations were found between daily step count and IPAQ total metabolic equivalent (MET) minutes/week (p < 0.001; r = 0.506), MVPA MET-minutes/week (p < 0.01; r = 0.479) and walking MET-minutes/week (p < 0.05; r = 0.372) in the total cohort. Time spent sitting was inversely correlated with total MET-minutes/week and MVPA MET-minutes/week (p < 0.05; r = -0.358 and r = -0.365). Subgroup analysis revealed, that daily step count was significantly correlated with total MET-minutes/week, MVPA MET-minutes/week and walking MET-minutes/week (p < 0.01, r = 0.569; p < 0.01, r = 0.531 and p < 0.05, r = 0.480, respectively) in the "mild disability" subgroup only, whereas time spent sitting was inversely correlated with total MET-minutes/week (p < 0.05; r = -0.582) in the "moderate to severe disability" subgroup. There was no association between objectively assessed PA and GLTEQ scores in any group. In the total cohort, moderate to weak correlations were found between daily step count and walking assessments (T25FW: p < 0.01, ρ = -0.508; 2MWT: p < 0.01, ρ=0.463) and MSWS-12 (p < 0.001; ρ = -0.609). Moderate to weak correlations were also observed between VO2peak and walking assessments (T25FW: p < 0.01; ρ = -0.516; 2MWT: p < 0.01, ρ=0.480). Multiple linear regression analysis identified disability and VO2peak as predictors of PA (p = 0.045; β=0.25 and p < 0.001; β=0.49). CONCLUSION Significant associations of objective PA measurements using accelerometry with IPAQ were found only in pwMS with "mild disability". In pwMS with "moderate to severe disability", IPAQ did not reflect the objectively assessed amount of PA. In our cohort, GLTEQ showed no association with objectively assessed PA. Thus, an MS-specific self-reported questionnaire for assessing PA is warranted.
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Affiliation(s)
- Andreas Wanitschek
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria; Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
| | - Barbara Seebacher
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria; Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria; Department of Rehabilitation Science, Clinic for Rehabilitation Muenster, Muenster, Austria
| | - Andreas Muehlbacher
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria; Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
| | - Christian Brenneis
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria; Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
| | - Rainer Ehling
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria; Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria.
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Motl RW, Bombardier CH, Duffecy J, Hibner B, Wathen A, Carrithers M, Cutter G. Study protocol: exercise training for treating major depressive disorder in multiple sclerosis. BMC Neurol 2024; 24:131. [PMID: 38632556 PMCID: PMC11022372 DOI: 10.1186/s12883-024-03634-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is prevalent, yet sub-optimally treated among persons with multiple sclerosis (MS). We propose that exercise training may be a promising approach for treating depression in persons with MS who have MDD. Our primary hypothesis predicts a reduction in depression severity immediately after an exercise training intervention compared with minimal change in an attention control condition, and the reduction will be maintained during a follow-up period. METHODS This study involves a parallel-group, assessor-blinded RCT that examines the effect of a 4-month home-based exercise training intervention on depression severity in a sample of persons with MS who have MDD based on the MINI International Neuropsychiatric Interview. The primary outcomes of depression severity are the Patient Health Questionnaire-9 and Hamilton Depression Rating Scale. Participants (N = 146) will be recruited from within 200 miles of the University of Illinois at Chicago and randomized (1:1) into either a home-based exercise training condition or control condition with concealed allocation. The exercise training and social-contact, attention control (i.e., stretching) conditions will be delivered remotely over a 4-month period and supported through eight, 1:1 Zoom-based behavioral coaching sessions guided by social-cognitive theory and conducted by persons who are uninvolved in screening, recruitment, random assignment, and outcome assessment. We will collect outcome data at 0, 4 and 8 months using treatment-blinded assessors, and data analyses will involve intent-to-treat principles. DISCUSSION If successful, the proposed study will provide the first Class I evidence supporting a home-based exercise training program for treating MDD in persons with MS. This is critical as exercise training would likely have positive secondary effects on symptoms, cognition, and quality of life, and provide a powerful, behavioral approach for managing the many negative outcomes of MDD in MS. The program in the proposed research is accessible and scalable for broad treatment of depression in MS, and provides the potential for integration in the clinical management of MS. TRIAL REGISTRATION The trial was registered on September 10, 2021 at clinicaltrials.gov with the identifier NCT05051618. The registration occurred before we initiated recruitment on June 2, 2023.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, 60612, USA.
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jennifer Duffecy
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Brooks Hibner
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Alison Wathen
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Michael Carrithers
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
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Motl RW, Sandroff BM, Benedict RHB, Aldunate R, Cutter G, Barron E. Internet-delivered lifestyle physical activity intervention for cognitive processing speed in multiple sclerosis. Contemp Clin Trials 2024; 138:107446. [PMID: 38242351 DOI: 10.1016/j.cct.2024.107446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/18/2023] [Accepted: 01/15/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND We propose a randomized controlled trial(RCT) of a Social Cognitive Theory-based(SCT), Internet-delivered behavioral intervention targeting lifestyle physical activity(LPA) for yielding improvements in cognitive processing speed(CPS), learning and memory(L/M), symptoms, and quality of life(QOL) among persons with mild multiple sclerosis(MS)-related ambulatory impairment who have impaired CPS. METHODS/DESIGN The study involves a Phase-II, parallel group, RCT design. Participants with MS(N = 300) will be randomly assigned on an equal basis(1:1) into behavioral intervention(n = 150) or attention and social contact control(n = 150) conditions. The conditions will be administered over 6-months by trained behavior coaches who will be uninvolved in screening, recruitment, random assignment, and outcome assessment. We will collect outcome data remotely every 6-months over the 12-month period(baseline, immediate follow-up, and 6-month follow-up) using a treatment blinded assessor. The primary outcome is the raw, oral Symbol Digit Modalities Test as a neuropsychological measure of CPS. The secondary outcomes include the California Verbal Learning Test-II as an objective measure of L/M, and patient-reported outcomes of fatigue, depressive symptoms, anxiety, pain, and QOL. The tertiary outcome is accelerometry as an objective, device-based measure of steps/day for generating a minimal clinically important difference(MCID) value that guides the prescription of LPA for improving CPS in clinical practice. The primary data analyses will involve intent-to-treat principles, and mixed-effects models and logistic regression. DISCUSSION If successful, the proposed study will provide Class I evidence for the efficacy of a theory-based, Internet-delivered behavioral intervention focusing on LPA for improving CPS and mitigating its negative impact on other outcomes in persons with MS. CLINICALTRIALS gov: NCT04518657.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, 1919 W. Taylor St, Chicago, IL 60612, USA..
| | - Brian M Sandroff
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA
| | - Ralph H B Benedict
- Jacobs School of Medicine, University at Buffalo, 1001 Main Street, Buffalo, NY 14203, USA
| | - Roberto Aldunate
- Center for Innovation and Applied Research, 1807 Savanna Dr., Champaign, IL 61820, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama Birmingham, 1665 University Blvd, Birmingham, AL 35233, USA
| | - Emily Barron
- Department of Kinesiology and Nutrition, University of Illinois Chicago, 1919 W. Taylor St, Chicago, IL 60612, USA
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Huynh TLT, Barstow EA, Motl RW. Feasibility of a theory-based physical activity intervention for persons newly diagnosed with multiple sclerosis. Mult Scler Relat Disord 2024; 83:105446. [PMID: 38262331 DOI: 10.1016/j.msard.2024.105446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/26/2023] [Accepted: 01/13/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Physical activity (PA) is beneficial for rehabilitation and symptom management in multiple sclerosis (MS), yet persons newly diagnosed with MS are insufficiently active and have not been the focus of PA research. This is important as early initiation of lifestyle PA, alongside other disease modifying therapies, might maximize the lasting benefits of this behavior on health outcomes and health-related quality of life (HRQOL) in MS. PURPOSE This single group, pre-post study examined the feasibility and initial efficacy of a 12-week remotely delivered COM-B-based behavior change intervention targeting lifestyle PA in persons newly diagnosed with MS. METHODS Persons newly diagnosed with MS (diagnosis of 2 years or less) were recruited for the study. The intervention was designed based on COM-B and formative research, and included a program manual, newsletters, video coaching calls, pedometer, logbook, and calendar. Feasibility was assessed in four domains: process (e.g., recruitment, retention), resource (e.g., time and costs), management (e.g., data management), and scientific evidence (e.g., safety, treatment effects). RESULTS Thirty-two persons newly diagnosed with MS underwent screening, 17 were eligible, and 14 started the intervention. Twelve participants completed the study (86 % retention rate). All participants in the intervention engaged in 100 % of video coaching calls and participants provided 73 % of online step count entries. Eighty-three percent of participants fully complied with reviewing the newsletters. No relapses were reported during the intervention. There were moderate-to-large increases in PA outcomes, as measured by the Godin Leisure-Time Exercise Questionnaire, International Physical Activity Questionnaire, and accelerometry (light PA) (d ≥ 0.5). There were no significant changes in other accelerometry outcomes, including step counts and moderate-to-vigorous PA (d = 0.2). There were large, positive effects of the intervention on physical and mental health-related quality of life with (d ≥ 1), but the change in fatigue severity was small and not statistically significant among the study participants (d = 0.3). CONCLUSIONS This study provides evidence for feasibility and initial efficacy of a COM-B-based PA intervention for persons newly diagnosed with MS. The results indicate that this intervention was feasible, safe, acceptable, and promising for promoting lifestyle PA in persons newly diagnosed with MS.
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Affiliation(s)
- Trinh L T Huynh
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA.
| | - Elizabeth A Barstow
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
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Silveira SL, Motl RW, Sandroff BM, Pilutti LA, Cutter GR. Randomized Controlled Trial of the Behavioral Intervention for Physical Activity in Multiple Sclerosis Project: Response Heterogeneity and Predictors of Change. Int J Behav Med 2024:10.1007/s12529-024-10265-7. [PMID: 38326673 DOI: 10.1007/s12529-024-10265-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND We reported that a social cognitive theory-based (SCT), Internet-delivered behavioral intervention increased device-measured minutes/day of moderate-to-vigorous physical activity (MVPA) over a 6-month period among persons with multiple sclerosis (MS). This paper examined the pattern and predictors of heterogeneity in change for MVPA. Based on previous research, we hypothesized that mild MS disability, fewer MS symptoms, lower baseline MVPA, and positive SCT characteristics (e.g., high exercise self-efficacy) would be associated with greater change in MVPA. METHOD Persons with MS (N = 318) were randomized into behavioral intervention (n = 159) or attention/social contact control (n = 159) conditions that were administered via Internet websites and supported with behavioral coaching. Demographic, clinical, symptom, behavioral, and SCT data were from before the 6-month period of delivering the conditions, and MVPA data were from before and after the 6-month period. We examined heterogeneity based on waterfall plots, box plots, and the Levene statistic. We identified predictors of MVPA change using bivariate correlation and multiple, linear regression analyses per condition. RESULTS The Levene statistic indicated statistically significant heterogeneity of variances for MVPA change between conditions (p = .003), and the waterfall plots and box plots indicated greater heterogeneity in MVPA change for the behavioral intervention. MVPA change score was correlated with baseline MVPA (r = - .33 and r = - .34, p = .0004 and p = .0001) in both conditions and walking impairment (r = - .188, p = .047) and race (r = .233, p = .014) in the behavioral intervention condition. The regression analysis indicated that baseline MVPA (Standardized B = - .449, p = .000002), self-reported walking impairment (Standardized B = - .310, p = .0008), and race (Standardized B = .215, p = .012) explained 25.6% of variance in MVPA change for the behavioral intervention condition. CONCLUSION We provide evidence for walking impairment, baseline MVPA, and race as predictors of the heterogeneity in the pattern of MVPA change with a behavioral intervention.
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Affiliation(s)
- Stephanie L Silveira
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX, 77030, USA.
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, USA
| | - Brian M Sandroff
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, USA
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
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Abou L, Whibley D, Clauw DJ, Kratz AL. Widespread Pain With Nociplastic Features is an Independent Predictor of Low Physical Activity in People with Multiple Sclerosis. J Pain 2024; 25:418-427. [PMID: 37741524 DOI: 10.1016/j.jpain.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/17/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023]
Abstract
Exploring the relationship between underlying pain mechanisms and physical activity could inform interventions to optimize physical activity in persons with multiple sclerosis (PwMS). This cross-sectional nationwide survey examined whether pain phenotype is a significant predictor of self-reported physical activity in PwMS. The study included 938 persons with a self-reported diagnosis of MS (93% reported neurologist-diagnosed MS) who completed surveys of demographic, clinical information, pain intensity, indicators of underlying pain mechanisms (Fibromyalgia Survey Criteria and painDETECT), and physical activity (Godin Leisure-Time Exercise Questionnaire). Responses were used to categorize pain phenotypes as widespread pain with nociplastic features (WPNF), neuropathic, nociceptive, or mixed (neuropathic/WPNF). Following current physical activity guidelines, self-reported physical activity was categorized as active or insufficiently active/sedentary. Applying multivariable logistic regression, participants with no chronic pain had 2.30 higher odds of being physically active when compared to participants with chronic mixed pain. Similarly, participants with neuropathic and nociceptive pain had, respectively, 1.90 and 1.66 higher odds of being physically active compared to individuals with mixed pain. Higher scores on the fibromyalgia survey criteria (operationalized in this study as an indicator of WPNF) were a significant independent predictor of insufficient physical activity (OR = .93, P < .01). Findings indicate that experience and phenotype of chronic pain, in particular WPNF, are associated with physical inactivity in PwMS. This suggests that assessing pain phenotype may be important to identify individuals at risk of inadequate physical activity and may guide the tailoring of behavioral therapeutic approaches to help PwMS achieve the recommended level of physical activity. PERSPECTIVE: This study examines the association between pain mechanism and physical activity in multiple sclerosis. These findings highlight the possibility that a basic screening for pain mechanism could offer clinically useful information without requiring extensive neurobiological phenotyping and may inform the development of behavioral interventions to enhance physical activity in multiple sclerosis.
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Affiliation(s)
- Libak Abou
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Daniel Whibley
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Daniel J Clauw
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Anna L Kratz
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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Silveira SL, Motl RW, Salter A, Marquez DX. Social Cognitive Theory Variables as Correlates of Physical Activity Behavior Among Hispanics With Multiple Sclerosis. Arch Phys Med Rehabil 2024:S0003-9993(24)00053-4. [PMID: 38281577 DOI: 10.1016/j.apmr.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To examine the association between social cognitive theory (SCT) variables and physical activity (PA) behavior in Hispanic adults with multiple sclerosis (MS). DESIGN Observational, survey study. SETTING General community. PARTICIPANTS Inclusion criteria: (a) age 18 years or older, (b) self-identify as Hispanic or Latino, (c) diagnosis of MS, and (d) English or Spanish as primary language. Two hundred forty-three individuals opened the survey, 24 individuals did not meet inclusion criteria, and 66 individuals were excluded due to not completing any of the SCT variable measures (N=153). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) PA was measured using the Godin Leisure Time Exercise Questionnaire (GLTEQ) total and Health Contribution Scores (HCS). SCT variables included standard measures of exercise self-efficacy, planning, goal setting, outcome expectations, social support, and functional impairment. RESULTS The final sample included 153 participants with a mean (SD) age of 43 (11) years, 78% identified as women, 57% were employed, and 63% had a college degree or higher. The mean (SD) MS disease duration was 11 (9) years, 74% of participants reported relapsing remitting MS, and median (interquartile range) Patient Determined Disease Steps (PDDS) score was 3.0 (3.0). Significant correlations were observed between all SCT variables and both GLTEQ total and GLTEQ HCS scores (P<.001). Forward stepwise regression with Akaike's Information Criterion (AICC) identified PDDS, age, exercise planning, exercise self-efficacy, and exercise goal setting as the most appropriate covariates and SCT variables to include in a multivariable model examining independent contributions on GLTEQ HCS scores. The multivariable, linear regression analysis indicated that PDDS (Standardized B=-.280, P<.001), exercise planning (Standardized B=.214, P<.05), and exercise self-efficacy (Standardized B=.183, P<.05) explained 42.4% of variance in GLTEQ HCS scores. CONCLUSIONS This study provides a contribution to the literature by identifying SCT variables that correlate with PA behavior among Hispanics with MS that may guide the creation of culturally appropriate PA programs.
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Affiliation(s)
- Stephanie L Silveira
- Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, TX.
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL
| | - Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, University of Texas Southwestern, Dallas, TX
| | - David X Marquez
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL
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Ertekin Ö, Kara T, Abasıyanık Z, Kahraman T, Özakbaş S. Sedentary behaviour and related factors in people with multiple sclerosis. Mult Scler Relat Disord 2024; 81:105152. [PMID: 38061316 DOI: 10.1016/j.msard.2023.105152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/03/2023] [Accepted: 11/21/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Sedentary behaviour is a major problem in persons with multiple sclerosis (pwMS). However, little is known about the related factors of sedentary behaviour in MS. Our study aimed to examine the association between sedentary behaviour and physical activity level, fear of falling, and fatigue. METHOD Demographic and clinical data have been recorded. Sedentary behaviour was assessed with the Marshall Sitting Questionnaire, physical activity level was evaluated with the Godin Leisure Time Exercise Questionnaire, fear of falling was evaluated with the Fall Efficacy Scale International, and fatigue was evaluated with the modified fatigue impact scale (MFIS). The Timed 25-Foot Walk, 6-Minute Walk Test, Timed Up and Go Test, and 12-Item Multiple Sclerosis Walking Scale were also used to assess walking and perceived walking disability. RESULTS We recruited 71 pwMS [49 were female (69 %), mean age:38.08 years, median EDSS:1.5]. The mean daily sitting time was 593.54 min (∼10 h). No significant correlation was found between sitting times and demographics, leisure time physical activity, fear of falling, walking, perceived walking disability, and neurological disability level (p > 0.05). Logistic regression analysis indicated that being male increased the risk of sedentary behaviour by 3.08 times, being employed increased the risk of sitting by 4.65 times, and each point increase in MFIS scores resulted in a 1.03-fold elevation in the odds of prolonged sitting. CONCLUSION The fact that pwMS, even with a mild disability spend almost 10 h sitting highlights the significance of sedentary behaviour in this population. Developing strategies to address modifiable factors, such as fatigue, may be effective in reducing sedentary behaviour.
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Affiliation(s)
- Özge Ertekin
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Tuğçe Kara
- Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Zuhal Abasıyanık
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey; REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey; Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom
| | - Serkan Özakbaş
- Department of Neurology, Faculty of Medicine, Izmir University of Economics, Izmir, Turkey
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Dorsch EM, Röhling HM, Zocholl D, Hafermann L, Paul F, Schmitz-Hübsch T. Progression events defined by home-based assessment of motor function in multiple sclerosis: protocol of a prospective study. Front Neurol 2023; 14:1258635. [PMID: 37881311 PMCID: PMC10597627 DOI: 10.3389/fneur.2023.1258635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023] Open
Abstract
Background This study relates to emerging concepts of appropriate trial designs to evaluate effects of intervention on the accumulation of irreversible disability in multiple sclerosis (MS). Major starting points of our study are the known limitations of current definitions of disability progression by rater-based clinical assessment and the high relevance of gait and balance dysfunctions in MS. The study aims to explore a novel definition of disease progression using repeated instrumental assessment of relevant motor functions performed by patients in their home setting. Methods The study is a prospective single-center observational cohort study with the primary outcome acquired by participants themselves, a home-based assessment of motor functions based on an RGB-Depth (RGB-D) camera, a camera that provides both depth (D) and color (RGB) data. Participants are instructed to perform and record a set of simple motor tasks twice a day over a one-week period every 6 months. Assessments are complemented by a set of questionnaires. Annual research grade assessments are acquired at dedicated study visits and include clinical ratings as well as structural imaging (MRI and optical coherence tomography). In addition, clinical data from routine visits is provided semiannually by treating neurologists. The observation period is 24 months for the primary endpoint with an additional clinical assessment at 27 month to confirm progression defined by the Expanded Disability Status Scale (EDSS). Secondary analyses aim to explore the time course of changes in motor parameters and performance of the novel definition against different alternative definitions of progression in MS. The study was registered at Deutsches Register für Klinische Studien (DRKS00027042). Discussion The study design presented here investigates disease progression defined by marker-less home-based assessment of motor functions against 3-month confirmed disease progression (3 m-CDP) defined by the EDSS. The technical approach was chosen due to previous experience in lab-based settings. The observation time per participant of 24, respectively, 27 months is commonly conceived as the lower limit needed to study disability progression. Defining a valid digital motor outcome for disease progression in MS may help to reduce observation times in clinical trials and add confidence to the detection of progression events in MS.
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Affiliation(s)
- Eva-Maria Dorsch
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Hanna Marie Röhling
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Motognosis GmbH, Berlin, Germany
| | - Dario Zocholl
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lorena Hafermann
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
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Adamson B, Wyatt N, Key L, Boone C, Motl RW. Results of the MOVE MS Program: A Feasibility Study on Group Exercise for Individuals with Multiple Sclerosis. Int J Environ Res Public Health 2023; 20:6567. [PMID: 37623153 PMCID: PMC10454660 DOI: 10.3390/ijerph20166567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
Exercise improves a wide range of symptoms experienced by those living with multiple sclerosis (MS) and may foster community and a positive sense of disability identity. However, exercise rates remain low. Sustained exercise participation has the greatest likelihood of improving symptoms and requires a theory-based approach accounting for the barriers faced by people with MS that impede exercise participation long-term. MOVE MS is a once weekly group exercise program based on Social Cognitive Theory supporting long-term exercise participation through peer instruction, behavior change education, multiple exercise modalities, and seated instruction. This feasibility study evaluated MOVE MS with a 7-month trial. The primary scientific outcome was exercise participation and the secondary outcomes were MS symptoms/impact, self-efficacy, depression, anxiety, disability identity, and quality of life, among others. We further conducted semi-structured formative interviews post-intervention. Thirty-three participants began the program. The onset of COVID-19 necessitated a shift toward online delivery. Seventeen participants completed the program. There were non-significant improvements in exercise participation (Godin Leisure-Time Exercise Questionnaire, baseline mean = 14.2 (SD = 11.8), post-intervention mean = 16.6 (SD = 11.2), F-value = 0.53 (Partial Eta2 = 0.08), and several secondary outcomes (including the MS Impact Scale, MS Walking Scale, and the Leeds MS Quality of Life Scale). Sixteen participants were interviewed, and analysis yielded five themes on program components and feedback. MOVE MS-delivered in-person or online-may be a feasible option for long-term exercise programming for people with MS.
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Affiliation(s)
- Brynn Adamson
- Department of Health Sciences, University of Colorado Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80907, USA
| | - Nic Wyatt
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 506 S. Wright St., Urbana, IL 61801, USA
| | - Latashia Key
- Department of Recreation, Sport, and Tourism, University of Illinois at Urbana-Champaign, 506 S. Wright St., Urbana, IL 61801, USA
| | - Carrena Boone
- Department of Health Sciences, University of Colorado Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80907, USA
| | - Robert W. Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, 1200 West Harrison St., Chicago, IL 60607, USA
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11
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Schlagheck ML, Hübner ST, Joisten N, Walzik D, Rademacher A, Wolf F, Bansi J, Warnke C, Zimmer P. Physical activity is related to disease severity and fatigue, but not to relapse rate in persons with relapsing remitting multiple sclerosis - a self-reported questionnaire based study. Front Neurol 2023; 14:1217000. [PMID: 37583953 PMCID: PMC10423808 DOI: 10.3389/fneur.2023.1217000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Based on theoretical models, physical activity has been introduced as a promoting method to mitigate the disease severity, fatigue and relapse rate in multiple sclerosis. The primary objective of the study was to investigate the relation between self-reported physical activity level and disease severity, fatigue and relapse rate in persons with relapsing remitting multiple sclerosis (RRMS). Methods A survey was offered to persons with RRMS from March 2019 to August 2021 (n = 253). Physical activity level, fatigue and disease severity were determined using the Godin Leisure-Time Questionnaire (GLTEQ), the Patient Determined Disease Steps (PDDS) scale and the Fatigue Scale for Motor and Cognitive Functions (FSMC). Additionally, participants' relapse rate was recorded. Results Bivariate correlations revealed an inverse relation between physical activity level and PDDS (ρ = -0.279; p < 0.001) as well as between physical activity and FSMC (r = -0.213, p < 0.001), but not between physical activity and relapse rate (r = 0.033, p > 0.05). Multiple linear regression analyses explained 12.6% and 5.2% of the variance of PDDS and FSMC. Conclusion Our findings confirm a relation between self-reported physical activity, disease severity and fatigue in persons with RRMS. However, self-reported physical activity level does not seem to affect the annualised relapse rate.
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Affiliation(s)
- Marit L. Schlagheck
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
| | - Sven T. Hübner
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Niklas Joisten
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
| | - David Walzik
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
| | - Annette Rademacher
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Florian Wolf
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
- Neurological Rehabilitation Centre Godeshöhe, Bonn, Germany
| | - Jens Bansi
- Department of Research and Development, Kliniken Valens, Valens, Switzerland
- Department of Health, OST – Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp Zimmer
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
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12
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Woelfle T, Bourguignon L, Lorscheider J, Kappos L, Naegelin Y, Jutzeler CR. Wearable Sensor Technologies to Assess Motor Functions in People With Multiple Sclerosis: Systematic Scoping Review and Perspective. J Med Internet Res 2023; 25:e44428. [PMID: 37498655 PMCID: PMC10415952 DOI: 10.2196/44428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/19/2022] [Accepted: 05/04/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Wearable sensor technologies have the potential to improve monitoring in people with multiple sclerosis (MS) and inform timely disease management decisions. Evidence of the utility of wearable sensor technologies in people with MS is accumulating but is generally limited to specific subgroups of patients, clinical or laboratory settings, and functional domains. OBJECTIVE This review aims to provide a comprehensive overview of all studies that have used wearable sensors to assess, monitor, and quantify motor function in people with MS during daily activities or in a controlled laboratory setting and to shed light on the technological advances over the past decades. METHODS We systematically reviewed studies on wearable sensors to assess the motor performance of people with MS. We scanned PubMed, Scopus, Embase, and Web of Science databases until December 31, 2022, considering search terms "multiple sclerosis" and those associated with wearable technologies and included all studies assessing motor functions. The types of results from relevant studies were systematically mapped into 9 predefined categories (association with clinical scores or other measures; test-retest reliability; group differences, 3 types; responsiveness to change or intervention; and acceptability to study participants), and the reporting quality was determined through 9 questions. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. RESULTS Of the 1251 identified publications, 308 were included: 176 (57.1%) in a real-world context, 107 (34.7%) in a laboratory context, and 25 (8.1%) in a mixed context. Most publications studied physical activity (196/308, 63.6%), followed by gait (81/308, 26.3%), dexterity or tremor (38/308, 12.3%), and balance (34/308, 11%). In the laboratory setting, outcome measures included (in addition to clinical severity scores) 2- and 6-minute walking tests, timed 25-foot walking test, timed up and go, stair climbing, balance tests, and finger-to-nose test, among others. The most popular anatomical landmarks for wearable placement were the waist, wrist, and lower back. Triaxial accelerometers were most commonly used (229/308, 74.4%). A surge in the number of sensors embedded in smartphones and smartwatches has been observed. Overall, the reporting quality was good. CONCLUSIONS Continuous monitoring with wearable sensors could optimize the management of people with MS, but some hurdles still exist to full clinical adoption of digital monitoring. Despite a possible publication bias and vast heterogeneity in the outcomes reported, our review provides an overview of the current literature on wearable sensor technologies used for people with MS and highlights shortcomings, such as the lack of harmonization, transparency in reporting methods and results, and limited data availability for the research community. These limitations need to be addressed for the growing implementation of wearable sensor technologies in clinical routine and clinical trials, which is of utmost importance for further progress in clinical research and daily management of people with MS. TRIAL REGISTRATION PROSPERO CRD42021243249; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=243249.
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Affiliation(s)
- Tim Woelfle
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Lucie Bourguignon
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Johannes Lorscheider
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Yvonne Naegelin
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
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13
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Sandroff BM, Wender CLA, Weber E, Wells G, Motl RW. Feasibility of remotely delivered and supported aerobic walking exercise training for cognitive processing speed impairment in fully-ambulatory persons with multiple sclerosis. Mult Scler Relat Disord 2023; 74:104709. [PMID: 37086638 DOI: 10.1016/j.msard.2023.104709] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/26/2023] [Accepted: 04/06/2023] [Indexed: 04/24/2023]
Abstract
PURPOSE The current pilot, single-blind, randomized controlled trial (RCT) examined the feasibility of remotely-delivered and supported aerobic walking exercise training compared with an active control condition on cognitive processing speed (CPS) in 19 fully-ambulatory persons with multiple sclerosis (pwMS) who were pre-screened for impaired CPS. METHODS Feasibility was assessed in the domains of process (e.g., recruitment), resource (e.g., monetary costs), management (e.g., time requirements), and scientific outcomes (i.e., treatment effect). Fully-ambulatory, but CPS-impaired pwMS were randomly assigned into either 16-weeks of home-based aerobic walking exercise or home-based stretching and range-of-motion activities. Both conditions involved delivery of informational newsletters and one-on-one, online video chats with a behavior coach. Participants across both conditions tracked their activity using highly accurate wearable motion sensors. Treatment-blinded assessors administered the Symbol Digit Modalities Test (SDMT) remotely before and after the 16-week study period. RESULTS The study was cost-effective, accessible, and acceptable. The intervention further was safe. Adherence and compliance rates across both conditions exceeded 80%. There was an overall moderate effect for change in SDMT score between the conditions (d = 0.42). The intervention was associated with a 4.8-point improvement in SDMT scores (d = 0.70; 10% increase) compared with a 1-point improvement for the control condition (d = 0.09; 2% increase). CONCLUSIONS This remotely-delivered and supported aerobic walking exercise training intervention was safe and feasible for fully-ambulatory, CPS-impaired pwMS. The pattern of results, including the promising effects on CPS, support the design and implementation of an appropriately-powered RCT on this approach for managing CPS impairment in a large MS sample.
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Affiliation(s)
- Brian M Sandroff
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, West Orange, NJ, United States; Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA.
| | - Carly L A Wender
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, West Orange, NJ, United States; Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Erica Weber
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, West Orange, NJ, United States; Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Grace Wells
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, West Orange, NJ, United States
| | - Robert W Motl
- University of Illinois Chicago, Department of Kinesiology and Nutrition, Chicago, IL, United States
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14
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Silveira SL, Jeng B, Cutter G, Motl RW. Diet, Physical Activity, and Stress Among Wheelchair Users With Multiple Sclerosis: Examining Individual and Co-Occurring Behavioral Risk Factors. Arch Phys Med Rehabil 2023; 104:590-596.e1. [PMID: 36649911 PMCID: PMC10073284 DOI: 10.1016/j.apmr.2022.12.194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/07/2022] [Accepted: 12/18/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This study examined individual and co-occurring behavioral risk factors (diet, exercise, and stress) in wheelchair users with multiple sclerosis (MS) and potential association with MS symptoms (ie, fatigue, depression, anxiety, pain, sleep, and health-related quality of life [HRQOL]). DESIGN Survey. SETTING General Community. PARTICIPANTS One hundred twenty-three wheelchair users with MS completed this study (N=123). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants were mailed instructions for accessing online questionnaires (demographic and clinical characteristics, Godin Leisure-Time Exercise Questionnaire, Perceived Stress Scale, Automated Self-Administered 24-Hour Dietary Assessment Tool, and MS symptoms). RESULTS Standard cut-points were used to categorize behavioral risk factors and then identify the extent and distribution of these behaviors both individually and co-occurring. We then analyzed the associations between behavioral risk factors and MS symptoms using bivariate correlation analyses and Mann-Whitney U tests. The mean age of participants was 60.6±10.0 years, 76% identified as women, 82% had a progressive disease course, and the mean MS duration was 23.0±9.7 years. Seven participants were classified as having 0 negative health behaviors, 41 participants had 1 negative health behavior, 49 participants had 2 negative health behaviors, and 26 participants had 3 negative health behaviors. The number of negative health behaviors was significantly correlated with HRQOL (physical, r=.30; psychological, r=.47), sleep (r=.25), depressive symptoms (r=.36), and anxiety (r=.43). Mann-Whitney U tests indicated greater fatigue, depression, and anxiety as well as lower sleep quality and HRQOL among participants who reported 2 or 3 behavioral risk factors compared with 0 or 1 behavioral risk factor. CONCLUSIONS Future research should examine the design and implementation of multiple health behavior change interventions targeting co-occurring behavioral risk factors among wheelchair users with MS.
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Affiliation(s)
- Stephanie L Silveira
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL; Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, TX.
| | - Brenda Jeng
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL; Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL; Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL
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15
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Romanò F, Motl RW, Valsasina P, Amato MP, Brichetto G, Bruschi N, Chataway J, Chiaravalloti ND, Cutter G, Dalgas U, DeLuca J, Farrell R, Feys P, Freeman J, Inglese M, Meza C, Salter A, Sandroff BM, Feinstein A, Rocca MA, Filippi M. Abnormal thalamic functional connectivity correlates with cardiorespiratory fitness and physical activity in progressive multiple sclerosis. J Neurol 2023; 270:3213-3224. [PMID: 36933030 DOI: 10.1007/s00415-023-11664-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Altered thalamic volumes and resting state (RS) functional connectivity (FC) might be associated with physical activity (PA) and cardiorespiratory fitness (CRF) in people with progressive multiple sclerosis (PMS). OBJECTIVES To assess thalamic structural and functional alterations and investigate their correlations with PA/CRF levels in people with PMS. METHODS Seven-day accelerometry and cardiopulmonary exercise testing were used to assess PA/CRF levels in 91 persons with PMS. They underwent 3.0 T structural and RS fMRI acquisition with 37 age/sex-matched healthy controls (HC). Between-group comparisons of MRI measures and their correlations with PA/CRF variables were assessed. RESULTS PMS people had lower volumes compared to HC (all p < 0.001). At corrected threshold, PMS showed decreased intra- and inter-thalamic RS FC, and increased RS FC between the thalamus and the hippocampus, bilaterally. At uncorrected threshold, decreased thalamic RS FC with caudate nucleus, cerebellum and anterior cingulate cortex (ACC), as well as increased thalamic RS FC with occipital regions, were also detected. Lower CRF, measured as peak oxygen consumption (VO2peak), correlated with lower white matter volume (r = 0.31, p = 0.03). Moreover, lower levels of light PA correlated with increased thalamic RS FC with the right hippocampus (r = - 0.3, p = 0.05). DISCUSSION People with PMS showed widespread brain atrophy, as well as pronounced intra-thalamic and thalamo-hippocampal RS FC abnormalities. White matter atrophy correlated with CRF, while increased thalamo-hippocampal RS FC was associated to worse PA levels. Thalamic RS FC might be used to monitor physical impairment and efficacy of rehabilitative and disease-modifying treatments in future studies.
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Affiliation(s)
- Francesco Romanò
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Maria Pia Amato
- Section Neurosciences, Department NEUROFARBA, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy.,AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Via Operai 30, 16149, Genoa, Italy
| | - Nicolò Bruschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Jeremy Chataway
- Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, UCL, London, UK.,Biomedical Research Centre, National Institute for Health Research, University College London Hospitals, London, UK
| | - Nancy D Chiaravalloti
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000, Aarhus, Denmark
| | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Rachel Farrell
- Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Peter Feys
- Faculty of Rehabilitation Sciences, REVAL, Hasselt University, Diepenbeek, Belgium.,UMSC Hasselt, Pelt, Belgium
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Devon, UK
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - Amber Salter
- Section on Statistical Planning and Analysis, Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Brian M Sandroff
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy. .,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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16
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Motl RW, Kinnett-Hopkins D, Neal W, Flores E, Pekmezi D, Flores V. Targeted exercise for African-Americans with multiple sclerosis: Project TEAAMS. Contemp Clin Trials 2023; 126:107088. [PMID: 36669728 DOI: 10.1016/j.cct.2023.107088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND We propose a randomized controlled trial (RCT) that examines the effects of a remotely-delivered, cultrally-tailored exercise training program for immediate and sustained improvements in patient-reported outcomes (PROs) of walking dysfunction, symptoms, and health-related quality of life (HRQOL) among African-Americans with multiple sclerosis (MS). METHODS/DESIGN The study will be conducted using a parallel group RCT design. The RCT examines the effects of a remotely-delivered, culturally-tailored exercise training program compared with an active control condition among 100 African-Americans with MS. The primary PROs focus on walking dysfunction. The secondary PROs include symptoms of fatigue, depression, anxiety, and HRQOL. The tertiary PROs include exercise behavior and mediator variables based on social cognitive theory. Participants will be randomly assigned into one of two conditions, intervention (Aerobic and Resistance Exercise Training) or active control (Stretching and Flexibility), using a random numbers sequence with concealed allocation. The conditions will be administered over four months by a trained behavioral coach who will be uninvolved in recruitment, screening, random assignment, and outcome assessment. We will monitor the outcomes of interest before and after the 4-month intervention period, and then again 4 months after intervention cessation for capturing stability of intervention effects. The data analysis will follow intent-to-treat principles with a linear mixed model. DISCUSSION If successful, this RCT will provide initial evidence for the uptake and implementation of the program in clinics/environments providing healthcare for African-Americans with MS.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA.
| | | | - Whitney Neal
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edson Flores
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Dorothy Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victoria Flores
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
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17
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Motl RW, Kidwell-Chandler A, Sandroff BM, Pilutti LA, Cutter GR, Aldunate R, Bollaert RE. Primary results of a phase-III, randomized controlled trial of the Behavioral Intervention for increasing Physical Activity in Multiple Sclerosis project. Mult Scler 2023; 29:415-426. [PMID: 36843446 DOI: 10.1177/13524585221146430] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
BACKGROUND We undertook a phase-III, randomized controlled trial (RCT) that examined the effectiveness of a behavioral intervention based on social cognitive theory (SCT) and delivered through the Internet using e-learning approaches for immediate and sustained increases in physical activity among persons with multiple sclerosis (MS). METHOD The study followed a parallel group RCT design. Persons with MS (N = 318) were randomized into either behavioral intervention (n = 159) or attention/social contact control (n = 159) conditions. The conditions were administered over a 6-month period by persons who were uninvolved in screening, recruitment, random assignment, and outcome assessment. There was a 6-month follow-up period without access of conditions. We collected outcome data every 6 months over the 12-month period. The primary outcome was device-measured minutes/day of moderate-to-vigorous physical activity (MVPA). The data analysis involved a modified intent-to-treat approach (i.e. those who received the allocated conditions) using a linear mixed model. RESULTS There was a significant group by time interaction on the primary outcome of device-measured minutes/day of MVPA (p < 0.005). MVPA was increased immediately after the 6-month period in the behavioral intervention compared with control, and this difference was sustained over the 6-month follow-up. CONCLUSION This study provides evidence for the effectiveness of a widely scalable approach for increasing MVPA in persons with MS.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | | | | | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Rachel E Bollaert
- Program in Exercise Science, Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
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Ozdogar AT, Ertekin O, Kahraman T, Dastan S, Ozakbas S. Effect of exergaming in people with restless legs syndrome with multiple sclerosis: A single-blind randomized controlled trial. Mult Scler Relat Disord 2023; 70:104480. [PMID: 36603295 DOI: 10.1016/j.msard.2022.104480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/24/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Restless legs syndrome (RLS) is a sensory-motor disorder characterized by an uncomfortable sensation in the lower extremity, triggered by sitting and lying positions and release with motion. There is strong evidence that RLS prevalence is higher in persons with multiple sclerosis (MS, pwMS) than in the general population. Current literature has shown that exergaming as non-pharmacological therapy may be an effective method for symptoms such as balance, walking, fatigue, cognitive functions in pwMS, but the effects on RLS are not known. Therefore, the study's main aim is to investigate the effects of exergaming in pwMS with RLS. METHODS Thirty-one pwMS with RLS and 34 pwMS without RLS were randomly divided as exergaming group and control group. The outcome measures were International RLS Study Group Rating Scale, Modified Fatigue Impact Scale, MS Walking Scale, Timed 25-Foot Walk Test, Hospital Anxiety and Depression Scale, Godin-Shephard Leisure-Time Physical Activity Questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, 6 min Walk Test, Timed and Up Go, MS International Quality of Life questionnaire, MS-Related Symptom Checklist. RESULTS 26 pwMS with RLS (11 exergaming group, 15 control group) and 27 pwMS without RLS (12 exergaming group, 15 control group) were included in 8-week post-treatment analyses. After an 8-week long-term follow-up, 16 pwMS with and without RLS completed the protocol. The RLS severity (p = 0.004), anxiety level (p = 0.024), sleep quality (0.005), walking (0.004), and balance functions (0.041) were improved in pwMS with RLS exergaming group, while RLS severity increased in control group (p = 0.004). At 8-week follow-up, the effect of exergaming on RLS severity, quality of life, sleep quality, and walking capacity was preserved. There was significant improvement in gait and balance functions in pwMS without RLS exergaming group, there was no significant differences control group. In 8-week follow-up, improvement obtained in pwMS without RLS exergaming group was not preserved. CONCLUSIONS This study suggests that exergaming training could be an effective method for managing RLS severity, anxiety, sleep quality, gait, balance, and quality of life in pwMS with RLS.
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Bollaert RE, Jones CD, Silic P, Motl RW. Depression, Anxiety, and Physical Activity in Older Adults With Multiple Sclerosis. J Aging Phys Act 2023; 31:128-34. [PMID: 35926843 DOI: 10.1123/japa.2021-0447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/28/2022] [Accepted: 06/09/2022] [Indexed: 02/03/2023]
Abstract
This study examined levels of depression and anxiety symptoms (Hospital Anxiety and Depression Scale scores), and self-reported (Godin Leisure-Time Exercise Questionnaire), and accelerometer-measured physical activity in older adults with multiple sclerosis (n = 40) compared with age- and sex-matched healthy controls (n = 40). We observed differences in depression, anxiety, and physical activity between groups and further observed that minutes/day of moderate to vigorous physical activity partially accounted for group differences in depression scores. We provide preliminary support for research examining approaches for increasing moderate to vigorous physical activity and possibly reducing depression symptoms in older adults with multiple sclerosis.
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Abstract
BACKGROUND The multiple sclerosis (MS) community is highly interested in diet as a potential protective factor against disability, but empirical evidence remains limited. OBJECTIVE Evaluate associations between patient-reported Mediterranean diet alignment and objective disability in a real-world MS cohort. METHODS Data were analyzed from persons with MS, aged 18-65, who completed the Mediterranean Diet Adherence Screener (MEDAS), MS Functional Composite (MSFC; primary disability metric), and patient-reported outcomes (PROs; disability, gait disturbance, fatigue, anxiety, and depression) as part of our Comprehensive Annual Assessment Program. Multiple regression predicted MSFC (and PROs) with MEDAS after adjusting for demographic (age, sex, race, ethnicity, and socioeconomic status) and health-related (body mass index (BMI), exercise, sleep disturbance, hypertension, diabetes, hyperlipidemia, and smoking) covariates. RESULTS Higher MEDAS independently predicted better outcomes across MSFC (z-score, B = 0.10 (95% confidence interval (CI): 0.06, 0.13), β = 0.18, p < 0.001), MSFC components, and PROs in 563 consecutive patients. Each MEDAS point was associated with 15.0% lower risk for MSFC impairment (⩽ 5th percentile on ⩾ 2 tasks; odds ratio (OR) = 0.850; 95% CI: 0.779, 0.928). Higher MEDAS attenuated effects of progressive disease and longer disease duration on disability. CONCLUSION With robust control for potential confounds, higher Mediterranean diet alignment predicted lower objective and patient-reported disability. Findings lay the necessary groundwork for longitudinal and interventional studies to guide clinical recommendations in MS.
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Affiliation(s)
- Ilana Katz Sand
- Department of Neurology, Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah Levy
- Department of Neurology, Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Tali Sorets
- Department of Neurology, Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James F Sumowski
- Department of Neurology, Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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21
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Motl RW, Baird JF. Health-Related Quality of Life and Physical Activity in Older Adults With Multiple Sclerosis. Int J MS Care 2023; 25:26-29. [PMID: 36711217 PMCID: PMC9881419 DOI: 10.7224/1537-2073.2021-136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND People with multiple sclerosis (MS) are living longer but not necessarily better lives, and this portends reduced health-related quality of life (HRQOL). Physical activity (PA) may be a correlate of HRQOL for people with MS. We examined differences in HRQOL and PA between older adults with and without MS to determine whether PA is associated with HRQOL and whether it accounts for group differences in HRQOL. METHODS Thirty-one older adults with MS and 30 age- and sex-matched controls without MS completed the 36-Item Short Form Health Survey (SF-36) and the Godin Leisure-Time Exercise Questionnaire (GLTEQ). Data were analyzed using the Baron and Kenny approach for examining PA via the GLTEQ as a mediator of group differences in HRQOL. RESULTS The MS group had significantly lower component scores on the SF-36 and the GLTEQ than the control group. The GLTEQ scores were correlated with SF-36 physical component scores (r = 0.52), whereas the correlation with mental component scores (r = 0.23) was small and nonsignificant. Group assignment initially explained 31% of the variance in physical component scores (β = 0.55) and adding GLTEQ to the model accounted for an additional 12% of the variance in physical component scores. Thus, group (β = 0.42) and GLTEQ (β = 0.37) were both significant correlates of physical component scores. The group effect was modestly attenuated with the addition of GLTEQ in step 2 (step 1 β = 0.55; step 2 β = 0.42) and indicated partial rather than full mediation. CONCLUSIONS These results provide cross-sectional support for future research examining approaches to increase PA to possibly improve the physical component of HRQOL in older adults with MS.
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Affiliation(s)
- Robert W. Motl
- From the Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA (RWM)
| | - Jessica F. Baird
- From the Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA (JFB)
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22
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Huynh TLT, Silveira SL, Motl RW. Physical activity behavior in persons newly diagnosed with multiple sclerosis: Applying the Capability - Opportunity - Motivation - Behavior (COM-B) model. Mult Scler Relat Disord 2023; 69:104432. [PMID: 36470170 DOI: 10.1016/j.msard.2022.104432] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/03/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Physical activity (PA) research in multiple sclerosis (MS) typically has not focused on persons newly diagnosed with the disease. This is noteworthy as PA might be most amenable for change in the early stages of MS and further yield long-term benefits over the disease course. PURPOSE This study examined correlates of PA based on the Capability-Opportunity-Motivation-Behavior (COM-B) model in persons newly diagnosed with MS. METHODS Participants newly diagnosed with MS (i.e., ≤ 2 years; n = 152) completed an online Qualtrics survey that assessed PA levels and COM-B constructs. Multivariate Analysis of Variance and Discriminant Function Analysis identified the constructs that differentiated PA groups. RESULTS The results indicated that 39.5% and 34.2% of the sample were classified as Insufficiently Active and Not Regularly Active, respectively. The results further identified Intention, Action Control, Action Self-efficacy, Action Planning, Outcome Expectation, Goal Setting, and Recovery Self-efficacy, and Fatigue as the primary correlates of PA in persons newly diagnosed with MS. CONCLUSIONS Our results identified COM-B constructs in the Capability and Motivation domains as the primary correlates of physical activity in persons newly diagnosed with MS. Such research might inform interventions for changing physical activity in this MS subpopulation.
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Affiliation(s)
- Trinh L T Huynh
- Department of Physical Therapy, University of Alabama at Birmingham, CH19 Room 301, 933 19th Street South, Birmingham, AL 35205, USA.
| | - Stephanie L Silveira
- Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, TX, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
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Polhemus A, Haag C, Sieber C, Sylvester R, Kool J, Gonzenbach R, von Wyl V. Methodological heterogeneity biases physical activity metrics derived from the Actigraph GT3X in multiple sclerosis: A rapid review and comparative study. Front Rehabil Sci 2022; 3:989658. [PMID: 36518351 PMCID: PMC9742246 DOI: 10.3389/fresc.2022.989658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/01/2022] [Indexed: 11/10/2023]
Abstract
BACKGROUND Physical activity (PA) is reduced in persons with multiple sclerosis (MS), though it is known to aid in symptom and fatigue management. Methods for measuring PA are diverse and the impact of this heterogeneity on study outcomes is unclear. We aimed to clarify this impact by comparing common methods for deriving PA metrics in MS populations. METHODS First, a rapid review of existing literature identified methods for calculating PA in studies which used the Actigraph GT3X in populations with MS. We then compared methods in a prospective study on 42 persons with MS [EDSS 4.5 (3.5-6)] during a voluntary course of inpatient neurorehabilitation. Mixed-effects linear regression identified methodological factors which influenced PA measurements. Non-parametric hypothesis tests, correlations, and agreement statistics assessed overall and pairwise differences between methods. RESULTS In the rapid review, searches identified 421 unique records. Sixty-nine records representing 51 eligible studies exhibited substantial heterogeneity in methodology and reporting practices. In a subsequent comparative study, multiple methods for deriving six PA metrics (step count, activity counts, total time in PA, sedentary time, time in light PA, time in moderate to vigorous PA), were identified and directly compared. All metrics were sensitive to methodological factors such as the selected preprocessing filter, data source (vertical vs. vector magnitude counts), and cutpoint. Additionally, sedentary time was sensitive to wear time definitions. Pairwise correlation and agreement between methods varied from weak (minimum correlation: 0.15, minimum agreement: 0.03) to perfect (maximum correlation: 1.00, maximum agreement: 1.00). Methodological factors biased both point estimates of PA and correlations between PA and clinical assessments. CONCLUSIONS Methodological heterogeneity of existing literature is high, and this heterogeneity may confound studies which use the Actigraph GT3X. Step counts were highly sensitive to the filter used to process raw accelerometer data. Sedentary time was particularly sensitive to methodology, and we recommend using total time in PA instead. Several, though not all, methods for deriving light PA and moderate to vigorous PA yielded nearly identical results. PA metrics based on vertical axis counts tended to outperform those based on vector magnitude counts. Additional research is needed to establish the relative validity of existing methods.
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Affiliation(s)
- Ashley Polhemus
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Christina Haag
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
| | - Chloé Sieber
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
| | - Ramona Sylvester
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
| | - Jan Kool
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
| | - Roman Gonzenbach
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
| | - Viktor von Wyl
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
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Tyszka EE, Bozinov N, Briggs FBS. Characterizing Relationships Between Cognitive, Mental, and Physical Health and Physical Activity Levels in Persons With Multiple Sclerosis. Int J MS Care 2022; 24:242-249. [PMID: 36090238 DOI: 10.7224/1537-2073.2021-108] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although persons with multiple sclerosis (MS) are encouraged to engage in physical activity, they are less active than the general population and experience poorer emotional/cognitive health, underscoring the need for increased understanding of the factors independently associated with exercise in MS. METHODS Six hundred forty people with MS completed a detailed demographic survey, the Godin Leisure-Time Exercise Questionnaire, and Quality of Life in Neurological Disorders short forms. The average number of weekly sessions of exercise was examined as a count, as a binary variable (a weekly minimum of 4 sessions of physical activity), and as an ordinal variable of being active using multivariable zero-inflated negative binomial, logistic, and ordered logistic regression models, respectively. Primary predictors of interest included depression, cognitive function, positive affect, and lower extremity functioning as measured by the Quality of Life in Neurological Disorders short forms. RESULTS The study sample was 91% White race, 83% female, 65% with a relapsing-remitting MS diagnosis. The mean participant age was 52 years. Across analyses, body mass index and disability were inversely associated with exercising. Greater lower extremity impairment was associated with decreased odds of exercising and being active. A greater burden of depression symptoms was correlated with lower odds of engaging in physical activity. People with MS with higher self-reported cognitive functioning were less likely to engage in any exercise, but it was not associated with frequency of activities. CONCLUSIONS These results demonstrate associations between exercise and cognitive and emotional health in people with MS, underscoring the need to consider these factors when designing MS-targeted physical activity recommendations.
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Affiliation(s)
- Emily E Tyszka
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA (EET, FBSB)
| | - Nina Bozinov
- Department of Neurology, Kootenai Clinic, Coeur d'Alene, ID, USA (NB)
| | - Farren B S Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA (EET, FBSB)
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25
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Royer N, Duboeuf M, Camdessanché JP, Millet G. Prevalence of fatigue and its explicative variables among people with multiple sclerosis. NeuroRehabilitation 2022; 51:509-517. [DOI: 10.3233/nre-220111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Fatigue is the most prevalent symptom among people with multiple sclerosis (PwMS). Although exercise effectively reduces fatigue, the relationship between daily physical activity and fatigue has only recently been demonstrated. OBJECTIVE: The aim of this study was to evaluate the prevalence of fatigue and to understand the relationship with several variables in French PwMS. METHODS: Data were collected from 191 PwMS using Modified Fatigue Impact Scale (MFIS) and Fatigue Severity Scale (FSS) for fatigue, and the Godin Leisure-Time Exercise Questionnaire (GLTEQ) for physical activity. RESULTS: 110 PwMS (57%), 35 PwMS (18%) and 46 PwMS (24%) were considered as fatigued, non-fatigued and in the grey zone, respectively. Greater physical activity was observed in non-fatigued PwMS (20.2±19.8) compared to fatigued PwMS (12.5±14.1). FSS and MFIS scores were associated with physical activity (r = –0.28 and r = –0.25, respectively, p < 0.05). Using multivariate analysis, disability, physical activity and being unemployed explained 21% of the variance of the MFIS. CONCLUSIONS: The present study confirms that physical activity and fatigue are associated. Disability and unemployment status should also to be consider when assessing fatigue. Activity-oriented health policies should be redesigned to improve fatigue among PwMS.
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Affiliation(s)
- Nicolas Royer
- Inter-University Laboratory of Human Movement Biology, UJM-Saint-Etienne, University of Lyon, Saint-Etienne, France
| | - Marine Duboeuf
- Department of Neurology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | | | - Guillaume Millet
- Inter-University Laboratory of Human Movement Biology, UJM-Saint-Etienne, University of Lyon, Saint-Etienne, France
- Institut Universitaire de France (IUF), Saint-Etienne, France
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26
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Silveira SL, Motl RW, Marquez DX, Salter A. Rates and patterns of physical activity among Hispanics with multiple sclerosis in the NARCOMS Registry. Mult Scler Relat Disord 2022. [DOI: 10.1016/j.msard.2022.104018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/24/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022]
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Kannarkat GT, Rafferty MR, Luo S, Liu H, Mills KA. Effect of Exercise and Rehabilitation Therapy on Risk of Hospitalization in Parkinson's Disease. Mov Disord Clin Pract 2022; 9:494-500. [PMID: 35586527 PMCID: PMC9092731 DOI: 10.1002/mdc3.13456] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/23/2022] [Accepted: 03/26/2022] [Indexed: 11/05/2022] Open
Abstract
Background Exercise and physical therapy (PT) can improve motor function and quality of life in individuals with Parkinson's disease (PD), but their role in hospitalization avoidance is not well-studied. Objectives To determine the longitudinal and temporal association of exercise and PT use with hospital encounter. Methods Longitudinal regression and χ2 analyses were performed on Parkinson's Foundation Parkinson's Outcome Project exercise and PT use data from 4674 and 9259 persons with PD, respectively. Results Greater exercise duration and intensity were associated with reduced odds of hospital encounter, whereas both PT and occupational therapy use were associated with increased odds. In the 2 years before a hospital encounter, there was an increased frequency of PT use, but not reductions in exercise. Conclusions Consistent exercise may reduce hospitalization risk whereas PT referral may identify at-risk individuals without preventing this outcome. Further work to incentivize consistent exercise in PD may reduce healthcare use.
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Affiliation(s)
| | - Miriam R. Rafferty
- Shirley Ryan AbilityLabChicagoIllinoisUSA
- Department of Physical Medicine and RehabilitationNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Sheng Luo
- Department of Biostatistics and BioinformaticsDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Hongliang Liu
- Department of Population Health SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Kelly A. Mills
- Department of NeurologyThe Johns Hopkins HospitalBaltimoreMarylandUSA
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28
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Lo BK, Haneuse S, McBride BA, Redline S, Taveras EM, Davison KK. Prospective Associations Between Fathers' Engagement in Infant Caregiving and Their Weight-Related Behaviors and Mental Health. Am J Mens Health 2022; 16:15579883221079152. [PMID: 35225045 PMCID: PMC8882948 DOI: 10.1177/15579883221079152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Fathers’ engagement in infant caregiving is linked with positive social,
emotional, and developmental outcomes in children; however, its relationship
with fathers’ own health is largely unknown. This longitudinal study examined
associations between fathers’ caregiving engagement with their 6-month-old
infants and their physical activity, sugar-sweetened beverage (SSB) consumption,
nighttime sleep duration, and depressive symptoms 6 months later when infants
were 12 months old. Participants were 143 fathers of infants (62.7% non-Hispanic
White, 82.3% with a bachelor’s degree). Fathers reported their frequency of
engagement in seven caregiving activities when infants were 6 months old.
Fathers’ physical activity, SSB consumption, nighttime sleep duration, and
depressive symptoms were assessed when infants were 6 and 12 months old.
Multivariate logistic regression analysis was used to assess if fathers who
reported higher infant caregiving at 6 months had more positive health outcomes
at 12 months, controlling for fathers’ age, race/ethnicity, education,
employment, household income, and the outcome at 6 months. Fathers who reported
higher caregiving engagement when infants were 6 months old had increased odds
of being sufficiently physically active 6 months later (unadjusted odds ratio
[OR] = 1.19, 95% confidence interval [CI] = [1.00, 1.41]; adjusted OR = 1.47,
95% CI = [1.11, 1.96]). No links were identified between fathers’ caregiving
engagement and their SSB consumption, nighttime sleep duration, or depressive
symptoms. In summary, fathers’ engagement in infant caregiving may be beneficial
to their physical activity in the first year after birth. There was insufficient
evidence in this study that the benefits of caregiving engagement were
experienced broadly across multiple health outcomes.
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Affiliation(s)
- Brian K Lo
- School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Brent A McBride
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - Elsie M Taveras
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA
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Baird JF, Silveira SL, Motl RW. Social cognitive theory variables are stronger correlates of moderate-to-vigorous physical activity than light physical activity in older adults with multiple sclerosis. Sport Sci Health. [DOI: 10.1007/s11332-021-00845-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Jeng B, Cederberg KLJ, Huynh TL, Silic P, Jones CD, Feasel CD, Morghen Sikes E, Baird JF, Silveira SL, Sasaki JE, Motl RW. Social Cognitive Theory variables as correlates of physical activity in fatigued persons with multiple sclerosis. Mult Scler Relat Disord 2022; 57:103312. [PMID: 35158422 PMCID: PMC8847831 DOI: 10.1016/j.msard.2021.103312] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/22/2021] [Accepted: 10/02/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is interest in the application of behavioral interventions based on theory for increasing physical activity among adults with multiple sclerosis (MS). To date, researchers have applied theory such as Social Cognitive Theory (SCT) for identifying correlates of physical activity that can then inform the design and delivery of behavioral interventions. Such research often has been conducted in heterogeneous samples of persons with MS without a focus on those with a specific symptom, such as fatigue, that may be targeted by physical activity behavioral interventions. To that end, this study examined SCT variables (i.e., self-efficacy, barriers, outcome expectations, goal-setting, planning, social support, and functional limitations) as correlates of physical activity in persons with MS who self-reported elevated fatigue. METHODS Persons with MS (N=210; aged 49.6[13.2] years) who ambulated with or without assistance participated in the study. Participants completed self-report measures of fatigue, physical activity, and SCT variables and wore an ActiGraph GT3X+ accelerometer on a belt around the waist for 7 days. The accelerometer data were processed and delineated into time spent in light and moderate-to-vigorous physical activity (MVPA) based on MS-specific cut-points. We generated groups of fatigued (n=134) and non-fatigued (n=76) persons with MS based on the cut-off score of 4 for the Fatigue Severity Scale. RESULTS There were differences in physical activity and SCT variables between fatigued and non-fatigued persons with MS. Among those with fatigue, functional limitations (ρ=0.52), self-efficacy (ρ=0.31), and goal-setting (ρ=0.25) were associated with device-measured MVPA, and all SCT variables except outcome expectations were associated with self-reported physical activity. The regression analyses indicated self-efficacy, functional limitations, and goal-setting as significant correlates of MVPA in those with fatigue. CONCLUSION Self-efficacy, goal-setting, and social support may be important targets of SCT-based behavioral interventions for increasing physical activity among persons with MS who have fatigue.
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Affiliation(s)
- Brenda Jeng
- Department of Physical Therapy, University of Alabama at Birmingham, School of Health Professions 360, 1720 2nd Ave S, Birmingham, AL 35294 USA
| | - Katie L. J. Cederberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305 USA
| | - Trinh L. Huynh
- Department of Physical Therapy, University of Alabama at Birmingham, School of Health Professions 360, 1720 2nd Ave S, Birmingham, AL 35294 USA
| | - Petra Silic
- Department of Physical Therapy, University of Alabama at Birmingham, School of Health Professions 360, 1720 2nd Ave S, Birmingham, AL 35294 USA
| | - Catherine D. Jones
- Department of Physical Therapy, University of Alabama at Birmingham, School of Health Professions 360, 1720 2nd Ave S, Birmingham, AL 35294 USA
| | - Corey D. Feasel
- Department of Physical Therapy, University of Alabama at Birmingham, School of Health Professions 360, 1720 2nd Ave S, Birmingham, AL 35294 USA
| | - E. Morghen Sikes
- Division of Occupational Therapy, Shenandoah University, 44160 Scholar Plaza Suite 100, Leesburg, VA 20176 USA
| | - Jessica F. Baird
- Department of Physical Therapy, University of Alabama at Birmingham, School of Health Professions 360, 1720 2nd Ave S, Birmingham, AL 35294 USA
| | - Stephanie L. Silveira
- Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, 1155 Union Circle #310769, Denton, TX 76203 USA
| | - Jeffer E. Sasaki
- Graduate Program in Physical Education, Federal University of Triângulo Mineiro, Av. Tutunas, 490. Sala 211, Bairro Tutunas, 38061-500 Uberaba, MG, Brazil
| | - Robert W. Motl
- Department of Physical Therapy, University of Alabama at Birmingham, School of Health Professions 360, 1720 2nd Ave S, Birmingham, AL 35294 USA
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Ozdogar AT, Kahraman T, Ozakbas S, Achiron A, Kalron A. Fatigue is associated with physical inactivity in people with multiple sclerosis despite different environmental backgrounds: Merging and comparing cohorts from Turkey and Israel. Mult Scler Relat Disord 2021; 57:103456. [PMID: 34896878 DOI: 10.1016/j.msard.2021.103456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/15/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Examining leisure-time physical activity in people with multiple sclerosis (PwMS) from different environmental backgrounds might increase understanding and awareness of inactivity in PwMS. Therefore, the study objective was twofold; to compare the level of physical activity in PwMS in Israel and Turkey and to examine the relationship between the level of physical activity with common disease-related symptoms and demographical characteristics of PwMS. METHODS Cross-sectional data collected by two centers were combined. The physical activity level was determined by the Godin Leisure-Time Exercise Questionnaire, and subsequently, classified into one of three subgroups: "active", "moderately active" and "insufficiently active". Logistic regressions determined the risks of insufficiently active PwMS, according to age, gender, body mass index, disability, impact of walking impairment, disease duration, type of MS and perceived fatigue. The analysis of variance test determined the differences between countries in terms of outcome variables. RESULTS The study comprised 458 patients from Israel and 575 from Turkey; 68.2% Turkish PwMS were classified as insufficiently active compared with 52.0% of Israeli PwMS. The percentage of insufficiently active PwMS was significantly higher in those categorized as fatigued compared to non-fatigued in the total cohort (72.4% vs. 51.9%, p<0.001) and in each country separately. Based on the regression analysis, fatigue was the main factor associated with the insufficiently physically active group; odds ratio=1.968. CONCLUSION PwMS with increased fatigue tend to participate in less leisure-time physical activities compared with the non-fatigued. This observation is supported by the merged data collected from two countries, Turkey and Israel, representing PwMS from different environmental backgrounds.
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Affiliation(s)
- Asiye Tuba Ozdogar
- Graduate School of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Serkan Ozakbas
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Anat Achiron
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel; Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Alon Kalron
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel; Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel; Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine Tel-Aviv University, Israel.
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Young HJ, Lai B, Mehta T, Thirumalai M, Wilroy J, Yates A, Kane B, Rimmer JH. The movement-to-music (M2M) study: study protocol for a randomized controlled efficacy trial examining a rhythmic teleexercise intervention for people with physical disabilities. Trials 2021; 22:779. [PMID: 34743701 PMCID: PMC8574035 DOI: 10.1186/s13063-021-05751-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with physical disabilities need exercise routines that are enjoyable, readily available in the home, adapted to their functional level, and eliminate common barriers to exercise participation related to transportation and time commitment. The purpose of the movement-to-music (M2M) study is to address these issues by establishing a remotely delivered, rhythmic exercise program for people with physical disabilities. METHODS The study is a two-arm randomized controlled efficacy trial examining a 12-week remotely delivered M2M intervention (eM2M) in 108 people with physical disabilities. The primary outcomes are changes in cardiorespiratory fitness and muscle strength at post 12-week intervention. DISCUSSION The eM2M study will enhance our understanding of an alternative intervention design and delivery mode that removes common barriers to exercise participation experienced by people with physical disabilities. The eM2M intervention may be an alternative option for people with physical disabilities to obtain regular exercise, especially during a pandemic when exercising in indoor facilities may be problematic. TRIAL REGISTRATION ClinicalTrials.gov NCT03797378. Registered on January 9, 2019, with the trial name "Movement-to-Music: Lakeshore Examination of Activity, Disability, and Exercise Response Study (M2M LEADERS)".
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Affiliation(s)
- Hui-Ju Young
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Byron Lai
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Pediatric and Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tapan Mehta
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mohanraj Thirumalai
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jereme Wilroy
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alex Yates
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brandon Kane
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James H Rimmer
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
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Fattahi MR, Noormohammadpour P, Ramezani M, Sahraian MA, Mansournia MA, Tabesh MR, Mesgarof MA, Abolhasani M. Translation and validation of the Persian version of Godin Leisure-Time Exercise Questionnaire in patients with multiple sclerosis. BMC Neurol 2021; 21:431. [PMID: 34740328 PMCID: PMC8569962 DOI: 10.1186/s12883-021-02465-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/25/2021] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- Mohammad-Reza Fattahi
- Multiple Sclerosis Research Center, Neuroscience institute, Tehran University of Medical Sciences, Tehran, Iran.,Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Sports and Exercise Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Pardis Noormohammadpour
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Sports and Exercise Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Meysam Ramezani
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Sports and Exercise Medicine, MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience institute, Tehran University of Medical Sciences, Tehran, Iran.,Neurology, MS Fellowship, MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mastaneh Rajabian Tabesh
- PHD Candidate in Sport Physiology Cardiac Primary Prevention Research Center (CPPRC), Heart Centre hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamed Ali Mesgarof
- Department of Sports and Exercise Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Abolhasani
- Sports and Exercise Medicine, MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Sports Medicine, Sports and Exercise medicine, Sina MS Research Center, Sina Hospital, Hassan Abad Square, Tehran, Iran.
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Sandroff BM, Motl RW, Amato MP, Brichetto G, Chataway J, Chiaravalloti ND, Cutter GR, Dalgas U, DeLuca J, Farrell R, Feys P, Filippi M, Freeman J, Inglese M, Meza C, Rocca MA, Salter A, Feinstein A. Cardiorespiratory fitness and free-living physical activity are not associated with cognition in persons with progressive multiple sclerosis: Baseline analyses from the CogEx study. Mult Scler 2021; 28:1091-1100. [PMID: 34595972 DOI: 10.1177/13524585211048397] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Aerobic exercise training (physical activity for improving cardiorespiratory fitness) represents a promising approach for managing cognitive impairment in multiple sclerosis (MS). However, there is limited evidence that levels of physical activity and fitness are associated with cognition in progressive MS. OBJECTIVE We examined associations among cardiorespiratory fitness, moderate-to-vigorous physical activity (MVPA), and cognitive performance in a large, international progressive MS sample. METHODS Two hundred forty European and North American persons with progressive MS underwent cardiorespiratory fitness measurement on a recumbent stepper, wore an ActiGraph GT3X + accelerometer for 7 days for measuring MVPA, and underwent the Brief International Cognitive Assessment in MS. RESULTS Cardiorespiratory fitness was not significantly correlated with Symbol Digit Modalities Test (SDMT; r = -0.01; r = -0.04), California Verbal Learning Test-II (CVLT-II; r = 0.05; r = 0.05), or Brief Visuospatial Memory Test-Revised (BVMT-R; r = -0.14; r = -0.14) z-scores controlling for age, sex, and education. MVPA and SDMT (r = 0.05), CVLT-II (r = -0.07), and BVMT-R (r = 0.01) z-scores were not significantly correlated. CONCLUSION Cardiorespiratory fitness and MVPA were not associated with cognition in this large progressive MS sample, yet these outcomes represent critical manipulation checks for documenting the success of the CogEx trial. This highlights the importance of examining other exercise-related mechanisms-of-action for improving cognition in progressive MS.
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Affiliation(s)
- Brian M Sandroff
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.,Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Robert W Motl
- Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy/Fondazione IRCCS Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy/AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK/National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| | - Nancy D Chiaravalloti
- Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gary R Cutter
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachel Farrell
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Peter Feys
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Neurology Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy/IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cecilia Meza
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, Neurology Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Amber Salter
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anthony Feinstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Silveira SL, Cederberg KLJ, Jeng B, Sikes EM, Sandroff BM, Jones CD, Motl RW. Do physical activity and social cognitive theory variable scores differ across symptom cluster severity groups in multiple sclerosis? Disabil Health J 2021; 14:101163. [PMID: 34219037 PMCID: PMC8448927 DOI: 10.1016/j.dhjo.2021.101163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/17/2021] [Accepted: 06/25/2021] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Stephanie L Silveira
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, 35209, USA.
| | - Katie L J Cederberg
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, 35209, USA
| | - Brenda Jeng
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, 35209, USA
| | - E Morghen Sikes
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, 35209, USA
| | - Brian M Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, 35209, USA; Center for Neuropsychology and Neuroscience Research, Kessler Foundation, West Orange, NJ 07052, USA
| | - Catherine D Jones
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, 35209, USA
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, 35209, USA
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Abstract
CONTEXT Return to sport is widely utilized by sports medicine researchers and clinicians as a primary outcome of interest for successful recovery when working with young patients who have undergone anterior cruciate ligament (ACL) reconstruction (ACLR). While return-to-sport outcomes are effective at tracking progress post-ACLR, they are limited because they do not necessarily capture physical activity (PA) engagement, which is important to maintain knee joint health and reduce the risk of noncommunicable diseases. Therefore, there is a critical need (1) to describe current PA participation and measurement recommendations; (2) to appraise common PA measurement approaches, including patient-reported outcomes and device-based methodologies; and (3) to provide clinical recommendations for future evaluation. EVIDENCE ACQUISITION Reports of patient-reported or device-based PA in patients with ACL injury were acquired and summarized based on a PubMed search (2000 through July 2020). Search terms included physical activity OR activity AND anterior cruciate ligament OR ACL. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 5. RESULTS We highlight that (1) individuals with ACLR are 2.36 times less likely to meet the US Department of Health and Human Services PA recommendations even when reporting successful return to sport, (2) common patient-reported PA assessments have significant limitations in the data that can be derived, and (3) alternative patient-reported and device-based assessments may provide improved assessment of PA in this patient population. CONCLUSION Clinicians and researchers have relied on return to sport status or self-reported PA participation via surveys. These approaches are not consistent with current recommendations for PA assessment and do not allow for comparison with contemporary PA recommendations or guidelines. Return to sport, patient-reported outcome measures, and device-based assessment approaches should be used in complementary manners to comprehensively assess PA participation after ACLR. However, appropriate techniques should be used when assessing PA in adult and adolescent populations.
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Affiliation(s)
- Christopher Kuenze
- Department of Kinesiology, Michigan State University, East Lansing, Michigan.,Department of Orthopedics, Michigan State University, East Lansing, Michigan
| | - Katherine Collins
- Department of Kinesiology, Michigan State University, East Lansing, Michigan
| | | | - Caroline Lisee
- Motion Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Stevens D, Loffler KA, Buman MP, Dunstan DW, Luo Y, Lorenzi-Filho G, Barbe FE, Anderson CS, McEvoy RD. CPAP increases physical activity in obstructive sleep apnea with cardiovascular disease. J Clin Sleep Med 2021; 17:141-148. [PMID: 32951632 DOI: 10.5664/jcsm.8792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
STUDY OBJECTIVES Uncertainty exists over whether continuous positive airway pressure (CPAP) treatment improves moderate to vigorous physical activity levels in those with obstructive sleep apnea. We aimed to determine effects of CPAP on moderate to vigorous physical activity among participants with co-occurring cardiovascular disease and obstructive sleep apnea. METHODS The Sleep Apnea cardioVascular Endpoints (SAVE) trial recruited participants with confirmed cardiovascular disease history and obstructive sleep apnea, 45-75 years old. The 2,687 participants (1,346 randomized to CPAP plus usual care and 1,341 to usual care alone) were followed up for a mean of 3.7 years. Self-reported physical activity was recorded at baseline, 6, 24, and 48 months using the Godin-Shepard Leisure Time Exercise Questionnaire (LTEQ). We also determined effects on any limitation of physical activity reported on the physical functioning subscale of the 36-item short form questionnaire (SF-36) and proportions of participants reaching guideline recommended physical activity levels. RESULTS Among 2,601 participants with available data, those in the CPAP group reported significantly more physical activity compared to the usual care group, with approximately 20% higher reported moderate activities on the LTEQ during follow-up (adjusted mean 95% confidence interval) scores: 8.7, 7.5-9.9 vs 7.3, 6.1-8.5; P = .003). Those in the CPAP group also reported less limitation in physical activity (adjusted between-group difference in SF-36 physical functioning subscale score 1.66, 95% confidence interval 0.87-2.45; P < 0.001), and more reported sufficient levels of physical activity to meet recommendations. CONCLUSIONS CPAP has positive effects on improving physical activity levels, consistent with long-term health benefits. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea to Prevent Cardiovascular Disease (SAVE); URL: https://clinicaltrials.gov/ct2/show/NCT00738179; Identifier: NCT00738179; and Registry: Australian New Zealand Clinical Trials Registry; Name: Sleep Apnea cardioVascular Endpoints study-An investigation of continuous positive airway pressure for the treatment of obstructive sleep apnea to prevent cardiovascular disease; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83062&isReview=true; Identifier: ACTRN12608000409370.
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Affiliation(s)
- David Stevens
- Adelaide Institute for Sleep Health - A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Kelly A Loffler
- Adelaide Institute for Sleep Health - A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Matthew P Buman
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - David W Dunstan
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Mary MacKillop Institute for Health Research, The Australian Catholic University, Melbourne, Victoria, Australia
| | - Yuanming Luo
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangzhou, China
| | | | - Ferran E Barbe
- Respiratory Department, IRBLleida, Catalonia, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,The George Institute China, Health Science Center, Peking University, Beijing, China.,Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, New South Wales, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health - A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Sleep Health Service, Sleep and Respiratory Services, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
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Silveira SL, Riemann-Lorenz K, Heesen C, Motl RW. Current and Long-Term Physical Activity Among Adults with Multiple Sclerosis in the United States: COM-B Variables as Explanatory Factors. Int J Behav Med 2021; 28:561-574. [PMID: 33420718 DOI: 10.1007/s12529-020-09946-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Physical activity is an evidence-based, safe second-line approach for improved multiple sclerosis (MS) symptoms and disease progression. This study examined the contributions of Capability-Opportunity-Motivation-Behavior (COM-B) factors for understanding engagement in current and long-term physical activity among persons with MS in the United States (U.S.). METHOD Adults with MS in the U.S. (N = 854) completed an online survey that included questions regarding demographic and clinical characteristics, COM-B constructs, Godin Leisure Time Exercise Questionnaire (GLTEQ), and Physical Activity Staging Questionnaire (PASQ). Participants were classified into groups based on the GLTEQ regarding current physical activity behavior and PASQ for long-term physical activity behavior. MANOVA and discriminant function analysis (DFA) identified COM-B constructs that differentiated physical activity groups. RESULTS MANOVA analyses indicated that all COM-B constructs were significantly different for both GLTEQ current physical activity groups (Wilks's λ = .5, F(44, 1432) = 14.8) and PASQ long-term physical activity groups (Wilks's λ = .4, F(44, 1464) = 16.9) status except Information Provision. DFA analysis regarding GLTEQ identified a function including exclusively Capability and Motivation sources of behavior that differentiated current physical activity groups such as intention and self-efficacy. DFA for PASQ identified a different function of the Capability and Motivation sources of behavior that differentiated long-term physical activity groups; the primary differentiating variables were action control and intention. CONCLUSION Our results identify internal factors as the primary COM-B predictors of current and long-term physical activity among adults with MS in the U.S., and health promotion interventions may focus on assessing individual competencies and behavioral regulation for changing physical activity in MS.
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Affiliation(s)
- Stephanie L Silveira
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, 35294, United States.
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, 35294, United States
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Wingo BC, Rinker JR, Goss AM, Green K, Wicks V, Cutter GR, Motl RW. Feasibility of improving dietary quality using a telehealth lifestyle intervention for adults with multiple sclerosis. Mult Scler Relat Disord 2020; 46:102504. [DOI: 10.1016/j.msard.2020.102504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/16/2020] [Accepted: 09/10/2020] [Indexed: 02/07/2023]
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Abstract
In Morocco, as in many countries, COVID-19 spread nationwide causing a public health emergency. Strict quarantine measures implemented as a result of the pandemic have disrupted many aspects of people's lives, triggering psychological distress. A total of 256 participants were recruited through a convenience sample. Data were collected through snowball sampling, an assessment of distress symptoms using the Brief Symptoms Inventory, and an assessment of leisure-time physical activity using the Godin-Shephard Leisure-Time Physical Activity Questionnaire. Bivariate and multivariate analyses were performed. Significant changes in paranoid ideation (z = -2.45, P = .01) and interpersonal sensitivity (z = -2.01, P = .04) dimensions were noted between those who were and those who were not authorized to leave their homes during quarantine. Similarly, for physical activity, significant changes in depression (z = -2.15, P = .03), anxiety (z = -2.13, P = .03), interpersonal sensitivity (z = -1.95, P = .05), and somatization (z = -2.11, P = .03) were reported among the insufficiently active group compared with the more physically active group. From multiple regression analysis, variables correlated with general distress were type of quarantine, gender, age, education level, chronic disease, and smoking (R2 = .80). With some variables, leisure-time physical activity domains appeared to be associated only with interpersonal sensitivity and somatization. Having to leave one's home during the outbreak was linked to distress, especially symptoms like suspiciousness, hostility, fearful thoughts of losing autonomy, and feelings of inadequacy, uneasiness, and discomfort during interpersonal interactions. Individuals who were moderately or sufficiently active physically reported less psychological distress.
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Affiliation(s)
- Anis Sfendla
- Anis Sfendla, PhD, is a Professor, Higher Institute of Nursing Professions and Health Techniques, Errachidia, and a Member, Abdelmalek Essaâdi University, Tetouan; and Fatine Hadrya, PhD, is a Professor, Unit of Epidemiology and Biomedical Sciences, High Institute of Health Sciences, Hassan 1st University, Settat, and a Member, Laboratory of Genetics and Biometry, Faculty of Sciences, Ibn Tofail University, Kenitra; all in Morocco
| | - Fatine Hadrya
- Anis Sfendla, PhD, is a Professor, Higher Institute of Nursing Professions and Health Techniques, Errachidia, and a Member, Abdelmalek Essaâdi University, Tetouan; and Fatine Hadrya, PhD, is a Professor, Unit of Epidemiology and Biomedical Sciences, High Institute of Health Sciences, Hassan 1st University, Settat, and a Member, Laboratory of Genetics and Biometry, Faculty of Sciences, Ibn Tofail University, Kenitra; all in Morocco
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Silveira SL, Baird JF, Motl RW. Rates, patterns, and correlates of fitness tracker use among older adults with multiple sclerosis. Disabil Health J 2020; 14:100966. [PMID: 32811785 DOI: 10.1016/j.dhjo.2020.100966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/03/2020] [Accepted: 06/14/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Older adults with multiple sclerosis (MS) engage in alarmingly low levels of physical activity. Fitness trackers may be a promising approach for promoting and monitoring physical activity among older adults with MS. OBJECTIVE/HYPOTHESIS This study reports on the rates, patterns of fitness tracker use in adults with MS who are over 60 years of age. We hypothesized that older adults with MS who use fitness trackers "users" would report significantly more physical activity than those who don't "non-users." METHODS Participants across the United States completed an online survey that included self-reported demographic and clinical characteristics, fitness tracker use questionnaire, and Godin Leisure-Time Exercise Questionnaire (GLTEQ) for measuring total and health-promoting physical activity (GLTEQ-HCS). RESULTS Of the 440 participants who completed the full survey, 112 (28%) identified as fitness tracker users. The most common activity monitors were Fitbit®, Smartphone app, Apple® watch, and Garmin®. Fitness tracker users mostly reported having relapsing-remitting MS, less disability (i.e., lower Patient Determined Disability Steps), higher income, and higher rates of employment. There was a statistically significant difference in GLTEQ Total (t(438) = -3.8, p = .001) and GLTEQ-HCS (t(438) = -2.8, p = .006) scores between fitness tracker users and non-users. Self-reported step counts were strongly correlated with both GLTEQ Total (ρ = .50) and GLTEQ-HCS (ρ = 0.54) scores in fitness tracker users. CONCLUSIONS Further research is warranted investigating fitness tracker use and interests among older adults with MS and how technology may be applied as a behavioral tool to increase physical activity among this growing portion of the MS population.
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Affiliation(s)
- Stephanie L Silveira
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Jessica F Baird
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA; University of Alabama at Birmingham Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA; University of Alabama at Birmingham Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Dodd-Reynolds CJ, Vallis D, Kasim A, Akhter N, Hanson CL. The Northumberland Exercise Referral Scheme as a Universal Community Weight Management Programme: A Mixed Methods Exploration of Outcomes, Expectations and Experiences across a Social Gradient. Int J Environ Res Public Health 2020; 17:ijerph17155297. [PMID: 32717836 PMCID: PMC7432420 DOI: 10.3390/ijerph17155297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 01/20/2023]
Abstract
Exercise referral schemes (ERS) are internationally recognised, yet little attention has been paid to discrete referral groups or the influence of wider social determinants of health. The primary quantitative element of this mixed methods study used a mixed effects linear model to examine associations of sociodemographic predictors, obesity class and profession of referrer on weight and physical activity (PA) variables for weight-related referrals (n = 3624) to an established 24-week ERS. Chained equations modelling imputed missing data. The embedded qualitative element (n = 7) used individual semi-structured interviews to explore participant weight-related expectations and experiences. Age, gender and profession of referrer influenced weight loss. PA increased and was influenced by age and gender. The weight gap between the most and least obese narrowed over time but the PA gap between most and least widened. Age, employment and obesity class were most predictive of missing data but would unlikely alter overall conclusions. Qualitative themes were weight-loss support, personal circumstances and strategies, and weight expectations versus wellbeing rewards. This ERS worked, did not widen existing obesity inequalities, but demonstrated evidence of PA inequalities for those living with deprivation. To improve equity of experience, we recommend further stakeholder dialogue around referral experience and ongoing support needs.
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Affiliation(s)
- Caroline J. Dodd-Reynolds
- Department of Sport and Exercise Sciences, Durham University, Durham DH1 3HN, UK
- Wolfson Research Institute for Health and Wellbeing Physical Activity Special Interest Group, Durham University, Durham DH1 3HN, UK; (A.K.); (N.A.)
- Durham Research Methods Centre, Durham University, Durham DH1 3HN, UK;
- Correspondence:
| | - Dimitris Vallis
- Durham Research Methods Centre, Durham University, Durham DH1 3HN, UK;
| | - Adetayo Kasim
- Wolfson Research Institute for Health and Wellbeing Physical Activity Special Interest Group, Durham University, Durham DH1 3HN, UK; (A.K.); (N.A.)
- Durham Research Methods Centre, Durham University, Durham DH1 3HN, UK;
- Department of Anthropology, Durham University, Durham DH1 3HN, UK
| | - Nasima Akhter
- Wolfson Research Institute for Health and Wellbeing Physical Activity Special Interest Group, Durham University, Durham DH1 3HN, UK; (A.K.); (N.A.)
- Department of Anthropology, Durham University, Durham DH1 3HN, UK
| | - Coral L. Hanson
- School of Health and Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK;
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Kalron A, Menascu S, Hoffmann C, Achiron A. The importance of physical activity to preserve hippocampal volume in people with multiple sclerosis: a structural MRI study. J Neurol 2020; 267:3723-30. [DOI: 10.1007/s00415-020-10085-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/31/2022]
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Kalb R, Brown TR, Coote S, Costello K, Dalgas U, Garmon E, Giesser B, Halper J, Karpatkin H, Keller J, Ng AV, Pilutti LA, Rohrig A, Van Asch P, Zackowski K, Motl RW. Exercise and lifestyle physical activity recommendations for people with multiple sclerosis throughout the disease course. Mult Scler 2020; 26:1459-1469. [PMID: 32323606 PMCID: PMC7575303 DOI: 10.1177/1352458520915629] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To provide clinicians who treat multiple sclerosis (MS) patients with evidence-based or expert opinion–based recommendations for promoting exercise and lifestyle physical activity across disability levels. Methods: The National MS Society (“Society”) convened clinical and research experts in the fields of MS, exercise, rehabilitation, and physical activity to (1) reach consensus on optimal exercise and lifestyle physical activity recommendations for individuals with MS at disability levels 0–9.0 on the Expanded Disability Status Scale (EDSS) and (2) identify and address barriers/facilitators for participation. Recommendations: Based on current evidence and expert opinion, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers:
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Affiliation(s)
- Rosalind Kalb
- National Multiple Sclerosis Society, New York, NY, USA
| | | | - Susan Coote
- School of Allied Health and Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Ulrik Dalgas
- Section of Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Eric Garmon
- National Multiple Sclerosis Society, New York, NY, USA
| | | | - June Halper
- Consortium of Multiple Sclerosis Centers and International Organization of MS Nurses, Hackensack, NJ, USA
| | - Herb Karpatkin
- Program in Physical Therapy, Hunter College, New York, NY, USA
| | - Jennifer Keller
- Motion Analysis Lab, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Alexander V Ng
- Exercise Science Program, Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Paul Van Asch
- Fit Up Neurological and Sport Physiotherapy, Antwerp, Belgium
| | | | - Robert W Motl
- UAB/Lakeshore Research Collaborative, The University of Alabama at Birmingham, Birmingham, AL, USA
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Friel CP, Garber CE. An Examination of the Relationship Between Motivation, Physical Activity, and Wearable Activity Monitor Use. J Sport Exerc Psychol 2020; 42:153-160. [PMID: 32150727 PMCID: PMC7483559 DOI: 10.1123/jsep.2019-0170] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/29/2019] [Accepted: 12/16/2019] [Indexed: 06/10/2023]
Abstract
Wearable physical activity (PA) monitors are widely promoted as a means to motivate people to be more active, but the motivational profile of users has never been assessed. This study's purpose was to classify adult users by their motivational regulation scores and examine how these profiles were associated with moderate to vigorous PA (MVPA). Current users (N = 320) recruited across the United States completed a Web-based survey. Motivational regulations were measured using the Behavioral Regulation in Exercise Questionnaire, and associations with MVPA were explored using bivariate correlations. MVPA was more highly correlated with autonomous rather than controlling regulations. A cluster analysis was conducted using the respondents' motivational regulation scores. Five motivational profiles emerged from this analysis, and they differed significantly across motivation and MVPA scores. PA monitor users characterized by more autonomous motives presented with higher MVPA. As technology use increases, assessing the multidimensionality of PA monitor users' motivation may add value when researching PA behaviors.
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Affiliation(s)
- Ciarán P Friel
- Teachers College, Columbia University
- Columbia University Medical Center
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46
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de Zoete RMJ, Osmotherly PG, Rivett DA, Snodgrass SJ. Cervical Sensorimotor Control Does Not Change Over Time and Is Not Related to Chronic Idiopathic Neck Pain Characteristics: A 6-Month Longitudinal Observational Study. Phys Ther 2020; 100:268-282. [PMID: 32031655 DOI: 10.1093/ptj/pzz167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/06/2019] [Accepted: 07/28/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cervical sensorimotor control (CSMC) outcomes have been suggested to be important in the assessment of individuals with neck pain, despite the lack of consistent supporting evidence that CSMC skills are related to neck pain. OBJECTIVE The aim of this study was to investigate whether CSMC changes over time in individuals with chronic idiopathic neck pain and whether neck pain characteristics are associated with CSMC. DESIGN A longitudinal observational study was performed. METHODS A total 50 participants with chronic idiopathic neck pain and 50 matched participants who were healthy (controls) completed 7 CSMC tests (including 14 test conditions): joint position error, postural balance, subjective visual vertical, head tilt response, The Fly, smooth pursuit neck torsion, and head steadiness. Neck pain characteristics included pain intensity (visual analog scale), pain duration, and neck disability (Neck Disability Index). Linear mixed models were used to investigate whether any factors were associated with changes in CSMC. RESULTS Neck pain intensity was associated with 1 of 14 CSMC test conditions (balance with torsion and eyes open), and neck disability was associated with balance with eyes open and high-load head steadiness. Other factors, including sex, age, body mass index, physical activity levels, and neck pain duration, showed no association with CSMC. LIMITATIONS Although all other tests involved computerized data collection, the joint position error test was administered manually, introducing the risk of researcher bias. CONCLUSIONS The few associations between test conditions and neck pain characteristics were at best weak; hence, these are likely to be chance findings. These results suggest that CSMC may not be associated with improvement/worsening of chronic idiopathic neck pain, spawning debate on the clinical usefulness of CSMC tests.
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Affiliation(s)
- Rutger M J de Zoete
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia; Center for Brain and Mental Health Research, The University of Newcastle; Hunter Medical Research Institute, Newcastle, New South Wales, Australia; and Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Queensland, Australia
| | - Peter G Osmotherly
- School of Health Sciences, The University of Newcastle; Center for Brain and Mental Health Research, The University of Newcastle; and Hunter Medical Research Institute
| | - Darren A Rivett
- School of Health Sciences, The University of Newcastle; Center for Brain and Mental Health Research, The University of Newcastle; and Hunter Medical Research Institute
| | - Suzanne J Snodgrass
- School of Health Sciences, The University of Newcastle; Center for Brain and Mental Health Research, The University of Newcastle; and Hunter Medical Research Institute
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So WY, Kalron A. The Association between Body Mass Index and Leisure-Time Physical Activity in Adults with Multiple Sclerosis. Int J Environ Res Public Health 2020; 17:ijerph17030920. [PMID: 32024246 PMCID: PMC7037989 DOI: 10.3390/ijerph17030920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 01/01/2023]
Abstract
(1) Purpose: Conflicting information exists regarding the relationship between obesity, leisure-time physical activity (PA), and disability in people with multiple sclerosis (PwMS). We aimed to investigate the association between leisure-time PA and weight status in a relatively large cohort of PwMS. Furthermore, we examined this relationship according to the level of neurological disability. (2) Methods: The study included 238 PwMS (138 women) with a mean Expanded Disability Status Scale (EDSS) score of 2.5 (standard deviation [SD] = 1.7), mean disease duration of 6.4 (SD = 8.2) years, and mean age of 40.5 (SD = 12.9) years. Obesity was defined using two different metrics, each based on body mass index (BMI). Leisure-time PA was determined by the Godin-Shephard leisure-time PA questionnaire. Statistical analyses included multivariate logistic regression, the chi-square test, and Pearson coefficient correlations. (3) Results: The unadjusted odds ratio (OR) between leisure-time PA and BMI based on the World Health Organization's (WHO) definition was 1.070 (p = 0.844) for overweight and 1.648 (p = 0.254) for obesity. The adjusted OR was 1.126 (p = 0.763) for overweight and 1.093 (p = 0.847) for obesity after adjustment for age, gender, and disability status. Chi-square analysis revealed no significant correlation between leisure-time PA and obesity (p = 0.564) according to the BMI threshold for PwMS. The unadjusted OR (95% confidence interval [CI]) between disability level and BMI based on the WHO definition was 1.674 (p = 0.220) for overweight and 0.618 (p = 0.460) for obesity. The adjusted OR was 1.130 (p = 0.787) for overweight and 0.447 (p = 0.234) for obesity after adjustment for age, gender, and leisure-time PA. Similarly, chi-square analysis revealed no significant correlation between disability level and obesity (p = 0.701) per the BMI threshold for PwMS. (4) Conclusions: No association was found between leisure-time PA and BMI in PwMS. An additional finding was the absence of any association between obesity and neurological disability level in the multiple sclerosis cohort.
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Affiliation(s)
- Wi-Young So
- Sports and Health Care Major, College of Humanities and Arts, Korea National University of Transportation, Chungju-si 27469, Korea;
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Ramat Aviv 6997801, Israel
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Ramat Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-9-9512726
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Kalron A, Frid L, Aloni R, Menascu S, Givon U. Physical activity participation according to the pyramidal, sensory, and cerebellar functional systems in multiple sclerosis. J Neural Transm (Vienna) 2019; 126:1609-16. [PMID: 31673926 DOI: 10.1007/s00702-019-02099-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
The objective of the study was to examine the differences in physical activity participation with the pyramidal, cerebellar, and sensory functional systems in people with multiple sclerosis (PwMS). This cross-sectional study included 289 PwMS with a median EDSS of 2.0 (range 0-6.5) and a mean disease duration of 6.8 (SD = 8.4) years. The Godin leisure-time exercise questionnaire (GLTEQ) assessed physical activity participation. The sample was divided into seven groups according to the pyramidal, cerebellar, and sensory functional system scores derived from the EDSS data. Additionally, PwMS were divided into three physical activity subgroups (active, moderately active, and insufficiently active). Furthermore, PwMS were categorized into four levels of disability based on their global Expanded Disability Status Scale (EDSS) score [very mild (0-1.5), mild (2.0-3.5), moderate (4.0-5.5), and severe (6.0-6.5)]. In the physical activity subgroups, 159 (55.0%) were classified as insufficiently active, 59 (20.4%) as moderately active, and 71 (24.6%) as active. Pyramidal, cerebellar, and sensory impairments were demonstrated in 134 (46.4%), 73 (25.3%), and 85 (29.4%) patients, respectively. No differences were found for the GLTEQ scores for all seven functional system groups (P value = 0.168). As for the EDSS disability subgroups, the percentage of active patients (moderately at least) were 60%, 45.8%, 36.5%, and 15.4%, for the very mild, mild, moderate, and severe subgroups, respectively. This study found that participation in leisure-time physical activity is independent from the pyramidal, cerebellar, and sensory functional systems in PwMS.
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Ndjavera W, Orange ST, O'Doherty AF, Leicht AS, Rochester M, Mills R, Saxton JM. Exercise-induced attenuation of treatment side-effects in patients with newly diagnosed prostate cancer beginning androgen-deprivation therapy: a randomised controlled trial. BJU Int 2019; 125:28-37. [PMID: 31605663 DOI: 10.1111/bju.14922] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES (i) To assess whether exercise training attenuates the adverse effects of treatment in patients with newly diagnosed prostate cancer beginning androgen-deprivation therapy (ADT), and (ii) to examine whether exercise-induced improvements are sustained after the withdrawal of supervised exercise. PATIENTS AND METHODS In all, 50 patients with prostate cancer scheduled for ADT were randomised to an exercise group (n = 24) or a control group (n = 26). The exercise group completed 3 months of supervised aerobic and resistance exercise training (twice a week for 60 min), followed by 3 months of self-directed exercise. Outcomes were assessed at baseline, 3- and 6-months. The primary outcome was difference in fat mass at 3-months. Secondary outcomes included: fat-free mass, cardiopulmonary exercise testing variables, QRISK® 2 (ClinRisk Ltd, Leeds, UK) score, anthropometry, blood-borne biomarkers, fatigue, and quality of life (QoL). RESULTS At 3-months, exercise training prevented adverse changes in peak O2 uptake (1.9 mL/kg/min, P = 0.038), ventilatory threshold (1.7 mL/kg/min, P = 0.013), O2 uptake efficiency slope (0.21, P = 0.005), and fatigue (between-group difference in Functional Assessment of Chronic Illness Therapy-Fatigue score of 4.5 points, P = 0.024) compared with controls. After the supervised exercise was withdrawn, the differences in cardiopulmonary fitness and fatigue were not sustained, but the exercise group showed significantly better QoL (Functional Assessment of Cancer Therapy-Prostate difference of 8.5 points, P = 0.034) and a reduced QRISK2 score (-2.9%, P = 0.041) compared to controls. CONCLUSION A short-term programme of supervised exercise in patients with prostate cancer beginning ADT results in sustained improvements in QoL and cardiovascular events risk profile.
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Affiliation(s)
- Wilphard Ndjavera
- Department of Urology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Samuel T Orange
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Alasdair F O'Doherty
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Anthony S Leicht
- Sport and Exercise Science, College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Mark Rochester
- Department of Urology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Robert Mills
- Department of Urology, Norfolk and Norwich University Hospital, Norwich, UK
| | - John M Saxton
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.,Norwich Medical School, Faculty of Medicine and Health Sciences, Norwich Research Park, University of East Anglia, Norwich, UK
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Silveira SL, Motl RW. Activity monitor use among persons with multiple sclerosis: Report on rate, pattern, and association with physical activity levels. Mult Scler J Exp Transl Clin 2019; 5:2055217319887986. [PMID: 31741742 PMCID: PMC6843743 DOI: 10.1177/2055217319887986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Commercially available activity monitors are a promising approach for tracking and changing physical activity in multiple sclerosis. OBJECTIVE This study reports on the rate and pattern of activity monitor use in persons with multiple sclerosis, and compares self-reported physical activity levels between persons who do wear and those who do not wear activity monitors. METHODS Participants completed a cross-sectional survey that included a demographic and clinical characteristics scale, activity monitor use questionnaire, and Godin Leisure-Time Exercise Questionnaire (GLTEQ) for measuring total and health-promoting physical activity. RESULTS Of the 629 participants who completed the full survey, 249 (40%) reported using an activity monitor. The most common activity monitors were Fitbit, Apple watch, iPhone, and Garmin. There was a significant (p < 0.05), moderate difference (d = 0.5) in GLTEQ total scores between activity monitor users (36.6 ± 23.9) and non-users (25.0 ± 22.2), and in GLTEQ Health Contribution Score between activity monitor users (25.6 ± 22.3) and non-users (14.6 ± 18.9) (p < 0.05, d = 0.5). Self-reported steps from the activity monitor were significantly correlated with GLTEQ total score (ρ = 0.45; r = 0.36) and GLTEQ Health Contribution Score (ρ = 0.41; r = 0.35). CONCLUSION Activity monitor use is common among persons with multiple sclerosis, and activity monitor users report more total and health-promoting physical activity; this warrants further research investigating how devices may be used as a behavioral intervention tool.
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Affiliation(s)
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, USA
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