Results of a feasibility and initial efficacy clinical trial of a high-intensity interval training program using adaptive equipment in persons with multiple sclerosis who have walking disability.

BACKGROUND: High intensity interval training (HIIT) has been identified as potential stimulus for eliciting health-promoting physical activity in an efficient manner among persons with multiple sclerosis (MS). The current study aimed to examine the feasibility and initial efficacy of a 12-week HIIT program using a recumbent stepper (RSTEP) in persons with MS who have walking disability. Feasibility outcomes of interest included process (i.e., recruitment, adherence, and retention rates), resource (i.e., time and monetary costs), management (i.e., data management and safety reporting assessment), and science (i.e., safety, burden, and treatment effect assessment). We hypothesized that 12-weeks of HIIT will be feasible via meeting a priori benchmarks in process, resource, management, and scientific outcomes. The efficacy outcomes of interest included changes in aerobic fitness, physical activity, walking, upper arm function, cognition, fatigue, and depressive symptoms. We hypothesized that 12 weeks of HIIT would result in improvements in aerobic capacity, walking, upper arm function, cognition, fatigue, and depression. METHODS: A pre-post clinical trial design was applied. Participants (N = 16) were recruited and enrolled in the 12-week RSTEP HIIT program who met the following inclusion criteria: age ≥18 years, self-reported diagnosis of MS, Patient Determined Disability Steps scale score 3.0-7.0, relapse free in past 30 days, willing to visit a University Laboratory for study protocol, asymptomatic status for maximal exercise testing, physician approval, and a self-reported ability to speak, read, and understand English. Measures of efficacy outcomes of interest included Six Minute Walk Test (6MW), Timed 25 Foot Walk Test (T25FW), the Brief International Cognitive Assessment in MS (BICAMS), 9-hole peg test (9-HPT), Expanded Disability Status Scale (EDSS), Fatigue Severity Survey (FSS), Hospital Anxiety and Depression Scale (HADS), Godin Leisure Time Exercise Questionnaire (GLTEQ), Multiple Sclerosis Walking Scale-12 (MSWS-12). Participants completed a graded maximal exercise test for measuring aerobic fitness (VO2peak) and prescription of exercise throughout the intervention. All outcomes were measured at baseline, mid-point (6-weeks), and post-intervention (12-weeks). The intervention involved 12 weeks of supervised, individualized HIIT sessions two times per week using RSTEP. The individual HIIT sessions included 10 cycles of 60 s intervals at the work rate associated with 90 % VO2peak followed by 60 s of active recovery intervals, totaling 20 minutes plus 5-minute warm-up and cool-down periods. Process, resources, management, and scientific feasibility outcomes were examined using descriptive statistics, percentage, and frequency analyses. The efficacy of the intervention was assessed using a 1-factor (Time), repeated measure analysis of variance to identify significant changes over time. RESULTS: Fourteen of 16 participants were retained throughout the full study period and adherence with prescribed exercise sessions was 97 %. Twenty-three staff were comprehensively trained across two sites. There was only one adverse event reported that did not impact participation in the study and overall mean satisfaction rating with the program among participants was 4.7/5. There were statistically significant changes in cognitive processing speed (p = 0.002), GLTEQ (p = 0.005), and MSWS-12 (p = 0.04), but not the other outcomes of fitness, arm function, and walking. Of note, there were large effect sizes noted for peak power output (d = 1.10) and FSS (d = 1.05) despite the lack of statistically significant changes CONCLUSION: Feasibility of a 12-week individualized RSTEP HIIT program was established and participants significantly improved on measures of cognition, physical activity, and walking.

Feasibility, acceptability, and initial efficacy of a wheelchair exercise training program in persons with multiple sclerosis: study protocol for a parallel group randomized controlled trial.

Purpose: This study is a randomized controlled trial (RCT) that examines the feasibility, acceptability, and initial efficacy of a home-based, remotely supported and supervised exercise training program that was developed using a three-step community engaged research process for persons with multiple sclerosis (MS) who are wheelchair users.Materials and Methods: The study design is a parallel group RCT (NCT05888727). We aim to enroll 24 wheelchair users with MS who will be randomly assigned using REDCap randomization module into exercise training or attention/contact wellness control conditions. The conditions will be delivered remotely over 16 weeks and supported using online, one-onone behavioral coaching. The feasibility outcomes of interest include recruitment and retention rates, and safety outcomes collected throughout the study period. The acceptability outcomes include participant satisfaction and perceptions measured using formative surveys and interviews following the 16-week period. Efficacy outcomes include metabolic health, MS symptoms, and exercise behavior measured before and after the 16-week period. The data analysis will follow intent-to-treat principles using 2 group by 2 time mixed factor ANOVA with estimation of Cohen's d values as effect sizes.Conclusions: The results will guide future research targeting health outcomes using exercise training among wheelchair users with MS who have largely been absent from health promotion research.

The current study aims to test the first home-based exercise training program for wheelchair users with multiple sclerosisCommunity-engaged research methods across this research agenda aim to build partnerships with the target populationThis research may yield a scalable approach for rehabilitation research and practice by providing a critically needed home-based exercise training program for wheelchair user with multiple sclerosis.

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

BACKGROUND: We reported that a social cognitive theory-based (SCT), Internet-delivered behavioral intervention increased device-measured minutes/day of moderate-to-vigorous physical activity (MVPA) over a 6-month period among persons with multiple sclerosis (MS). This paper examined the pattern and predictors of heterogeneity in change for MVPA. Based on previous research, we hypothesized that mild MS disability, fewer MS symptoms, lower baseline MVPA, and positive SCT characteristics (e.g., high exercise self-efficacy) would be associated with greater change in MVPA. METHOD: Persons with MS (N = 318) were randomized into behavioral intervention (n = 159) or attention/social contact control (n = 159) conditions that were administered via Internet websites and supported with behavioral coaching. Demographic, clinical, symptom, behavioral, and SCT data were from before the 6-month period of delivering the conditions, and MVPA data were from before and after the 6-month period. We examined heterogeneity based on waterfall plots, box plots, and the Levene statistic. We identified predictors of MVPA change using bivariate correlation and multiple, linear regression analyses per condition. RESULTS: The Levene statistic indicated statistically significant heterogeneity of variances for MVPA change between conditions (p = .003), and the waterfall plots and box plots indicated greater heterogeneity in MVPA change for the behavioral intervention. MVPA change score was correlated with baseline MVPA (r = - .33 and r = - .34, p = .0004 and p = .0001) in both conditions and walking impairment (r = - .188, p = .047) and race (r = .233, p = .014) in the behavioral intervention condition. The regression analysis indicated that baseline MVPA (Standardized B = - .449, p = .000002), self-reported walking impairment (Standardized B = - .310, p = .0008), and race (Standardized B = .215, p = .012) explained 25.6% of variance in MVPA change for the behavioral intervention condition. CONCLUSION: We provide evidence for walking impairment, baseline MVPA, and race as predictors of the heterogeneity in the pattern of MVPA change with a behavioral intervention.

Social Cognitive Theory Variables as Correlates of Physical Activity Behavior Among Hispanics With Multiple Sclerosis.

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.

Physical Activity and Quality of Life in Persons Newly Diagnosed With Multiple Sclerosis: A Cross-sectional Study.

OBJECTIVE: To examine the association between physical activity (PA) and quality of life (QOL) in persons newly diagnosed with multiple sclerosis (MS) who have been under-represented in MS research. DESIGN: Cross-sectional study with secondary data analysis. SETTING: General community. PARTICIPANTS: The study included 152 persons newly diagnosed with MS (ie, diagnosed with MS within the past 2 years) aged 18 and older (N=152). MAIN OUTCOME MEASURES: Participants completed the Godin Leisure-Time Exercise Questionnaire to measure PA. QOL, disability status, fatigue, mood, and comorbidity were assessed using the 12-Item Short Form Survey (SF-12), Patient Determined Disease Steps, Hamburg Quality of Life Questionnaire Multiple Sclerosis, and comorbidity questionnaire. RESULTS: The bivariate correlations indicated that PA was significantly and positively associated with the physical component of QOL (ie, SF-12 PCS) (r=0.46). The stepwise multiple linear regression analysis indicated PA as associated with SF-12 PCS (ß=0.43, R2=0.17) when solely included in the model. After controlling for fatigue, mood, disability status, and comorbidity as covariates (R2=0.63), the association between PA and SF-12 PCS was still statistically significant, but attenuated in magnitude (ß=0.11). CONCLUSIONS: This study observed that PA was significantly associated with the physical component of QOL in persons newly diagnosed with MS, even after controlling for covariates. The findings underscore the importance of developing behavior change interventions targeting PA while addressing the roles of fatigue and disability status for enhancing the physical component of QOL of this MS subpopulation.

Diet, Physical Activity, and Stress Among Wheelchair Users With Multiple Sclerosis: Examining Individual and Co-Occurring Behavioral Risk Factors.

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.

Formative evaluation of an exercise training program for persons with multiple sclerosis who are wheelchair users.

Exercise training is an effective and safe second-line therapy for improving multiple sclerosis (MS) symptoms and disease progression among adults. This study aimed to determine the appropriateness of a novel exercise training program for wheelchair users with MS. Ten wheelchair users with MS were recruited from a previous cross-sectional research study to attend one of three focus groups with 3-4 participants that lasted between 69 and 87 min. The focus groups were conducted online using a semi-structured format and participants were invited to complete an evaluation survey. During the focus groups, participants provided qualitative feedback regarding the exercise prescription, exercise modes (resistance and aerobic), training manual, exercise equipment, fitness tracker, rating scale, newsletters, logbook, and coaching. Most feedback focused on minor considerations such as avoiding the color red as it can be an issue for individuals with optic neuritis. Among quantitative evaluation survey ratings, coaching calls were rated the highest 4.7 ± 0.4 on a 5-point scale, followed by the exercise prescription (4.4 ± 0.8) and fitness tracker (4.3 ± 0.9). Focus group participants provided invaluable feedback for finalizing a novel exercise training program for wheelchair users with MS and provided focal suggestions for further improvements.

Developing a community-engaged wheelchair exercise program for persons with MS: community advisory board formation and feedback.

PURPOSE: Exercise is a safe, evidence-based approach for improving symptoms such as mobility impairment, cognitive dysfunction, and fatigue; however, persons with multiple sclerosis (MS) who use wheelchairs for mobility have been excluded from most research. This paper describes our approach for recruiting ten community advisor board (CAB) members and partnering with them on developing a novel home-based exercise training program for wheelchair users with MS. MATERIALS AND METHODS: The exercise training program, which was developed based on initial qualitative research, includes a progressive exercise prescription, equipment, and one-on-one behavioural coaching based on Social Cognitive Theory. The CAB members convened in groups of five people for five meetings online, using virtual conference software. The CAB meetings each lasted approximately 1-hour and notes were transcribed into digital format for data analyses. RESULTS: Content analysis identified elements that aligned with meeting foci (i.e., prescription, equipment, coaching, and outcomes). Feedback was divided into categories to refine the program, specifically modifying, adding, or retaining content and/or activities. CAB member feedback was very positive and emphasised potential additions to the materials presented. The research team proposed implementing modifications based on the CAB member feedback such as adding wrist weights to the equipment options for completing resistance training exercises. CONCLUSIONS: The overall CAB feedback was invaluable for assessing the appropriateness of the proposed exercise training program before initiating feasibility testing. This report provides a model and guidance for researchers who seek community-engaged research approaches in creating products and interventions.Implication for RehabilitationCommunity advisory board participation was invaluable in creating and modifying a novel exercise training programmes for wheelchair users with multiple sclerosis (MS).The current study provides a framework for the creation of exercise interventions for subpopulations of persons with MS that may provide substantial rehabilitation benefits such as improved symptoms and quality of life.Health behaviour interventists targeting individuals with disabilities may consider the benefits of recruiting stakeholders from the community in creation of novel programmes.

Physical activity behavior in persons newly diagnosed with multiple sclerosis: Applying the Capability - Opportunity - Motivation - Behavior (COM-B) model.

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.

Physical activity as a correlate of symptoms, quality of life, comorbidity, and disability status in Hispanics with multiple sclerosis.

BACKGROUND: Hispanics with multiple sclerosis (MS) experience disproportionate rates of mobility disability compared to non-Hispanic Whites with MS. Physical activity (PA) is highlighted as a potential adjuvant therapy for improving MS symptoms and disease progression, however less than 30% of Hispanics with MS report sufficient levels of PA. OBJECTIVES: The current study aimed to examine the correlates of PA behavior among Hispanics with MS in the North American Research Committee on Multiple Sclerosis Registry (NARCOMS). METHODS: In Spring 2015, 136 NARCOMS participants identified as Hispanic and completed the International Physical Activity Questionnaire (IPAQ). IPAQ scores were converted to Health Contribution Scores (HCS) for estimating PA. The association between the HCS scores and MS symptoms (i.e., mobility, cognition, fatigue, spasticity, hand function, bowel/bladder, sensory, tremors, depression, and pain), quality of life (QOL), comorbid conditions, and disability status were evaluated using Pearson or Spearman correlation coefficients with follow-up multivariable regression analyses. RESULTS: The mean age among participants was 58 years and 79% identified as female. The mean MS disease duration was 20 years and 68% reported relapsing disease course. The mean HCS score among participants was 15.6 ± 20.9. HCS was moderately associated with disability status (rs = -0.39), mobility (rs = -0.37), bowel/bladder function (rs = -0.33), and physical health related QOL (r = 0.32). There were small associations between HCS and hand function (rs = -0.29), fatigue (rs = -0.20), and tremor (rs = -0.25). Multivariable regression analyses indicated that disability status, mobility, bowel/bladder function, and physical health related QOL were all associated with HCS but did not independently contribute to the models when controlling for age, sex, and employment. CONCLUSIONS: This study highlights correlates of PA behavior among Hispanics with MS. Researchers and clinicians may consider disability status, mobility, and physical health related QOL in future studies examining PA among Hispanics with MS.

Considerations When Designing and Implementing Pragmatic Clinical Trials That Include Older Hispanics.

Introduction: Pragmatic clinical trials (PCTs) are designed to connect researchers with clinicians to assess the real-world effectiveness and feasibility of interventions, treatments, or health care delivery strategies in routine practice. Within PCTs larger, more representative sampling is possible to improve the external validity of the research. Older adults from underrepresented groups can benefit from PCTs given their historically lower engagement in clinical research. The current article focuses on older Hispanic adults with Alzheimer disease and related dementias (ADRDs). Older Hispanic adults represent 19% of the US population and have a higher prevalence of ADRDs than Whites. We provide data from 2 PCTs about the recruitment of older Hispanics with ADRDs and discuss unique challenges associated with conducting PCTs and propose strategies to overcome challenges. Data and Methods: The first PCT outlined is the Patient Priorities Care for Hispanics with Dementia (PPC-HD) trial. PPC-HD is testing the feasibility of implementing a culturally adapted version of the Patient Priorities Care approach for older Hispanic adults with multiple chronic conditions and dementia. The second PCT is the Dementia Care (D-CARE) Study, which is a multisite pragmatic study comparing the effectiveness of a health care system-based approach and a community-based approach to dementia care to usual care in patients with ADRDs and their family caregivers. Lessons Learned and Recommendations for Future Studies: The lessons learned are summarized according to the various stakeholders that need to work together to effectively recruit diverse participants for PCTs: individuals, health care systems, research teams, and communities. Individual-level considerations include communication, priorities, and flexibility. Health care system-level considerations are grounded in 4 principles of Community-Based Participatory Research and include collaboration/partnership, available resources, priorities of the health care system, and sustainability. Research team-level considerations include team members, intentionality, and communication. Community-level considerations highlight the importance of partnerships, community members, and appropriate incentives. Discussion: PCTs provide a unique and potentially impactful opportunity to test interventions in real-world settings that must be culturally appropriate to reach underrepresented groups. Collectively, considering variables at multiple levels to address the needs of older adults with ADRDs is crucial, and the examples and suggestions provided in this report are a foundation for future research.

Desired Resources for Changing Diet Among Persons With Multiple Sclerosis: Qualitative Inquiry Informing Future Dietary Interventions.

BACKGROUND: There are approximately 1 million adults in the United States with multiple sclerosis (MS). Persons with MS are interested in diet as a second-line therapy for improving MS symptoms and disease progression. Examination of desired resources regarding diet among persons with MS is necessary for supporting behavior change. METHODS: Twenty-five adults with MS completed 1-on-1, online semistructured interviews. An inductive, 6-phase, semantic thematic analysis was applied to identify themes associated with participant preferences for dietary behavior change. RESULTS: The research team crafted 4 key themes from the data that encompassed participants' desired resources for dietary behavior change. Theme 1, MS-specific evidence, involved the need for clear information about the impact of diet regimens or specific foods on MS. Theme 2, dietary guidelines, was related to guidelines provided by a reliable source such as a registered dietitian. Theme 3, behavioral supports, underscored the need for support for behavior change, including accountability, self-monitoring, motivation, habituation, and incremental changes. Theme 4, diet resources, highlighted tangible resources for supporting dietary change, including recipes, food lists, meal services, or games. CONCLUSIONS: This study provides a foundation for guiding dietary interventions for persons with MS that incorporates their needs and preferences and could improve their overall health. Such dietary change can be facilitated by theory-based behavioral interventions that incorporate behavior change techniques such as self-monitoring and goal setting for supporting behavior change.

Association of disease outcomes with physical activity in multiple sclerosis: A cross-sectional study.

Purpose/Objective Research: This study examined combinations of disease outcomes (i.e., walking, cognition, and symptoms) as correlates of physical activity subgroups (insufficiently active vs. sufficiently active) in persons with multiple sclerosis (MS). RESEARCH METHOD/DESIGN: This study included 213 participants who completed walking and cognitive function tests and self-report measures of symptoms and physical activity. Multivariate analysis of variance and discriminant function analysis identified combinations of MS outcomes associated with physical activity. RESULTS: The sample had a mean age of 49.6 years (SD = 13.2), a 3:1 female:male ratio, and a Patient Determined Disease Steps median (interquartile range) score of 1.0 (3.0). Multivariate analysis of variance demonstrated that MS outcome clusters were significantly associated with physical activity, namely walking (i.e., Six-Minute Walk, Timed Up and Go, and MS Walking Scale), Pillai's trace V = .16, F(3, 180) = 11.43, η² = .16; cognition (i.e., Symbol Digits Modalities Test, California Verbal Learning Test-Second Edition, Brief Visuospatial Memory Test-Revised), Pillai's trace V = .04, F(3, 204) = 2.79, η² = .04; and symptoms (i.e., fatigue, anxiety, depression, and pain), Pillai's trace V = .16, F(4, 199) = 9.30, η² = .16. Discriminant function analysis indicated that a significant discriminant function of walking endurance and walking limitations, depression, fatigue, and processing speed was associated with physical activity subgroups. CONCLUSION/IMPLICATIONS: The findings identified walking endurance and limitations, processing speed, depression, and fatigue as primary correlates of physical activity differences in persons with MS. These results may inform researchers and health care providers to consider these factors in behavior change interventions and clinical practices for promoting adequate physical activity levels in MS. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Rates and patterns of physical activity among Hispanics with multiple sclerosis in the NARCOMS Registry.

BACKGROUND: Multiple sclerosis (MS) is the most common cause of non-traumatic neurological disability among adults with an estimated incidence of 2.9 cases per 100,000 Hispanic adults. Hispanics with MS experience disproportionate rates of mobility disability compared to non-Hispanic Whites with MS. The current study aimed to examine the rates and patterns of physical activity (PA) behavior among Hispanics with MS and compare physical activity behavior to non-Hispanic Whites with MS in the North American Research Committee on Multiple Sclerosis Registry (NARCOMS). METHODS: NARCOMS registry participants who completed the physical activity questions in the Spring 2015 semi-annual survey were included in the analyses. Self-identified Hispanic and non-Hispanic Whites were compared. Rates and patterns of physical activity were based on the International Physical Activity Questionnaire. We performed a 2:1 propensity score matching for comparing non-Hispanic White and Hispanic participants. RESULTS: Of the 6,352 NARCOMS participants in Spring 2015, we included 136 Hispanic and 6,216 non-Hispanic White participants. Among the Hispanic sample, median number of days engaged in vigorous PA was 0 and moderate PA was 1 day. Mean number of minutes sitting per day was 531±266 (approximately 9 hours). Further, a minority of Hispanic participants classified themselves as moderate or heavy active for work (11%), home (24%), and leisure (33%) physical activity. There were no significant differences between participants who identified as Hispanic (n=119) and propensity-matched non-Hispanics White participants (n=238) in demographics, clinical characteristics, or physical activity variables. CONCLUSION: Rates of physical activity were low among Hispanics with MS. This highlights an opportunity for examining the impact of physical activity interventions for improving mobility disability.

Perceptions of physical activity guidelines among wheelchair users with multiple sclerosis.

Background: Physical activity guidelines provide prescriptive resources for population-level promotion of behavior change to improve health outcomes. The National Multiple Sclerosis Society (NMSS) recently created and disseminated physical activity guidelines for persons with multiple sclerosis (MS) across the disease spectrum. Objective: This study aimed to assess perceptions of the updated NMSS Physical Activity Guidelines among wheelchair users with MS. Methods: One hundred thirty-four wheelchair users with MS participated in a cross-sectional study examining health behaviors. Outcomes were measured using an online questionnaire that included items related to demographic and clinical characteristics and a battery of questions regarding perceptions of the NMSS Physical Activity Guidelines based on Expanded Disability Status Scale groups 7.0-7.5 & 8.0-8.5. Results: Among the 134 participants, 77 participants (58%) did not meet the general recommendations, 43 participants sometimes meet the general recommendations (32%), and 14 participants (10%) reported meeting the general recommendations. Participants reported positive perceptions across modalities (i.e. Breathing, Flexibility, Upper Extremity, Lower Extremity, and Core Exercises); however Upper and Lower Extremity Exercises were rated as the most challenging based on inability to complete independently. Conclusion: Wheelchair users with MS in this study generally rated the NMSS Guidelines for Physical Activity as appropriate.

Association between individual wheelchair skills and fitness in community-dwelling manual wheelchair users with spinal cord injuries.

PURPOSE: Wheelchair skills are a key component to promotion of community participation among persons with spinal cord injury (SCI). The objective of this secondary analysis was to examine the association between individual wheelchair skills from the Wheelchair Skills Test Questionnaire (WST-Q) and fitness among community-dwelling adults with SCI. MATERIALS AND METHODS: Twenty-six adults were recruited to complete the WST-Q and a standard graded aerobic wheelchair exercise test on a motorized treadmill for assessing peak power output (POpeak). RESULTS: Spearman Rho rank-order correlation (ρ) analyses indicated statistically significant correlations between POpeak and six basic (ρ = 0.41-0.57), eight intermediate (ρ = 0.44-0.59), and nine advanced (ρ = 0.42-0.80) WST-Q skill scores. After controlling for sex and injury level (Partial Spearman Rho rank order) significant correlations persisted for four advanced skills (i.e., descends high curb, turns in place in wheelie position, descends steep incline in wheelie position, descends high curb in wheelie position; ρ = 0.46-0.59) and one additional skill (i.e., ascends high curb ρ = 0.51). CONCLUSIONS: More advanced wheelchair skills are significantly associated with fitness in persons with SCI. The directionality of the skills-fitness relationship, specifically whether wheelchair skills facilitate greater fitness or fitness is a prerequisite for certain wheelchair skills needs to be determined in future, larger studies. However, results from this study provide a comprehensive list of wheelchair skills that are associated with fitness that can be directly applied to guide further research and practice promoting community participation among persons with SCI.Implications for RehabilitationSignificant positive associations exist between advanced wheelchair skills (i.e., descends high curb, turns in place in wheelie position, descends steep incline in wheelie position, descends high curb in wheelie position and ascends high curb) and fitness in manual wheelchair users with spinal cord injury (SCI).This study provides a list of skills associated with fitness to guide clinical practice and areas for further rehabilitation research assessing the directionality of the relationship between fitness and wheelchair skills.

Social Cognitive Theory variables as correlates of physical activity in fatigued persons with multiple sclerosis.

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.

Lifestyle physical activity in manual wheelchair users - an overlooked public health opportunity.

Public health guidelines and health promotion efforts have traditionally focused on weekly accumulation of moderate to vigorous physical activity (MVPA) via structured exercise. There has been a recent paradigm shift towards the organic incorporation of MVPA in daily leisure and non-leisure time, termed "Lifestyle Physical Activity" (LPA). However, this paradigm shift and the underlying research has neglected manual wheelchair users (MWCUs) with spinal cord injury (SCI), who could benefit from LPA. This article argues for expanding the LPA paradigm shift into research and health promotion efforts involving MWCUs with SCI. We suggest a working definition of LPA for MWCUs and candidate metrics for quantifying LPA. This is followed by brief overviews of LPA correlates, outcomes/consequences, and interventions and the need for theory based approaches to study these domains. We lastly suggest an approach for mitigating potential negative outcomes of increased LPA in MWCUs and suggest a research agenda.

Systematic review of participant characteristics in theory-based behavior change interventions for physical activity in multiple sclerosis: are we missing those with the greatest potential for lifelong benefits?

PURPOSE: This study examined participant characteristics, particularly disease duration, in theory-based physical activity behavior change trials in multiple sclerosis (MS) and summarized theoretical frameworks and changes in physical activity outcomes. MATERIALS AND METHODS: PubMed, CINAHL, Embase, and Scopus were searched to identify potential trials. One reviewer screened titles and abstracts, and two reviewers then independently screened full-text articles based on predetermined eligibility criteria. Data were extracted by one reviewer and checked by a second reviewer. RESULTS: Among 33 trials reviewed, only one trial reported a mean disease duration of less than five years (i.e., 4.5 years) for the sample. The remaining trials included samples with a mean disease duration of 6.7 years or longer. The most common theories used were Social Cognitive Theory, Trans-theoretical Model, and Motivational Interviewing. The effects on physical activity were heterogeneous; device-measured outcomes increased in 41.4% of studies, self-reported outcomes improved in 72.4%. Adherence (≥80%) was reported in 34.5% of studies. CONCLUSIONS: There is little focus on persons with MS in the early disease course in physical activity behavior change interventions. Future research should include comprehensive theoretical approaches for more homogeneous effects across outcome measures when targeting those in the early stage and all MS populations.IMPLICATIONS FOR REHABILITATIONTheory-based physical activity behavior change interventions have not included persons with multiple sclerosis (MS) in the early disease course (<5 years since diagnosis).Disease duration has not been a criterion used to include or exclude participants in the reviewed theory-based behavior change interventions for physical activity in people with MS.The theory-based behavior change interventions in this review positively affected short-term physical activity levels in people with MS.

Diet Quality Assessment in Wheelchair Users with Multiple Sclerosis.

BACKGROUND: Diet quality has not been distinctively examined in wheelchair users with multiple sclerosis (MS). METHODS: This cross-sectional study examined the Diet History Questionnaire (DHQ) III and the Automated Self-Administered 24-h (ASA24) Dietary Assessment Tool in 128 wheelchair users with MS. Participants were prompted to complete the DHQ-III and 3 ASA24 recalls during a seven-day data collection period. Healthy Eating Index (HEI)-2015 scores were calculated for DHQ-III and ASA24, and scores were compared with normative values. Spearman's correlation analyses (rs) estimated the associations between DHQ-III and ASA24 HEI-2015 total and component scores with supportive paired sample t-tests. RESULTS: HEI-2015 scores for DHQ-III and ASA24 were significantly higher than normative values for total score, total protein foods, and added sugar. Correlations between HEI-2015 scores generated using ASA24 and DHQ-III were all statistically significant (range rs = 0.23-0.69); however, significant differences between ASA24 and DHQ-III values were noted for HEI-2015 total score, total fruits, whole fruit, total vegetable, greens and beans, whole grains, seafood and plant protein, refined grains, and saturated fats. CONCLUSION: This study provided a novel description of diet quality in wheelchair users with MS for guiding future research promoting healthy eating in this population.