Multiple sclerosis patients need and want information on exercise promotion from healthcare providers: a qualitative study.

BACKGROUND: There is growing recognition of the benefits and safety of exercise and its importance in the comprehensive care of persons with multiple sclerosis (MS), yet uptake is low. OBJECTIVE: We explored the needs and wants of patients with MS regarding exercise promotion through healthcare providers. SETTING AND PARTICIPANTS: Participants were adults with MS who had mild-or-moderate disability and a range of exercise levels. All participants lived in the Midwest of the United States. METHODS: Fifty semi-structured interviews were conducted and analysed using thematic analysis. Two themes emerged, namely interactions between patients and healthcare providers and needs and wants of patients. RESULTS: Analysis of participant accounts illustrate that current exercise promotion by healthcare providers does not meet patient needs and wants. The identified needs and wants of persons with MS involved (i) information and knowledge on the benefits of exercise and exercise prescription, (ii) materials to allow home and community exercise and (iii) tools for initiating and maintaining exercise behaviour. DISCUSSION AND CONCLUSION: Patients with MS frequently interact with healthcare providers and are generally unsatisfied with exercise promotion during interactions. Healthcare providers can address the low uptake of exercise among persons with MS by acting upon the identified unmet needs involving materials, knowledge and behaviour change strategies for exercise.

Identifying preferred format and source of exercise information in persons with multiple sclerosis that can be delivered by health-care providers.

BACKGROUND: There is increasing recognition of the benefits of exercise in individuals with multiple sclerosis (MS), yet the MS population does not engage in sufficient amounts of exercise to accrue health benefits. There has been little qualitative inquiry to establish the preferred format and source for receiving exercise information from health-care providers among persons with MS. OBJECTIVE: We sought to identify the desired and preferred format and source of exercise information for persons with MS that can be delivered through health-care providers. SETTING AND PARTICIPANTS: Participants were adults with MS who had mild or moderate disability and participated in a range of exercise levels. All participants lived in the Midwest of the United States. METHODS: Fifty semi-structured interviews were conducted and analysed using thematic analysis. RESULTS: Two themes emerged, (i) approach for receiving exercise promotion and (ii) ideal person for promoting exercise. Persons with MS want to receive exercise information through in-person consultations with health-care providers, print media and electronic media. Persons with MS want to receive exercise promotion from health-care providers with expertise in MS (ie neurologists) and with expertise in exercise (eg physical therapists). CONCLUSIONS: These data support the importance of understanding how to provide exercise information to persons with MS and identifying that health-care providers including neurologists and physical therapists should be involved in exercise promotion.

Cognitive motor interference during walking in multiple sclerosis using an alternate-letter alphabet task.

OBJECTIVE: To examine cognitive motor interference (CMI) during walking using a simple, standardized, and well-refined alphabet dual-task (DT) paradigm in individuals with multiple sclerosis (MS) in whom cognitive and walking impairment often co-occur. DESIGN: A single time point, cross-sectional study. SETTING: A university clinical laboratory. PARTICIPANTS: Individuals with MS (N=61; mean age ± SD, 50.8±9.3 y) performed 4 walking trials over a 4.6-m walkway to determine gait parameters. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Gait parameters were assessed over 4 walking trials. The first 2 walks involved the single task (ST) of walking only; the second 2 walks involved participants performing the DT of reciting alternate letters of the alphabet while walking. The gait parameters recorded during the ST and DT walks were used to compute a dual-task cost (DTC) of walking (% change in gait parameter between ST and DT walks) as a metric of CMI. RESULTS: Our multivariate analysis with univariate follow-ups indicated CMI during walking based on slower velocity (ηp(2)=.59; F=84.6; P<.001) and cadence (ηp(2)=.46; F=51.6; P<.001), shorter step length (ηp(2)=.38; F=36; P<.001), and increased step time (ηp(2)=.34; F=31; P<.001) and double-support time (ηp(2)=.31; F=27.3; P<.001) in DT versus ST conditions. The DTC of walking for the gait parameters was not correlated with clinical (disability, disease duration) and demographic (eg, education, age) factors (all |r|≤.240). CONCLUSIONS: The alphabet DT paradigm is easily administered and well refined. We highlight its ability and acceptability to determine CMI during walking in people with MS, independent of disease status.

Accelerometer cut-points derived during over-ground walking in persons with mild, moderate, and severe multiple sclerosis.

BACKGROUND: There has been increased interest in objectively quantifying time spent in moderate-to-vigorous physical activity (MVPA) using accelerometry as an outcome among persons with multiple sclerosis (MS). This requires development of a cut-point for interpreting the rate of accelerometer output based on its association with energy expenditure during physical activity. OBJECTIVE: The current study measured activity counts from a waist-worn accelerometer and energy expenditure based on indirect calorimetry during three speeds of over-ground walking for deriving cut-points for interpreting accelerometer output in persons with mild, moderate, and severe MS disability. METHODS: 54 participants with MS initially completed a neurological examination for generation of an EDSS score. Participants were then fitted with an ActiGraph model GT3X+ accelerometer and a Cosmed portable metabolic system, and completed three, 6-minute walk (6 MW) tests that were interspersed with 10-15 min of rest. The first 6 MW was undertaken at a comfortable walking speed (CWS), and the two remaining 6 MW tests were undertaken above (faster walking speed) or below (slower walking speed) the participant's CWS in a counterbalanced order. RESULTS: The linear association between activity counts per minute and energy expenditure did not differ between persons with mild and moderate MS disability, but it was significantly different among persons with severe disability. This resulted in disability-specific cut-points for MVPA of 1980 and 1185 counts per minute for groups with mild/moderate disability and severe disability, respectively. CONCLUSIONS: We believe that this research will facilitate a better understanding of time spent in MVPA across a broad range of MS disability.

Accuracy of StepWatch™ and ActiGraph accelerometers for measuring steps taken among persons with multiple sclerosis.

INTRODUCTION: There has been increased interest in the objective monitoring of free-living walking behavior using accelerometers in clinical research involving persons with multiple sclerosis (MS). The current investigation examined and compared the accuracy of the StepWatch activity monitor and ActiGraph model GT3X+ accelerometer for capturing steps taken during various speeds of prolonged, over-ground ambulation in persons with MS who had mild, moderate, and severe disability. METHODS: Sixty-three persons with MS underwent a neurological examination for generation of an EDSS score and undertook two trials of walking on the GAITRite electronic walkway. Participants were fitted with accelerometers, and undertook three modified six-minute walk (6MW) tests that were interspersed with 10-15 minutes of rest. The first 6MW was undertaken at a comfortable walking speed (CWS), and the two remaining 6MW tests were undertaken above (faster walking speed; FWS) or below (slower walking speed; SWS) the participant's CWS. The actual number of steps taken was counted through direct observation using hand-tally counters. RESULTS: The StepWatch activity monitor (99.8%-99.9%) and ActiGraph model GT3X+ accelerometer (95.6%-97.4%) both demonstrated highly accurate measurement of steps taken under CWS and FWS conditions. The StepWatch had better accuracy (99.0%) than the ActiGraph (95.5%) in the overall sample under the SWS condition, and this was particularly apparent in those with severe disability (StepWatch: 95.7%; ActiGraph: 87.3%). The inaccuracy in measurement for the ActiGraph was associated with alterations of gait (e.g., slower gait velocity, shorter step length, wider base of support). CONCLUSIONS: This research will help inform the choice of accelerometer to be adopted in clinical trials of MS wherein the monitoring of free-living walking behavior is of particular value.