TRACking health behavior in people with multiple sclerosis: Effects of a randomized trial on physical activity and working memory.

OBJECTIVE: Multiple sclerosis is associated with impairments in working memory functioning. Lifestyle physical activity interventions show promise in improving cognitive functioning; however, the evidence is limited. We examined the efficacy of a lifestyle physical activity intervention, involving step tracking and psychoeducational materials, on improving step counts, working memory functioning, and network strength in a whole-brain network of working memory. METHOD: Participants (n = 75) were randomly assigned to a group tracking steps with a pedometer (step-track), or a group tracking water intake with a smart water bottle (water-track), for 6 months. At baseline, mid, and postintervention, we assessed weekly physical activity (GT3X+ accelerometer), weekly water intake (H20 Pal Smart Bottle), and working memory functioning. Additionally, the combined network strength of a validated working memory connectome was calculated. RESULTS: We ran random intercept linear mixed models to examine differences between the groups, over time. A significant Group × Time interaction effect with steps and water intake indicated that the step-track group increased their steps, and the water-track group increased their water intake, in comparison to each other, from baseline to postintervention (p < .05). Both groups improved in behavioral working memory over time (p < .05). No significant differences were found on the network strength. CONCLUSION: Our 6-month randomized controlled trial involving physical activity tracking showed increased step count in the intervention group. Behavioral working memory improved in both groups, potentially due to practice effects. Future studies should include both active and passive control groups to discern practice effects from intervention impact. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Age differences in emotion regulation strategy use and flexibility in daily life.

OBJECTIVES: Age-related shifts in emotion regulation patterns are important for explaining preserved emotional well-being in late adulthood amidst declines in physical and cognitive health. Although several studies have examined age-related shifts in emotion regulation strategy use, age differences in how specific strategies are flexibly adapted to shifting contexts in daily life and the adaptiveness of such shifts remains poorly understood. METHODS: 130 younger adults (ages 22-35) and 130 older adults (ages 65-85) completed a modified Day Reconstruction Method Assessment and self-report questionnaires to examine age differences in emotion regulation strategy use and one aspect of emotion regulation flexibility (responsiveness) in daily life, and the adaptive implications of these differences. RESULTS: Older adults exhibited more frequent acceptance use, less frequent distraction use, and less flexibility in the responsiveness of strategies with varying negative affect. Across age groups, the use of expressive suppression and distraction was associated with less adaptive outcomes, whereas higher acceptance responsiveness, positive reappraisal responsiveness, and situation selection responsiveness were associated with more adaptive outcomes. Age-group moderated the associations between adaptiveness metrics with the use and flexibility of several emotion regulation strategies. CONCLUSION: The current findings provide early evidence of age-related decreases in emotion regulation flexibility as well as age-related shifts in the adaptiveness of emotion regulation patterns.

Accelerometry measures of physical activity and sedentary behavior: Associations with cognitive functioning in MS.

BACKGROUND: Cognitive dysfunction is a pervasive symptom of multiple sclerosis (MS). Correlational evidence on the relationships between physical activity, sedentary behavior, and cognition has been mixed and limited to a few activity measures. The collinearity of accelerometry-based metrics has precluded an assessment of the full activity spectrum. Here, we aimed to examine the rich set of activity measures using analytic approaches suitable for collinear metrics. We investigated the combination of physical activity, sedentary, and clinicodemographic measures that explain the most variance in composite scores of working memory/processing speed, visual memory, and verbal memory. METHODS: We analyzed baseline accelerometry and neuropsychological data (n = 80) from a randomized controlled trial of pedometer tracking. Using partial least squares regression (PLSR), we built three models to predict latent scores on the three domains of cognition using 12 activity metrics, sex, education, and Expanded Disability Status Scale (EDSS) scores. Significance was assessed using linear regression models with model component scores as predictors and cognitive composites as outcomes. RESULTS: The latent component was significant for working memory/processing speed but was not significant for visual memory and verbal memory after Bonferroni correction. Working memory/processing speed was positively associated with average kilocalories, moderate-to-vigorous physical activity (MVPA), steps, and sex (i.e., higher scores in males) and negatively related to duration of long sedentary bouts and EDSS. CONCLUSIONS: These findings suggest that increasing overall energy expenditure through walking and MVPA, while decreasing prolonged sedentary time may positively benefit working memory/processing speed in people with MS. TRIAL REGISTRATION: This RCT #NCT03244696 was registered on Clinicaltrials.gov (https://www. CLINICALTRIALS: gov/ct2/show/NCT03244696).

TRACking health behaviors in people with Multiple Sclerosis (TRAC-MS): Study protocol and description of the study sample.

Introduction: People with multiple sclerosis (PwMS) experience a range of physical, cognitive, and affective symptoms. Behavioral interventions targeting increased physical activity show promising support as low-cost methods to improve working memory, episodic memory, and processing speed in PwMS. In this randomized controlled trial, we will examine the efficacy of a pedometer-tracking intervention, designed to increase low-to-moderate levels of physical activity, for improving working memory in PwMS. Methods and Analysis: Eighty-seven PwMS, between the ages of 30-59, have been recruited for the study. Seventy-five of the eligible and interested individuals were randomized to six-month health behavior monitoring groups: a Step-track group or a Water-track group (serving as the active control). Neuropsychological measures, assessing the primary outcome of the study, were administered at pre, midpoint, and post-intervention. Exploratory factor analysis of neuropsychological measures resulted in three factors: a working memory/processing speed factor, a visual episodic memory factor, and a verbal episodic memory factor. Changes in this latent measure of working memory/processing speed is the primary outcome of the current study. Functional MRI data will be analyzed to examine changes in the functional connectivity of the neural network supporting working memory. Ethics and dissemination: The institutional review board granted approval for the study and all participants provided written informed consent. The results of this study will provide support showing that step-tracking increases overall levels of physical activity, improves working memory and processing speed, and strengthens the neural circuitry that supports better cognition. Evidence from this study will thus offer promising support for the routine use of step-tracking devices to improve cognitive functioning in PwMS. Study results will be disseminated through peer-reviewed publications and presentations at scientific conferences.

Protocol for a randomized controlled trial of mindfulness-based stress reduction to improve attentional control in older adults (HealthyAgers trial).

BACKGROUND: Mindfulness meditation is a form of mind-body intervention that has increasing scientific support for its ability to reduce age-related declines in cognitive functioning, improve affective health, and strengthen the neural circuitry supporting improved cognitive and affective health. However, the majority of existent studies have been pilot investigations with small sample sizes, limited follow-up data, and a lack of attention to expectancy effects. Here, we present the study design of a Phase I/II, efficacy trial-HealthyAgers trial-that examines the benefits of a manualized mindfulness-based stress reduction program in improving attentional control and reducing mind-wandering in older adults. METHODS: One hundred fifty older adults (ages 65-85 years) will be randomized into one of two groups: an eight-week mindfulness program or an eight-week, placebo-controlled, lifestyle education program. Behavioral and neuroimaging assessments are conducted before and after the training. Participants are then invited to booster sessions once every three months for a period of 12 months with post-intervention follow-up assessments conducted at 6-months and 12-months. The primary outcomes for the study are behavioral measures of attentional control and mind-wandering. Additional, secondary outcomes include network strength in an a priori defined neuromarker of attentional control, fluid and everyday cognition, emotion regulation strategy use, and markers of inflammation. DISCUSSION: This study will establish the efficacy of a group-based, low-cost mind-body intervention for the inter-related facets of attentional control and mind-wandering in older adults. Strengths of this study include a well-designed, placebo-controlled comparison group, use of web/mobile application to track study adherence, and longitudinal follow-up. TRIAL REGISTRATION: Clinicaltrials.gov (# NCT03626532 ). Registered August 4, 2018.

Impact of mindfulness training on emotion regulation in multiple sclerosis: Secondary analysis of a pilot randomized controlled trial.

Purpose/Objective Research: This secondary analysis of a pilot randomized controlled trial in people with multiple sclerosis (PwMS) aimed to compare mindfulness-based training (MBT), adaptive cognitive training (aCT), and a waitlist control (WL) on the use of emotion regulation strategies during daily worries and ruminations. Further, we examined cognitive functioning as a moderator of training effects. RESEARCH METHOD/DESIGN: Sixty-one PwMS were randomized into an MBT, aCT, or a WL control group for four weeks. Participants completed daily diaries assessing their use of emotion regulation strategies and measures of cognitive functioning at pre- and posttraining. The frequency of acceptance use, maladaptive strategies, and cognitive reappraisal, as well as the success of acceptance use, were the primary outcomes of interest. We also examined whether a cognitive composite score moderated treatment gains. RESULTS: Relative to pretraining, at posttraining, participants in the MBT group used acceptance more frequently, and this change was significantly greater compared to the change in aCT and WL groups. Training did not have differential effects on the frequency of maladaptive strategy and cognitive reappraisal use or on the success of acceptance use. Cognitive functioning did not moderate observed treatment gains. CONCLUSION/IMPLICATIONS: Our findings, based on this pilot study, suggest that after brief training in mindfulness meditation, PwMS used more acceptance strategies to regulate their emotions. Future studies with larger sample sizes, longer duration of treatment, and longitudinal follow-up are needed to better understand the efficacy of mindfulness mediation for promoting affective and cognitive health in PwMS. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A promising cognitive screener in multiple sclerosis: The NIH toolbox cognition battery concords with gold standard neuropsychological measures.

BACKGROUND: Routine cognitive screening is a priority in MS clinical care. The National Institutes of Health Toolbox (NIHTB) Cognition Battery is a 30-min instrument validated in neurological populations excluding MS. OBJECTIVES: To assess construct validity of NIHTB tests and compare classification of cognitive impairment with gold-standard tests. To evaluate relationships between fluid cognition and clinical measures. METHODS: Eighty-seven individuals, aged 30-59 years, completed the NIHTB, Minimal Assessment of Cognitive Function in MS (MACFIMS), Wechsler Adult Intelligence Scale-IV subtests, and measures of disease severity, depression, and fatigue. RESULTS: The NIHTB showed adequate convergent validity for processing speed, working memory, and episodic memory. Although fluid cognition scores from the NIHTB and MACFIMS classified a similar proportion of participants as cognitively impaired, the two batteries differed in which individuals were classified as impaired versus preserved. NIHTB fluid cognition was inversely correlated with disease severity but not related to depression or fatigue. CONCLUSIONS: The NIHTB concords with gold-standard measures, and classifies cognitive impairment at similar rates to the MACFIMS. Adjusted NIHTB fluid cognition was negatively associated with disease severity suggesting clinical utility. Psychometric validation of the NIHTB in clinical practice will elucidate its promise as a cognitive screener in MS.

Trait mindfulness, emotion dysregulation, and depression in individuals with multiple sclerosis.

OBJECTIVES: Emotion dysregulation plays a role in the development and maintenance of psychopathology. Given the higher rates of mood disturbances in people with multiple sclerosis (PwMS), there is a need to explore the relationships between metrics of emotion dysregulation and potential protective traits. Mindfulness, a multi-faceted trait characteristic reflecting present moment awareness, is one such trait showing promise for positive associations with affective health. The current project assessed the relationship between trait mindfulness, the use of emotion regulation strategies during an emotionally evocative task, and depression in PwMS. METHODS: Sixty-one PwMS completed a worry/rumination induction task that examined emotion regulation strategy use in response to emotionally evocative stimuli. RESULTS: Higher trait mindfulness was associated with both lower symptoms of depression and greater employment of acceptance-based strategies following worry and rumination inductions. Acceptance use mediated the relationship between trait mindfulness and symptoms of depression. CONCLUSIONS: Our results suggest that the association between trait mindfulness and emotion dysregulation extends to the use of emotion regulation strategies during an emotionally evocative task. Additionally, emotion regulation strategy use, and acceptance in particular, may play a role in the relationship between trait mindfulness and depression. These findings suggest that increasing levels of mindfulness through clinical interventions may present a path toward improving emotion regulation, and by extension, reducing the symptoms of depression in PwMS.

Trait mindfulness and emotion regulation responsiveness to negative affect in daily life.

Objectives: Recent conceptualizations of adaptive emotion regulation is predicated on the ability to flexibly use emotion regulation strategies to meet changing contextual demands. Although trait mindfulness has been linked to enhanced emotional well-being and use of adaptive emotion regulation strategies, there is a dearth of literature examining associations between trait mindfulness and emotion regulation flexibility. Further, despite a rich literature suggesting that emotion regulation processes change with age, no study to date has assessed whether the role of trait mindfulness on emotion regulation responsiveness to negative emotions-a component of emotion regulation flexibility-differs between young and older adults. Methods: The current study recruited 130 young adults and 130 older adults to assess trait mindfulness, emotion regulation strategy use, and emotion regulation responsiveness of six distinct strategies in daily life. Results: Across the full sample, trait mindfulness was related to reduced distraction (ß = -0.11, t(238.09) = -3.02, p = .003) and expressive suppression (ß = -0.15, t(237.70) = -4.62, p < .001) strategy use. Age moderation analyses revealed that trait mindfulness was associated with reduced expressive suppression responsiveness (ß = 0.12, t(247) = 2.31, p = .022) in young adults and increased detached reappraisal responsiveness among older adults (ß = 0.15, t(247) = -2.95, p = .003). Conclusions: The current findings highlight the importance of understanding how trait mindfulness is associated with strategy use and responsiveness to negative affect changes in daily life as well as how these patterns may shift across the lifespan. Manuscript Pre-registration: Open Science Framework, registration number: z5g8v.

Mindfulness training for emotion dysregulation in multiple sclerosis: A pilot randomized controlled trial.

OBJECTIVE: People with multiple sclerosis (PwMS) report greater emotion dysregulation, which is associated with increased symptoms of depression and anxiety, and reduced quality of life. Given the transdiagnostic significance of emotion dysregulation, the current study was designed to assess the feasibility and treatment effects of mindfulness meditation in reducing emotion dysregulation for PwMS. METHOD: Sixty-one PwMS were randomized to 1 of 3 groups: 4-week mindfulness-based training (MBT), 4-week adaptive cognitive training (aCT), or a waitlist control group. Using self-report and behavioral measures, we examined the effects of MBT on emotion dysregulation, use of emotion regulation strategies, experience of negative and positive affect, and overall quality of life. RESULTS: Mindfulness training was associated with reduced emotion dysregulation compared with the adaptive cognitive training and the waitlist control group (ηp² = .20). Relative to the waitlist group, the MBT group also demonstrated reductions on a composite score of preservative cognition, measuring rumination and worry (ηp² = .15). However, there was no differential use of emotion regulation strategies or between-groups differences in overall quality of life as a function of training. CONCLUSIONS: Our pilot study provides preliminary support for MBT to reduce self-reported emotion dysregulation in PwMS. Given the widespread prevalence of mental health disturbances in this population, MBT can serve as a promising rehabilitation tool for PwMS (clinicaltrials.gov # NCT02717429). (PsycInfo Database Record (c) 2020 APA, all rights reserved).