Home-based Balance Training on Balance and Mobility in Persons with Multiple Sclerosis: A Systematic Review and Meta-analysis.

OBJECTIVE: To 1) examine the effects of home-based balance training on balance and mobility outcomes, 2) evaluate comparable effects between home-based and center-based balance training, 3) determine the impacts of different levels of supervision on treatment effects, and 4) investigate dose-response relationships of home-based balance training on balance and mobility performance in persons with multiple sclerosis (MS). DATA SOURCES: Literature searches were conducted in MEDLINE, EMBASE, PsycINFO, SPORTSDiscus, and CINAHL in April 2023. Other literature sources included website and citation searches. STUDY SELECTION: The study included randomized controlled trials of home-based balance training that included balance and mobility outcomes in persons with MS. DATA EXTRACTION: Data extracted from each study included 1) number of participants, 2) dropout rate, 3) sex, 4) MS phenotype, 5) age, 6) Expanded Disability Status Scale (EDSS) range, 7) exercise dose, 8) level of supervision, 9) type of intervention, 10) exercise progression, 11) type of control, and 12) outcomes measures. For the meta-analysis, mean and standard deviation of the balance and mobility outcomes in both the intervention and control groups were used. The methodological quality of included studies was evaluated by TESTEX. DATA SYNTHESIS: Eleven studies were identified in this systematic and meta-analysis. Each balance and mobility outcome was standardized using Hedge's g. CONCLUSIONS: This meta-analysis revealed comparable results between home- and center-based balance training in terms of balance and mobility improvement. There was also no evidence for the superiority of home-based balance training over no training except for static steady-state balance. This study revealed that training sessions (>36 sessions) and total exercise time (>1100 minutes) were significant moderators for overall balance improvements. Results also indicated that, when designing future interventions, at least an indirect level of supervision (e.g., weekly or bi-weekly phone/video calls) is warranted to maintain adherence.

Information processing speed and disease severity predict real-world ambulation in persons with multiple sclerosis.

BACKGROUND: Impairments in real-world gait quality and quantity are multifaceted for individuals with multiple sclerosis (MS), encompassing mobility, cognition, and fear of falling. However, these factors are often examined independently, limiting insights into the combined contributions they make to real-world ambulation. RESEARCH QUESTION: How do mobility, cognition, and fear of falling contribute to real-world gait quality and quantity in individuals with MS? METHODS: Twenty individuals with MS underwent a series of cognitive assessments, including the Paced Auditory Serial Addition Test (PASAT), Symbol Digits Modalities Test (SDMT), Stroop Test, and the Selective Reminding Test (SRT). Participants also completed the Falls Efficacy Scale - International (FES-I) and walking impairment using the Patient Determined Disease Steps (PDDS). Following the in-lab session, participants wore an inertial sensor on their lower back and asked to go about their typical daily routines for three days. Metrics of gait speed, stride regularity, time spent walking, and total bouts were extracted from the real-world data. RESULTS: Significant correlations were found between both real-world gait speed and stride regularity and the SDMT, FES-I, and PDDS. Backward linear regression analysis was conducted for gait speed and stride regularity, with PDDS and SDMT included in the final model for both metrics. These variables explained 63% of the variance in gait speed and 69% of the variance in stride regularity. Results were not significant for gait quantity after adjusting for age and sex. SIGNIFICANCE: The study's results provide insight regarding the roles of cognition, walking impairment, and fear of falling on real-world ambulation. Deeper understanding of these contributions can inform the development of targeted interventions that aim to improve walking. Additionally, the absence of significant correlations between gait metrics, cognition, and fear of falling with gait quantity underscores the need for further research to identify factors that increased walking in this population.

An Exploratory Study of Community Mobility in Adults With Multiple Sclerosis Across Different Ambulation Levels.

BACKGROUND: The purpose of this study was to identify differences in community mobility in adults with multiple sclerosis (MS) at various ambulation levels. METHODS: Seventy-one adults with MS completed a survey about their mobility impairment and avoidance of challenging mobility tasks. Individuals were categorized as having mild, moderate, or severe gait impairment. RESULTS: Participants across the different functional groups significantly differed in perceived ambulation disability, fatigue impact, falls efficacy, quality of life, challenges with dual-tasking, and self-efficacy for community mobility. There were no significant differences between the mild and moderate gait impairment groups in crossing a busy street or going out in different ambient conditions. Significant differences were found between those with mild impairment and those with severe impairment in avoidance of various terrain elements, heavy manual doors, postural transitions, attentional situations, and crowded places. The only environmental dimension that significantly differed across all 3 groups was carrying 2 or more items, in which avoidance increased as ambulation worsened. CONCLUSIONS: Avoidance behavior for particular environmental features can begin relatively early in the disease process. This underscores the need to further study mobility differences, community ambulation, and participation restrictions in adults with MS.

High intensity exercise training on functional outcomes in persons with multiple sclerosis: A systematic review.

BACKGROUND: There is growing interest and evidence for high intensity training (HIT) in clinical populations, including persons with multiple sclerosis (MS). While HIT has been shown to be a safe modality in this group, it is still unclear what collective knowledge exists for HIT on functional outcomes. This study examined HIT modalities (e.g., aerobic, resistance, functional training) on functional outcomes such as walking, balance, postural control, and mobility in persons with MS. METHODS: High intensity training studies, including RCTs and non-RCTs, that targeted functional outcomes in persons with MS were included in the review. A literature search was conducted in MEDLINE, EMBASE, PsycINFO, SPORTSDiscus, and CINAHL in April 2022. Other literature search methods were performed via website and citation searching. The methodological quality of included studies was assessed by TESTEX for RCTs and ROBINS-I for non-RCTs. This review synthesized the following data: study design and characteristics, participant characteristics, intervention characteristics, outcome measures, and effect sizes. RESULTS: Thirteen studies (6 RCTs and 7 non-RCTs) were included in the systematic review. The included participants (N = 375) had varying functional levels (EDSS range: 0-6.5) and phenotypes (relapsing remitting, secondary progressive, primary progressive). HIT modalities involving high intensity aerobic training (n = 4), high intensity resistance training (n = 7), and high intensity functional training (n = 2), revealed a significant and consistent benefit on walking speed and walking endurance in response to HIT, while the evidence regarding balance and mobility improvement was less clear. CONCLUSION: Persons with MS can successfully tolerate and adhere to HIT. While HIT appears to be an effective modality for improving some functional outcomes, the heterogeneous testing protocols, HIT modalities, and exercise doses among the studies preclude any conclusive evidence for its effectiveness thus necessitating future inquiry.

Mobility and Dual Tasking in the Everyday Lives of Adults with Multiple Sclerosis: A Qualitative Exploration.

OBJECTIVE: The purpose of the study was to understand how people with multiple sclerosis experience dual-tasking situations in their everyday lives. METHODS: Focus groups involving a total of 11 individuals with multiple sclerosis (eight females and three males) participated in this qualitative inquiry. Participants were asked open-ended questions focused on the nature of and consequences around dual tasking when standing or walking. Reflexive thematic analysis was employed to examine the data. RESULTS: Three themes were generated from the data: (a) Life Is a Dual Task, (b) The Social Divide, and (c) Sacrifices for Stability. CONCLUSIONS: This study highlights the significance and impact of dual tasking on the lived experience of adults with multiple sclerosis, furthering the need to more fully examine this phenomenon and potentially improve fall-prevention interventions and facilitate community participation.

Predicting falls in adults with multiple sclerosis using patient-reported measures: Are perceptions of dual-tasking missing?

BACKGROUND: Mobility challenges and cognitive impairments prominent in adults with multiple sclerosis (MS) significantly increase the risk of falling. Examining perceptions of how the simultaneous performance of completing motor and cognitive tasks impacts fall risk may have clinical utility. The purpose of this study was to identify the most significant self-reported predictors of falling including perceived dual-tasking. METHODS: Participants included 79 individuals with MS were surveyed and reported their fall history over the previous 3 months and completed the Multiple Sclerosis Walking Scale -12 (MSWS-12), Modified Fatigue Impact Scale (MFIS), Falls Efficacy Scale International (FES-I), and two Dual-Task Questionnaires (DTQ), a previously published original one and a newly expanded version. RESULTS: Of the sample, 63 were classified as non-fallers and 16 as fallers. Backward stepwise regression analysis revealed that perceived ambulation disability and dual-tasking best predicted fall status (sensitivity of 57.7%, specificity of 90.6%, area under the receiving operating curve of 0.81 (95% CI 0.70-0.92). CONCLUSION: The inclusion of self-reported dual-tasking perceptions has utility in predicting fall risk. Effective assessment toward this end offers the potential for early detection and intervention.

Cognitive-Motor Interference and Cortical Activation While Walking in Individuals With Multiple Sclerosis.

The present study expands on current understanding of dual-task cognitive-motor interference, by including cortical activation measures to both traditional and ecologically valid dual-task paradigms. Fifteen individuals with multiple sclerosis and 14 control participants underwent mobility testing while wearing functional near-infrared spectroscopy. In the absence of increased prefrontal cortical activation, subjects with multiple sclerosis performed significantly worse on measures of cognition under both single- and dual-task conditions. These findings suggest that persons with multiple sclerosis may be unable to allocate additional cortical resources to cognition under dual-task conditions, leading to significant cognitive-motor interference and decrements in performance. This study is the first to investigate cortical activation across several commonly used and ecologically valid dual-task assessments.

Motivation for Physical Activity in Adults With Multiple Sclerosis: A Self-determination Theory-Based Approach.

Background: Despite the benefits of regular physical activity (PA), most adults with multiple sclerosis (MS) are insufficiently active. Identifying the motivational correlates of PA is necessary to facilitate health behavior change. The extent to which the constructs of psychological need satisfaction and motivational regulations associate with self-determined PA in adults with the disease was examined. Methods: Individuals with MS were provided a link to a web-based survey. There were 290 respondents: 242 women and 48 men aged 22 to 71 (mean ± SD, 49.50 ± 12.05) years with primarily mild to moderate mobility impairment who completed the Psychological Need Satisfaction in Exercise scale, the Behavioral Regulation in Exercise Questionnaire, and the International Physical Activity Questionnaire. Results: Path analysis revealed that PA was best predicted by integrated regulation, competence, and mobility, explaining 28% of the variance in PA behavior. All 3 need satisfaction variables (relatedness, competence, and autonomy) and mobility impairment accounted for 43% of the variance in integrated regulation. Conclusions: Increasing satisfaction of the need for relatedness, competence, and autonomy can lead to more integrated and internally motivated PA engagement in adults with MS.

Acute effects of axial loading on postural control during walking and turning in people with multiple sclerosis: A pilot study.

BACKGROUND: Impaired sensory integration is heavily involved in gait control and accentuates fall risk in individuals with multiple sclerosis (MS). While axial loading has been found beneficial, little is known about the effect of non-specific axial loads on gait parameters and mobility tasks in those with MS. RESEARCH QUESTION: What are the effects of non-specific axial loading via weighted vests on walking and turning in those with MS. METHODS: Twelve participants with MS and eleven age- and gender-matched healthy controls participated in a cross-sectional study. All participants completed five trials of continuous walking with turns wearing weighted vests at 0%, 2%, 4%, 5%, and then 0% of their body weight. Gait parameters were measured using wireless inertial sensors. A 2 (group) x 5 (vest weight) multivariate analysis of variance (MANOVA) was performed to determine any significant differences between groups and across weighted vests for each gait variable. Post-hoc analysis and paired t-tests with corresponding effect sizes were also conducted. RESULTS: A significant between groups main effect was found for group (F (6100) = 14.74, p = .000) in multiple gait parameters (p < 0.05), although no significant main effect was found for weighted vest. Within group analyses indicated significantly increased cadence and gait speed across varying weighted vests for both MS and control groups (p < 0 >05). Increased vest weight from 0%PRE to 2% also had large effect on shortening double support time and increasing stride length in the MS group. SIGNIFICANCE: This study provided preliminary evidence that non-specific axial loads of varying weights appear to improve certain gait parameters. As such, this modality may offer mobility benefit and serve as an accessible home-based intervention alternative aimed at improving walking in individuals with MS.

Spousal support underlying self-determined physical activity in adults with multiple sclerosis.

AIM: Identifying motivational factors that facilitate physical activity engagement in adults with multiple sclerosis (MS) is important given beneficial health outcomes. The purpose of this study was to examine the relationship between physical activity of adults with MS and perceived spousal behaviors underlying self-determination. METHODS: One-hundred and twelve individuals with MS completed the Patient Determined Disease Steps, Physical Exercise Self-Efficacy Scale, Spousal Support for Physical Activity Scale, and Godin Leisure-Time Exercise Questionnaire. Descriptive statistics, scale reliabilities, and bivariate correlations were obtained. To examine the influence of perceived spousal behavior on total metabolic equivalents, a regression analysis was conducted. RESULTS: All subscales were found to be highly reliable. Strong and significant associations between each of the variables and physical activity existed except for that of expectations, social control, and self-efficacy. Physical activity was best predicted by spousal behaviors supporting the self-determination constructs of relatedness, competence, and autonomy (R = 0.49, R2=0.24, F8,93=2.27, p < 0.05), with spousal support contributing 14.8% to total self-determined physical activity. CONCLUSIONS: Given the significant role of the spouse in fostering intrinsic motivation for physical activity in adults with MS, delivering more partner-oriented and targeted interventions that build relationship, competence and autonomy appear warranted.Implications for RehabilitationPhysical activity offers significant physical and psychological benefit to adults with multiple sclerosis (MS) and can contribute to greater marital satisfaction.Self-determined physical activity of individuals with MS can be facilitated by spouses who support their partner's needs for relatedness, competency, and autonomy.Delivering more partner-oriented and targeted interventions that develop self-determination have the potential to increase physical activity and improve quality of life in those with MS.

A Preliminary Investigation of the Effects of Obstacle Negotiation and Turning on Gait Variability in Adults with Multiple Sclerosis.

Many falls in persons with multiple sclerosis (PwMS) occur during daily activities such as negotiating obstacles or changing direction. While increased gait variability is a robust biomarker of fall risk in PwMS, gait variability in more ecologically related tasks is unclear. Here, the effects of turning and negotiating an obstacle on gait variability in PwMS were investigated. PwMS and matched healthy controls were instrumented with inertial measurement units on the feet, lumbar, and torso. Subjects completed a walk and turn (WT) with and without an obstacle crossing (OW). Each task was partitioned into pre-turn, post-turn, pre-obstacle, and post-obstacle phases for analysis. Spatial and temporal gait measures and measures of trunk rotation were captured for each phase of each task. In the WT condition, PwMS demonstrated significantly more variability in lumbar and trunk yaw range of motion and rate, lateral foot deviation, cadence, and step time after turning than before. In the OW condition, PwMS demonstrated significantly more variability in both spatial and temporal gait parameters in obstacle approach after turning compared to before turning. No significant differences in gait variability were observed after negotiating an obstacle, regardless of turning or not. Results suggest that the context of gait variability measurement is important. The increased number of variables impacted from turning and the influence of turning on obstacle negotiation suggest that varying tasks must be considered together rather than in isolation to obtain an informed understanding of gait variability that more closely resembles everyday walking.

The role of resilience: Physical activity continuation after falling in adults with multiple sclerosis.

BACKGROUND: As activity curtailment is common after a fall, the ability to harness resiliency is particularly salient for those with multiple sclerosis (MS) who fall frequently and who significantly benefit from remaining physically active. OBJECTIVE: The purpose of the study was to identify resilience factors, coping processes, and benefit finding underscoring the continuation of physical activity after experiencing a fall in individuals with MS. METHODS: Twelve individuals with MS (seven females and five males) participated in this qualitative study. Participants were asked general questions regarding their physical activity engagement and experiences around falling. Specific questions focused on health perceptions, personal characteristics, strategies and behaviors employed after a fall that related to remaining physically active, and any positives they perceived from falling. Transcribed interviews were analyzed and semantic themes identified. RESULTS: From the data, specific protective factors, resilience processes, and benefit finding emerged to explain participant capability to bounce back and continue with physical activity after falling. These personal factors included Locus of Control, Perseverance, Positive Attitude and Optimism, and Flexibility. Resilience processes included Utilizing Support, Problem Based Coping, and Perspective Taking. Finally, the theme of Looking Beyond Oneself was identified as a benefit. CONCLUSIONS: Understanding existing resilience factors that allow an individual to remain physically active after falling can potentially inform resilience-building interventions that broaden and build resilience resources and improve psychological and physical health in those with MS.

Using Body-Worn Sensors to Detect Changes in Balance and Mobility After Acute Aerobic Exercise in Adults with Multiple Sclerosis.

BACKGROUND: Current mobility and functional assessments do not capture the subtle changes in balance and gait that may predispose people with multiple sclerosis (MS) to falling. The purpose of this study was to use clinical and instrumented measures to examine the effects of an acute bout of aerobic exercise on balance and gait in individuals with MS. METHODS: Ten adults with MS performed 15 minutes of moderate-intensity recumbent cycling or 15 minutes of rest. Exercise and rest visit order was randomized and separated by 1 week. Balance and mobility were assessed before, immediately after, and 2 hours after each test condition. RESULTS: There were no significant differences across measurement periods for Timed 25-Foot Walk test times or Brief Balance Evaluation Systems Test scores. Significant improvements in mean sway radius and sway velocity when standing on foam and in percentage of stance stride time variability were found immediately after exercise compared with immediately after rest. CONCLUSIONS: This study lends further evidence that individuals with MS can safely engage in single bouts of aerobic exercise without detrimental short-term effects on function and may actually receive some short-term benefit regarding standing postural sway and gait variability. Future research should examine the dose-dependent relationship of varying types, intensities, or timing of exercise necessary to elicit short-term functional benefit and long-term health outcomes.

Mediating Role of Resilience on Quality of Life in Individuals With Multiple Sclerosis: A Structural Equation Modeling Approach.

OBJECTIVE: To examine the relationship between disease-related risk factors, protective factors, coping, and resilience on quality of life in adults with multiple sclerosis (MS). DESIGN: Quantitative descriptive research employing structural equation modeling. SETTING: Online survey fielded to community members associated with the Greater New England Chapter of the National Multiple Sclerosis Society. PARTICIPANTS: Convenience sample of 271 individuals with MS. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: The Leeds Multiple Sclerosis Quality of Life (LMSQoL) scale was the primary outcome. Other measures entered into the model included the Brief Resilience Scale (BRS) and the Coping Orientation to Problems Experienced (COPE) scale modeled as 2 latent variables: emotion-based coping and problem-based coping. Disability level, fatigue, walking impairment, fear of falling, falls, and pain were modeled as a latent variable for risk factors while physical activity, self-efficacy, social support, optimism, and health locus of control were modeled as a latent variable of protective factors. RESULTS: BRS had a total effect of -0.44 on LMSQoL, significant at P<.001. Protective factors also directly and significantly increased QoL (total effect size -0.46; P<.001). Emotion-based coping and problem-based coping had insignificant effects on QoL. Risk factors had a complex influence on QoL, mediated by resilience, protective factors, emotion-based coping, and problem-based coping. Risk factors had total effect size of 0.32 on quality of life (significant at P<.001). Whereas higher risk factors decreased QoL, both directly and indirectly, resilience increased the likelihood of higher QoL with a slightly higher effect size. The model fit the data reasonably well and explained 96.7% of the variance in QoL in people with MS. CONCLUSIONS: The model suggests that developing interventions that increase protective factors and broaden and build resilience may contribute to improved quality of life in individuals with MS.

Spousal support and self-determined physical activity in individuals with multiple sclerosis: A theory-informed qualitative exploration.

BACKGROUND: Individuals with multiple sclerosis (MS) tend to exhibit high levels of sedentary behavior which contributes to increased disability and comorbidity. Understanding what factors underlie the motivation to be physically active in this group is therefore important. OBJECTIVE: This theory-informed qualitative study explored spousal support and behavior in fostering self-determined physical activity engagement of adults with MS. METHODS: Eight couples were interviewed using a semi-structured interview guide derived from Self-Determination Theory. RESULTS: Analysis of transcribed audio recordings revealed that supportive and empathetic spousal communication, encouragement and expectations regarding physical activity, and bonding through co-participation increased feelings of relatedness. In addition, co-planning and problem-solving around physical activity and serving as a behavioral model facilitated perceptions of competency, while spouses who valued their partners' independence and offered choice enhanced autonomous motivation for physical activity. CONCLUSIONS: Insight into the marital context that supports self-determined physical activity decisions of individuals with MS may better inform family-oriented health promotion approaches in this group.

Social Cognitive Factors, Physical Activity, and Mobility Impairment in Adults with Multiple Sclerosis.

Among those with multiple sclerosis (MS), mobility impairment is common and significantly affects independent functioning and quality of life. The purpose of the study was to examine the role of physical activity in mobility impairment in individuals with MS and explore the social cognitive factors of social support, outcome expectations, and self-efficacy that facilitate physical activity among those with the disease. A sample of 319 individuals with MS were assessed on the following: family and friend social support, self-efficacy, and physical and social outcome expectations. Self-reported physical activity, perceived ambulation disability, balance confidence, and fall history were also measured. The structural model fit the data (χ2 (29) = 24.49, p = 0.70; Root Mean Square Error of Approximation < 0.01; Comparative Fit Index = 1.0; Normed Fit Index = 0.96; Goodness of Fit Index = 0.98; Standardized Root Mean Square Residual = 0.03). The primary findings of the study revealed that physical activity was strongly linked to mobility impairment (path coefficient, -0.43), such that increasing levels of physical activity were associated with less mobility impairment. The most important predictors of health-promoting levels of physical activity were self-efficacy (path coefficient, 0.48) and social support (path coefficient, 0.38), with support from friends being a stronger indicator of social support than support from family. It may be prudent to design interventions aimed at increasing physical activity, especially in regard to helping individuals become more efficacious and building larger social networks, as this may serve to forestall advancing mobility impairment in those with MS.

Symptom variability, affect and physical activity in ambulatory persons with multiple sclerosis: Understanding patterns and time-bound relationships.

BACKGROUND: Individuals with multiple sclerosis (MS) experience a clinical course that is highly variable with daily fluctuations in symptoms significantly affecting functional ability and quality of life. Yet, understanding how MS symptoms co-vary and associate with physical and psychological health is unclear. OBJECTIVE: The purpose of the study was to explore variability patterns and time-bound relationships across symptoms, affect, and physical activity in individuals with MS. METHODS: The study employed a multivariate, replicated, single-subject repeated-measures (MRSRM) design and involved four individuals with MS. Mood, fatigue, pain, balance confidence, and losses of balance were measured daily over 28 days by self-report. Physical activity was also measured daily over this same time period via accelerometry. Dynamic factor analysis (DFA) was used to determine the dimensionality and lagged relationships across the variables. RESULTS: Person-specific models revealed considerable time-dependent co-variation patterns as well as pattern variation across subjects. Results also offered insight into distinct variability structures at varying levels of disability. CONCLUSION: Modeling person-level variability may be beneficial for addressing the heterogeneity of experiences in individuals with MS and for understanding temporal and dynamic interrelationships among perceived symptoms, affect, and health outcomes in this group.

Effects of balance-specific exercises on balance, physical activity and quality of life in adults with multiple sclerosis: a pilot investigation.

OBJECTIVE: To evaluate the efficacy of functional balance exercises on balance impairment, physical activity and quality of life (QOL) in adults with multiple sclerosis (MS). DESIGN: A multiple-baseline time-series design with an uncontrolled intervention. METHOD: Ten subjects with MS completed assessments twice before and once after a 10-week balance intervention. ANOVA were used to evaluate the effects of testing session on the Brief-BESTest, instrumented stance and gait recordings by inertial motion sensors, lower-limb strength recorded by force transducers, accelerometry-based activity, the 12-item MS Walking Scale (MSWS-12), the Multiple Sclerosis Quality of Life-54 (MSQOL-54) questionnaire, the Modified Fatigue Impact scale (MFIS) and the Activity-specific Balance Confidence (ABC) scale. RESULTS: The intervention associated with significantly improved scores on the MSQOL-54 mental component, MFIS, MSWS-12 and Brief-BESTest. Sway amplitude significantly decreased and jerk significantly increased during instrumented standing on foam with eyes closed. Instrumented gait recordings of sagittal trunk range of motion also significantly decreased. ABC scores, strength measures and activity measures were not significantly changed. CONCLUSIONS: Ten weeks of functional balance exercises provided a feasible intervention for individuals with MS that improved components of balance, mental well-being and perceived fatigue impact and ambulation disability. A future randomized, controlled clinical trial should confirm these preliminary findings. Implications for Rehabilitation A balance-specific exercise program is both safe and feasible for individuals with mild-to-moderate MS. Comprehensive exercise interventions that are conceptually driven and employ well-designed progressive exercise across multiple contexts of balance control can facilitate improvements in balance impairments associated with MS. Functional balance exercises can positively impact clinical and objective measures of balance control and favorably influence perceptions of ambulation disability and fatigue as well as perceived quality of life in people with MS.

Exploring physical activity in women with multiple sclerosis: associations with fear of falling and underlying impairments.

OBJECTIVE: The aim of this study was to conduct an exploratory analysis of fear of falling (FoF), balance, gait, and strength impairments and future physical activity in women with multiple sclerosis. DESIGN: This prospective study followed a convenience sample of 99 women with multiple sclerosis for 1 yr. The participants were assessed on FoF and perceived mental health by questionnaire. Objective measures included Limits of Stability, the Sensory Organization Test, and the Functional Ambulation Profile. Strength was quantified by knee extensor power asymmetry. Activity-specific metabolic equivalent values were used to determine minutes per week of moderate and vigorous physical activity. RESULTS: Future physical activity most strongly associated with baseline FoF (R = 0.09, P < 0.01), and baseline FoF associated with limits of stability and lower extremity strength asymmetry (R = 0.21, P < 0.001). Follow-up FoF is best predicted by initial levels of FoF independent of intervening falls (ß = 3.26, P < 0.001). CONCLUSIONS: Future physical activity of women with multiple sclerosis was best predicted by FoF independent of physical and mental functioning. Increased FoF was associated with greater lower extremity strength asymmetry and decreased limits of stability rather than with the experience of falls.