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There is increasing recognition that exercise is an efficacious strategy for managing many consequences of multiple sclerosis (MS), yet persons with MS are not engaging in sufficient exercise for accruing health benefits. Poor exercise uptake might be associated with the design of previous research. We conducted a randomised controlled trial (RCT) for examining the feasibility of a 4-month home-based, exercise-training program designed based on recent physical activity guidelines for MS and supplemented by behavioural strategies for compliance. Feasibility was assessed in the domains of process (e.g., recruitment), resource (e.g., monetary costs), management (e.g., personnel time requirements) and scientific outcomes (e.g., treatment effect). We recruited persons with mild-to-moderate MS who were randomised into an intervention or wait-list control condition. Intervention participants received a pedometer, elastic resistance bands, DVD, training manual, calendars, log-book, video coaching calls and newsletters. Participants in both conditions completed home-based assessments before and after the 4-month period. Ninety-nine persons with MS were assessed for eligibility, and 57 were randomised. Fifty-one persons completed the study (90%). Total costs of the study were US $5331.03. Personnel time to conduct the study totaled 263h. Participants in the intervention group complied fully with 71% of all exercise sessions. There was a moderate increase in self-reported exercise behaviour of the intervention participants as measured by the Godin Leisure-Time Exercise Questionnaire (d≥0.5). The results support the feasibility and acceptability of a home-based exercise intervention based on physical activity guidelines and supplemented with behavioural strategies for adults with mild-to-moderate MS.

BackgroundInternet-delivered, behavioral interventions represent a cost-effective, broadly disseminable approach for teaching persons with multiple sclerosis (MS) the theory-based skills, techniques, and strategies for changing physical activity.ObjectivesThis pilot, randomized controlled trial examined the efficacy of a newly developed Internet website based on e-learning approaches that delivered a theory-based behavior intervention for increasing physical activity and improving symptoms, walking impairment, and neurological disability.MethodsParticipants with MS (N = 47) were randomly assigned into behavioral intervention (n = 23) or waitlist control (n = 24) conditions delivered over a six-month period. Outcomes were administered before and after the six-month period using blinded assessors, and data were analyzed using analysis of covariance in SPSS.ResultsThere was a significant, positive intervention effect on self-reported physical activity (P = 0.05, ηρ2 = 0.10), and non-significant improvement in objectively measured physical activity (P = 0.24, ηρ2 = 0.04). There were significant, positive effects of the intervention on overall (P = 0.018, ηρ2 = 0.13) and physical impact of fatigue (P = 0.003, ηρ2 = 0.20), self-reported walking impairment (P = 0.047, ηρ2 = 0.10), and disability status (P = 0.033, ηρ2 = 0.11). There were non-significant improvements in fatigue severity (P = 0.10, ηρ2 = 0.06), depression (P = 0.10, ηρ2 = 0.07) and anxiety (P = 0.06, ηρ2 = 0.09) symptoms, and self-reported disability (P = 0.10, ηρ2 = 0.07).ConclusionsWe provide evidence for the efficacy of an Internet-based behavioral intervention with content delivered through interactive video courses grounded in e-learning principles for increasing physical activity and possibly improving secondary outcomes of fatigue, depression, anxiety, and walking impairment/disability in persons with MS.

BackgroundOlder adults with multiple sclerosis (MS) exhibit disease-related impairments such as compromised strength, balance, mobility, coordination, and quality of life (QOL). Exercise training as an intervention to reverse these conditions in older adults with MS is limited.ObjectiveThe objective of this pilot trial was to examine the effects of a DVD exercise intervention targeting flexibility, strength, and balance in older adults with MS in order to generate effect sizes to power a larger trial.MethodsParticipants were randomly assigned to a six-month DVD exercise intervention (n = 24) or a healthy aging DVD control condition (n = 24). Measures of physical function, physical activity, sedentary behavior, QOL and program satisfaction were assessed at baseline and at follow-up.ResultsThe DVD exercise intervention was well received with no adverse events. Effects sizes ranged from small to modest reflecting improved function, increased physical activity, decreased sitting time, and improved QOL in the intervention condition compared to the control condition.ConclusionThis pilot randomized controlled trial suggests that older adults with MS are receptive to an exercise program via DVD, and the program results in modest but potentially important improvements in function and physical activity.

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BackgroundThere is increased interest in the application of smartphone applications and wearable motion sensors among multiple sclerosis (MS) patients.ObjectiveThis study examined the accuracy and precision of common smartphone applications and motion sensors for measuring steps taken by MS patients while walking on a treadmill.MethodsForty-five MS patients (Expanded Disability Status Scale (EDSS) = 1.0–5.0) underwent two 500-step walking trials at comfortable walking speed on a treadmill. Participants wore five motion sensors: the Digi-Walker SW-200 pedometer (Yamax), the UP2 and UP Move (Jawbone), and the Flex and One (Fitbit). The smartphone applications were Health (Apple), Health Mate (Withings), and Moves (ProtoGeo Oy).ResultsThe Fitbit One had the best absolute (mean = 490.6 steps, 95% confidence interval (CI) = 485.6–495.5 steps) and relative accuracy (1.9% error), and absolute (SD = 16.4) and relative precision (coefficient of variation (CV) = 0.0), for the first 500-step walking trial; this was repeated with the second trial. Relative accuracy was correlated with slower walking speed for the first (rs = −.53) and second (rs = −.53) trials.ConclusionThe results suggest that the waist-worn Fitbit One is the most precise and accurate sensor for measuring steps when walking on a treadmill, but future research is needed (testing the device across a broader range of disability, at different speeds, and in real-life walking conditions) before inclusion in clinical research and practice with MS patients.

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Study design: This is an experimental design. Objectives: This study examined the association between rates of energy expenditure (that is, oxygen consumption (VO 2 )) and accelerometer counts (that is, vector magnitude (VM)) across a range of speeds during manual wheelchair propulsion on a motor-driven treadmill. Such an association allows for the generation of cutoff points for quantifying the time spent in moderate-to-vigorous physical activity (MVPA) during manual wheelchair propulsion. Setting: The study was conducted in the University Laboratory. Methods: Twenty-four manual wheelchair users completed a 6-min period of seated rest and three 6-min periods of manual wheelchair propulsion on a motor-driven wheelchair treadmill. The 6-min periods of wheelchair propulsion corresponded with three treadmill speeds (1.5, 3.0 and 4.5 mph) that elicited a range of physical activity intensities. Participants wore a portable metabolic unit and accelerometers on both wrists. Primary outcome measures included steady-state VO 2 and VM, and the strength of association between VO 2 and VM was based on the multiple correlation and squared multiple correlation coefficients from linear regression analyses. Results: Strong linear associations were established between VO 2 and VM for the left (R = 0.93 ± 0.44; R 2 = 0.87 ± 0.19), right (R = 0.95 ± 0.37; R 2 = 0.90 ± 0.14) and combined (R = 0.94 ± 0.38; R 2 = 0.88 ± 0.15) accelerometers. The linear relationship between VO 2 and VM for the left, right and combined wrists yielded cutoff points for MVPA of 3659 ± 1302, 3630 ± 1403 and 3644 ± 1339 counts min − 1 , respectively. Conclusion: We provide cutoff points based on the linear association between energy expenditure and accelerometer counts for estimating time spent in MVPA during manual wheelchair propulsion using wrist-worn accelerometry. The similarity across wrist location permits flexibility in selecting a location for wrist accelerometry placement.