BackgroundRecent exercise guidelines for people with multiple sclerosis (MS) recommend a minimum of 30 min moderate intensity aerobic exercise and resistance exercise twice per week. This trial compared the secondary outcomes of a combined 10-week guideline based intervention and a Social Cognitive Theory (SCT) education programme with the same exercise intervention involving an attention control education.MethodsPhysically inactive people with MS, scoring 0–3 on Patient Determined Disease Steps Scale, with no MS relapse or change in MS medication, were randomised to 10-week exercise plus SCT education or exercise plus attention control education conditions. Outcomes included fatigue, depression, anxiety, strength, physical activity, SCT constructs and impact of MS and were measured by a blinded assessor pre and post-intervention and 3 and 6 month follow up.ResultsOne hundred and seventy-four expressed interest, 92 were eligible and 65 enrolled. Using linear mixed effects models, the differences between groups on all secondary measures post-intervention and at follow-up were not significant. Post-hoc, exploratory, within group analysis identified improvements in both groups post intervention in fatigue (mean ∆(95% CI) SCT -4.99(−9.87, −0.21), p = 0.04, Control −7.68(−12.13, −3.23), p = 0.00), strength (SCT -1.51(−2.41, −0.60), p < 0.01, Control −1.55(−2.30, −0.79), p < 0.01), physical activity (SCT 9.85(5.45, 14.23), p < 0.01, Control 12.92(4.69, 20.89), goal setting (SCT 7.30(4.19, 10.4), p < 0.01, Control 5.96(2.92, 9.01), p < 0.01) and exercise planning (SCT 5.88(3.37, 8.39), p < 0.01, Control 3.76(1.27, 6.25), p < 0.01) that were maintained above baseline at 3 and 6 month follow up (all p < 0.05). Only the SCT group improved at 3 and 6 month follow up in physical impact of MS(−4.45(−8.68, −0.22), −4.12(−8.25, 0.01), anxiety(−1.76(−3.20, −0.31), −1.99(−3.28, −0.71), depression(−1.51(−2.89, −0.13), −1.02(−2.05, 0.01)) and cognition(5.04(2.51, 7.57), 3.05(0.81, 5.28), with a medium effect for cognition and fitness (Hedges’ g 0.75(0.24, 1.25), 0.51(0.01, 1.00) at 3 month follow up.ConclusionsThere were no statistically significant differences between groups for the secondary outcomes once age, gender, time since diagnosis and type of MS were accounted for. However, within the SCT group only there were improvements in anxiety, depression, cognition and physical impact of MS. Exercising at the minimum guideline amount has a positive effect on fatigue, strength and PA that is sustained at 3 and 6 months following the cessation of the program.Trial registrationClinicalTrials.gov, NCT02301442, retrospectively registered on November 13th 2014.

The Mini-BESTest had a lower ceiling effect and higher values on responsiveness tests. These findings suggest that the Mini-BESTest may be better at detecting changes in balance in people who have MS, are ambulatory, and have relatively little walking disability.

ObjectiveTo investigate feasibility of multiple sclerosis (MS) exercise guidelines for inactive people with MS (PwMS) and to examine preliminary efficacy for walking. To investigate effect of augmenting that intervention with education based on social cognitive theory (SCT).DesignPilot multicentre, double-blind, randomised, parallel, controlled trial.SettingCommunity-delivered programme.ParticipantsSixty-five physically inactive PwMS walked independently, scored 0–3 on the Patient Determined Disease Steps Scale, had no MS relapse or change in MS medication in 12 weeks.Interventions10-week exercise plus SCT education (SCT) compared with exercise plus attention control education (CON).Outcome measuresSix-Minute Walk Test (6MWT), Timed Up and Go (TUG) test and Multiple Sclerosis Walking Scale-12 (MSWS-12).Results174 expressed interest, 92 were eligible and 65 enrolled (SCT, n=32; CON, n=33). The intervention was feasible and delivered as intended. 68% of SCT group and 50% of control group met the exercise guidelines after intervention. Using linear mixed effects models, intention-to-treat basis, there was insufficient evidence for difference between the groups over the trial (6MWT, p=0.30; TUG, p=0.4; MSWS-12, p=0.8). Using secondary analysis of a cohort with data for≥3 assessments (SCT, n=21; CON, n=20), there was significant treatment effect favouring the intervention group (p=0.04) with mean effect for 6MWT 39.0 m (95% CI 2.26 to 75.73) at 12 weeks and 40.0 m (95% CI 2.3 to 77.8) at 36 weeks. Both groups improved significantly in 6MWT following 10-week intervention (SCT, mean ∆=83.02, SD=60.1, p≤0.01; CON, mean ∆=56.92, SD=73.5, p≤0.01), TUG (SCT, ∆=−0.70, SD=1.25, p≤0.01; CON, ∆=−0.54, SD=0.95, p≤0.01) and MSWS-12 (SCT, ∆=−8.03, SD=16.18, p=0.02; CON, ∆=−0.86, SD=18.74, p=0.81).ConclusionsA 10-week exercise programme based on the MS exercise guidelines for improving walking in previously inactive PwMS was feasible. There is marginal evidence of a treatment effect in favour of the exercise plus SCT intervention at 12 and 36 weeks.Trial registration numberNCT02301442; Results.

Data suggest that the protocol is feasible, there were no adverse effects. A trial including 120 people would be needed to detect an effect on walking endurance.

Objective: The aim of this paper is to review the current evidence on the effectiveness of PNF techniques on gait parameters in patients with stroke. Data Sources: The electronic platforms of CINAHL, MEDLINE, PubMed, and PEDro were searched using the relevant search terms. Study Selection: Intervention studies that had gait parameters as an outcome and, in which PNF techniques were used in a post stroke population, were reviewed. The studies were reviewed by both authors and a consensus was reached. The literature search identified 84 studies. Following screening, there were 5 studies which met the inclusion criteria for this review. Data extraction: Data was extracted from the studies by both authors and independently reviewed. Methodological quality of randomised controlled trials (RCTs) was assessed with the Physiotherapy Evidence Database (PEDro) scale and for non-RCTs with the Quality Assessment Tool for Quantitative Studies. Data Synthesis: It was found that treatment using the PNF method led to a statistically significant improvement in gait outcome measures in patients with stroke in all the studies.

This article confirms the potential role of MS symptoms, in particular anxiety, in explaining PA behavior in an inactive sample of persons with multiple sclerosis (pwMS). Further exploration is warranted, and future PA interventions should acknowledge the potential interplay of psychosocial constructs such as self-efficacy and anxiety in changing PA behavior among pwMS. (PsycINFO Database Record

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The constructs of SCT explained little of the variance of objectively measured PA in a sample of inactive people with MS who volunteered for an exercise trial. The only significant variable was exercise self-efficacy, which confirms the importance of enhancing it through PA interventions.