Pragmatic exercise intervention in people with mild to moderate multiple sclerosis: a randomised controlled feasibility study. Pragmatic intervention for increasing self-directed exercise behaviour and improving important health outcomes in people with multiple sclerosis: a randomised controlled trial Effects of change in fatigue and depression on physical activity over time in relapsing-remitting multiple sclerosis A pragmatic parallel arm multi-centre randomised controlled trial to assess the effectiveness and cost-effectiveness of a group-based fatigue management programme (FACETS) for people with multiple sclerosis Effectiveness of rehabilitation intervention in persons with multiple sclerosis: a randomised controlled trial The feasibility and short-term benefits of Blue Prescription: a novel intervention to enable physical activity for people with multiple sclerosis The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Clinical trial of a formal group fatigue program in multiple sclerosis Internet-delivered behavioral intervention to increase physical activity in persons with multiple sclerosis: Sustainability and secondary outcomes Treatment for depression and its relationship to improvement in quality of life and psychological well-being in multiple sclerosis patients Effects of Multidisciplinary Rehabilitation on Chronic Fatigue in Multiple Sclerosis: A Randomized Controlled Trial Internet-delivered lifestyle physical activity intervention improves body composition in multiple sclerosis: preliminary evidence from a randomized controlled trial. Randomized trial of a teleconference-delivered fatigue management program for people with multiple sclerosis Short form 36 (SF36) health survey questionnaire: normative data for adults of working age. Effect of Combination Exercise Therapy on Walking Distance, Postural Balance, Fatigue and Quality of Life in Multiple Sclerosis Patients: A Clinical Trial Study Reliability of Physical-Activity Measures Over Six Months in Adults with Multiple Sclerosis: Implications for Designing Behavioral Interventions Randomized controlled trial of a behavioral intervention targeting symptoms and physical activity in multiple sclerosis A randomized clinical trial of a wellness intervention for women with multiple sclerosis. Prevalence of Stress Urinary Incontinence in Women with Multiple Sclerosis Randomized controlled trial of physical activity, cognition, and walking in multiple sclerosis Energy conservation for fatigue management in multiple sclerosis: a pilot randomized controlled trial Risk of bias in randomised controlled trials of health behaviour change interventions: Evidence, practices and challenges The Multiple Sclerosis Impact Scale (MSIS-29): a new patient-based outcome measure. Evaluation of an adjustment group for people with multiple sclerosis: a pilot randomized controlled trial The efficacy of telephone counseling for health promotion in people with multiple sclerosis: a randomized controlled trial. Pilot study of an energy conservation education program delivered by telephone conference call to people with multiple sclerosis. Views and experiences of behaviour change techniques to encourage walking to work: a qualitative study Internet intervention for increasing physical activity in persons with multiple sclerosis Randomized controlled trial of an energy conservation course for persons with multiple sclerosis Randomized controlled pilot study of customized pamphlets to promote physical activity and symptom self-management in women with multiple sclerosis Comparing Individualized Rehabilitation to a Group Wellness Intervention for Persons with Multiple Sclerosis Telephone-based physical activity counseling for major depression in people with multiple sclerosis. Motivational interviewing may improve exercise experience for people with multiple sclerosis: A small randomized trial. A randomized controlled trial of a health promotion education programme for people with multiple sclerosis Enhancing physical activity adherence and well-being in multiple sclerosis: a randomised controlled trial
BACKGROUND People with Multiple Sclerosis ( PwMS ) are less physically active than the general population and pragmatic approaches design ed to equip them with the skills and confidence to participate in long-term physical activity are required . OBJECTIVE The objective of this study was to determine the feasibility of a pragmatic exercise intervention in PwMS . METHODS A voluntary sample of 30 PwMS ( male n = 4 , female n = 26 ; mean age = 40 years ; range = 24 - 49 years ) , with mild to moderate disability ( EDSS ≤ 5.5 ) , were recruited from eligible participants attending outpatient clinics . A total of 28 participants were r and omised to a 10 week pragmatic exercise intervention ( 2 × supervised and 1 × home-based session per week ) or usual care . Clinical , functional and quality of life ( MSQoL-54 ) outcomes were assessed at baseline , immediately and 3 months after the intervention . RESULTS Attrition was low ( 2 participants lost to immediate follow-up and 4 participants lost to 3 month follow-up ) , with high compliance rates ( > 75 % of all sessions ) . The intervention group achieved progression of exercise volume ( 24.3 ± 7.0 to 30.9 ± 5.5 min per session ) , intensity ( 60.4 ± 8.8 to 67.7 ± 6.9 % HR max ) and training impulse ( min × average HR = training impulse/load [ arbitrary units ; AU ] ) ( 2600 ± 1105 to 3210 ± 1269AU ) during the intervention , whilst significantly increasing(P = 0.050 ) their physical composite score ( MSQOL-54 ) at 10 weeks and readiness to exercise ( P = 0.003 ) at 3 months compared with usual care . CONCLUSION This pragmatic intervention was feasible for PwMS , but further research is needed to assess its long-term impact on physical activity behaviour Background : Exercise programmes that can demonstrate evidence of long-lasting clinical effectiveness are needed for people with multiple sclerosis ( PwMS ) . Objective : The objective of this study was to assess the effects of a practically implemented exercise programme on self-directed exercise behaviour and important health outcomes in PwMS to nine months of follow-up . Methods : We conducted a parallel-arm , r and omised controlled trial : 120 PwMS ( Exp and ed Disability Status Scale ( EDSS ) 1.0–6.5 ) r and omised to a three-month exercise intervention plus usual care , or usual care only . Two supervised plus one home-exercise session ( weeks 1–6 ) were followed by one supervised and two home-exercise sessions ( weeks 7–12 ) . Cognitive-behavioural techniques promoted long-term exercise behaviour change . Outcomes were blindly assessed at baseline and at three and nine months after r and omisation . The primary outcome was self-reported exercise behaviour ( Godin Leisure Time Exercise Question naire ( GLTEQ ) ) . Secondary outcomes included fatigue and health-related quality of life ( HRQoL ) . Results : The intervention increased self-reported exercise ( 9.6 points ; 95 % CI : 2.0 to 17.3 points ; p = 0.01 ) and improved fatigue ( p < 0.0001 ) and many HRQoL domains ( p ≤ 0.03 ) at three months . The improvements in emotional well-being ( p = 0.01 ) , social function ( p = 0.004 ) and overall quality of life ( p = 0.001 ) were sustained for nine months . Conclusion : This pragmatic approach to implementing exercise increases self-reported exercise behaviour , improves fatigue and leads to a sustained enhancement of HRQoL domains in PwMS This prospect i ve , observational study examined the effects of change in the symptoms of fatigue and depression on  physical activity  over time in persons with relapsing-remitting multiple sclerosis ( RRMS ) . Adults with a confirmed diagnosis of RRMS completed a battery of question naires at baseline ( n = 269 ) and six-month follow-up ( n = 263 ) . The data were analyzed using linear panel analysis and covariance modeling in Mplus 3.0 . The panel model fit the data ( χ2 = 24.00 , df = 15 , p = 0.07 , SRMR = 0.04 , CFI = 0.98 ) and demonstrated that changes in both fatigue ( path coefficient = −0.09 ) and depressive symptoms ( path coefficient = −0.12 ) were significantly associated with residual change in physical activity . Such findings support the importance of fatigue and depression for predicting longitudinal changes in physical activity in adults with RRMS Background Fatigue is a common and troubling symptom for people with multiple sclerosis ( MS ) . Aim To evaluate the effectiveness and cost-effectiveness of a six-session group-based programme for managing MS-fatigue ( Fatigue : Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle ( FACETS ) ) . Methods Three-centre parallel arm r and omised controlled trial with economic evaluation . Patients with MS and significant fatigue were r and omised to FACETS plus current local practice ( FACETS ) or current local practice alone ( CLP ) , using concealed computer-generated r and omisation . Participant blinding was not possible . Primary outcomes were fatigue severity ( Fatigue Assessment Instrument ) , self-efficacy ( Multiple Sclerosis-Fatigue Self-Efficacy ) and disease-specific quality of life ( Multiple Sclerosis Impact Scale ( MSIS-29 ) ) at 1 and 4 months postintervention ( follow-up 1 and 2 ) . Quality adjusted life years ( QALYs ) were calculated ( EuroQoL 5-Dimensions question naire and the Short-form 6-Dimensions question naire ) . Results Between May 2008 and November 2009 , 164 patients were r and omised ; primary outcome data were available for 146 ( 89 % ) . Statistically significant differences favour the intervention group on fatigue self-efficacy at follow-up 1 ( mean difference ( MD ) 9 , 95 % CI ( 4 to 14 ) , st and ardised effect size ( SES ) 0.54 , p=0.001 ) and follow-up 2 ( MD 6 , 95 % CI ( 0 to 12 ) , SES 0.36 , p=0.05 ) and fatigue severity at follow-up 2 ( MD −0.36 , 95 % CI ( −0.63 to −0.08 ) , SES −0.35 , p=0.01 ) but no differences for MSIS-29 or QALYs . No adverse events reported . Estimated cost per person for FACETS is £ 453 ; findings suggest an incremental cost-effectiveness ratio of £ 2157 per additional person with a clinical ly significant improvement in fatigue . Conclusions FACETS is effective in reducing fatigue severity and increasing fatigue self-efficacy . However , it is difficult to assess the additional cost in terms of cost-effectiveness ( ie , cost per QALY ) as improvements in fatigue are not reflected in the QALY outcomes , with no significant differences between FACETS and CLP . The strengths of this trial are its pragmatic nature and high external validity . Trial registration : Current Controlled Trials IS RCT N76517470 Objective : A stratified , r and omised , waitlist controlled study over 12 months assessed the effectiveness of rehabilitation in persons with multiple sclerosis ( MS ) in an Australian community cohort . Methods : Patients with definite MS ( n = 101 ) recruited from a tertiary hospital data base , r and omised to a treatment group ( n = 49 ) for individualised rehabilitation programme or a control waitlist group ( n = 52 ) . Functional Independence Measure ( FIM ) was used to assess “ activity ” while the Multiple Sclerosis Impact Scale ( MSIS-29 ) and General Health Question naire ( GHQ-28 ) assessed “ participation ” and quality of life ( QoL ) . Assessment s were at baseline and 12 months . Results : Analysis of data from 98 patients ( treatment n = 48 , control n = 50 ) showed reduced disability in the treatment group , with statistically significant differences in post-treatment FIM motor scores for the two groups ( p<0.001 ) . There was a clinical and statistically significant improvement in FIM ( motor ) total scores ( p<0.001 ) , and the FIM motor domains of : transfer ( p<0.001 ) , locomotion ( p<0.001 ) , self-care ( p<0.001 ) and the FIM cognitive subscale ( p<0.016 ) . In the treated group , 70.8 % improved compared with 13 % of controls . Significantly more patients in the control group deteriorated over the study period ( 58.7 % vs 16.7 % ; p<0.001 ) . There were no differences between the control and treatment group scores on the MSIS-physical ( p = 0.18 ) , MSIS-psychological ( p = 0.45 ) or GHQ subscales . Conclusion : An individualised rehabilitation programme reduces disability in persons with MS compared with no intervention . The impact of rehabilitation on QoL needs further evaluation . More information on the effectiveness of the various components of the multidisciplinary rehabilitation programmes are now needed . Australian clinical trials registry : Trials registration number : ACTRNO12605000676617 Purpose : Participation in physical activity for people with Multiple sclerosis ( MS ) is important but can be difficult to sustain long-term . Facilitators for long-term adherence include choice over activity and control over level of engagement , coupled with support , advice and encouragement from a physiotherapist . This is the basis of Blue Prescription , a novel physiotherapy approach aim ed at optimising long-term adherence with physical activity . We evaluated the feasibility and short-term benefits of Blue Prescription in people with MS . Methods : Twenty-seven people with MS ( mean age : 51 ± 11 years , with a range of MS type and disability ) were assessed at baseline and immediately post-intervention with the MS Impact Scale , MS Self-efficacy Scale , and European Quality of Life Question naire . Change in outcomes were analysed with Wilcoxon signed ranks tests . Results : All participants , irrespective of level of disability , were able to choose a physical activity and to engage in it . The physical component MS Impact Scale score significantly improved by a median change of 6.5 ( 95 % CI = −10.5 to −2.0 ; p = 0.007 ; effect size = 0.38 ) . There were no other significant changes in outcomes . Conclusion : Blue Prescription appears feasible and potentially beneficial , particularly in reducing the negative impacts of MS upon individuals , and thus warrants further evaluation . Implication s for Rehabilitation Facilitators for long-term adherence for disabled people include choice over activity and control over level of engagement , coupled with support , advice and encouragement from a physiotherapist . Blue Prescription is a physiotherapy approach aim ed at optimising long-term adherence with physical activity for people with multiple sclerosis . Blue Prescription appears to reduce the negative impacts of multiple sclerosis upon individuals Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Fatigue : Take Control is a novel program to teach fatigue management to people with multiple sclerosis ( MS ) following recommendations in the Fatigue and Multiple Sclerosis guideline . Fatigue : Take Control includes six 2-hour group sessions with DVD viewing , discussion and homework and accompanying participant and leader workbooks . While many people have participated in Fatigue : Take Control programs , its efficacy has not been determined . The objective of this study was to determine whether participation in Fatigue : Take Control reduces fatigue and increases self-efficacy in people with MS . Thirty participants were r and omly assigned to a group who immediately participated in the program ( FTC ) or a wait-list group ( WL ) . The primary outcome was the Modified Fatigue Impact Scale ( MFIS ) and secondary outcomes were the Multiple Sclerosis Self-Efficacy Scale ( MSSE ) and the Fatigue Severity Scale ( FSS ) . The MFIS was administered on 10 occasions . Other measures were administered on four occasions . A mixed model tested the effects using all observations . Compared with the WL , the FTC group had significantly more improvement on the MFIS [ F(1 , 269 ) = 7.079 , p = 0.008 ] and the MSSE [ F(1 , 111 ) = 5.636 , p = 0.019 ] . No significant effect was found for the FSS . Across all visits , fatigue was significantly lower and self-efficacy was significantly higher for the FTC group compared with the WL group . This pilot study demonstrated significant effects in fatigue and self-efficacy among subjects taking the Fatigue : Take Control program  , suggesting that this comprehensive program based on the Fatigue and Multiple Sclerosis guideline may be beneficial in MS Physical activity is associated with many benefits , but persons with multiple sclerosis ( MS ) are less physically active than the general population . There is a critical need for research on methods of increasing and sustaining the physical activity levels of this population . This r and omized controlled trial examined the efficacy of an Internet-delivered and theory-based behavioral intervention that was supplemented with video coaching for increasing and sustaining physical activity over time in persons with MS . Physically inactive , ambulatory persons with MS ( N = 45 ) were r and omly assigned to intervention ( n = 22 ) or control ( n = 23 ) conditions and completed a battery of question naires before , after , and three months after a 12-week intervention period . Data analyses were conducted in PASW 18.0 . Partial eta squared ( ) effect size indicated that there was a large , statistically significant condition-by-time interaction on physical activity ( ) . Cohen 's d effect sizes indicated that the intervention group had a large increase in physical activity after the 12-week trial ( d = .98 ) that was sustained over a three-month follow-up ( d = .79 ) . The current study supports the efficacy of a behavioral intervention for increasing and sustaining physical activity in a sample of persons with MS Depression , a common problem in multiple sclerosis ( MS ) , is generally associated with poorer quality of life ( QOL ) . However , it is unclear whether treating depression also extends to better perceived QOL . Underst and ing QOL in MS has been limited by narrow definitions and exclusive focus on symptomology , with little emphasis on positive aspects of QOL . This study examined the impact of treating depression on QOL in 60 patients with a relapsing form of MS and moderate to severe depression , who were r and omly assigned to one of three vali date d 16-week treatments for depression : individual cognitive-behavioral therapy , group psychotherapy , or sertraline .  QOL was measured by the  MSQOL-54  , a version of the SF-36 adapted for MS , and Ryff ’s scales of psychological well-being , which measure positive attitudes and functioning . Depression and QOL were measured at baseline and immediately following treatment completion . Controlling for baseline neurological impairment and baseline QOL scores , regression analyses showed treating depression was significantly associated with improvements in the MSQOL-54 scales ( R2s = 0.19–0.55 , p < 0.001 ) and in four of the six scales of psychological well-being : environmental mastery ( R2 = 0.13 , p < 0.001 ) , positive relations ( R2 = 0.08 , p < 0.001 ) , purpose in life ( R2 = 0.16 , p < 0.001 ) , and self-acceptance ( R2 = 0.26 , p < 0.001 ) . Findings suggest treating depression influences both the negative and positive aspects of QOL and underscore the importance of examining QOL with two complementary approaches Background Several rehabilitation programmes aim at reducing the impact of fatigue in MS patients . Acute and chronic fatigue should require different management . Objectives To assess the effects of individually tailored , multidisciplinary outpatient rehabilitation ( MDR ) on chronic fatigue . Methods Forty-eight ambulatory MS patients with chronic fatigue were r and omized to MDR or to  MS – nurse consultation .  Fatigue was assessed by the Checklist Individual Strength ( CIS-20R ) . Secondary outcomes included the Modified Fatigue Impact Scale , Fatigue Severity Scale , Functional Independence Measure , Disability and Impact Profile ( DIP ) , Multiple Sclerosis Impact Scale and the Impact on Participation and Autonomy ( IPA ) . Results The primary outcome measure CIS-20R overall score showed no significant differences between groups at 12 weeks ( P = 0.39 ) and 24 weeks follow-up ( P = 0.14 ) , nor for subscales ( t = 12 and t = 24 , 0.19≤P≤0.88 ) . No significant within-group effects were found for both groups with respect to the primary ( 0.57≤p≤0.97 ) and secondary ( 0.11≤p≤0.92 ) outcome measures from baseline to 12 or 24 weeks . Conclusion Multidisciplinary rehabilitation was not more effective in terms of reducing self-reported fatigue  in MS patients  compared to MS-nurse consultation . Our results suggest that chronic fatigue in patients with MS may be highly invariant over time , irrespective of interventions . Trial Registration controlled-trials.com IS RCT OBJECTIVE To examine the efficacy of a physical activity behavioral intervention for improving outcomes of body composition in persons with multiple sclerosis ( MS ) . DESIGN Secondary analysis of data from a r and omized controlled trial . SETTING University research laboratory . PARTICIPANTS Ambulatory persons with MS ( N=82 ) . INTERVENTION A 6-month , internet-delivered physical activity behavioral intervention design ed to increase lifestyle physical activity , primarily walking . The behavioral intervention was based on principles of social cognitive theory . MAIN OUTCOME MEASURES Whole-body bone mineral content ( BMC ) , bone mineral density ( BMD ) , and soft tissue composition , using dual-energy x-ray absorptiometry . RESULTS There were no significant differences between conditions posttrial on body composition outcomes using the adjusted critical value ( P<.008 ) . There was a significant effect of the intervention on whole-body BMC ( P=.04 , ω(2)<.001 ) and BMD ( P=.01 , ω(2)=.003 ) using the unadjusted critical value ( P<.05 ) . The effect of the intervention on percent body fat ( P=.09 , ω(2)=.001 ) and whole-body fat mass ( P=.05 , ω(2)=.003 ) approached significance using unadjusted criteria . There was not a significant effect on whole-body lean soft tissue ( P=.28 , ω(2)<.001 ) or body mass index ( P=.86 , ω(2)<.001 ) . CONCLUSIONS Our results provide preliminary evidence that an internet-delivered lifestyle physical activity intervention might improve bone health and body composition in MS . Such findings are important considering that physical activity is a modifiable behavior with the potential to confer long-term benefits for the prevention and management of fracture risk and comorbidities among those with MS Background : Previous studies support the efficacy and effectiveness of face-to-face group-based fatigue management education for people with multiple sclerosis ( MS ) . Nevertheless , many people are unable to access these programs due to environmental barriers . Objectives : To test the efficacy and effectiveness of a group-based , teleconference-delivered fatigue management program for people with MS . Methods : A r and omly allocated two-group time series design with a wait-list control group was used . In total 190 participants were allocated ( 94 intervention , 96 wait-list control ) . Primary outcomes ( fatigue impact , fatigue severity , health-related quality of life ( HRQOL ) ) were measured before , immediately after , at 6 weeks , 3 months , and 6 months post . Secondary outcome ( self-efficacy ) was measured at the same points . Effectiveness ( intent-to-treat ) and efficacy ( per protocol ) analyses were conducted . Results : The program was more effective and efficacious than control for reducing fatigue impact but not fatigue severity . Before and after comparisons with the pooled sample demonstrated efficacy and effectiveness for fatigue impact , fatigue severity , and 6 of 8 HRQOL dimensions . Changes were maintained for 6 months with small to moderate effect sizes . Conclusion : The results offer strong support for the viability of teleconference-delivered fatigue management education for enabling people with MS to manage this disabling symptom OBJECTIVES --To gain population norms for the short form 36 health survey question naire ( SF36 ) in a large community sample and to explore the question naire 's internal consistency and validity . DESIGN --Postal survey by using a booklet containing the SF36 and several other items concerned with lifestyles and illness . SETTING --The sample was drawn from computerised registers of the family health services authorities for Berkshire , Buckinghamshire , Northamptonshire , and Oxfordshire . SAMPLE --13,042 r and omly selected subjects aged 18 - 64 years . MAIN OUTCOME MEASURES --Scores for the eight health dimensions of the SF36 . RESULTS --The survey achieved a response rate of 72 % ( n = 9332 ) . Internal consistency of the different dimensions of the question naire was high . Normative data broken down by age , sex , and social class were consistent with those from previous studies . CONCLUSIONS --The SF36 is a potentially valuable tool in medical research . The normative data provided here may further facilitate its validation and use Background : Multiple Sclerosis ( MS ) is a demyelinating disease of the nervous system which has numerous disabling effects on patients . Objectives : This study aim ed at investigating the short- and long-term effects of a period of combination exercise therapy on walking distance , balance , fatigue and quality of life in multiple sclerosis patients referred to the physiotherapy clinic of Iran 's Multiple Sclerosis Society in 2013 . Patients and Methods : This study was a r and omized controlled clinical trial on 59 patients divided into the intervention ( n = 39 ) and control groups ( n = 20 ) . The intervention group received 10 weeks of combination therapy including aerobic , strengthening , balancing and stretching exercises . A week before , a week later and a year after the beginning of the exercises , both groups of patients received BBSS , six minute walking , Family Support Services ( FSS ) , Exp and ed Disability Status Scale ( EDSS ) and quality of life tests . The scores of two groups were then compared using statistical tests such as repeated measures ANOVA test . Results : The results indicated significant changes in the intervention group in comparison to the control group in the second phase of the study comparing to the first one for all tests except EDSS ( Mean difference scores of EDSS : -0.13 ) , P-value = 0.60 ; FSS : -6.9 , P-value = 0.02 , Mental Quality of Life ( QOL ) : 16.36 , P-value = 0.001 ; Physical QOL : 12.17 , P-value = 0.001 , six minute walking : 137.2 , P-value < 0.0001 ; and Berg : 3.34 , P-value < 0.0001 . These changes were not significant in the second phase of the study comparing to the third one ; however , they were again significant in the third phase comparing to the first phase of the study ( P < 0.05 ) . Conclusions : Exercise has significant effect on improving symptoms of multiple sclerosis , and cessation of exercise may cause recurrence of symptoms in the intervention group with a slope similar to that of the control group . Therefore , continuous rather than short period exercises have valuable symptomatic and supportive relief effects in patients Reliability estimates are important parameters for power analyses and sample -size calculations in behavioral interventions for increasing physical activity among persons with multiple sclerosis ( MS ) . This study involved a secondary data analysis for providing reliability estimates for measures of physical activity over a six-month period in MS . On two occasions separated by six months , participants completed the Godin Leisure-Time Exercise Question naire ( GLTEQ ) and wore an ActiGraph model 7164 accelerometer on a belt around the waist for a seven-day period . The outcomes from the accelerometer were total activity counts and minutes of moderate-to-vigorous physical activity ( MVPA ) per day . The main analyses involved two-way , r and om effects intraclass correlation coefficients ( ICCs ) . The ICCs for GLTEQ scores , total activity counts , and minutes of MVPA were .66 , .84 , and .84 , respectively . Additionally , the sample was less physically active than adults without MS , and correlation analyses supported the validity of the measures , but within a substantially larger sample . Overall , the measures had acceptable , but different , reliability over six months in this sample of mostly women with relapsing – remitting MS . Power analyses using the reliability estimates indicated vastly different sample sizes for the measures of physical activity and when compared with the default parameter in software packages Background : Exercise training is beneficial , but most persons with multiple sclerosis ( MS ) are sedentary and physically inactive . This has prompted a new focus on the promotion of lifestyle physical activity in MS . We previously design ed , tested , and refined a behavioral intervention delivered through the Internet that successfully increased lifestyle physical activity in MS , but have not evaluated the effects on secondary symptomatic and health-related quality of life ( HRQOL ) outcomes . Objective : We conducted a 6-month r and omized controlled trial ( RCT ) that examined the efficacy of an Internet-delivered , behavioral intervention for improving outcomes of fatigue , depression , anxiety , pain , sleep quality , and HRQOL in 82 ambulatory persons with MS . The secondary aim was to replicate previous results regarding change in free-living physical activity . Results : There was a significant and positive effect of the intervention on fatigue severity ( p=.001 , ηρ2=.15 ) and its physical impact ( p=.008 , ηρ2=.09 ) , depression ( p=.006 , ηρ2=.10 ) , and anxiety ( p=.006 , ηρ2=.10 ) . There were non-significant improvements in pain ( p=.08 , ηρ2=.04 ) , sleep quality ( p=.06 , ηρ2=.05 ) , and physical HRQOL ( p=.06 , ηρ2=.05 ) . We replicated our previous results by demonstrating an increase in self-reported physical activity ( p=.001 , ηρ2=.13 ) . Conclusions : Our results support behavioral interventions targeting lifestyle physical activity as an alternative approach for managing symptoms in MS OBJECTIVE To examine the effects of a wellness intervention program for women with multiple sclerosis ( MS ) on health behaviors and quality of life ( QOL ) . DESIGN R and omized clinical trial . SETTING Community setting in the southwestern United States . PARTICIPANTS Convenience sample of 113 women with physician-confirmed MS ( mean age , 45.79y ) . INTERVENTIONS The 2-phase intervention program included lifestyle-change classes for 8 weeks , then telephone follow-up for 3 months . Participants were followed over an 8-month period . MAIN OUTCOME MEASURES A series of self-report instruments to measure barriers , re sources , self-efficacy for health behaviors , health promotion behaviors , and health-related QOL were completed at baseline , 2 months ( after the classes ) , 5 months ( after telephone follow-up ) , and at 8 months . Principal outcomes measures were health-promoting behaviors ( scores on the Health Promoting Lifestyle Profile II ) and QOL ( scores on the Medical Outcomes Study 36-Item Short-Form Health Survey [ SF-36 ] scales ) . RESULTS Hierarchical linear modeling techniques revealed a statistically significant group by time effect for self-efficacy for health behaviors , health-promoting behaviors , and the mental health and pain scales of the SF-36 . CONCLUSION These data provide initial support for the positive effects of wellness interventions to improve health behaviors and selected dimensions of QOL for women with MS Purpose The purpose of this study was to determine the prevalence of stress urinary incontinence ( SUI ) in women with multiple sclerosis ( MS ) and to what degree these women are bothered by their SUI , since there is a paucity of literature regarding the nature of SUI in this unique population of women . Methods We conducted a prospect i ve Institutional Review Board approved study . Women scheduled for outpatient follow-up appointments at a dedicated MS center were asked to complete a question naire regarding urinary incontinence . Urgency urinary incontinence ( UUI ) and SUI were defined as an answer of slightly , moderately or greatly to the Urogenital Distress Inventory ( UDI-6 ) question # 2 and question # 3 , respectively . Impact of SUI on physical activity was determined by Incontinence Impact Question naire ( IIQ-7 ) question # 2 . Results A total of 55.9 % ( 80/143 ) women had SUI , 70.6 % ( 101/143 ) women had UUI , and 44.8 % ( 64/143 ) women had mixed urinary incontinence . The mean age was 45.8 years old ( range , 20 to 72 years ) . Women with SUI were significantly older ( mean , 47.2 vs. 41.9 ; P=0.023 ) and there was a trend towards a greater body mass index ( mean , 29.3 vs. 26.5 ; P=0.057 ) . Women with SUI had significantly higher IIQ-7 scores compared to women without SUI ( P<0.001 ) . Impact of urinary incontinence on physical activity was also found to be significantly greater in women with SUI ( mean IIQ-7 question # 2 , 0.96 vs. 0.35 ; P<0.001 ) . Conclusions The prevalence of SUI in women with MS is 55.9 % and the presence of SUI has a significant impact on their quality of life . A comprehensive urologic evaluation of a woman with MS should include assessment of SUI The present study adopted a r and omized controlled trial design and examined the effect of a physical activity behavioral intervention on cognitive and walking performance among persons with MS who have mild or moderate disability status . A total of 82 MS patients were r and omly allocated into intervention or wait-list control conditions . The intervention condition received a theory-based program for increasing physical activity behavior that was delivered via the Internet , and one-on-one video chat sessions with a behavior-change coach . Participants completed self-report measures of physical activity and disability status , and underwent the oral Symbol Digit Modalities Test ( SDMT ) and 6-minute walk ( 6MW ) test before and after the 6-month period . Analysis using mixed-model ANOVA indicated a significant time × condition × disability group interaction on SDMT scores ( p = 0.02 , partial-η2 = 0.08 ) , such that persons with mild disability in the intervention condition demonstrated a clinical ly meaningful improvement in SDMT scores ( ~6 point change ) . There was a further significant time × condition interaction on 6MW distance ( p = 0.02 , partial-η2 = 0.07 ) , such that those in the intervention condition demonstrated an increase in 6MW distance relative to those in the control group . The current study supports physical activity as a promising tool for managing cognitive impairment and impaired walking performance in persons with MS , and suggests that physical activity might have specific effects on cognition and non-specific effects on walking performance in this population Objective : To develop and test the feasibility of an energy conservation programme to manage fatigue in multiple sclerosis . Design : A pilot r and omized controlled trial . Setting : Community setting . Subjects : People with multiple sclerosis reporting fatigue . Interventions : An energy conservation programme was compared to a peer support group . Both interventions were delivered in group format with 2-hour sessions once a week for five weeks . Patients ’ views about the interventions were sought in discussion groups one week post intervention . Main measures : The primary feasibility outcomes were recruitment and adherence . Other outcome measures were the Fatigue Impact Scale , Fatigue Severity Scale , MS-Impact Scale-29 , MS Self-efficacy Scale , Beck ’s Depression Scale-Fast Screen and Epworth Sleepiness Scale . Outcomes were administered at baseline , post intervention , 6-week and 3-month follow-up . Results : Almost 30 % of the people approached to take part in the study did not commit to participation because of transport/time issues . Twenty-three patients took part in the study . Three patients dropped out , one reporting adverse effects . A power calculation indicated that a sample of 56 ( 28 per group ) would be required for a main r and omized controlled trial . Patients valued peer support and those in the energy conservation group described the programme as useful , but reported difficulties completing some practice activities . Conclusion : An energy conservation programme in the community is feasible and welcomed by people with multiple sclerosis . However , future research needs to consider longer follow-ups and practical issues to improve recruitment rate by accommodating to patients ’ needs The major strength of a r and omised controlled trial ( RCT ) is the degree to which it can establish a causal relationship between an experimental treatment and the outcome ( i.e. internal validity ) , as r and omisation should ensure that potential confounders are equally distributed over the treatment and control arms . Internal validity in RCTs can be threatened , however , by multiple sources of bias . For example , poor r and omisation procedures ( e.g. failure to conceal allocations until treatments have been assigned ) can lead to selection bias because more high-risk individuals are selected to receive the experimental treatment . There is a range of potential sources of bias in RCTs , and several well-known tools for assessing the risk of bias provide useful overviews of these sources and strategies for reducing them ( e.g. Guyatt et al. , 2011 ; Higgins , Altman , & Sterne , 2011 ) . These tools are also influential : trials scoring high on risk-of-bias assessment s should have a smaller chance on publication and – if published – to be included in ‘ best evidence ’ systematic review s ( Johnson , Low , & MacDonald , 2015 ) , and thus for their interventions to influence policy and practice . Systematic review s suggest that many health behaviour change ( HBC ) trials suffer from a moderate to high risk of bias ( e.g. Oberjé , de Kinderen , Evers , van Woerkum , & de Bruin , 2013 ; Poobalan , Aucott , Precious , Crombie , & Smith , 2009 ) ; more so than , for example , drug trials ( Crocetti , Amin , & Scherer , 2010 ) . Moreover , risk-of-bias scores have been found to explain heterogeneity in effect sizes , especially in trials with subjective outcome measures ( Savovic et al. , 2012 ; Wood et al. , 2008 ) . Since replication studies of HBC intervention evaluations are uncommon , invalid inferences due to bias may not be easily discovered and rectified . Despite these concerns , there has been little attention in the behaviour change intervention literature to the sources and consequences of bias in trials , and to strategies that may be effective in reducing the risk of bias . This paucity of research on risk of bias in HBC trial is in turn reflected in widely used instruments for assessing the risk of bias , such as the Cochrane risk-of-bias tool ( Higgins et al. , 2011 ) , which seems to be mostly based on evidence from non-behavioural trials . The objective of this special issue is to reflect on the evidence , practice s and challenges in relation to reducing the risk of bias in HBC trials . We hope that this special issue will both impact scientific practice ( i.e. enhancing the quality of HBC trial design , reporting and synthesis ) and have an agenda- setting effect ( i.e. inspire people to do empirical research into what sources of bias actually do affect HBC trials , what strategies are effective for mitigating these , and thus what criteria should be used for grading the quality of the evidence of HBC trials ) Changes in health policy have underlined the importance of evidence -based clinical practice and rigorous evaluation of patient-based outcomes . As patient-based outcome measurement is particularly important in treatment trials of multiple sclerosis , a number of disease-specific instruments have been developed recently . One limitation of these instruments is that none was developed using the st and ard psychometric approach of reducing a large item pool generated from people with multiple sclerosis . Consequently , an outcome measure for clinical trials of multiple sclerosis that is disease specific and combines patient perspective with rigorous psychometric methods will complement existing instruments . The aim of this study was to develop such a measure . St and ard psychometric methods were used . A pool of 129 question naire items was generated from interviews with 30 people with multiple sclerosis , expert opinion and literature review . The question naire was administered by postal survey to 1530 people selected r and omly from the Multiple Sclerosis Society membership data base . Redundant items and those with limited measurement properties were removed . The remaining items ( n = 41 ) were grouped into scales using factor analysis , and then refined to form the Multiple Sclerosis Impact Scale ( MSIS-29 ) , an instrument measuring the physical ( 20 items ) and psychological ( nine items ) impact of multiple sclerosis . Five psychometric properties of the MSIS-29  ( data quality , scaling assumptions , acceptability , reliability and validity ) were examined in a separate postal survey of 1250 Multiple Sclerosis Society members . A preliminary responsiveness study of the MSIS-29 was undertaken in 55 people admitted for rehabilitation and intravenous steroid treatment of relapses . The MSIS-29 satisfied all psychometric criteria . Data quality was excellent , missing data were low ( maximum 3.9 % ) , item test-re-test reliability was high ( r = 0.65 - 0.90 ) and scale scores could be generated for > 98 % of respondents . Item descriptive statistics , item convergent and discriminant validity , and factor analysis indicated that it was legitimate to generate scores for MSIS-29 scales by summing items . MSIS-29 scales showed good variability , small floor and ceiling effects , high internal consistency ( Cronbach 's alpha < or=0.91 ) and high test-re-test reliability ( intraclass correlation < or=0.87 ) . Correlations with other measures and the analysis of group differences provided evidence that the MSIS-29 measures the physical and psychological impact of multiple sclerosis . Effect sizes ( physical scale = 0.82 , psychological scale = 0.66 ) demonstrated preliminary evidence of good responsiveness . These results indicate the MSIS-29 is a clinical ly useful and scientifically sound patient-based outcome measure of the impact of multiple sclerosis suitable for clinical trials and epidemiological studies Objective : The aim was to evaluate a group treatment for people with multiple sclerosis and low mood . Design : R and omized controlled trial . Setting : Community . Participants : Patients with multiple sclerosis and low mood , scoring > 7 on the Hospital Anxiety and Depression Scales or > 2 on the General Health Question naire 12 . Interventions : Participants either attended an adjustment group for six , 2-hour group treatment sessions or were on a waiting list to attend the group . Outcomes : Hospital Anxiety and Depression Scale , General Health Question naire 12 , Multiple Sclerosis Self Efficacy Scale , Multiple Sclerosis Impact Scale and Short Form 36 administered 3 and 6 months after r and om allocation . Results : Of the 219 patients identified , 100 ( 46 % ) reported depressive symptoms and 126 ( 58 % ) anxiety symptoms . Forty participants were recruited , aged 25—68 ( mean 47.7 SD 9.7 ) and eight were men . Patients allocated to the group intervention reported fewer depressive symptoms than those in the control group ( U 109.5 , P<0.05 ) but there were no significant differences in anxiety symptoms , self-efficacy or quality of life . Conclusion : Depressive symptoms were reduced following group intervention , which suggests this may be an effective psychological treatment and warrants further evaluation OBJECTIVE To determine if motivational interviewing-based telephone counseling increases health promotion activities and improves other health outcomes in people with multiple sclerosis ( MS ) . DESIGN R and omized controlled trial with wait-list controls and single-blinded outcome assessment s conducted at baseline and at 12 weeks . SETTING MS research and training center in the Pacific Northwest . PARTICIPANTS Community-residing persons ( N=130 ) with physician confirmed MS aged 18 or older who were able to walk unassisted at least 90 m ( 300 ft ) . INTERVENTION A single in-person motivational interview followed by 5 scheduled telephone counseling sessions to facilitate improvement in 1 of 6 health promotion areas : exercise , fatigue management , communication and /or social support , anxiety and /or stress management , and reducing alcohol or other drug use . MAIN OUTCOME MEASURES Health Promotion Lifestyle Profile II plus fatigue impact , subjective health , and objective measures of strength , fitness , and cognition . Intent-to-treat analyses of change scores were analyzed using nonparametric tests . RESULTS Seventy persons were r and omized to treatment and 60 to the control condition . The treatment group reported significantly greater improvement in health promotion activities , including physical activity , spiritual growth , and stress management as well as in fatigue impact and mental health compared with controls . In addition , the exerciser subgroup showed greater improvement than controls in self-selected walking speed . CONCLUSIONS A less intensive , more accessible approach to health promotion based on telephone counseling and motivational interviewing shows promise and merits further study OBJECTIVE To modify and pilot test a face-to-face group energy conservation education program for delivery by group telephone teleconference to people with multiple sclerosis . PARTICIPANTS 29 community dwelling individuals with multiple sclerosis . METHODS The first phase of the study involved the modification of an existing energy conservation education program to accommo date teleconference delivery . The second phase involved a pilot test of the intervention using a basic pre/post intervention design . Licensed occupational therapists delivered the intervention . OUTCOME MEASURES Fatigue severity , fatigue impact , health related quality of life , self-efficacy for performing energy conservation strategies , and use of energy conservation behaviors . FINDINGS Using an a priori alpha of p = 0.10 , paired t-tests found significant reductions in fatigue severity , fatigue impact , and improvements in the following aspects of quality of life : bodily pain and general health . Average effect size was 0.31 . The most used energy conservation strategies after the course were simplifying activities , adjusting priorities , changing body position , resting , and planning the day to balance work and rest . CONCLUSION The pilot study supports on-going development and testing of energy conservation education delivered by teleconference to people with multiple sclerosis Background High levels of physical inactivity are linked to several chronic diseases including coronary heart disease , type-2 diabetes , obesity , some cancers and poor mental health . Encouraging people to be more active has proven difficult . One way to incorporate physical activity into the daily routine is through the journey to and from work . Although behaviour change techniques ( BCTs ) are considered valuable in promoting behaviour change , there is very little in the published literature about the views and experiences of those encouraged to use them . Methods The Walk to Work study was a feasibility study incorporating an exploratory cluster r and omised controlled trial . The 10-week intervention involved training workplace-based Walk to Work promoters ( volunteers or nominated by participating employers ) to encourage colleagues to increase walking during their daily commute . The intervention used nine specific BCTs : Intention formation , barrier identification , specific goal setting , instruction , general encouragement , self-monitoring of behaviour social support , review of behavioural goals and relapse prevention . Digitally recorded interviews were undertaken with 22 employees , eight of whom were Walk to Work promoters to underst and their views and experiences of using these techniques . The Framework method of data management and constant comparison were used to analyse the data and identify key themes . Results For each individual BCT , there appeared to be people who found it useful in helping them to increase walking to work and others who did not . Following training , the Walk to Work promoters varied in the extent to which they were able to fulfil their role : additional support and encouragement during the 10-week intervention may be required for the promoters to maintain motivation . Wider context ual ( economic climate , unprecedented wet weather ) and organisational ( workload , car parking facilities ) issues were identified that influenced the delivery of , and response to , the intervention . Conclusions Walk to work interventions employing BCTs should include sufficient techniques to enable participants to choose a ‘ package ’ to suit their needs . Additional support at organisational level should also be encouraged , and consideration given to wider context ual factors that impinge on the delivery of , and response to , the intervention . Trial registration IS RCT N72882329 Background : Physical activity has been associated with improvements in walking mobility and quality of life in persons with multiple sclerosis ( MS ) , and yet this population is largely sedentary and inactive compared with the general population . Objectives : We conducted a pilot , r and omized controlled trial ( RCT ) for examining the effect of an Internet intervention based on social cognitive theory ( SCT ) for favorably increasing physical activity among persons with MS . We further examined variables from SCT as possible mediators of the Internet intervention . Methods : We r and omly allocated 54 persons with MS into either an Internet intervention condition or a waitlist control condition .  The participants completed measures of physical activity , self-efficacy , outcome expectations , functional limitations , and goal setting before and after the 12-week period . Results : The intervention group reported a statistically significant ( p = 0.01 ) and large increase in physical activity over time ( d = 0.72 ) , whereas the control group had a small ( d = 0.04 ) and non-significant change in physical activity ( p = 0.71 ) . The intervention group further reported a statistically significant ( p = 0.001 ) and large increase in goal setting over time ( d = 0.97 ) , whereas the control group had a small ( d = −0.13 ) and non-significant change ( p = 0.17 ) . The change in goal setting over time mediated the effect of the Internet intervention on physical activity behavior . Conclusions : This pilot study sets the stage for a subsequent RCT that includes a larger sample of persons with MS , longer intervention period along with a follow-up , objective measure of physical activity , and secondary outcomes of walking mobility and QOL Objective : To assess the short-term efficacy and effectiveness of a six-week energy conservation course on fatigue impact , quality of life and self-efficacy for persons with multiple sclerosis ( MS ) . Methods : In this r and omized controlled trial , we r and omly assigned 169 persons with MS to an immediate intervention group or a delayed control group using a crossover design . The outcome measures : Fatigue Impact Scale , SF-36 Health Survey and Self-Efficacy for Performing Energy Conservation Strategies were measured before and after courses and no intervention control periods . We performed intent-to-treat analysis and compliers-only analyses using mixed effects analysis of variance models . Results : Taking the energy conservation course had significant effects on reducing the physical and social subscales of Fatigue Impact Scale and on increasing the Vitality subscale of the SF-36 scores compared with not taking the course . Additional subscales were significant depending on methods of analyses . Self-Efficacy for Performing Energy Conservation Strategies Assessment increased significantly ( p<0.05 ) postcourse compared to precourse . Conclusions : Results support the efficacy and effectiveness of the energy conservation course to decrease fatigue impact , and to increase self-efficacy and some aspects of quality of life Objective : Investigate the feasibility and potential efficacy of a customized print-based intervention to promote physical activity and symptom self-management in women with multiple sclerosis . Design : A r and omly allocated two-group repeated measures design , with a delayed-treatment contact group serving as the control . Participants were r and omized to receive the intervention immediately ( n = 14 ) or receive it at week 12 ( n = 16 ) . Outcome measures were administered at weeks 1 , 12 , and 24 . Setting : Community-based in metropolitan area . Subjects : Thirty women with multiple sclerosis . Intervention : Prescribing a home-exercise program and following up with customized pamphlets , which are matched to participants ’ stage of readiness to change physical activity behavior and physical activity barriers ( e.g. encouraging self-management of symptoms ) . Main Measures : Physical Activity and Disability Survey-revised , Godin Leisure-Time Exercise Question naire , SF-12 , Symptoms of Multiple Sclerosis Scale , and 6-minute walk test . Results : Intent-to-treat analyses using mixed multivariate analysis of variance ( MANOVA ) were conducted on ( 1 ) physical activity levels and ( 2 ) health and function outcomes . The mixed MANOVAs for physical activity levels and health and function outcomes indicated significant improvements in the immediate group compared with the delayed group ( i.e. condition by time interaction was significant , Wilks ’ λ = 0.59 , F2 , 27 = 9.31 , P = 0.001 and Wilks ’ λ = 0.70 , F4 , 25 = 2.72 , P = 0.052 , respectively ) . The intervention had moderate to large effect sizes in improving physical activity levels ( d = 0.63 to 0.89 ) , perceptions of physical function ( d = 0.63 ) , and 6-minute walk test ( d=0.86 ) . Conclusion : This pilot study indicates that a customized print-based intervention shows promise in improving physical activity levels and health and function in women with multiple sclerosis Purpose . Compare the efficacy of two interventions design ed to promote health and physical activity ( PA ) . Design . This study was a r and omized clinical trial using a time series design . Subjects were r and omized into individualized physical rehabilitation ( IPR ) and group wellness intervention ( GWI ) . Primary question naires were administered twice preintervention and twice postintervention . Physical fitness and PA frequency were assessed preintervention and postintervention . Setting . Clinic based in a metropolitan area . Subjects . Fifty volunteers with multiple sclerosis . Interventions . IPR consisted of four physical therapy sessions plus three telephone calls . GWI consisted of seven educational sessions . Measures . Primary : SF-36 Health Survey , Modified Fatigue Impact Scale , Mental Health Inventory . Secondary : physical assessment , PA frequency . Analysis . Stability of primary question naires between the two pretests was examined . Efficacy of interventions was evaluated by multivariate analysis of variance ( MANOVA ) and effect sizes . Results . Primary measures were stable between pretests . MANOVA showed nonsignificant differences between interventions . Eight weeks postintervention , both groups had improved PA , fatigue , resting heart rate , and strength . Effect sizes suggested that IPR had a greater effect on preventing decline of physical health , whereas GWI had a greater effect on improving mental health . Conclusion . Preliminary evidence indicated that health and PA improved in both groups . Effect sizes suggested that participants benefited more physically from IPR and more mentally from GWI . Future research should determine whether combining therapeutic exercise with group education improves both mental and physical health OBJECTIVE Physical activity represents a promising treatment for  major depressive disorder ( MDD ) in people with multiple sclerosis ( MS ) . We conducted a single-blind , two-arm r and omized controlled trial comparing a 12-week physical activity counseling intervention delivered primarily by telephone ( n = 44 ) to a wait-list control group ( N = 48 ) . METHOD Ninety-two adults with MS and MDD or dysthymia ( M(age ) = 48 years ; 86 % female , 92 % White ) completed an in-person baseline assessment and were r and omized to wait-list control or an intervention involving motivational-interviewing-based promotion of physical activity . The treatment group received an initial in-person session ; 7 telephone counseling sessions ( Weeks 1 , 2 , 3 , 4 , 6 , 8 , and 10 ) , and an in-person session at Week 12 . The primary outcome , treatment response , was defined as those with 50 % or greater reduction in the Hamilton Depression Rating Scale ( HAM-D ) score . RESULTS Our primary hypothesis , that the proportion of responders in the treatment group would be significantly greater than in the control group , was not confirmed . However , compared with the control group , those in the treatment group evidence d significantly lower depression severity on the HAM-D , on self-reported depression , and on a measure of potential side effects and at 12 weeks were less likely to meet the criteria for MDD as set forth in the Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . ) .  Physical activity increased significantly more in the treatment condition , though it did not mediate improvement in depression severity . CONCLUSIONS Telephone-based physical activity promotion represents a promising approach to treating MDD in MS . Further research is warranted on ways to bolster the impact of the intervention and on mediators of the treatment effect People with multiple sclerosis ( MS ) are likely to benefit from regular exercise , but physical inactivity is more common among people with MS than among the general population . This small r and omized study evaluated whether motivational interviewing ( MI ) affects adherence to and personal experience in an exercise program .  Inactive people with MS participating in an eight-week exercise program  were r and omized to either three brief MI ( n = 7 ) or three health coaching ( n = 6 ) sessions . Session attendance for both conditions was high , and MI fidelity was rigorously and reliably measured using the Motivational Interviewing Treatment Integrity Scales . The feasibility of using this approach was demonstrated with a small sample . Large effects favoring the MI condition were found for physical exertion , affect during exercise , and fatigue , but no effects were found for adherence to the exercise program . Treatment integrity measures of MI  were correlated with outcomes in expected directions . Although this study demonstrated the feasibility of this MI approach , the large effect sizes found should be viewed with substantial skepticism and replicated in sufficiently powered studies using objective measures of exercise adherence Objective : To evaluate the effectiveness of a health promotion education programme for people with multiple sclerosis ( the OPTIMISE programme ) in terms of increasing the level of health-promoting activity undertaken , improving self-efficacy and enhancing quality of life . Design : A r and omized controlled single blinded trial . Non-parametric analysis was undertaken to test for significant differences between treatment and control groups change scores . Subjects and setting : Sixty-two adults ( 32 treatment and 30 control subjects ) with multiple sclerosis of any type , Exp and ed Disability Status Scale ( EDSS ) 1 - 7 . Intervention : An eight-week multidisciplinary outpatient health promotion education programme aim ed at increasing knowledge , skills and confidence in undertaking health promotion activities . Outcome measures : Health Promoting Lifestyle Profile , Self-Rated Abilities for Health Practice s Scale and the Short Form 36 Item Health Survey . Results : Following completion of the programme , treatment subjects had significantly higher levels of health promotion activity undertaken ( P<0.01 ) and self-efficacy for health promotion activities ( P<0.01 ) . These benefits were sustained for at least three months after the programme ceased . Certain domains of quality of life also improved in treatment subjects more than controls ( physical P=0.03 , mental health and general health P=0.01 ) , although only mental health and general health showed further improvement at three months . Participants provided positive feedback regarding the usefulness of the intervention and demonstrated observable changes to their health promotion behaviours . Conclusions : The OPTIMISE programme produced significant changes in health-promoting behaviours Individuals with multiple sclerosis ( MS ) are more sedentary than the general population , increasing their propensity for reduced functional ability , mobility , and activities of daily living . Self-efficacy has been one of the most consistent determinants of physical activity across population s , including those with MS . However , no studies exist that have attempted to influence self-efficacy in MS patients , in an effort to improve physical activity participation . We conducted a three-month r and omised , controlled trial ( n = 26 ) , contrasting the effects of an efficacy-enhancement exercise condition and a control exercise condition on exercise adherence , well-being , and affective responses to exercise .  Analyses indicated that individuals in the efficacy enhancement condition attended more exercise sessions , reported greater levels of well-being and exertion , and felt better following exercise than individuals in the st and ard care condition . Regardless of treatment condition , individuals with a stronger sense of exercise self-efficacy , who reported more enjoyment following the exercise sessions , demonstrated significantly greater adherence with the  exercise program  . We believe this to be the first empirical attempt to change physical activity behavior in persons with MS using a well-established theoretical framework to drive the intervention . Continued examination of self-efficacy as a determinant of behavior change in individuals with MS is needed . Multiple Sclerosis 2007 ; 13 : 652 - 659 .
Objective : A systematic review and meta- analysis was conducted to illustrate whether people with multiple sclerosis engage in more physical activity following behaviour change interventions .