The feasibility and short-term benefits of Blue Prescription: a novel intervention to enable physical activity for people with multiple sclerosis Results of a feasibility randomised controlled study of the guidelines for exercise in multiple sclerosis project. Internet-delivered behavioral intervention to increase physical activity in persons with multiple sclerosis: Sustainability and secondary outcomes Randomized controlled trial of a teleconference fatigue management plus physical activity intervention in adults with multiple sclerosis: rationale and research protocol Internet-delivered lifestyle physical activity intervention improves body composition in multiple sclerosis: preliminary evidence from a randomized controlled trial. Self-efficacy and environmental correlates of physical activity among older women and women with multiple sclerosis. Telephone-based physical activity counseling for major depression in people with multiple sclerosis. Symptom cluster as a predictor of physical activity in multiple sclerosis: preliminary evidence. Randomized controlled trial of a behavioral intervention targeting symptoms and physical activity in multiple sclerosis Increasing Physical Activity in Multiple Sclerosis Using a Behavioral Intervention Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Yoga effects on physical activity and sexual satisfaction among the Iranian women with multiple sclerosis: a randomized controlled trial. Fatigue, Physical Activity, Quality of Life, and Fall Risk in People with Multiple Sclerosis. Feasibility study design and methods for Project GEMS: Guidelines for Exercise in Multiple Sclerosis. Mii-vitaliSe: a pilot randomised controlled trial of a home gaming system (Nintendo Wii) to increase activity levels, vitality and well-being in people with multiple sclerosis Enhancing physical activity adherence and well-being in multiple sclerosis: a randomised controlled trial Internet intervention for increasing physical activity in persons with multiple sclerosis Reactivity in baseline accelerometer data from a physical activity behavioral intervention. Reliability of Physical-Activity Measures Over Six Months in Adults with Multiple Sclerosis: Implications for Designing Behavioral Interventions A formative evaluation of customized pamphlets to promote physical activity and symptom self-management in women with multiple sclerosis. Pilates for people with multiple sclerosis who use a wheelchair: feasibility, efficacy and participant experiences Physical Activity Correlates With Neurological Impairment and Disability in Multiple Sclerosis Motivational interviewing may improve exercise experience for people with multiple sclerosis: A small randomized trial. Exercise in the community for people with multiple sclerosis — a follow-up of people with minimal gait impairment Pathways between physical activity and quality of life in adults with multiple sclerosis. The efficacy of telephone counseling for health promotion in people with multiple sclerosis: a randomized controlled trial. Efficacy of a behavioral intervention for reducing sedentary behavior in persons with multiple sclerosis: a pilot examination.
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 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 r and omised controlled trial ( RCT ) for examining the feasibility of a 4-month home-based , exercise-training program design ed 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 ) , re source ( 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 r and omised into an intervention or wait-list control condition . Intervention participants received a pedometer , elastic resistance b and s , DVD , training manual , calendars , log-book , video coaching calls and newsletters . Participants in both conditions completed home-based assessment s before and after the 4-month period . Ninety-nine persons with MS were assessed for eligibility , and 57 were r and omised . 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 Question naire ( 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 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 Background Chronic fatigue and inactivity are prevalent problems among individuals with multiple sclerosis ( MS ) and may independently or interactively have detrimental effects on quality of life and ability to participate in life roles . However , no studies to date have systematic ally evaluated the benefits of an intervention for both managing fatigue and promoting physical activity in individuals with MS . This study involves a r and omized controlled trial to examine the effectiveness of a telehealth intervention that supports individuals with MS in managing fatigue and increasing physical activity levels . Methods / Design A r and omly-allocated , three-parallel group , time-series design with a social support program serving as the control group will be used to accomplish the purpose of the study . Our goal is to recruit 189 ambulatory individuals with MS who will be r and omized into one of three  telehealth interventions : ( 1 ) a contact-control social support intervention , ( 2 ) a physical activity-only intervention , and ( 3 ) a physical activity plus fatigue management intervention . All interventions will last 12 weeks and will be delivered entirely over the phone . Our hypothesis is that , in comparison to the contact-control condition , both the physical activity-only intervention and the physical activity plus fatigue management intervention will yield significant increases in physical activity levels as well as improve fatigue and health and function , with the physical activity plus fatigue management intervention yielding significantly larger improvements . To test this hypothesis , outcome measures will be administered at Weeks 1 , 12 , and 24 . Primary outcomes will be the Fatigue Impact Scale , the Godin Leisure-Time Exercise Question naire ( GLTEQ ) , and Actigraph accelerometers . Secondary outcomes will include the SF-12 Survey , Mental Health Inventory , Multiple Sclerosis Impact Scale , the Community Participation Indicator , and psychosocial constructs ( e.g. , self-efficacy ) . Discussion The proposed study is novel , in that it represents a multi-disciplinary effort to merge two promising lines of research on MS : fatigue management and physical activity promotion . Collectively , the proposed study will be the largest r and omized controlled trial to examine the effects of a lifestyle physical activity intervention in people with MS.Trial registration 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 Physical inactivity is a major health problem in the United States , particularly in elderly and disabled population s. Little research exists examining the relationships between aspects of the built environment and physical activity in older adults and individuals with multiple sclerosis ( MS ) . We adopted a social cognitive perspective to examine the independent roles of perceptions of the environmental , self-efficacy and functional limitations in underst and ing physical activity levels among elderly women and women with MS . Older women ( n=136 ) and women diagnosed with MS ( n=173 ) were recruited to participate in separate cross-sectional studies . Individuals completed a battery of question naires and wore an activity monitor for 7 days . All measures were issued and collected through the mail with the use of self-addressed , pre-paid envelopes . Initial correlational analyses indicated that self-efficacy , functional limitations and environmental perceptions were significantly related to physical activity . Among older women , self-efficacy , functional limitations and street connectivity demonstrated independent contributions to physical activity behavior . Only self-efficacy and functional limitations demonstrated significant associations among women with MS . The prospect i ve contributions of the environment and individual factors to changes in physical activity need to be determined 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 The present study examined the symptom cluster of fatigue , pain , and depression , and its direct and indirect prediction of physical  activity  behavior in a sample of individuals with multiple sclerosis ( MS ) using a prospect i ve research design and the Theory of Unpleasant Symptoms . The sample included 292 individuals with a definite diagnosis of MS . The participants completed self-report measures of fatigue , depression , pain , self-efficacy , and functional limitations at baseline and six months later , wore an accelerometer for seven days and completed a self-report measure of physical activity behavior .  The data analysis indicated that : 1 ) fatigue , depression , and pain represented a symptom cluster ; 2 ) the symptom cluster had a strong and negative predictive relationship with physical activity behavior ; and 3 ) functional limitations , but not self-efficacy , accounted for the predictive relationship between the symptom cluster and physical activity behavior . Such findings provide preliminary support to the importance of considering symptom clusters as a meaningful correlate of physical activity behavior in persons with MS 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 The present study adopted an interrupted time-series design for identifying the possibility of behavioral reactivity and examining the effect of an Internet-delivered behavioral intervention for increasing self-reported and objective ly-measured physical activity among persons with multiple sclerosis ( MS ) . Participants ( n = 18 ) wore an accelerometer for 7 days and completed a battery of question naires to measure  physical activity  at 3 time points ( before and after a 3-month period of no treatment and again after a 3-month period of treatment ) . There was a small change in objective ly-measured , but not self-reported , physical activity in the period of no treatment , whereas there was a large increase in self-reported and objective ly-measured physical activity in the period of treatment . These findings both complement and extend previous research and further support the efficacy of the current Internet behavioral intervention for increasing physical activity in persons with MS BACKGROUND Multiple sclerosis ( MS ) is a major cause of chronic , neurological disability , with a significant long-term disability burden , often requiring comprehensive rehabilitation . OBJECTIVES To systematic ally evaluate evidence from published Cochrane Review s of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS ( pwMS ) , to improve patient outcomes , and to highlight current gaps in knowledge . METHODS We search ed the Cochrane Data base of Systematic Review s up to December 2017 , to identify Cochrane Review s that assessed the effectiveness of organised rehabilitation interventions for pwMS . Two review ers independently assessed the quality of included review s , using the Revised Assessment of Multiple Systematic Review s ( R-AMSTAR ) tool , and the quality of the evidence for reported outcomes , using the GRADE framework . MAIN RESULTS Overall , we included 15 review s published in the Cochrane Library , comprising 164 r and omised controlled trials ( RCTs ) and four controlled clinical trials , with a total of 10,396 participants . The included review s evaluated a wide range of rehabilitation interventions , including : physical activity and exercise therapy , hyperbaric oxygen therapy ( HBOT ) , whole-body vibration , occupational therapy , cognitive and psychological interventions , nutritional and dietary supplements , vocational rehabilitation , information provision , telerehabilitation , and interventions for the management of spasticity . We assessed all review s to be of high to moderate method ological quality , based on R-AMSTAR criteria .Moderate- quality evidence suggested that physical therapeutic modalities ( exercise and physical activities ) improved functional outcomes ( mobility , muscular strength ) , reduced impairment ( fatigue ) , and improved participation ( quality of life ) . Moderate- quality evidence suggested that inpatient or outpatient multidisciplinary rehabilitation programmes led to longer-term gains at the levels of activity and participation , and interventions that provided information improved patient knowledge . Low-qualitty evidence suggested that neuropsychological interventions , symptom-management programmes ( spasticity ) , whole body vibration , and telerehabilitation improved some patient outcomes . Evidence for other rehabilitation modalities was inconclusive , due to lack of robust studies . AUTHORS ' CONCLUSIONS The evidence suggests that regular specialist evaluation and follow-up to assess the needs of patients with all types of MS for appropriate rehabilitation interventions may be of benefit , although the certainty of evidence varies across the different types of interventions evaluated by the review s. Structured , multidisciplinary rehabilitation programmes and physical therapy ( exercise or physical activities ) can improve functional outcomes ( mobility , muscle strength , aerobic capacity ) , and quality of life . Overall , the evidence for many rehabilitation interventions should be interpreted cautiously , as the majority of included review s did not include data from current studies . More studies , with appropriate design , which report the type and intensity of modalities and their cost-effectiveness are needed to address the current gaps in knowledge BACKGROUND Multiple Sclerosis ( MS ) is a chronic and disabling disease result ing in disabilities in young and middle-aged persons . In this study , research ers explored the effect of yoga techniques on physical activities and sexual function among some Iranian women with MS . MATERIAL S AND METHODS In this study , 60 Iranian women with multiple sclerosis ( MS ) were placed in two equally divided control and case groups through r and om selection to assess pre- and post-effects of yoga exercises on their physical activities and sexual satisfaction levels . Women in case group were offered a series of yoga training and exercises for 3 months , which consisted of 8 sessions per month for 60 to 90 minutes at each session . Yoga training program included the 3 principles of slow motions ( Hatayoga ) , respiratory exercises ( Pranayama ) and central ization to control mind via meditation , expansion and stasis ( Rajayoga ) . After 3 months both groups were surveyed using the initial question naire to evaluate and compare findings with the base-line data . RESULTS Research ers found significant statistical difference in physical activity and sexual satisfaction levels among the women in case group ( P=0.001 ) . Women in case group showed improvement in physical ability while women in control group manifested exacerbated symptoms .  CONCLUSION Yoga techniques may improve physical activities and sexual satisfaction function of women with MS Background Fatigue , inactivity , and falls are major health issues for people with multiple sclerosis ( MS ) . We examined the extent to which fatigue and low walking activity are associated with quality of life and increased fall risk in people with MS . Methods People with MS ( N = 210 , aged 21 - 74 years ) were categorized as having either high or low reported fatigue and walking activity levels  and were then followed up for falls using monthly fall diaries for 6 months . Results A high level of fatigue was significantly associated with higher MS Disease Steps scores , worse balance , high composite physiological ( Physiological Profile Assessment ) fall risk scores , greater fear of falling , lower World Health Organization Disability Assessment Schedule ( WHODAS ) quality of life scores , and more prospect ively recorded falls . Low walking activity was significantly associated with higher MS Disease Steps scores , reduced proprioception , worse st and ing and leaning balance , slow stepping , slow gait speed , worse fine motor control , high Physiological Profile Assessment fall risk scores , more fear of falling , and lower WHODAS quality of life scores . Conclusions Increased fatigue and low walking activity levels were significantly associated with increased fall risk and lower quality of life in people with MS . Interventions aim ed at addressing fatigue and inactivity may have multiple benefits for this group The Guidelines for Exercise in Multiple Sclerosis ( GEMS ) program is a r and omized controlled trial ( RCT ) examining the feasibility and efficacy of a home-based exercise training program based on recent physical activity guidelines and principles of behavior change for improving symptoms and health-related quality of life ( HRQOL ) in adults with multiple sclerosis ( MS ) . The primary aim is to assess program feasibility in the four domains of process ( e.g. , recruitment , retention , and adherence ) , re sources ( e.g. , communication , staff requirements , and monetary costs ) , management ( e.g. , time and accuracy in data collection /entry , and reporting of adverse events ) and scientific outcomes ( e.g. , safety , burden , participant feedback and efficacy/ outcomes ) . The trial will recruit individuals with mild-to-moderate MS-related disability across the United States who will be r and omized into intervention or waitlist control conditions . All participants will complete home-based assessment s ( including wearing an accelerometer for 7 days and completion of a question naire booklet ) prior to and upon completion of the 4-month program . Participants in the intervention will receive a 4-month home-based exercise program emphasizing aerobic and resistance training . Participants will be provided with exercise equipment , a DVD , a manual and a log-book . The exercise program will be supplemented with periodic newsletters in the mail highlighting principles of behavior change , and video-chats with an exercise specialist to provide motivation and social accountability . This trial serves to inform development of Phase II and III RCTs which can determine the actual efficacy and effectiveness of home-based exercise based on the MS-specific physical activity guidelines for improving symptoms and HRQOL Objectives While the health and well-being benefits of physical activity are recognised , people with multiple sclerosis ( MS ) often face greater barriers than the general population . The Nintendo Wii potentially offers a fun , convenient way of overcoming some of these . The aim was to test the feasibility of conducting a definitive trial of the effectiveness and cost-effectiveness of Mii-vitaliSe ; a home-based , physiotherapist-supported Nintendo Wii intervention . Design A single-centre wait-list r and omised controlled study . Setting MS service in secondary care . Participants Ambulatory , relatively inactive people with clinical ly confirmed MS . Intervention Thirty participants were r and omised to receive Mii-vitaliSe either immediately ( for 12 months ) or after a 6-month wait ( for 6 months ) . Mii-vitaliSe consisted of two supervised Nintendo Wii familiarisation sessions in the hospital followed by home use ( Wii Sports , Sports Resort and Fit Plus software ) with physiotherapist support and personalised re sources . Outcomes Included self-reported physical activity levels , quality of life , mood , self-efficacy , fatigue and assessment s of balance , gait , mobility and h and dexterity at baseline , 6 and 12 months . Interviews ( n=25 ) explored participants ’ experiences and , at study end , the two Mii-vitaliSe facilitators ’ experiences of intervention delivery ( main qualitative findings reported separately ) . Results Mean ( SD ) age was 49.3 ( 8.7 ) years , 90 % female , with 47 % diagnosed with MS < 6 years ago and 60 % new to active gaming .  The recruitment rate  was 31 % ( 95 % CI 20 % to 44 % ) . Outcome data were available for 29 ( 97 % ) at 6 months and 28 ( 93 % ) at 12 months . No serious adverse events were reported during the study . Qualitative data indicated that Mii-vitaliSe was well-received . Mean Wii use across both groups over the initial 6-month intervention period was twice a week for 27 min/day . Mean cost of delivering Mii-vitaliSe was £ 684 per person . Discussion Mii-vitaliSe appears acceptable and a future trial feasible and warranted . These findings will inform its design . Trial registration IS RCT 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 . 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 This brief report describes the possibility of reactivity in the baseline assessment of physical activity using accelerometry from two separate r and omized controlled trials of a behavior intervention for increasing physical activity in persons with multiple sclerosis ( MS ) . METHOD The sample s included 18 persons with multiple sclerosis ( MS ) from Study 1 and 20 from Study 2 who were r and omized into treatment arms of the intervention . The participants initially wore an accelerometer over a 7-day period for collection of baseline data , and one week later wore a pedometer over a 7-day period for collection of data for self-monitoring and goal setting in week 1 of the 12-week intervention . The accelerometer and pedometer data were both expressed in average steps per day over a 7-day period . RESULTS There was a moderate ( d = .56 ) , statistically significant ( p = .03 ) difference of 1,822 steps per day between baseline and week 1 of the intervention in Study 1 . There was a large ( d = 1.36 ) , statistically significant ( p = .0001 ) difference of 2,338 steps per day in Study 2 . CONCLUSION We are unaware of other research describing a significant change in physical activity between baseline and the first week of a behavioral intervention and believe that this change reflects reactivity in the baseline assessment using accelerometry 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 Inactivity is a prevalent problem in the population affected with multiple sclerosis ( MS ) . Thus , there is a need to develop and test physical activity ( PA ) interventions that can be widely disseminated . We conducted a formative evaluation as part of a r and omized controlled trial of a pamphlet-based PA intervention  among 30 women with MS .  Pamphlets were customized to sub-sets of participants who shared similar symptoms and barriers to PA . Mixed methods were used to examine the intervention 's influence on self-efficacy , social support , processes of change and stages of change placement , as well as explore participants ' perceived barriers , motivators and strategies for engaging in a PA program . Results indicated that the intervention group significantly improved stages of change placement ( F = 16.64 , P < 0.01 ) and social support ( F = 4.08 , P = 0.05 ) in comparison to the control group . Fatigue , pain and lack of time were the commonly cited barriers to engage in the PA program ; whereas the pamphlets , phone calls and action planning were cited as motivators . Participants used fatigue management strategies , enlisted social support and modified their environment to routinely engage in the PA program . Strategies were identified to improve the PA intervention in future research Abstract Purpose : This mixed methods study aim ed to explore the feasibility , efficacy and the participants ’ experiences of a Pilates programme for people with Multiple Sclerosis ( pwMS ) who use a wheelchair . Method : Fifteen pwMS took part in the 12-week Pilates programme . At baseline and after 6 and 12 weeks of the programme , sitting stability , measured as maximum progression of the Centre of Pressure when leaning sideways ( COPmax ) , posture , pain on a Visual Analogue Scale , function , fatigue and the impact of MS ( MSIS29 ) were assessed . Ten participants took part in two focus groups within six weeks of the completion of the programme . Results : Significant improvements at the 12-week assessment were found in COPmax ( p = 0.046 ) , sitting posture ( p = 0.004 ) , pain in the shoulders ( p = 0.005 ) and back ( p = 0.005 ) and MSIS29 ( p = 0.006 ) . The majority of participants described various physical , functional , psychological and social benefits from participation that reflected increased confidence in activities of daily living . Enjoyment of the classes was expressed by all , and most wished to continue participation . Conclusions : Pilates appears to be efficacious in improving sitting stability and posture and decreasing pain and was also well tolerated by wheelchair users with MS . Further mixed methods studies are warranted . Implication s for Rehabilitation Group-based core stability exercise or Pilates for people with MS who use wheelchair is a feasible and safe way of exercising for this patient group . Pilates exercises for people moderately to severely affected by MS result ed in a decrease in back and shoulder pain and improvement in sitting balance . Future appropriately powered r and omised controlled studies into Pilates for people with MS reliant on wheelchair are warranted This study examined the correlation of physical activity with  neurological impairment and disability in persons with multiple sclerosis ( MS ) . Eighty individuals with MS wore an accelerometer for 7 days and completed the Symptom Inventory ( SI ) , Performance Scales ( PS ) , and Exp and ed Disability Status Scale . There were large negative correlations between the accelerometer and SI ( r = −0.56 ; ρ = −0.58 ) and Exp and ed Disability Status Scale ( r = −0.60 ; ρ = −0.69 ) and a moderate negative correlation between the accelerometer and PS ( r = −0.39 ; ρ = −0.48 ) indicating that physical activity was associated with reduced neurological impairment and disability . Such findings provide a preliminary basis for using an accelerometer and the SI and PS as outcome measures in large-scale prospect i ve and experimental examinations of the effect of physical activity behavior on disability and dependence in MS 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 Background : Although there are many studies evaluating exercise interventions , few studies have evaluated the effect at follow-up . Objectives : This paper presents follow-up data for participants who completed the exercise interventions in a large r and omised controlled trial . Methods : One hundred twenty-one people with multiple sclerosis ( MS ) with minimal gait impairment who completed 10 weeks of community-based exercise interventions  were evaluated by a blinded assessor 12 weeks after the intervention . The primary outcome measure was the Multiple Sclerosis Impact Scale-29 version 2 ( MSIS-29,v2 ) physical component . Other outcomes were the MSIS-29 psychological component , the Modified Fatigue Impact Scale ( MFIS ) and the 6-minute walk test ( 6MWT ) distance . Results : The positive effect on the physical impact of MS was not maintained from baseline to follow-up ( −1.6 , 95 % CI −0.8 , 4.0 , p=0.189 ) . The psychological impact and the impact of fatigue remained significantly improved ( −3.5 , 95 % CI −6.1 , −1.0 , p = 0.006 and −4.68 , 95 % CI −6.9 , −2.5 , p < 0.001 , respectively ) . There was no time effect for the 6MWT ( f = 1.76 , p = 0.179 ) although the trend suggests reversal of the benefits gained from the physiotherapist (PT)- and fitness instructor (FI)-led intervention . Conclusion : The maintained benefit on the psychological impact of MS and fatigue may have important personal and socioeconomic consequences ; however , it is important to find ways to maintain the physical benefits of exercise over the long term OBJECTIVE This prospect i ve study examined symptoms of depression , fatigue , pain , self-efficacy , and social support as possible intermediaries in the pathway between changes in physical activity and quality of life ( QOL ) across a 6-month period in persons with multiple sclerosis ( MS ) . DESIGN AND MAIN OUTCOME MEASURES Adults with a definite diagnosis of MS wore an accelerometer for 7 days and then completed a battery of question naires at baseline ( n = 292 ) and 6-months follow-up ( n = 276 ) . The data were analyzed using panel analysis and covariance modeling in Mplus 3.0 . RESULTS The initial analysis indicated that change in physical activity was associated with a statistically significant and small residual change in QOL ( beta = .07 ) . The subsequent analysis indicated that change in physical activity was associated with residual changes in fatigue ( gamma = -.17 ) , pain ( gamma = -.13 ) , social support ( gamma = .07 ) , and self-efficacy ( gamma = .11 ) , and , in turn , changes in fatigue ( beta = -.13 ) , pain ( beta = -.09 ) , social support ( beta = .18 ) , and self-efficacy ( beta = .10 ) were associated with a residual change in QOL . CONCLUSION The observed pattern of relationships supports the possibility that physical activity is indirectly associated with improved QOL through pathways that include fatigue , pain , social support , and self-efficacy in individuals with MS 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 BACKGROUND Sitting time ( ST ) , a form of sedentary behavior , has been identified as a highly prevalent risk factor for multiple sclerosis (MS)-related morbidity . There is limited information on the efficacy of behavioral interventions for reducing ST in persons with MS . PURPOSE To examine the efficacy of a behavioral intervention for reducing ST in persons with MS in a pilot RCT . METHODS Seventy MS patients were r and omly assigned to intervention and waitlist control conditions . The behavioral intervention was delivered April-September 2012 via the Internet and consisted of a dedicated website and one-on-one Skype video chats that taught participants the skills , techniques , and strategies for reducing sedentary behavior based on social cognitive theory . ST was measured by questions on the abbreviated International Physical Activity Question naire ( IPAQ ) before and after the 6-month RCT . Data were analyzed in SPSS , version 21.0 in March 2014 . RESULTS ANCOVA was performed on post-intervention scores controlling for pre-intervention values using an intent-to-treat analysis . The group main effect was statistically significant ( F[1 , 67]=4.03 , p<0.05 , η²=0.06 ) and yielded a parameter estimate of 98.9 ( SE=49.3 , t=2.01 , p<0.05 ) . The adjusted mean scores for intervention and control groups were 429.2 ( 201.2 ) and 528.2 ( 200.7 ) minutes of ST , respectively ( d=0.49 ) . CONCLUSION We provide the first data on the efficacy of a behavioral intervention for reducing ST in MS patients . This highlights the importance of design ing and testing the effect of behavioral interventions that reduce ST on secondary outcomes such as function , symptoms , quality of life , and health status in persons with MS
Our case study successfully enabled us to address the four feasibility metrics , and we provide new information on management feasibility ( i.e. estimate data completeness and estimate data entry ) and scientific outcomes feasibility ( i.e. determining data collection material s appropriateness ) .
Conclusion Our review highlights the existing research and provides a case study which assesses important metrics of study feasibility .
Background Much research has been undertaken to establish the important benefits of physical activity in persons with multiple sclerosis ( MS ) .
There is disagreement regarding the strength of this research , perhaps because the majority of studies on physical activity and its benefits have not undergone initial and systematic feasibility testing .
We aim to address the feasibility processes that have been examined within the context of physical activity interventions in MS .