ORCID Profile
0000-0002-4857-8480
Current Organisation
Murdoch University
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Publisher: Public Library of Science (PLoS)
Date: 04-09-2013
Publisher: Informa UK Limited
Date: 17-09-2020
DOI: 10.1080/09638288.2020.1817985
Abstract: Multiple sclerosis (MS) often leads to reduced physical activity and exercise participation. Sedentary behaviour is associated with poor health, whereas exercise is effective in managing MS symptoms. This study assessed physical activity, exercise and sedentary sitting time, and identified associations with symptoms. Participants of the Australian MS Longitudinal Study completed surveys in 2016. We measured physical activity and sitting time via the International Physical Activity Questionnaire (short-form), and assessed participation in exercise (type and duration). Multivariable regression models assessed associations between physical activity, sitting time and exercise and demographic characteristics and MS-related symptoms. Of the 1216 participants, 53.0% reported moderate-high physical activity levels (71.5% among those with no/mild disability). Median sitting time was 7 h/day. Most (78.4%) participated in aerobic exercise, while only 16.4% participated in strength training. Having a progressive MS onset, more severe symptoms (i.e., cognitive impairment, depression, fatigue, mobility impairment) and being male was indicative of lower physical activity levels and higher sitting time. Health promotion efforts should encourage physical activity and exercise, in particular strength training, among people with MS. People with more severe symptoms and progressive disease may require focused exercise promotion from healthcare professionals.Implications for RehabilitationComprehensive MS management should include strategies to increase physical activity and exercise participation, with particular focus upon people with higher MS-symptom burden (i.e., depression, fatigue and mobility and cognitive impairment), men, and those with progressive onset MS.Efforts to promote physical activity guidelines for people with MS and address barriers to physical activity must be implemented in standard MS care, with a particular focus on adhering to strength training guidelines.Exercise type and duration varies among people with MS, and it would behove healthcare professionals and researchers to consider promoting activities which align with in iduals preferences and abilities when promoting exercise.
Publisher: Informa UK Limited
Date: 03-04-2015
DOI: 10.1080/02701367.2015.1023099
Abstract: An estimated 2.5 million people worldwide are living with multiple sclerosis (MS), and this disease may be increasing in prevalence. MS is a disease of the central nervous system that is associated with heterogeneous symptoms and functional consequences, and the current first-line disease-modifying therapies often become ineffective later in the disease. There is increasing evidence for the benefits of physical activity (PA) in people with MS, but this population is generally physically inactive and sedentary. We proposed 10 research questions to guide future research on PA and MS: (1) Is PA an MS disease-modifying behavior? (2) What are the benefits of PA among people with MS? (3) What is the optimal PA prescription for people with MS? (4) What are the safety issues with PA in people with MS? (5) What characteristics of people with MS modify the benefits of PA? (6) What variables explain participation in PA among people with MS? (7) What are effective behavioral interventions for PA change in people with MS? (8) How do we translate PA research into clinical MS practice? (9) What is the role of sedentary behavior in people with MS? And (10) what is the optimal measurement of PA in people with MS? These questions are critical for informing our understanding of the short- and long-term consequences of PA in MS as well as for identifying approaches for promoting and sustaining PA in MS. Addressing these questions may greatly improve the lives of people with this chronic disease.
Publisher: Springer Science and Business Media LLC
Date: 04-09-2014
Publisher: S. Karger AG
Date: 2014
DOI: 10.1159/000356116
Abstract: b i Background and Objective: /i /b Minimal clinically important difference (MCID) values of 4 and 6 points have been proposed for interpreting meaningful change in Multiple Sclerosis Walking Scale-12 (MSWS-12) scores. b /b This study examined the validity of those MCID values based on capturing corresponding changes in other walking outcomes in persons with multiple sclerosis (MS). b i Methods: /i /b On 2 occasions separated by 6 months, 82 persons with MS completed the MSWS-12, timed 25-ft walk (T25FW), 6-min walk (6MW), and gait analysis, and then wore an accelerometer over a 7-day period. We generated change scores for the MSWS-12 and formed groups of stable, worsened, and improved perceived walking based on both 4- and 6-point changes. The groups were compared for corresponding changes in other walking measures over time using mixed-model ANOVAs. b i Results: /i /b The mixed-model ANOVAs did not identify statistically significant group-by-time interactions on the T25FW (p = 0.98 and p = 0.67), the 6MW (p = 0.89 and p = 0.72), gait (p = 0.54 and p = 0.21), or accelerometry (p = 0.40 and p = 0.68) for MCID values of 4- or 6-point changes in MSWS-12 scores. b i Conclusions: /i /b We did not confirm that MCID values of 4 and 6 points for the MSWS-12 correspond with changes in performance, gait, and free-living assessments of walking in MS.
Publisher: Informa UK Limited
Date: 02-06-2012
DOI: 10.3109/09638288.2012.688922
Abstract: The evidence base to support therapeutic exercise for people with multiple sclerosis (MS) is improving however few studies have considered the patients' perspective. This study aimed to explore the experiences and views of people moderately affected with MS following participation in a 12-week exercise programme. Twenty people with MS participated in a group exercise class. Subsequently, four men and ten women took part in one of two focus groups. Semi-structured questions were used to elicit participants' views on the exercise class, outcomes from exercise and the exercise class and any perceived facilitators or barriers to exercise. Data were analysed using a general inductive method. Benefits to participating in exercise for those with MS included social support and symptom improvement. Psychosocial factors, symptoms and lack of service emerged as exercise barriers. Three inter-related themes emerged (1) The exercise class developed as a bridge to allow participants to realise, (2) the benefits of the class, helping them to overcome and (3) barriers to exercise. Taking part in an exercise class was a positive experience for people with MS. Healthcare professionals should work with exercise professionals to provide feasible exercise opportunities to help those with MS benefit from therapeutic exercise.
Publisher: SAGE Publications
Date: 26-10-2023
Publisher: SAGE Publications
Date: 04-02-2020
Publisher: Informa UK Limited
Date: 07-11-2017
DOI: 10.1080/09638288.2017.1383519
Abstract: This study adopted a qualitative research design with directed content analysis and examined the interpretations of physical activity, exercise, and sedentary behaviour by persons with multiple sclerosis. Fifty three persons with multiple sclerosis who were enrolled in an exercise trial took part in semi-structured interviews regarding personal interpretations of physical activity, exercise, and sedentary behaviours. Forty three percent of participants indicated a consistent understanding of physical activity, 42% of participants indicated a consistent understanding of exercise, and 83% of participants indicated a consistent understanding of sedentary behaviour with the standard definitions. There was evidence of definitional ambiguity (i.e., 57, 58, and 11% of the s le for physical activity, exercise, and sedentary behaviour, respectively) 6% of the s le inconsistently defined sedentary behaviour with standard definitions. Some participants described physical activity in a manner that more closely aligned with exercise and confused sedentary behaviour with exercise or sleeping/napping. Results highlight the need to provide and utilise consistent definitions for accurate understanding, proper evaluation and communication of physical activity, exercise, and sedentary behaviours among persons with multiple sclerosis. The application of consistent definitions may minimise ambiguity, alleviate the equivocality of findings in the literature, and translate into improved communication about these behaviours in multiple sclerosis. Implications for Rehabilitation The symptoms of multiple sclerosis can be managed through participation in physical activity and exercise. Persons with multiple sclerosis are not engaging in sufficient levels of physical activity and exercise for health benefits. Rehabilitation professionals should use established definitions of physical activity, exercise, and sedentary behaviours when communicating about these behaviours among persons with multiple sclerosis.
Publisher: Informa UK Limited
Date: 11-2016
Publisher: Consortium of Multiple Sclerosis Centers
Date: 07-2014
DOI: 10.7224/1537-2073.2013-005
Abstract: Background: This pilot study was conducted to determine whether a 15-minute bout of moderate-intensity aerobic cycling exercise would affect symptoms (pain and fatigue) and function (Timed 25-Foot Walk test [T25FW] and Timed Up and Go test [TUG]) in people with multiple sclerosis (MS) or chronic fatigue syndrome (CFS), and to compare these results with those of a healthy control group. Methods: Eight people with MS (Expanded Disability Status Scale score 5–6 Karnofsky score 50–80), eight people with CFS (Karnofsky score 50–80), and eight healthy volunteers participated in the study. Pain and fatigue levels and results of the T25FW and TUG were established at baseline as well as at 30 minutes, 2 hours, and 24 hours following a 15-minute stationary cycling aerobic exercise test. Repeated-measures analysis of variance (ANOVA) and covariance (ANCOVA) were used to analyze the findings over time. Results: At baseline there were statistically significant differences between groups in fatigue (P = .039), T25FW (P = .034), and TUG (P = .010). A significant group/time interaction emerged for fatigue levels (P= .005). We found no significant group/time interaction for pain levels or function. Conclusions: Undertaking 15 minutes of moderate-intensity aerobic cycling exercise had no significant adverse effects on pain or function in people with MS and CFS (with a Karnofsky score of 50–80) within a 24-hour time period. These initial results suggest that people with MS or CFS may undertake 15 minutes of cycling as moderate aerobic exercise with no expected negative impact on pain or function.
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.APMR.2015.12.031
Abstract: To examine the validity of the timed Up and Go (TUG) test as a measure of functional mobility in persons with multiple sclerosis (MS) by using a comprehensive framework based on construct validity (ie, convergent and ergent validity). Cross-sectional study. Hospital setting. Community-residing persons with MS (N=47). Not applicable. Main outcome measures included the TUG test, timed 25-foot walk test, 6-minute walk test, Multiple Sclerosis Walking Scale-12, Late-Life Function and Disability Instrument, posturography evaluation, Activities-specific Balance Confidence scale, Symbol Digits Modalities Test, Expanded Disability Status Scale, and the number of steps taken per day. The TUG test was strongly associated with other valid outcome measures of ambulatory mobility (Spearman rank correlation, rs=.71-.90) and disability status (rs=.80), moderately to strongly associated with balance confidence (rs=.66), and weakly associated with postural control (ie, balance) (rs=.31). The TUG test was moderately associated with cognitive processing speed (rs=.59), but not associated with other nonambulatory measures (ie, Late-Life Function and Disability Instrument-upper extremity function). Our findings support the validity of the TUG test as a measure of functional mobility. This warrants its inclusion in patients' assessment alongside other valid measures of functional mobility in both clinical and research practice in persons with MS.
Publisher: Springer Science and Business Media LLC
Date: 14-02-2014
DOI: 10.1007/S11136-014-0639-2
Abstract: There is substantial interest in testing interventions for improving quality of life (QOL) and health-related quality of life (HRQOL) in people with multiple sclerosis (MS). Yet, there is limited research on the psychometric properties of QOL [e.g., Satisfaction with Life Scale (SWLS), Leeds MS Quality of Life Scale (LMSQOL)] and HRQOL [e.g., Short Form 12 Health Survey (SF-12) and Multiple Sclerosis Impact Scale-29 (MSIS-29)] measures in this population. Such research is important for designing and interpreting interventions. We examined the test-retest reliability, measurement error, and interpretability of QOL (i.e., SWLS and LMSQOL) and HRQOL (i.e., SF-12 and MSIS-29) measures over 6 months in people with MS. In iduals with MS (n = 274) completed the SWLS, LMSQOL, SF-12 and MSIS-29 on two occasions, 6 months apart. We estimated test-retest reliability [intraclass correlation coefficient (ICC)], measurement error [standard error of measurement (SEM) and coefficient of variation] and interpretability [smallest detectable change (SDC)]. Intraclass correlation coefficient values ranged between moderate and good (ICC range = 0.669-0.883) the MSIS-29 physical component had the best reliability, and the SF-12 mental component had the worst reliability. Measurement error, based on percent SEM, varied among measures the physical and mental components of the SF-12 (%SEM = 4.6 and 5.3, respectively) had the best measurement error, and the MSIS-29 mental component (%SEM = 13.2) and the SWLS (%SEM = 12.7) had the worst measurement error. Interpretability, based on percent SDC, varied among measures interpretability was best for the physical and mental components of the SF-12 (%SDC = 12.7 and 14.7, respectively) and worst for the MSIS-29 mental component (%SDC = 36.7) and the SWLS (%SDC = 35). We provide novel data for helping researchers and clinicians select and interpret QOL and HRQOL measures and scores for interventions among people with MS. Such information will better inform our understanding of intervention effectiveness.
Publisher: Wiley
Date: 20-07-2016
DOI: 10.1111/HEX.12482
Publisher: BMJ
Date: 12-2014
Publisher: Public Library of Science (PLoS)
Date: 18-10-2018
Publisher: Future Medicine Ltd
Date: 12-2014
DOI: 10.2217/NMT.14.32
Abstract: SUMMARY Neurological disability and walking impairment are two common, co-varying consequences of multiple sclerosis (MS) that can result in substantial patient burden for daily activities and quality of life. Indeed, neurological disability and walking impairment are driven by pathological changes in the central nervous system, and measurement of walking function is a common method of monitoring the progression of disease and neurological disability. The existing data indicate that the presence of walking impairments range from performance through real-world outcomes based on comparison of MS versus healthy controls, and walking impairments become worse with increasing severity of neurological disability (i.e., progression). Accordingly, researchers and clinicians have considered both pharmaceutical and rehabilitation approaches for managing walking impairment in MS. Both approaches yield beneficial effects on walking outcomes, although the majority of research has focused on exercise training rather than pharmaceutical interventions. Overall, this underscores the importance of continued efforts toward identifying approaches for preventing, forestalling and restoring walking function in persons with MS across the spectrum of neurological disability and its progression.
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.CCT.2015.12.002
Abstract: The Guidelines for Exercise in Multiple Sclerosis (GEMS) program is a randomized 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), resources (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 in iduals with mild-to-moderate MS-related disability across the United States who will be randomized into intervention or waitlist control conditions. All participants will complete home-based assessments (including wearing an accelerometer for 7 days and completion of a questionnaire 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.
Publisher: Informa UK Limited
Date: 06-06-2023
DOI: 10.1080/09638288.2022.2082564
Abstract: Physical activity (PA) participation offers many benefits for persons with multiple sclerosis (MS). Persons with MS are significantly less active than the general population however, there is insufficient evidence regarding the association between geographical remoteness and PA participation in persons with MS. We identify PA levels across levels of rurality in an Australian MS population. The Australian MS Longitudinal Study collects regular survey data from persons with MS in Australia, including demographic, clinical, and health behavioural data. Physical activity engagement was identified with the International Physical Activity Questionnaire-short form and geographical remoteness was identified from participants' postcode using the Access and Remoteness Index for Australia. Hurdle regression analysis examined the relationship between remoteness and PA participation, and level of PA, after controlling for confounding. Data from 1260 respondents showed that 24% of persons with MS did not participate in any PA. Remoteness was not associated with the participation in any PA (OR 1.04 89% highest density probability interval (HDPI) estimate 0.88, 1.22). Amongst those with any PA ( Physical activity promotion does not need to differ based on geographical location. Implications for rehabilitationAlmost one quarter of persons with MS in our study recorded no participation in any physical activity (PA).Healthcare practitioners are encouraged to include the promotion of PA as part of MS management.Physical activity participation is similar for persons with MS across different geographical locations.Physical activity promotion does not need to differ based on geographical location.
Publisher: Informa UK Limited
Date: 24-07-2018
Publisher: Springer Science and Business Media LLC
Date: 20-07-2021
DOI: 10.1186/S13643-021-01751-0
Abstract: There has been an exponential growth in the number of clinical research studies regarding exercise training in multiple sclerosis, and literature reviews and meta-analyses have documented the many benefits of exercise training. This research further requires careful review for documenting the safety of exercise training in multiple sclerosis, as clarity on safety represents a major hurdle in the clinical prescription of exercise behaviour. To enhance understanding of the feasibility of exercise in multiple sclerosis, we (1) provide a protocol of a systematic review and meta-analysis that summarises rates and risks of clinical relapse, adverse events (i.e., an unfavourable outcome that occurs during the intervention delivery time period), and serious adverse events (i.e., an untoward occurrence that results in death or is life threatening, requires hospitalisation, or results in disability during the intervention delivery time period), as well as retention, adherence, and compliance, from randomised controlled trials of exercise training in persons with multiple sclerosis and (2) identify moderators of relapse, adverse events, and serious adverse event rates. Eight field-relevant databases will be searched electronically. Studies that involve a randomised controlled trial of exercise training (with non-exercise, non-pharmacological, comparator), report on safety outcomes, and include adults with multiple sclerosis will be included. Rates and relative risks of the three primary outcomes (relapse, adverse event, and serious adverse event) will be calculated and reported each with standard error and 95% confidence interval. Random-effects meta-analysis will estimate mean population relative risk for outcomes. Potential sources of variability, including participant characteristics, features of the exercise stimulus, and comparison condition, will be examined with random-effects meta-regression with maximum likelihood estimation. The results from this systematic review and meta-analysis will inform and guide healthcare practitioners, researchers, and policymakers on the safety of exercise training in persons with multiple sclerosis. Where possible, we will identify the impact of exercise type, exercise delivery style, participant disability level, and the prescription of exercise guidelines, on the safety of exercise training. The result will identify critical information on the safety of exercise in persons with multiple sclerosis, while also identifying gaps in research and setting priorities for future enquiries. PROSPERO 2020 CRD42020190544
Publisher: SAGE Publications
Date: 26-10-2023
Publisher: Springer Science and Business Media LLC
Date: 21-07-2017
Publisher: Elsevier BV
Date: 06-2021
Publisher: Springer International Publishing
Date: 13-10-2016
Publisher: BMJ
Date: 06-2022
DOI: 10.1136/BMJOPEN-2021-055796
Abstract: Comorbid depression is prevalent in people with multiple sclerosis (MS). Depression is commonly untreated or undertreated, thus, there is a need for effective and safe interventions and current guidelines recommend psychological and pharmaceutical interventions for people with MS. However, research suggests that other interventions, such as exercise, could also be effective. The comparative efficacy and safety of intervention modalities have not been quantified. We plan to conduct a systematic review and network meta-analysis to compare efficacy and safety of psychological, pharmaceutical, physical and magnetic stimulation interventions for depression in people with MS. We will search EMBASE, Medline, Cochrane CENTRAL, APA PsycINFO, Web of Science, CINAHL and PEDro from inception to 31 December 2021. Search terms will stem from three concepts: MS, depression and randomised controlled trials. Included studies will be randomised controlled trials, where participants are people with MS randomised to receive one of the aforementioned intervention types, and depression or depressive symptoms is the primary outcome, only outcome or secondary outcome with an a priori power calculation. Screening, data extraction and risk of bias assessment (using the Risk of Bias 2 tool) will be conducted independently by two reviewers. If possible, we will synthesise the evidence by fitting a frequentist network meta-analysis model with multivariate random effects, or a pairwise random-effects meta-analysis model. For each model, efficacy will be measured using a standardised mean difference, and safety using an OR. We plan to provide summary measures including forest plots, a geometry of the network, surface under the cumulative ranking curve, and a league table, and perform subgroup analyses. Otherwise, a narrative review will be provided. Ethics is not required for a systematic review and network meta-analysis. Results will be published in a peer reviewed journal. CRD42020209803.
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.APMR.2016.07.018
Abstract: To synthesize the evidence for differences in cognitive motor interference (CMI) between persons with multiple sclerosis (MS) and those without MS by using systematic review and meta-analysis. EMBASE, PubMed, ScienceDirect, Scopus, SPORTDiscus, and Web of Science. Our focused literature search was informed by past systematic reviews of CMI during walking in MS. The key terms searched included Multiple sclerosis and synonyms of motor function (eg, Gait disorders, Gait, Walking, Balance, or Fall) and motor and cognitive functions (eg, Cognitive motor interference or Thinking). From the 116 abstract-identified articles, 13 experimental studies were selected for the final analysis and were rated using the Quality Assessment of Diagnostic Accuracy Studies tool. A meta-analysis was performed for all considered outcomes. The results yielded a small overall effect size (ES) of .08 (SE=.17 95% confidence interval, -.25 to .40 z=.49 P>.05), which indicated a nonsignificant minimal difference in CMI between persons with MS and those without MS. The moderator analysis for motor task (mobility task: ES, .22 postural task: ES, -.11) was not significantly different between persons with MS and those without MS. The moderator analysis for cognitive task (verbal fluency task: ES, .66 mental tracking task: ES, .04 discrimination and decision-making task: ES, -.30) resulted in a significant difference in CMI between persons with MS and those without MS (P<.05). We provide evidence that overall there is a minimal difference in CMI between persons with MS and those without MS.
Publisher: Public Library of Science (PLoS)
Date: 08-04-2014
Publisher: Elsevier BV
Date: 06-2021
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.GAITPOST.2015.04.014
Abstract: Researchers have examined cognitive motor interference (CMI) for lower extremity function in MS, but have not examined this in the upper extremity. This study examined CMI for both lower and upper extremity motor tasks in persons with MS and without MS. Eighty-two persons walked on a GAITRite electronic walkway (velocity) and performed the nine-hole peg test (NHPT, seconds) without (single task) and with a cognitive challenge (dual task). The data were analysed with mixed-factor ANOVA and Pearson correlations. When comparing MS and controls, there were statistical significant and exceptionally large Task main effects on gait velocity (ηp(2)=.41 F1,60=55.78 p<.005) and NHPT performance (ηp(2)=.62 F1,60=127.8 p<.005). When considering disability status among those with MS, there were statistically significant and large Task main effects on velocity (ηp(2)=.38 F1,60=37.3 p<.005) and NHPT test (ηp(2)=.62 F1,60=95.7 p .450). CMI occurs in both the lower and upper extremities, and is comparable between persons with and without MS and across MS disability level.
Publisher: SAGE Publications
Date: 15-04-2013
Abstract: Assessing walking impairment in those with multiple sclerosis (MS) is common, however little is known about the reliability, precision and clinically important change of walking outcomes. The purpose of this study was to determine the reliability, precision and clinically important change of the Timed 25-Foot Walk (T25FW), Six-Minute Walk (6MW), Multiple Sclerosis Walking Scale-12 (MSWS-12) and accelerometry. Data were collected from 82 persons with MS at two time points, six months apart. Analyses were undertaken for the whole s le and stratified based on disability level and usage of walking aids. Intraclass correlation coefficient (ICC) analyses established reliability: standard error of measurement (SEM) and coefficient of variation (CV) determined precision and minimal detectable change (MDC) defined clinically important change. All outcome measures were reliable with precision and MDC varying between measures in the whole s le: T25FW: ICC=0.991 SEM=1 s CV=6.2% MDC=2.7 s (36%), 6MW: ICC=0.959 SEM=32 m CV=6.2% MDC=88 m (20%), MSWS-12: ICC=0.927 SEM=8 CV=27% MDC=22 (53%), accelerometry counts/day: ICC=0.883 SEM=28450 CV=17% MDC=78860 (52%), accelerometry steps/day: ICC=0.907 SEM=726 CV=16% MDC=2011 (45%). Variation in these estimates was seen based on disability level and walking aid. The reliability of these outcomes is good and falls within acceptable ranges. Precision and clinically important change estimates provide guidelines for interpreting these outcomes in clinical and research settings.
Publisher: SAGE Publications
Date: 26-10-2023
Publisher: SAGE Publications
Date: 07-10-2011
Abstract: Objective: To establish the effects of a 12-week, community-based group exercise intervention for people moderately affected with multiple sclerosis. Design: Randomized controlled pilot trial. Setting: Two community leisure centres. Participants: Thirty-two participants with multiple sclerosis randomized into intervention or control groups. Intervention: The intervention group received 12 weeks of twice weekly, 60-minute group exercise sessions, including mobility, balance and resistance exercises. The control group received usual care. Main outcome measures: An assessor blinded to group allocation assessed participants at baseline, after eight weeks and after 12 weeks. The primary outcome measure was 25-foot (7.6 m) walk time, secondary outcomes assessed walking endurance, balance, physical function, leg strength, body mass index, activity levels, fatigue, anxiety and depression, quality of life and goal attainment. Results: The intervention made no statistically significant difference to the results of participants’ 25-foot walk time. However the intervention led to many improvements. In the intervention group levels of physical activity improved statistically between baseline and week 8 ( P 0.001) and baseline and week 12 ( P = 0.005). Balance confidence results showed a significant difference between baseline and week 12 ( P = 0.013). Good effect sizes were found for dynamic balance ( d = 0.80), leg strength ( d = 1.33), activity levels ( d = 1.05) and perceived balance ( d = 0.94). Conclusion: The results of the study suggest that community-based group exercise classes are a feasible option for people moderately affected with multiple sclerosis, and offer benefits such as improved physical activity levels, balance and leg strength.
Publisher: Springer Science and Business Media LLC
Date: 09-06-2017
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.APMR.2014.03.007
Abstract: To examine cognitive motor interference (CMI) during walking using a simple, standardized, and well-refined alphabet dual-task (DT) paradigm in in iduals with multiple sclerosis (MS) in whom cognitive and walking impairment often co-occur. A single time point, cross-sectional study. A university clinical laboratory. In iduals with MS (N=61 mean age ± SD, 50.8±9.3 y) performed 4 walking trials over a 4.6-m walkway to determine gait parameters. Not applicable. Gait parameters were assessed over 4 walking trials. The first 2 walks involved the single task (ST) of walking only the second 2 walks involved participants performing the DT of reciting alternate letters of the alphabet while walking. The gait parameters recorded during the ST and DT walks were used to compute a dual-task cost (DTC) of walking (% change in gait parameter between ST and DT walks) as a metric of CMI. Our multivariate analysis with univariate follow-ups indicated CMI during walking based on slower velocity (ηp(2)=.59 F=84.6 P<.001) and cadence (ηp(2)=.46 F=51.6 P<.001), shorter step length (ηp(2)=.38 F=36 P<.001), and increased step time (ηp(2)=.34 F=31 P<.001) and double-support time (ηp(2)=.31 F=27.3 P<.001) in DT versus ST conditions. The DTC of walking for the gait parameters was not correlated with clinical (disability, disease duration) and demographic (eg, education, age) factors (all |r|≤.240). The alphabet DT paradigm is easily administered and well refined. We highlight its ability and acceptability to determine CMI during walking in people with MS, independent of disease status.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2018
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.CCT.2016.11.012
Abstract: There is increasing recognition that exercise is an efficacious strategy for managing many consequences of multiple sclerosis (MS), yet persons with MS are not engaging in sufficient exercise for accruing health benefits. Poor exercise uptake might be associated with the design of previous research. We conducted a randomised controlled trial (RCT) for examining the feasibility of a 4-month home-based, exercise-training program designed based on recent physical activity guidelines for MS and supplemented by behavioural strategies for compliance. Feasibility was assessed in the domains of process (e.g., recruitment), resource (e.g., monetary costs), management (e.g., personnel time requirements) and scientific outcomes (e.g., treatment effect). We recruited persons with mild-to-moderate MS who were randomised into an intervention or wait-list control condition. Intervention participants received a pedometer, elastic resistance bands, DVD, training manual, calendars, log-book, video coaching calls and newsletters. Participants in both conditions completed home-based assessments before and after the 4-month period. Ninety-nine persons with MS were assessed for eligibility, and 57 were randomised. Fifty-one persons completed the study (90%). Total costs of the study were US $5331.03. Personnel time to conduct the study totaled 263h. Participants in the intervention group complied fully with 71% of all exercise sessions. There was a moderate increase in self-reported exercise behaviour of the intervention participants as measured by the Godin Leisure-Time Exercise Questionnaire (d≥0.5). The results support the feasibility and acceptability of a home-based exercise intervention based on physical activity guidelines and supplemented with behavioural strategies for adults with mild-to-moderate MS.
Publisher: Informa UK Limited
Date: 19-05-2012
DOI: 10.1080/09638288.2017.1327989
Abstract: We undertook a qualitative study that explored the needs of healthcare providers for promoting exercise behaviour among persons with mild or moderate multiple sclerosis (MS). We used interpretive description methodology, and conducted semi-structured interviews with Neurologists (n = 13), occupational therapists (n = 10), physical therapists (n = 11), and nurses (n = 10). The interviews were analysed using thematic analysis. We identified three themes with multiple subthemes regarding exercise promotion by healthcare providers. The first theme was "opportunities for exercise promotion" through the healthcare system, healthcare team, and clinical appointment. The second theme was "healthcare provider education" that included professional training, training among healthcare providers, and clear and defined exercise promotion protocols. The third theme was "patient tools/strategies" that should be delivered among persons with MS as part of the exercise prescription. Providers in MS healthcare consider the patient-provider interaction within the healthcare system, healthcare team, and clinical appointment as a novel opportunity for exercise promotion. Such an opportunity requires education of healthcare providers and provision of tools and strategies for exercise promotion among persons with MS. Implications for rehabilitation Healthcare providers are interested in and motivated for promoting exercise participation among persons with multiple sclerosis. Successful exercise promotion must consider opportunities at three different organisational levels, namely the healthcare system, the local healthcare team, and clinical appointment. Healthcare providers need further training for promoting exercise among persons with multiple sclerosis. The promotion of exercise among persons with multiple sclerosis will require resources and strategies that can be readily offered by providers.
Publisher: Informa UK Limited
Date: 28-08-2015
DOI: 10.3109/09638288.2015.1077397
Abstract: This systematic review was conducted to provide rich and deep evidence of the perceived determinants and consequences of physical activity and exercise based on qualitative research in multiple sclerosis (MS). Electronic databases and article reference lists were searched to identify qualitative studies of physical activity and exercise in MS. Studies were included if they were written in English and examined consequences/determinants of physical activity in persons with MS. Content analysis of perceived determinants and consequences of physical activity and exercise was undertaken using an inductive analysis guided by the Physical Activity for people with Disabilities framework and Social Cognitive Theory, respectively. Nineteen articles were reviewed. The most commonly identified perceived barriers of physical activity and exercise were related to the environmental (i.e. minimal or no disabled facilities, and minimal or conflicting advice from healthcare professionals) and related to personal barriers (i.e. fatigue, and fear and apprehension). The most commonly identified perceived facilitators of physical activity were related to the environment (i.e. the type of exercise modality and peer support) and related to personal facilitators (i.e. appropriate exercise and feelings of accomplishment). The most commonly identified perceived beneficial consequences of physical activity and exercise were maintaining physical functions, increased social participation and feelings of self-management and control. The most commonly identified perceived adverse consequences were increased fatigue and feelings of frustration and lost control. Results will inform future research on the perceived determinants and consequences of physical activity and exercise in those with MS and can be adopted for developing professional education and interventions for physical activity and exercise in MS. Physical activity and exercise behaviour in people with multiple sclerosis (MS) is subject to a number of modifiable determinants. Healthcare professionals working to promote physical activity and exercise in those with MS should choose to endorse the positive benefits of participation. Future physical activity interventions for those with MS may be improved by incorporating behavioural management strategies.
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.JNS.2013.05.023
Abstract: Fatigue is one of the most common, debilitating and life altering symptoms experienced by those with multiple sclerosis (MS) and has become the focus of therapeutic interventions and clinical rehabilitation. There is limited evidence regarding the psychometric properties and clinical relevance of fatigue outcomes for interpreting the effectiveness of intervention and rehabilitation strategies. This study determined the reliability, precision and clinically important change of the uni-dimensional Fatigue Severity Scale (FSS) and the multi-dimensional Modified Fatigue Impact Scale (MFIS). The FSS and MFIS along with physical, psychological and cognitive clinical outcomes were administered to a s le of 82 persons with MS in a clinical research setting on two time points, separated by six months. Intraclass correlation coefficient (ICC) analyses established reliability standard error of measurement (SEM) and coefficient of variation (CV) determined precision minimal detectable change (MDC) defined clinically important change. Participants varied in type of MS and disability status, with 77% of participants classified as having substantial fatigue, based on the criteria of a mean FSS score ≥4. The MFIS (ICC=0.863) and the FSS (ICC=0.751) had acceptable reliability over six months. Precision was reasonable for both scales (based on SEM and CV estimates) but better for the FSS. MDC estimates were established and were lower for the FSS. Reliability of the FSS and MFIS falls within acceptable ranges, and precision and clinically important change estimates provide guidelines for interpreting change in scores from these outcomes in clinical research of intervention and rehabilitation approaches for managing fatigue.
Publisher: Springer Science and Business Media LLC
Date: 25-04-2013
Abstract: The Patient Determined Disease Steps (PDDS) is a promising patient-reported outcome (PRO) of disability in multiple sclerosis (MS). To date, there is limited evidence regarding the validity of PDDS scores, despite its sound conceptual development and broad inclusion in MS research. This study examined the validity of the PDDS based on (1) the association with Expanded Disability Status Scale (EDSS) scores and (2) the pattern of associations between PDDS and EDSS scores with Functional System (FS) scores as well as ambulatory and other outcomes. 96 persons with MS provided demographic/clinical information, completed the PDDS and other PROs including the Multiple Sclerosis Walking Scale-12 (MSWS-12), and underwent a neurological examination for generating FS and EDSS scores. Participants completed assessments of cognition, ambulation including the 6-minute walk (6 MW), and wore an accelerometer during waking hours over seven days. There was a strong correlation between EDSS and PDDS scores ( ρ = .783). PDDS and EDSS scores were strongly correlated with Pyramidal ( ρ = .578 & ρ = .647, respectively) and Cerebellar ( ρ = .501 & ρ = .528, respectively) FS scores as well as 6 MW distance ( ρ = .704 & ρ = .805, respectively), MSWS-12 scores ( ρ = .801 & ρ = .729, respectively), and accelerometer steps/day ( ρ = -.740 & ρ = -.717, respectively). This study provides novel evidence supporting the PDDS as valid PRO of disability in MS.
Publisher: Consortium of Multiple Sclerosis Centers
Date: 06-2018
Publisher: Elsevier BV
Date: 03-2021
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.APMR.2017.01.007
Abstract: To examine whether differences in propulsion technique as a function of intrain idual variability occur as a result of shoulder pain and physical activity (PA) level in full-time manual wheelchair users (MWUs). Observational study. Research laboratory. Adults (N=14) with spinal cord injury (mean age: 30.64±11.08) who used a wheelchair for >80% of daily ambulation and were free of any condition that could be worsened by PA. Not applicable. PA level was measured using the Physical Activity Scale for In iduals with Physical Disabilities (PASIPD), and shoulder pain was measured using the Wheelchair User's Shoulder Pain Index (WUSPI) survey. Mean and intrain idual variability propulsion metrics were measured for propulsion analysis. WUSPI scores indicated participants experienced low levels of shoulder pain. The results of the Spearman rank-order correlation revealed that PASIPD scores were significantly related to mean contact angle (r Differences in propulsion technique were observed on the basis of PA levels. Participants with higher PASIPD scores used a more injurious stroke technique when propelling at higher speeds. This may indicate that active in iduals who use injurious stroke mechanics may be at higher risk of injury. A strong relation was found between peak propulsion forces and shoulder pain. Rehabilitation professionals should emphasize the use of a protective stroke technique in both inactive and active MWUs during exercise and faster propulsion.
Publisher: Wiley
Date: 18-05-2017
DOI: 10.1111/HEX.12541
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.APMR.2017.06.024
Abstract: To determine whether a powered ankle-foot orthosis (AFO) that provides dorsiflexor and plantar flexor assistance at the ankle can improve walking endurance of persons with multiple sclerosis (MS). Short-term intervention. University research laboratory. Participants (N=16) with a neurologist-confirmed diagnosis of MS and daily use of a prescribed custom unilateral passive AFO. Three 6-minute walk tests (6MWTs), 1 per footwear condition: shoes (no AFO), prescribed passive AFO, and portable powered AFO (PPAFO). Assistive devices were worn on the impaired limb. Distance walked and metabolic cost of transport were recorded during each 6MWT and compared between footwear conditions. Each participant completed all three 6MWTs within the experimental design. PPAFO use resulted in a shorter 6MWT distance than did a passive AFO or shoe use. No differences were observed in metabolic cost of transport between footwear conditions. The current embodiment of this PPAFO did not improve endurance walking performance during the 6MWT in a s le of participants with gait impairment due to MS. Further research is required to determine whether expanded training or modified design of this powered orthosis can be effective in improving endurance walking performance in persons with gait impairment due to MS.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2015
Publisher: Consortium of Multiple Sclerosis Centers
Date: 05-2015
DOI: 10.7224/1537-2073.2014-018
Abstract: Background: People with advanced multiple sclerosis (MS) are less physically active than those with milder forms of the disease, and wheelchair use has a negative association with physical activity participation. Thus, wheelchair users with MS are doubly disadvantaged for accruing the benefits of physical activity and exercise. Appropriate physical activity and exercise interventions are needed for this population. Methods: We undertook a qualitative study to explore the meanings, motivations, and outcomes of physical activity in wheelchair users with MS. We sought to understand daily opportunities to accumulate physical activity and exercise, and to identify perceived barriers, facilitators, and benefits that might inform the design of future interventions. Results: We interviewed 15 wheelchair users (mean age, 52 ± 8.8 years n = 12 women). Data were transcribed and analyzed to identify and explore common themes. Our first theme was the reduced opportunity to participate in physical activity due to participants' dependence on mobility devices, environmental adaptations, and tangible support. Our second theme was the importance of incorporating physical activity and exercise into the everyday environment, highlighting the need for adaptive exercise and accessible environments. This indicated the need to incorporate behavior change modulators into physical activity and exercise interventions for those with advanced MS. Health-care professionals played an important role in promoting increased physical activity and exercise participation in those with advanced MS. Conclusions: Our findings may inform future interventions to increase initiation and maintenance of physical activity and exercise among people with advanced MS.
Publisher: Springer Science and Business Media LLC
Date: 17-03-2015
DOI: 10.1038/SC.2015.33
Abstract: This is an experimental design. This study examined the association between rates of energy expenditure (that is, oxygen consumption (VO2)) and accelerometer counts (that is, vector magnitude (VM)) across a range of speeds during manual wheelchair propulsion on a motor-driven treadmill. Such an association allows for the generation of cutoff points for quantifying the time spent in moderate-to-vigorous physical activity (MVPA) during manual wheelchair propulsion. The study was conducted in the University Laboratory. Twenty-four manual wheelchair users completed a 6-min period of seated rest and three 6-min periods of manual wheelchair propulsion on a motor-driven wheelchair treadmill. The 6-min periods of wheelchair propulsion corresponded with three treadmill speeds (1.5, 3.0 and 4.5 mph) that elicited a range of physical activity intensities. Participants wore a portable metabolic unit and accelerometers on both wrists. Primary outcome measures included steady-state VO2 and VM, and the strength of association between VO2 and VM was based on the multiple correlation and squared multiple correlation coefficients from linear regression analyses. Strong linear associations were established between VO2 and VM for the left (R=0.93±0.44 R2=0.87±0.19), right (R=0.95±0.37 R2=0.90±0.14) and combined (R=0.94±0.38 R2=0.88±0.15) accelerometers. The linear relationship between VO2 and VM for the left, right and combined wrists yielded cutoff points for MVPA of 3659 ±1302, 3630±1403 and 3644±1339 counts min(-1), respectively. We provide cutoff points based on the linear association between energy expenditure and accelerometer counts for estimating time spent in MVPA during manual wheelchair propulsion using wrist-worn accelerometry. The similarity across wrist location permits flexibility in selecting a location for wrist accelerometry placement.
Publisher: Springer Science and Business Media LLC
Date: 08-01-2019
DOI: 10.1038/S41366-018-0300-1
Abstract: School-based physical education (PE) and organised leisure-time sports participation (LTSP) represent important physical activity opportunities for children. We examined the preventive effect of increased PE as well as LTSP on overweight and obesity (OW/OB) in school children. Longitudinal data from children attending 10 primary schools in the Danish municipality of Svendborg, comprising 6 intensive PE (270 min/week) and 4 control (90 min/week) schools were assessed. Age- and sex-specific cut-offs for body mass index (BMI) determined OW/OB status. Associations between OW/OB status and school type (intensive PE or control) or LTSP were investigated using mixed, multilevel logistic regression models. Significant parameter estimates were converted into number needed to treat statistics (NNT). In total, 1009 children (53.3% female mean age 8.4 ± 1.4 years) were included in the analysis, with 892 children (52% female) being normal weight (NW) at baseline. Eighteen (NNT = 17.1 95% CI [11.0, 226.1]) children attending an intensive PE school for 2 years, resulted in one fewer case of OW/OB compared with attendance at a normal PE school. For NW children, prevention of one case of OW/OB requires 36 (NNT = 35.8 95% CI [25.1, 596.3]) children to participate in intensive PE for 2 years in comparison with normal PE. LTSP over 2 years may prevent OW/OB if 15 children participate in one LTSP session/week, 9 in two LTSP sessions/week and 8 in three LTSP sessions/week for normal weight children, 25 children had to participate in one LTSP session/week, 16 in two LTSP sessions/week and 14 in three LTSP sessions/week. We provide the first NNT estimates of school-based PE and LTSP to prevent the onset of OW/OB. PE, and separately, LTSP seem to have both a protective and a treatment effect against OW/OB in children.
Publisher: SAGE Publications
Date: 29-05-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2017
Publisher: Consortium of Multiple Sclerosis Centers
Date: 03-2014
DOI: 10.7224/1537-2073.2013-014
Abstract: Objective: This quasi-experimental study was conducted to determine whether differences existed in the total distance walked and energy expended between two conditions of administering the 6-Minute Walk test (6MW) across different levels of disability in people with multiple sclerosis (MS). Methods: The s le comprised 160 in iduals with MS. One group of participants (n = 82) completed a 6MW while wearing a portable metabolic unit (K4b2, Cosmed, Italy) in a square hallway with four corridors and performing 90° turns. Another group (n = 78) completed a 6MW while wearing the same metabolic unit in a single corridor and performing 180° turns. Main outcome measures included total distance walked (in feet) and oxygen consumption (in milliliters per minute) expressed as 30-second averages for 1 minute before the 6MW and over the entire 6MW. Disability status was assessed using the Patient-Determined Disease Steps scale. Results: Participants undertaking the 6MW in a single corridor (1412 ft) walked 37 ft (2.7%) farther than those undertaking the test in a square hallway (1375 ft), but this difference was not statistically significant (F = 0.45, P = .51). Those completing the 6MW in a single corridor expended more energy than those completing the 6MW in the square hallway with four corridors (F = 3.41, P & .01). Conclusions: Either protocol is acceptable, but researchers should be aware of the additional physiological demands when administering the 6MW in a single corridor with 180° turns.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2012
Publisher: Elsevier BV
Date: 03-2023
No related grants have been discovered for Yvonne Learmonth.