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Background: Multiple sclerosis (MS) is a leading cause of neurological disability among young and middle-aged adults worldwide, and disability is measured using a variety of approaches, including patient reported outcome measures (PROMs) such as the Patient Determined Disease Steps (PDDS) scale. There is limited evidence for the validity of inferences from the middle-range of scores on the PDDS (i.e., 3 "gait disability" - 6 "bilateral support"), but that range of scores seemingly represents moderate disability characterized by varying levels of walking dysfunction., Purpose: The current study examined whether the middle-range of scores from the PDDS reflect varying levels of walking dysfunction among people with MS., Method: Participants (N = 374) completed the Patient Determined Disease Steps (PDDS) scale, Multiple Sclerosis Walking Scale-12 (MSWS-12), timed 25-foot walk (T25FW), six-minute walk (6 MW), Modified Fatigue Impact Scale (MFIS), and Multiple Sclerosis Impact Scale-29 (MSIS-29), and underwent a neurological exam for generating an Expanded Disability Status Scale (EDSS) score as part of screening and baseline data collection for a clinical trial of exercise training in MS. We undertook a series of linear trend analyses that examined differences in the outcomes of EDSS, T25FW, 6 MW, MSWS-12, MFIS subscales, and MSIS-29 subscales across the 4 levels of PDDS scores (i.e., 3-6)., Results: There were statistically significant and strong linear trends for EDSS (F 1,370 = 306.1, p < .0001, η 2  = 0.48), T25FW (F 1,370 = 161.0, p < .0001, η 2  = 0.32), 6 MW (F 1,370 = 178.9, p < .0001, η 2  = 0.34), and MSWS-12 (F 1,370 = 97.0, p < .0001, η 2  = 0.24). There was a strong correlation between PDDS and EDSS scores (r s = 0.695, 95% CI = 0.643, 0.748). Both PDDS and EDSS scores had strong correlations with walking outcomes, yet weaker correlations with measures of fatigue and QOL., Conclusion: The PDDS could serve as a simple, inexpensive, and rapidly administered PROM for remote screening and early detection of walking dysfunction for initial eligibility into clinical trials and practice for managing mobility-specific disability in MS., Registration: The study was registered on ClinicalTrials.gov on March 19, 2018 (NCT03468868)., (© 2024. The Author(s).)

Background: Acetabular dysplasia (AD) causes pain, limited function, and development of early hip osteoarthritis. Periacetabular osteotomy (PAO) is a surgical treatment for AD that aims to reposition the acetabulum to reduce pain and improve function., Purpose: To examine pain recovery and physical activity (PA) before and during the six months after PAO., Study Design: Case series, prospective., Methods: Individuals with AD scheduled for PAO were enrolled. Pain intensity was evaluated before PAO and at one week and one, three, and six months following PAO. PA levels was evaluated before and six months following PAO using accelerometers (time spent in sedentary behavior, light PA, moderate-to-vigorous PA [MVPA], and daily steps) and the International Physical Activity Questionnaire (IPAQ; time spent in walking and in MVPA). Pain improvements was examined over time following PAO using a repeated-measures one-way ANOVA as well as improvements in PA levels before and six months after PAO using paired-sample t tests. In addition, time spent in MVPA was qualitatively summarized at each time point (before and six months after PAO) measured by both the accelerometers and IPAQ., Results: Out of 49 screened participants, 28 were enrolled, and 23 individuals (22 females; age=23.1±7.9 years) completed both study visits. Compared to pre-PAO pain, participants reported significant improvements in pain at one month and onward following PAO ( p \<0.011). However, PA levels at six months following PAO did not differ from pre-PAO PA levels ( p >0.05). Qualitatively, participants reported spending more time in MVPA recorded by the IPAQ (pre-PAO=73.3±150.2 mins/day; six-months after PAO=121.2±192.2 mins/day), compared with MVPA recorded by accelerometers (pre-PAO=22.6±25.2 mins/day; six-months after PAO=25.0±21.4 mins/day)., Conclusions: Individuals with AD reported significant pain reduction at one month and up to six months after PAO, but PA levels did not change six months after PAO compared to baseline testing. Future studies should consider examining longitudinal pain recovery and PA improvements over longer periods of time with larger samples of individuals with AD undergoing PAO and identifying modifiable factors to minimize pain and increase PA participation., Level of Evidence: III., Competing Interests: The authors declare no conflicts of interest related to this work., (© The Author(s).)

Background: The knowledge base on physical activity and sedentary behaviour in adults with Down syndrome (DS) may advance by accelerometer calibration studies. This study aimed to develop cut‐points for sedentary behaviour and moderate‐to‐vigorous physical activity (MVPA) for adults with DS based on output from accelerometers worn on the dominant and non‐dominant hips. Methods: Sixteen adults with DS (10 men; age 31 ± 15 years) performed 12 tasks including sedentary behaviours and physical activities. We obtained metabolic equivalents (METs) with indirect calorimetry and vector magnitude (VM) output from triaxial accelerometers (wGT3X‐BT, ActiGraph) worn on the dominant and non‐dominant hips. Receiver operating characteristic curves were used to identify optimal VM cut‐points that maximised sensitivity and specificity. Results: Overall classification accuracy was very high (area under the ROC curve: 0.95 and 0.92 for sedentary and MVPA models, respectively). For the non‐dominant hip, the optimal VM cut‐points were (1) sedentary behaviour ≤236 counts·min−1 and (2) MVPA ≥2167 counts·min−1. For the dominant hip, optimal cut‐points were (1) sedentary behaviour ≤243 counts·min−1 and (2) MVPA ≥2092 counts·min−1. Conclusions: The presented VM cut‐points for sedentary behaviour and MVPA for adults with DS had high classification accuracy. There were small differences in accelerometer cut‐points between the dominant and non‐dominant hip. [ABSTRACT FROM AUTHOR]

Background: Adults with intellectual disability (ID) have a higher rate of fall events than the general population. Consequently, interventions for reducing fall events and improving health are highly required for individuals with ID. One essential step towards effectively delivering fall prevention interventions among adults with ID involves evaluating their feasibility. This study examined the feasibility of a home‐based exercise intervention, supplemented with behavioural change strategies, among individuals with ID living in residential settings. Method: This study provided an 8‐week intervention, consisting of a workshop for support workers and sessions for participants with ID, focusing on behavioural reward/s, education regarding fall prevention/exercise and exercise training. One week prior to and 1 week following such an intervention, such participants underwent measurements for (1) physical performance, (2) fall efficacy, (3) self‐efficacy for activity and (4) social support. Results: Participants having ID (n = 33), support workers (n = 11) and one administrator participated in this study. There were no adverse events during the intervention, and the mean adherence rate was 70.8 ± 19.5%. Two participants with ID dropped out of the programme due to a lack of interest. The participants with ID significantly improved individual physical performance, self‐efficacy for activity, fall efficacy and support from friends and support workers. Conclusions: Fall prevention interventions for adults with ID living in group‐homes were highly promising for eventual large‐scale implementation within such communities. [ABSTRACT FROM AUTHOR]

Background: Multiple Sclerosis (MS) disease progression has notable heterogeneity among patients and over time. There is no available single method to predict the risk of progression, which represents a significant and unmet need in MS., Methods: MS and healthy control (HC) participants were recruited for a 2-year observational study. A latent-variable growth mixture model (GMM) was applied to cluster baseline 6-min walk gait speed trajectories (6MW GST ). MS patients within different 6 MW GST clusters were identified and stratified. The group membership of these MS patients was compared against 2-year confirmed-disease progression (CDP). Clinical and patient-reported outcome (PRO) measures were compared between HC and MS subgroups over 2 years., Results: 62 MS and 41 HC participants completed the 2-year study. Within the MS cohort, 90% were relapsing MS. Two distinct patterns of baseline 6 MW GST emerged, with one cluster displaying a faster gait speed and a typical "U" shape, and the other showing a slower gait speed and a "flattened" 6 MW GST curve. We stratified MS participants in each cluster as low- and high-risk progressors (LRP and HRP, respectively). When compared against 2-year CDP, our 6 MW GST approach had 71% accuracy and 60% positive predictive value. Compared to the LRP group, those MS participants stratified as HRP (15 out of 62 MS participants), were on average 3.8 years older, had longer MS disease duration and poorer baseline performance on clinical outcomes and PROs scores. Over the subsequent 2 years, only the HRP subgroup showed a significant worsened performance on 6 MW, clinical measures and PROs from baseline., Conclusion: Baseline 6 MW GST was useful for stratifying MS participants with high or low risks for progression over the subsequent 2 years. Findings represent the first reported single measure to predict MS disease progression with important potential applications in both clinical trials and care in MS., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Goldman, Chen, Motl, Pearsall, Oh and Brenton.)

Purpose: Pediatric-onset multiple sclerosis (MS) is associated with risk for functional limitations defined as the perceived reduction in capacity for undertaking activities of daily living. Moderate-to-vigorous physical activity (MVPA) has been associated with less frequent and less impactful functional limitations, but the symptoms of fatigue and depression have not been considered as potential confounding variables. This study examined whether fatigue and depression confound the association between MVPA and functional limitations among youth with pediatric MS., Methods: Participant data were accumulated from three ongoing observational studies. The combined sample included 65 cases of pediatric-onset MS (24 male/41 female, 16±1.7 years of age). Data on self-report MVPA, functional limitations, depression, and fatigue were analyzed., Results: MVPA was significantly associated with functional limitations (r = 0.45), fatigue (r = -0.28), and depression (r = -0.32). Functional limitations were associated with fatigue (r = -0.45) and depressive symptoms (r = -0.53). MVPA was significantly correlated with functional limitations (β= 0.27, p = 0.04) even after accounting for general fatigue (β= 0.08, p = 0.64) and depressive symptoms (β= -0.40, p = 0.03) among those with pediatric MS., Conclusion: Self-reported MVPA was associated with perceived functional limitations among youth with pediatric MS independent of perceived fatigue and depressive symptoms.

Background: Triaxial accelerometer output [vector magnitude (VM) counts] may better estimate physical activity intensity as reflected in the rate of oxygen uptake (V̇O2) than the traditional vertical axis (VA) counts in adults with Down syndrome (DS). This study examined the accuracy of VM vs. VA counts in estimating V̇O2 in adults with and without DS across different physical activities and sedentary behaviours. Methods: Sixteen adults with DS (10 men and 6 women; 31 ± 15 years) and 19 adults without DS (10 men and 9 women; 24 ± 5 years) performed 12 tasks. V̇O2 was measured by portable spirometer (K4b2, Cosmed) and VM and VA with an accelerometer (wGT3X‐BT, Actigraph). Results: Vector magnitude and VA were significant predictors of V̇O2 in adults with DS (P < 0.001; R2 = 0.74 and 0.65, respectively) and adults without DS (P < 0.001; P < 0.001; R2 = 0.75 and 0.61, respectively). Absolute error of prediction was significantly smaller for VM than VA for sitting, playing app, drawing, sweeping, standing and basketball (P ≤ 0.005), but smaller for VA than VM for walking at 0.8 m·s−1 (P = 0.005). Bland–Altman plots for adults with and without DS indicated narrower limits of agreement for VM than VA (−5.57 to 5.57 and −6.44 to 6.44 mL·kg−1·min−1; −6.21 to 6.17 and −7.75 to 7.74 mL·kg−1·min−1, respectively). Conclusions: Vector magnitude and VA are significant predictors of V̇O2 in adults with and without DS, yet VM more accurately estimated V̇O2 than VA for most tasks. Development of accelerometer‐based prediction of physical activity levels in adults with and without DS may improve by utilising VM counts. [ABSTRACT FROM AUTHOR]

Purpose: Physical inactivity is one of the important factors leading to chronic diseases including cardiovascular disease (CVD) in individuals with disabilities. However, not many Physical Activity (PA) interventions are available for improving the efficacy of PA and cardiovascular outcomes among community wheelchair users. Therefore, this systematic review will appraise the existing PA interventions for the community dwelling wheelchair users; we especially examined features of the PA programs that showed the improvements in PA and the CVD outcomes compared to the interventions that did not show any improvements in these outcomes among these population. The study also aimed to provide some recommendations for future research., Materials and Methods: A comprehensive and systematic search of literature published between 2015 and 2020 using the databases Scopus, Pubmed, Embase, and Cochrane CENTRAL was conducted. This review has followed the Preferred Reporting Items for Systematic Review (PRISMA) guidelines. The quality of the evidence was assessed by Using Joanna Briggs Institute's critical appraisal tool. Studies that tested the efficacy of PA interventions for community-dwelling adult wheelchair users and published in English were involved. Two reviewers reviewed the literature and any disagreements among these reviewers were resolved by a third reviewer., Results: Fourteen articles were selected for this review. Most of the studies reported improvements in PA. A few studies followed up the participants and majority of the studies have looked at the CVD outcomes., Conclusion: Large-scale studies with follow-ups, and community participatory research that evaluates the effect of PA interventions on PA and CVD outcomes among wheelchair users are needed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Andrabi, Mumba, Key and Motl.)

Background: To date, no medication has slowed the progression of Parkinson's disease (PD). Preclinical, epidemiological, and experimental data on humans all support many benefits of endurance exercise among persons with PD. The key question is whether there is a definitive additional benefit of exercising at high intensity, in terms of slowing disease progression, beyond the well-documented benefit of endurance training on a treadmill for fitness, gait, and functional mobility. This study will determine the efficacy of high-intensity endurance exercise as first-line therapy for persons diagnosed with PD within 3 years, and untreated with symptomatic therapy at baseline., Methods: This is a multicenter, randomized, evaluator-blinded study of endurance exercise training. The exercise intervention will be delivered by treadmill at 2 doses over 18 months: moderate intensity (4 days/week for 30 min per session at 60-65% maximum heart rate) and high intensity (4 days/week for 30 min per session at 80-85% maximum heart rate). We will randomize 370 participants and follow them at multiple time points for 24 months. The primary outcome is the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor score (Part III) with the primary analysis assessing the change in MDS-UPDRS motor score (Part III) over 12 months, or until initiation of symptomatic antiparkinsonian treatment if before 12 months. Secondary outcomes are striatal dopamine transporter binding, 6-min walk distance, number of daily steps, cognitive function, physical fitness, quality of life, time to initiate dopaminergic medication, circulating levels of C-reactive protein (CRP), and brain-derived neurotrophic factor (BDNF). Tertiary outcomes are walking stride length and turning velocity., Discussion: SPARX3 is a Phase 3 clinical trial designed to determine the efficacy of high-intensity, endurance treadmill exercise to slow the progression of PD as measured by the MDS-UPDRS motor score. Establishing whether high-intensity endurance treadmill exercise can slow the progression of PD would mark a significant breakthrough in treating PD. It would have a meaningful impact on the quality of life of people with PD, their caregivers and public health., Trial Registration: ClinicalTrials.gov NCT04284436 . Registered on February 25, 2020., (© 2022. The Author(s).)

Background: There is increasing research interest regarding physical activity behavior among persons with multiple sclerosis (MS), yet there is little known about physical activity and its correlates in Black persons with MS., Objective: This cross-sectional study assessed associations among social cognitive theory (SCT) variables and device-measured and self-reported physical activity in samples of Black and White persons with MS., Methods: Participants included 67 Black and 141 White persons with MS who wore an ActiGraph accelerometer on a belt around the waist measuring moderate-to-vigorous physical activity (MVPA) for seven days and completed a battery of questionnaires. Questionnaires included demographic and clinical characteristics, leisure-time exercise, exercise self-efficacy, overcoming barriers self-efficacy, function, social support, exercise outcome expectations, and goal setting and planning., Results: Black participants with MS engaged in significantly less MVPA, but not sedentary behavior or light physical activity, than the White participants with MS. Black participants further had significantly lower levels of exercise self-efficacy and outcome expectations than the White sample. All SCT correlates were significantly correlated with self-reported physical activity, but only exercise and barriers self-efficacy, perceived function, and exercise goal setting were associated with device-measured MVPA. The difference in physical activity between Black and White participants with MS was accounted for by differences in exercise self-efficacy and outcome expectations., Conclusions: Researchers should consider developing behavioral interventions that target exercise self-efficacy and outcome expectations as SCT variables for increasing physical activity in Black persons with MS., Competing Interests: Conflicts of interest DKH and RWM have no known competing financial interests or personal relationships that could have appeared to influence the work in this article., (Copyright © 2022 Elsevier Inc. All rights reserved.)

This study examined the associations among cardiovascular comorbidities, symptoms of depression and anxiety, and physical activity in persons with multiple sclerosis. Participants with multiple sclerosis (N = 217) completed demographic, cardiovascular comorbidity, depression, and anxiety self-report measures, and wore an accelerometer for 7 days. We examined the bivariate, non-parametric correlations among the variables and conducted parametric, independent samples t-tests when examining the differences in variables based on cardiovascular comorbidity status. Bivariate correlation analysis indicated that there were statistically significant associations between anxiety scores, but not depression scores, and cardiovascular comorbidities. Physical activity, especially moderate-to-vigorous physical activity (MVPA), was correlated with cardiovascular comorbidities. There were small significant differences based on hyperlipidemia status in anxiety scores (p = 0.015, d = -0.42), MVPA (p < 0.001, d = 0.44), and steps/day (p < 0.001, d = 0.50), and based on hypertension status in anxiety scores (p = 0.010, d = -0.35), depression scores (p = 0.046, d = -0.26), MVPA (p = 0.003, d = 0.41), and steps/day (p < 0.001, d = 0.53). The findings indicate that there are significant associations among cardiovascular comorbidities, symptoms of depression and anxiety, and physical activity in persons with multiple sclerosis. Physical activity, specifically MVPA, may be a target for managing those outcomes in persons with multiple sclerosis. [ABSTRACT FROM AUTHOR]

Physical inactivity and comorbidities (e.g., hypertension) result in poor prognoses among persons with chronic, disabling conditions including multiple sclerosis, Parkinson disease, and stroke. Theory can guide the design of behavior change interventions that can be delivered remotely for broad scale implementation. We hypothesize that theory-based behavior change interventions can increase physical activity and reduce comorbidities and associated consequences among persons with chronic, disabling conditions., (Copyright © 2022 by the American College of Sports Medicine.)

Background and purpose: Multiple sclerosis (MS) is a demyelinating and neurodegenerative disease of the central nervous system (CNS) that can be tracked through biomarkers of disease status. We investigated the effects of exercise on MS biomarkers associated with CNS status including imaging, blood–brain barrier (BBB) function and neurotrophic factors. Methods: We conducted open‐dated searches of Scopus, Medline, EMBASE and the Cochrane Library. We included studies written in English describing interventions of exercise that measured one or more of the biomarkers associated with MS published up to October 2018. Results: We located a total of 3012 citations through searches in electronic databases. Of these, 16 studies were eligible for review; six studies focused on magnetic resonance imaging (MRI) markers, nine studies focused on neurotrophic factors and three studies focused on BBB function markers. It is of note that two studies included both neurotrophic factor and BBB function markers and are therefore included across categories of biomarkers in this review. The existing evidence from MRI studies confirmed that exercise training can improve CNS integrity and function. There is evidence of a positive effect of exercise training on modulation of BBB permeability markers and brain‐derived neurotrophic factor. Conclusions: Exercise successfully improves MRI outcomes and peripheral biomarkers (i.e. brain‐derived neurotrophic factor) in people with MS. This suggests that exercise can be recommended as an adjuvant therapy for MS treatment. This conclusion is tempered by some methodological limitations including small sample sizes and high drop‐out rates in the reviewed studies. [ABSTRACT FROM AUTHOR]

Exercise is becoming more integrated into the management of multiple sclerosis (MS) and is promoted to manage impairments and symptoms. Whereas extensive research outlines factors impacting participation, less is known regarding how medicalized exercise promotion might impact views of exercise and self. We conducted a secondary data analysis to understand how medicalized exercise-promotion paradigms impact the meaning and roles of exercise among those with MS. Twenty-two interviews were selected for reanalysis with an interpretative phenomenological analysis methodology and a critical disability studies lens. Three themes were identified: Constant Vigilance (worry about exercise), Productivity and Social Engagement (exercise to feel productive, engage socially, and enhance self-worth), and Exercise as Medicine/Self-Care (exercise to manage MS, relax, improve mental well-being, prevent/reverse disability, and stay healthy). This research underscores that exercise occupies many contradictory roles reflecting a medicalized exercise-promotion paradigm for those with MS, and this should inform exercise promotion practices.

Pandemic restrictions have led to changes in therapy plans and disrupted rehabilitation services for people with multiple sclerosis. CogEx is an international, multicentre MS dual-intervention (cognitive rehabilitation, aerobic exercise) randomized, controlled rehabilitation trial confined to people with progressive disease. The primary outcome is cognition (processing speed).There are 11 treatment sites in six countries with participants required to make 27 site visits over 12 weeks. Collectively, the large, in-person demands of the trial, and the varying international policies for the containment of COVID-19, might disproportionately impact the administration of CogEx. During the first lockdown, all centres closed on average for 82.9 (SD = 24.3) days. One site was required to lockdown on two further occasions. One site remained closed for 16 months. Ten staff (19.2%) were required to quarantine and eight staff (15.4%) tested positive for COVID. 10 of 264 (3.8%) participants acquired COVID-19. All survived. The mean duration of enrollment delay has been [236.7 (SD = 214.5) days]. Restarting participants whose interventions were interrupted by the pandemic meant recalculating the intervention prescriptions for these individuals. While the impact of the pandemic on CogEx has been considerable, all study sites are again open. Participants and staff have shown considerable flexibility and resilience in keeping a complex, international endeavour running. The future in general remains uncertain in the midst of a pandemic, but there is cautious optimism the study will be completed with sufficient sample size to robustly evaluate our hypothesis and provide meaningful results to the MS community on the impact of these interventions on people with progressive MS.Trial registration: The trial was registered on September 20th 2018 at www.clinicaltrials.gov having identifier NCT03679468. Registration was performed before recruitment was initiated., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: Ambulatory disability and cognitive impairment are common and co-occuring manifestations of multiple sclerosis (MS). Neurofunctional training is a specific intervention performed in realistic environments that may have beneficial effects on ambulatory disability in persons with MS who have cognitive impairment. This pilot sudy investigated the feasibility and efficacy of an eight-week home-based neurofunctional training (HBNFT) program vs. home-based resistance training (HBRT) on ambulatory performance in MS patients with cognitive impairment., Methods: Thirty males/females with MS (age 18-50 years, Expanded Disability Status Scale (EDSS) score ≤ 6, and processing speed score ≤ 41.5 as a marker of cognitive impairment) were randomly assigned into HBNFT and HBRT groups. After one week (three sessions) of center-based, supervised training for learning the programs and maximizing safety, the participants completed eight weeks (three sessions per week) of the home-based training programs. The programs were supported through videos, brochures and Digital Video Discs (DVDs) provided during clinic visits (weeks 1 and 5). Ambulatory performance (tandem stance test; tandem walk test; timed up-and-go (TUG); six-minute walk test (6MWT), 10- meter walking test (10MWT); timed 25 foot walk test (T25FWT); five times sit to stand test (5TSTS); six spot step test (SSST); and hand grip) was measured before and after the exercise programs. Feasibility and acceptability of exercise programs was assessed after the eight-week period., Results: HBNFT significantly improved tandem walk test (P = 0.018), SSST (P = 0.026), and 6MWT (P = 0.037) compared with HBRT. No significant changes or differences were observed in other outcomes (P ≥ 0.05). HBNFT was well tolerated and resulted in no adverse events, whereas there were reports of pain, muscle cramps, and extreme fatigue among HBRT participant., Conclusion: The current pilot study provided initial support for HBNFT as a safe and feasible approach for improving some aspects of ambulation in persons with MS who have cognitive impairment. Such a pilot study provides initial proof-of-concept data for the design and implementation of an appropriately-powered randomized controlled trial (RCT) of neuro-functional training vs. traditional resistance exercise in a larger sample of persons with MS who present with co-occurring impairments in mobility and cognition., (Copyright © 2021. Published by Elsevier B.V.)

Background: The timed 25-foot walk (T25FW) is a key clinical outcome measure in multiple sclerosis patient management and clinical research., Objectives: To evaluate T25FW performance and factors associated with its change in the Multiple Sclerosis Outcome Assessments Consortium (MSOAC) Placebo Database ( n  = 2465)., Methods: We created confirmed disability progression (CDP) variables for T25FW and Expanded Disability Status Scale (EDSS) outcomes. We used intraclass correlation coefficients (ICCs) and Bland Altman plots to evaluate reliability. We evaluated T25FW changes and predictive validity using a mixed-effects model, survival analysis, and nested case-control analysis., Results: The mean baseline score for the T25FW in this study population was 9.2 seconds, median = 6.1 (standard deviation = 11.0, interquartile range (IQR) = 4.8, 9.0). The T25FW measure demonstrated excellent test-retest reliability (ICC = 0.98). Walk times increased with age, disability, disease type, and disease duration; relapses were not associated with an increase. Patients with T25FW progression had a faster time to EDSS-CDP compared to those without (hazards ratio (HR): 2.6; confidence interval (CI): 2.2, 3.1). Changes in the T25FW were more likely to precede changes in EDSS., Conclusion: This research confirms the association of the T25FW with disability and provides some evidence of predictive validity. Our findings support the continued use of the T25FW in clinical practice and clinical trials.

Objective: Multiple Sclerosis (MS) is a neurological condition which widely affects people 50-60 years of age. While clinical presentations of MS are highly heterogeneous, mobility limitations are one of the most frequent symptoms. This study examines a machine learning (ML) framework for identifying MS through spatiotemporal and kinetic gait features., Methods: In this study, gait data during self-paced walking on an instrumented treadmill from 20 persons with MS and 20 age, weight, height, and gender-matched healthy older adults (HOA) were obtained. We explored two strategies to normalize data and minimize dependence on subject demographics; size-normalization (standard body size-based normalization) and regress-normalization (regression-based normalization using scaling factors derived by regressing gait features on multiple subject demographics); and proposed an ML based methodology to classify individual strides of older persons with MS (PwMS) from healthy controls. We generalized both across different walking tasks and subjects., Results: We observed that regress-normalization improved the accuracy of identifying pathological gait using ML when compared to size-normalization. When generalizing from comfortable walking to walking while talking, gradient boosting machine achieved the optimal subject classification accuracy and AUC of 94.3 and 1.0, respectively and for subject generalization, a multilayer perceptron resulted in the best accuracy and AUC of 80% and 0.86, respectively, both with regression-normalized data., Conclusion: The integration of gait data and ML may provide a viable patient-centric approach to aid clinicians in monitoring MS., Significance: The results of this study have future implications for the way regression normalized gait features may be clinically used to design ML-based disease prediction strategies and monitor disease progression in PwMS.

Background: Major depression disorder (MDD) and severe depression symptoms are highly prevalent in multiple sclerosis (MS). Depression can worsen symptoms of MS and is associated with significantly reduced quality of life and increased risk of suicide. Currently, there is no gold-standard, single treatment available for depression in MS. Pharmacotherapy, cognitive behavior therapy (CBT), and exercise training individually are moderately, yet incompletely, efficacious for managing depression in the general population and MS., Purpose: This review provides an overview of evidence from meta-analyses and systematic reviews for current treatments of depression in persons with MS. This review further develops the rationale for using a combinatory treatment approach in persons with MS., Methods: We performed a narrative review of meta-analyses and systematic reviews regarding the current state of evidence for the three most common treatments of depression in persons with MS (i.e., antidepressant medication, cognitive-behavior therapy, and exercise training). We provide a concise assessment of the overall effect of these treatments on depression in the general population and then persons with MS. We further note short-comings of research on these treatments for depression., Conclusion: There is no single, gold-standard treatment for depression in MS, and we proposed that combinatory treatments should be considered for the management of depression in MS. However, there is a paucity of evidence for the use of combinatory therapy on depression and its outcomes in persons with MS, and this supports direct examination of the feasibility and efficacy of such combinatory approaches for MDD in MS., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: Individuals with pre-existing chronic illness have shown increased anxiety and depression due to COVID-19. Here, we examine the impact of the COVID-19 pandemic on emotional symptomatology and quality of life in individuals with Progressive Multiple Sclerosis (PMS)., Methods: Data were obtained during a randomized clinical trial on rehabilitation taking place at 11 centers in North America and Europe. Participants included 131 individuals with PMS. Study procedures were interrupted in accordance with governmental restrictions as COVID-19 spread. During study closure, a COVID Impact Survey was administered via telephone or email to all participants, along with measures of depressive symptoms, anxiety symptoms, quality of life, and MS symptomatology that were previously administered pre-pandemic., Results: 4% of respondents reported COVID-19 infection. No significant changes were noted in anxiety, quality of life, or the impact of MS symptomatology on daily life from baseline to lockdown. While total HADS-depression scores increased significantly at follow-up, this did not translate into more participants scoring above the HADS threshold for clinically significant depression. No significant relationships were noted between disease duration, processing speed ability or EDSS, and changes in symptoms of depression or anxiety. Most participants reported the impact of the virus on their psychological well-being, with a little impact on financial well-being. The perceived impact of the pandemic on physical and psychological well-being was correlated with the impact of MS symptomatology on daily life, as well as changes in depression., Conclusions: Overall, little change was noted in symptoms of depression or anxiety or overall quality of life.

Background: Within the pediatric MS population, physical activity (PA) has been associated with positive health outcomes such as lower lesion and relapse rates (Grover et. al., 2015). Recently, associations between variables from a social-cognitive theory (SCT) and levels of PA in youth with multiple sclerosis have been reported (Sikes & Motl, 2020), suggesting a SCT-based intervention may be efficacious in changing PA. We developed and delivered a 12-week SCT-based intervention and sought to gain an understanding of youth's perspectives on PA over time., Methods: We performed a qualitative analysis on 34 coaching call transcripts from 13 participants as part of a theory-based intervention promoting PA in youth with MS (NCT03137602). Coaching calls were semi-structured and each participant was scheduled to have three coaching calls spaced monthly for three months. We used an inductive content analysis approach to analyze the data (Elo and Kyngas, 2008)., Results: General themes from the calls aligned with the SCT constructs. Youth consistently discussed facilitators for changing PA over time, including a positive attitude, goal setting and social connectedness. There was increasing conversation around PA barriers over time including the environment and a lack of time., Conclusion: Youth perceptions on PA can be either positive or negative and can change over time. There is an underlying emergence and importance of social connectedness within PA behaviours. Increases in coaching call content related to goal setting suggest a positive effect of coaching and SCT in these areas. Future studies will focus on interactions between SCT constructs, particularly social connectedness and increased physical activity., (Published by Elsevier B.V.)

Objective: This study examined body fatness and its association with cardiorespiratory fitness (CRF) in persons with multiple sclerosis (pwMS) accounting for disability status. Materials and Methods: This study involved a secondary data analysis from a previous study of 62 pwMS. Body fatness was indirect measured as body mass index (BMI), and CRF was measured as peak oxygen consumption from an incremental exercise test with spirometry. Participants were allocated into 3 different groups based on established BMI categories (ie, normal, overweight, and obese), and data were analyzed using SPSS. Results: The average BMI was 27.0 (6.7) kg/m2, and CRF was 19.5 (7.2) mL/kg/min. There was an inverse correlation (pr = ‐.38 [−.57; −.14]; P = .003) between BMI and CRF controlling for age, sex, disease duration, and disability level. ANCOVA with linear contrast analysis revealed a statistical significant reduction in CRF between groups of different BMI categories; normal weight 20.8 (0.85); overweight 19.8 (1.13); and obese 16.9 (1.73) mL/kg/min; F (2, 55) = 3.33, P = .043; η2 = .11. Conclusions: The findings suggest that BMI has a negative impact on CRF in pwMS, with a marked reduction in CRF for those classified as obese compared to those in the normal and overweight category. [ABSTRACT FROM AUTHOR]

Background: Limited data exist on the prevalence and distribution of sedentary behavior (SB) in multiple sclerosis (MS). Objective: The objective of this paper is to describe sitting time as a metric of SB in a large national sample of people with MS. Methods: A total of 8004 individuals from the North American Research Committee on MS (NARCOMS) Registry completed the sitting time question from the International Physical Activity Questionnaire in spring 2015. We present descriptive data on sitting time for the total sample and across sociodemographic, clinical, and behavioral characteristics. Results: The final sample included 6483 individuals. Of these, 36.7% were classified with mild disability, 24.7% with moderate disability, and 38.6% with severe disability. Median sitting time for the total sample was 480 min/day (P25 = 310 min/day, P75 = 720 min/day). Sitting time was highest for individuals with MS who were male (540 min/day), not married (540 min/day), had a disease duration >30 years (540 min/day), were underweight (540.5 min/day), had an annual income of <$15,000 (585 min/day), presented with a progressive form of MS (600 min/day), were classified as insufficiently active (600 min/day), or presented with severe disability (661 min/day). Conclusion: Sitting time is twice as high in individuals with MS compared to the general population (240 min/day). [ABSTRACT FROM AUTHOR]

Background: Impaired cognition and ambulation are common in multiple sclerosis (MS). Dalfampridine is the first Food and Drug Administration (FDA)-approved medication to treat impaired ambulation in MS. Dalfampridine may benefit patients with cognitive impairment, given its effects on saltatory conduction and the association between cognitive and motor function., Objective: To examine the effects of dalfampridine on cognition in MS. To determine if the anticipated improved cognition is grounded in dalfampridine's effects on ambulation., Methods: Adults with MS were randomized to dalfampridine ( n  = 45) or placebo ( n  = 16) for 12 weeks. Cognition and motor function were assessed at baseline and end-point., Results: T25FW and 6-minute walk (6MW) performance improved at end-point in the treatment group but not in the placebo group ( p  < 0.05). Our primary outcome, performance on the Symbol Digit Modalities Test, did not improve. About 30% ( n  = 12) of the dalfampridine group demonstrated ⩾20% improved ambulation and were categorized "responders." Among "responders", Symbol Digit Modalities test performance did not improve. However, performance on the Paced Auditory Serial Addition Test improved among "responders" ( p  < 0.05)., Conclusion: Dalfampridine benefits timed ambulation but not cognition. Some improvement among ambulation "responders" is consistent with prior reports of cognition-motor coupling in MS ( ClinicalTrials.gov #: NCT02006160).

Background: The promotion of exercise among black individuals with multiple sclerosis (MS) is important for managing the functional and symptomatic manifestations of MS., Objective: The objective of this study was to elicit exercise program preferences among black individuals with MS., Methods: Participants completed a survey delivered through Qualtrics. The survey measured exercise program component preferences, the importance of racial considerations, and barriers and facilitators to exercise participation., Results: Forty black individuals with MS completed the survey and reported a preference for five days per week (range 0-7) of exercise at a moderate intensity (50% of the sample). Over 60% of participants desired an exercise program that was longer than six months, and over half wanted the aid of a behavioral coach. Participants preferred weight/resistance training exercises (52.5%) and easy walking (35%) modalities. The outcomes expected from exercise were increased muscle strength (65%) and improved overall body functioning (60%). The anticipated barriers for exercise were largely fatigue (40%) and time management (32.5%). The desired facilitators were a personal trainer (57.5%) and more exercise information (32.5%). Cultural and racial tailoring was very important or held some importance on the components of the program., Conclusion: The findings of this study should be considered when developing exercise interventions for black individuals with MS.

Context: Excessive weight is a health problem that can exacerbate multiple sclerosis (MS) symptoms and its associated comorbidities such as depression and fatigue. In addition, weight may be a moderator of exercise effects on depression and fatigue symptoms., Objective: This study aimed to investigate the effects of exercise training on fatigue and depression in normal and overweight individuals with MS., Methods: Sixty-six persons with MS were randomly assigned into an exercise or control condition based on body weight status (overweight vs. normal weight). The exercise conditions involved 8-weeks of interval exercise at 60%-75% Watt peak , while the control condition did not involve any exercise. Fatigue, depression, aerobic capacity, time up and go (TUG) and body mass index were measured before and following the 8-week period., Results: There were no significant relationship's revealed for weight status interactions for any of the variables examined. There were significant condition main effects for fatigue, depression, aerobic capacity and TUG, and significant improvements were noted for the exercise conditions, but not in the non-exercising control group., Conclusion: The results from this study confirm that exercise is an effective therapeutic intervention for improving fatigue, depression and functional parameters, independent of initial weight status, in persons with MS., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: While the barriers and facilitators of physical activity adherence are well-defined, there is a limited number of studies focusing specifically on exercise adherence, which is crucial to identify in patients with multiple sclerosis (MS) due to its known disease-modifying effect., Objective: To investigate the factors affecting adherence to physical exercise in MS patients., Methods: Literature search was conducted in PubMed, Cochrane, Web of Science, and Scopus electronic databases up to the current date. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) for quantitative studies and the McMaster Critical Appraisal Tool for qualitative studies, with evidence synthesis conducted using the Modified Bakker Scale., Results: The systematic review incorporated thirteen studies, consisting of seven qualitative and six quantitative ones. These studies' methodological quality was high; 12 were high, and the other was medium (unclear). In all reviewed studies, the primary patient-related and environmental barriers with high levels of evidence regarding exercise adherence included fatigue (38%), false beliefs (18%), cost (18%), and lack of time (15%). Barriers identified in very few studies included cognitive problems (3%), bladder-bowel problems (3%), and family support and advice (3%), indicating a necessity for further research to reveal their impact on exercise adherence., Conclusion: The scarcity of studies on exercise barriers in MS is partly due to the absence of reliable assessment methods for evaluating exercise adherence, along with the prevalent emphasis on physical activity. Future research should prioritize the development of adherence scales tailored to physical exercise and shifting focus towards less explored barriers., (© 2024. The Author(s) under exclusive licence to Belgian Neurological Society.)

Objectives: 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., Methods: 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., Results: 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 sample for physical activity, exercise, and sedentary behaviour, respectively); 6% of the sample 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., Conclusions: 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., Practice Implications: 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.

Background: Exercise training is a promising approach for managing multiple sclerosis (MS), but existing research has not focused on black individuals with MS. This is important as black individuals with MS may experience a more aggressive disease course, increased comorbidities, and have a poorer prognosis with disease modifying therapies., Materials and Methods: Thirty-two black adults with mild-to-moderate MS related disability participated in a patient-informed, three-month, home-based, racially tailored, exercise program. The exercise program, Project GEMS, was modified for black persons with MS through patient feedback. The feasibility of the modified exercise program was measured through the four domains of process (e.g., recruitment and retention), resources (e.g., communication and monetary costs), management (e.g., of data management and safety reporting), and scientific outcomes (e.g., safety, burden, adherence, experience, and treatment effect)., Results: This exercise program was feasible, safe, and well received based on data analysis and formative evaluation. Twenty-four participants completed post-assessment (75%; two dropped out, six did not return follow-up assessments). The exercise program cost a total of $3726.57 (personnel costs = $2128.74 USD, $20.87 USD per/h; exercise program costs = $1597.83 USD, mean cost per person = $46.93). Participants were adherent with 70% of the 48 exercise sessions via self-reported exercise logs. There was a significant and large increase (t = -5.1, p < .001, d = -1.0) in exercise behavior as measured by the Godin Leisure-Time Exercise Questionnaire., Conclusion: The results support the feasibility, acceptability, safety, and efficacy of this intervention for increasing exercise behavior among black adults with mild-to-moderate MS., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Multiple sclerosis (MS) is a disease of the central nervous system that causes ataxia and deficits in balance. Exercise-based therapies have been identified as integral to the recovery of motor function in MS, but few studies have investigated non-traditional movement interventions. We examined a targeted ballet program (TBP) designed to mitigate ataxia and improve balance in females with mild-to-moderate relapsing-remitting MS., Methods and Findings: Twelve females with mild-to-moderate disability due to MS were assessed for study eligibility for the study. Ten participants met the inclusion criteria. Two were lost to unrelated health complications. Eight participants completed the TBP. The TBP met twice a week for 60 minutes for 16 weeks. Assessments included (a) the International Cooperative Ataxia Rating Scale (ICARS), (b) the Mini-Balance Evaluations Systems Test (Mini-BESTest), (c) smoothness of movement during a five-meter walk, and (d) balance in a step to stand task before and after the TBP. There were no TBP-related adverse events. Single-tailed paired samples t-tests and Wilcoxon tests were conducted. Improvements were observed in ICARS (p = 7.11E-05), Mini-BESTest (p = 0.001), smoothness of movement in the left (p = 0.027) and right (p = 0.028) sides of the body, and balance in a step-to-stand task in the back (p = 0.025) direction. Results yielded 42% and 58% improvements in the mean Mini-BESTest and ICARS scores, respectively., Conclusions: This study adds to current research by providing support for a TBP intervention targeting ataxia and balance in MS. The TBP was well tolerated, improved balance, and mitigated ataxia. Clinical improvements were larger than those of previous studies on physical rehabilitation in MS with similar outcome measures., Trial Registration: ISRCTN ISRCTN67916624., Competing Interests: The authors have declared that no competing interests exist.