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The article presents a randomized controlled trial (RCT) of the efficacy of a behavioral intervention that targets symptoms and physical activity of patients with multiple sclerosis (MS). It examines the effectiveness of an Internet-delivered behavioral intervention to improve depression, fatigue, pain, anxiety and sleep quality in ambulatory persons with MS. Results showed behavioral intervention targeting lifestyle physical activity as an alternative approach for MS symptoms treatment.

We compared the explanatory power of two symptom clusters that consisted of either three or five symptoms as correlates of physical activity in individuals with relapsing-remitting multiple sclerosis (RRMS; N = 218). The data were primarily analyzed using covariance modeling in Mplus 3.0. A symptom cluster of fatigue, depression, and pain had a moderate, negative relationship with physical activity, and this relationship was comparable inmagnitude with a symptom cluster of fatigue, depression, pain, perceived cognitive dysfunction, and poor sleep quality. The relationships were attenuated after controlling for exercise history and neurological impairment. Such findings further support the consideration of a narrowly defined cluster of three symptoms as an independent correlate of physical activity in persons with RRMS. [ABSTRACT FROM AUTHOR]

Background: Individuals who sustain an ACL injury and undergo reconstruction (ACLR) are at risk for the development of osteoarthritis. Recent investigations have applied the Englund criteria to categorize people with a history of ACLR as someone with a symptomatic or asymptomatic knee., Purpose/hypothesis: The purpose of this study was to examine differences in health-related quality of life (HRQL) and psychological outcomes in people with a history of ACLR who were categorized as symptomatic or non-symptomatic by application of the Englund criteria. The authors' hypothesized participants classified as symptomatic would have lower HRQL, increased fear-avoidance beliefs, and decreased resilience compared to participants classified as non-symptomatic., Study Design: Cross-sectional, survey., Methods: Participants at least one-year after ACLR were recruited for the study and completed the Tegner Activity Scale, the Brief Resilience Scale (BRS), the modified Disablement in the Physically Active Scale (mDPA), and the Fear-Avoidance Belief Questionnaire (FABQ) at one time-point. Descriptive statistics were summarized using median [interquartile range] and differences between groups were examined using separate Mann-Whitney U tests., Results: Participants with symptomatic knees had a significantly higher BMI (24.8 [6.4]) than the non-symptomatic group (21.2 [4.3], p=0.013). Participants in the symptomatic group had worse HRQL on the physical subscale (12.5 [16.3] vs. 0.0 [2.5], p<0.001) and mental subscale (2.0 [1] vs. 0.0 [1], p=0.031), higher scores on the FABQ-Sport (14.5 [11] vs. 0.0 [6], p<0.001) and FABQ-Physical Activity (20 [24] vs. 1 [4], p<0.001) and less resilience (3.7[0.42] vs. 4.0 [0.83], p=0.028) compared to those participants in the non-symptomatic group. There were no differences in current physical activity (p=0.285) or change in physical activity (p=0.124) levels between the two groups., Conclusions: This series of differences may represent a cascade of events that can continue to negatively impact health outcomes across the lifespan for individuals with a history of ACLR. Future research should consider longitudinal investigations of these outcomes after injury and throughout the post-surgical and post-rehabilitation timeframe., Level of Evidence: Level 3b., Competing Interests: The authors report no conflicts of interest., (© The Author(s).)

Purpose: This study examined associations between physical activity (PA) and obesity with blood pressure (BP) in young children. Furthermore, a possible moderating effect of obesity status was examined., Methods: A cross-sectional study was completed with 121 children (3.96 [1.14] y). BP, weight, and height were measured, and body mass index (BMI) was calculated. Z scores were calculated for BMI, systolic, and diastolic values. Accelerometry measured time spent in PA intensities. Correlations and regressions examined relationships among PA intensities, BMI z scores, and BP z scores and to determine if obesity status moderated these relationships., Results: On average, the children spent 52 minutes per day in moderate-to-vigorous physical activity, 31% were considered overweight/obese, and 15% were considered hypertensive. After adjusting for confounders, participation in moderate, vigorous, and moderate-to-vigorous physical activity was related with lower systolic and diastolic BP z scores (P < .05). BMI z score was not related to BP values. Obesity status did not moderate the relationships between time spent in PA and BP., Conclusions: Participation in PA, but not obesity, was related to lower BP levels in young children. The impact PA has on BP is the same regardless of obesity status. Thus, young children should be encouraged to be active in different intensities to benefit the cardiovascular system.

Background: Many adults in the United States do not reach the recommended levels of activity needed for health benefits. Single-female caregivers present a unique and vulnerable population that is often less active than their partnered peers or single-male caregivers., Objective: The primary objective of this cross-sectional investigation was to identify the prevalence of physical inactivity in single-family, female-led households and determine differences in personal factors and social characteristics between physically active and not physically active single-female caregivers. A secondary objective was to examine associations among the social characteristic variables and physical inactivity in single-female caregiver households. Finally, we examined the odds single-female caregivers who are physically inactive reported chronic health conditions., Design: Cross-sectional survey design., Methods: We used the 2020 Behavioral Risk Factor Surveillance System (BRFSS) data. Participants were selected based on pre-determined criteria for inclusion., Results: There was a 39.3% prevalence of physical inactivity among single-female caregivers in the sample. Single-female caregivers who were physically inactive had greater odds of having a history of multiple chronic health conditions., Conclusion: Healthcare providers and other community stakeholders should explore existing physical activity promotion strategies to increase physical activity in single-female caregivers. Future research should employ more rigorous, prospective research designs to determine if these chronic conditions and various social characteristics are caused by physical inactivity.

Objective: To examine the interaction between high school (HS) sports participation and injury history with current moderate-to-vigorous physical activity (MVPA) among young adults. Participants: Participants ( N  = 236) were 18-25 years old, not currently injured, and reported no physical activity limitations. Methods: Participants completed online demographic, injury history, and physical activity surveys. A two-way analysis of covariance was used to test the interaction between HS athlete status and previous injury severity on current self-reported MVPA. Results: Participants were 22.2 ± 2.1 years, primarily White (81.8%) or Asian (6.4%), and female (77.5%). After including body mass index and race as covariates, there was a statistically significant interaction between HS athlete status and previous injury history such that current MVPA was higher among former HS athletes compared to HS recreational/nonathletes when individuals reported no injuries or mild injury severity. MVPA was similar across athlete status groups when participants reported high levels of injury severity. Conclusions: Future studies should examine whether young adults who have experienced multiple and/or severe injuries as competitive HS athletes have unique physical activity barriers.

Background: Over 75% of American adults are not meeting aerobic and muscular physical activity recommendations, with the majority being females. Equestrian activities are a potential avenue to increase physical activity, especially in females who account for approximately 90% of sport participants. This study describes perceptions of equestrian activities and establishes the patterns of self-reported equestrian, barn work, and nonequestrian physical activity engagement to understand participation in activities that may sustain physical activity across the lifespan., Methods: American equestrians (n = 2551) completed an anonymous online survey with questions about perceptions and benefits of equestrian activities, demographics, and engagement in equestrian activities, barn work, and nonequestrian activities., Results: There were 2039 completed responses, (95.6% female), with representation from all regions of the United States. Professionals (20.6%), amateurs (39.1%), and recreational (40.3%) comprised participation status. Significantly fewer recreational participants perceived equestrian as physical activity and as a sport than amateurs (P < .05) and professionals (P < .05). Engagement in equestrian and barn work physical activity was significantly higher in professionals (P < .0001), followed by amateurs (P < .0001), with the lowest in recreational equestrians (P = .001). Professional and amateur equestrians engaged in significantly more nonequestrian physical activity than recreational participants (P < .05)., Conclusions: Equestrian physical activity engagement is dependent on the status of participation. Equestrian, barn work, and nonequestrian physical activity do meet physical activity aerobic and muscular recommendations and should be encouraged as a physical activity for females across the lifespan.

Context: Youth sport specialization may be associated with physical literacy and physical activity in young adulthood. The purposes of this study were to compare young adult (18-25 y) physical literacy and physical activity by high school sport specialization status and to examine the relationship between current physical activity and physical literacy., Design: Retrospective, cross-sectional study design., Methods: Participants were recruited from ResearchMatch, university classes, and social media posts. Participants (N = 172; aged 22.1 [2.1] y; 80.1% female) completed the following anonymous surveys on REDCap to assess: demographics and injury history, sport specialization, physical literacy (PLAYself), and physical activity (Godin Leisure-Time Exercise Questionnaire)., Results: When controlling for age, there were no statistically significant differences in physical literacy (F2,166 = 2.02, P = .14) or moderate to vigorous physical activity (F2,161 = 0.24, P = .79) between sport specialization groups. There was a moderate, positive relationship between physical literacy and physical activity (r = .33, P < .001)., Conclusions: Young adult physical literacy and physical activity were similar regardless of youth sport specialization level. Young adult physical literacy was positively associated with physical activity. Future studies should consider physical literacy as a possible correlate of physical activity among young adults.

The PLAYself is a commonly utilized tool to assess physical literacy in child and adolescent populations. Currently, there are no measurement tools designed to examine physical literacy among adults. The purpose of this cross-sectional study was to examine the psychometric properties of PLAYself subsections in a sample of young adults. Two hundred forty-five young adults (ages 18-25) from the United States completed the PLAYself questionnaire. Multiple principal component analyses using promax rotation were utilized to assess the current factor structure of the PLAYself subsections. Each subsection was analyzed independently to explore individual summary components. PLAYself subsections were assessed for reliability using Cronbach's  α , inter-item correlations, and item-total correlations. A multi-factor structure was identified for each PLAYself subsection. A 2-factor structure was identified for the Environment subsection accounting for 55.2% of the variance. A 2-factor structure was identified for the Physical Literacy Self-Description subsection accounting for 57.1% of the variance. A 3-factor structure was identified for the Relative Ranking of Literacies subsection accounting for 70.3% of the variance. The Environment, Physical Literacy Self-Description, and Relative Ranking of Literacies subsections demonstrated poor ( α  = 0.577), good ( α  = 0.89), and acceptable ( α  = 0.79) internal consistencies, respectively. The Physical Literacy Self-Description subsection demonstrated the best psychometric properties in our sample, and thus may be an appropriate tool to assess physical literacy in a young adult population until additional measurement tools are developed.

Purpose: Preschool-aged children, especially girls, have low levels of physical activity that may be influenced through parent role modeling. Evidence for mother-daughter interventions that include preschool-aged children is sparse. The primary purpose of this study was to examine the feasibility of recruitment procedures, protocol compliance, and participant retention for the Mothers and Daughters Moving Together intervention. The secondary aim was to provide initial estimates of the intervention effect on mother-daughter and family physical activity co-participation, moderate to vigorous physical activity, and maternal physical activity enjoyment and support., Method: This nonrandomized feasibility study included mother-daughter (2-5 y) dyads who self-selected into the intervention (n = 21 dyads) or comparison (n = 10 dyads) group., Results: The recruitment rate was 41.9% (31 enrolled/74 interested). Intervention group mother-daughter dyads attended 57% of intervention sessions. Among the whole sample, 70% to 80% of participants (mothers and daughters) had at least 4 valid days of accelerometer data at preintervention and postintervention. The retention rate was 90% (28/31 dyads completed the study). Initial estimates of intervention effect indicated small, positive changes for mother-daughter physical activity co-participation, and maternal physical activity support and enjoyment., Conclusions: This study provides valuable information that should be confirmed using an adequately powered and randomized study design.

Parents are known to influence the athlete sport experience through motivational climates. Athletes' perception of motivational climates and their own motives for sport participation influence enjoyment and long-term sport commitment. It is unknown, however, the extent parent motives for initially enrolling their child in a year-round sports program associate with children's sport participation enjoyment and commitment. The purposes of this study were to (a) determine parent motives for enrolling their child (5-8 years) in year-round swimming and (b) explore the relationships of parent motives and motivational climates with child enjoyment and commitment. Parents ( n = 40) completed questionnaires on enrollment motives and motivational climate, while children ( n = 40) answered questions on enjoyment and commitment. Of the seven motives measured, parents enrolled children in swimming primarily for fitness benefits ( M = 4.5, SD = .45 ) followed by skill mastery ( M = 4.31, SD = .48) and fun ( M = 4.10, SD = .51) reasons. Findings revealed the fitness motive was moderately, negatively correlated with the success-without-effort facet of a performance climate ( r = -.50, p < .01). The fun motive was moderately, positively associated with commitment ( r = .43, p < .01). Parent motives for enrolling their child in sport may impact the young child sport experience and long-term sport continuation via motivational climates, enjoyment, and commitment.

Background: Regular participation in strength training significantly enhances older adults' physical and functional health, yet only 14% of adults over age 50 report engaging in strength training at least twice per week. Exercise messages about why and how older adults should engage in strength training could influence their perceptions of and participation in the behavior. This study was designed to promote strength training among adults aged 50-70 and to determine whether the message frame accompanying a brief workout would have an impact on participants' motivation, self-efficacy, and/or physical activity behavior., Methods: Participants (N = 308) were randomly assigned to one of four message conditions: Easy Intrinsic, Hard Intrinsic, Easy Extrinsic, or Hard Extrinsic. Immediately after completing baseline measures of motivation and physical activity, participants received the recommended strength training workout and corresponding motivational message. They completed follow-up measures of motivation and physical activity 2 weeks later., Results: Controlled regulation was higher at follow-up among participants exposed to an extrinsic message relative to an intrinsic message (F(3,208) = 3.08, p = .03). Strength training (Z = - 5.95, p < .001) and moderate physical activity (Z = - 3.23, p = .001) increased among participants not engaging in regular strength training at baseline., Conclusions: These results suggest message framing may have a short-term impact on Baby Boomers' physical activity motivation, such that emphasizing extrinsic goals (i.e., weight loss and appearance) may contribute to controlled motivation. However, repeated measurements are needed to determine the longer-term maintenance and influence of these effects.

Obesity is an increasing public health concern in the U.S. and a contributor to chronic illness, with trends revealing a rise in adult obesity and chronic disease rates among the most vulnerable and disadvantaged populations, including those in rural communities. A mixed-methods approach was used to examine perspectives on perceived physical activity barriers, resources, and level of community support. Researchers utilized the socioecological model to examine the multiple domains that support physical activity in rural Appalachia. The present study focuses on baseline data, including a cohort survey to assess physical activity, health status, and barriers to physical activity, and five focus groups with elected community leaders, community residents, members, and key stakeholders to assess perspectives on physical activity barriers and resources within the county. The cohort survey sample ( N = 152) reported a median of 6 barriers (range 0-13) to participating in at least 30 min of physical activity daily. The qualitative analysis yielded three overarching themes related to physical activity participation: lack of motivation, physical environment, and cultural barriers. This mixed-methods study revealed the challenges and perceptions among rural residents across the socioecological model when assessing physical inactivity. Findings can be used to tailor future interventions focused on expanding social support, designing infrastructure, and creating policies that promote physical activity.

Objective: The objective of this study was to examine the relationship between fear-avoidance beliefs and physical activity (PA) in people with a history of anterior cruciate ligament reconstruction (ACLR)., Design: Modified cross-sectional., Setting: Research laboratory Participants: A total of 19 participants with a history of unilateral ACLR., Main Outcome Measures: Participants completed the Fear-Avoidance Beliefs Questionnaire (FABQ), a valid and reliable measure of FAB measured across two subscales (FABQ-Sport and FABQ-Physical Activity (PA)). Higher scores indicated greater FAB. The participants were provided a wearable accelerometer to wear on the wrist for one-week to capture PA outcomes (vertical counts per minute and average steps/day)., Results: Weak, non-statistically significant positive correlations were identified between average daily steps per day (11,237.7 ± 5667.7), FABQ-PA (6 ± 8; r = 0.12, p = .63) and FABQ-S (8 ± 15; r = 0.26, p = .35). Weak, non-statistically significant negative correlations were identified between vertical counts per minute (131.4 ± 141.4) and FABQ-PA (r = -0.13, p = .59) and no relationship was observed with FABQ-Sports (r = 0.00, p = .98)., Conclusions: There were no significant relationships between FABs and PA. The ability for individuals to remain physically active, with measurable levels of FABs (greater than 0), may be due to other psychological variables that should be further examined., Competing Interests: Declaration of competing interest None declared., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose: This study examined patterns of physical activity coparticipation among parent-child (2-5 y) dyads., Method: The dyads (N = 47; 51% mother-child) each wore a Bluetooth-enabled accelerometer for 8 days to measure physical activity and physical activity coparticipation. The parents completed demographic and self-reported family physical activity questionnaires., Results: The parent-child dyads spent 145 (79) minutes per day in-proximity according to the Bluetooth-enabled accelerometers. The majority (90%) of parent-child in-proximity time was spent with the parent and child engaged in some combination of sedentary or light activities. Child light, moderate, and vigorous physical activity was not associated with parent light (P = .12) or moderate to vigorous physical activity (P = .45), but was positively associated with parent-child in-proximity active minutes (light, moderate, and vigorous) (P < .01). Children in the highest tertile of parent-child physical activity coparticipation engaged in more daily moderate to vigorous physical activity compared with children in the lowest tertile (72.7 vs 50.3 min). There was a positive, statistically significant association between self-reported and objective measures of physical activity coparticipation (r = .47, P = .001)., Conclusion: Children who engaged in the most physical activity with their parent had the highest moderate to vigorous physical activity. Future studies should continue to provide contextual information about how parents and children spend their time together to improve family-based physical activity interventions.

Objective: Mothers have lower moderate-to-vigorous physical activity than non-mothers and this negatively impacts health. Group dynamics interventions have been successful for increasing physical activity, yet studies using these strategies among mothers are limited and rely on self-reported physical activity. The goal of this study was to examine the effectiveness of a collective-efficacy enhanced physical activity intervention that used group dynamics principles compared to a standard group-based intervention. Design: Mothers ( N  = 86) were randomly assigned to a 6-week intervention (collective-efficacy enhanced) or standard health education/walking group. Main outcome measures: participants wore pedometers for 1-week and completed a self-efficacy questionnaire at pre-intervention, post-intervention, and 3-month follow-up. Results: There were statistically significant increases in activity minutes ( p  = 0.05) and step counts ( p  = 0.049) and no changes in self-efficacy ( p  = 0.74) from pre- to post-intervention. There were no group by time interactions for changes in physical activity or self-efficacy. None of the changes in physical activity were maintained at follow-up. Conclusions: There is a continued need to understand how to use social factors to promote sustained physical activity among mothers.

Objectives: In this study, we investigated how exercise is portrayed in popular, non-fitness focused magazines targeting various audiences. Methods: Ten popular magazines were selected based on target audience (Teens, Young Adults, Family, Middle-Aged Adults, Older Adults). Ten digital articles from each magazine's health/fitness section were coded for the primary reason to exercise, the frequency, intensity, time, and type of exercise recommended, and whether their recommendations were evidence-based. Frequencies were calculated by target audience. Results: The primary reason for exercise differed by audience, with appearance and fitness empha- sized by magazines targeting younger audiences, and mental health/quality of life emphasized in magazines targeting older adults. Over half of the articles described exercises that should be completed 2x-3x/week for <10 minutes. Articles frequently recommended circuit workouts that could be completed at moderate or self-selected intensity. Only 10% of articles cited peer- reviewed evidence. Conclusions: Results showed popular magazines often represent exercise as something that can be completed in a short time frame with meaningful benefits. However, an overemphasis on appearance in young adults is apparent, which could undermine intrinsic mo- tivation and behavior. Improved communication between researchers and popular magazines is needed to promote sharing of credible, evidence-based exercise content with the public.

Background: Many parents are insufficiently active. Further research is needed to understand the goals that drive sustained exercise participation among parents. The purpose of this study was to use self-determination theory derived constructs to examine the relationship between parents' exercise goals and their autonomous motivation, controlled motivation, and exercise behavior across 1 year., Methods: Mothers (n = 226) and fathers (n = 70) of children less than 16 years completed the Exercise Motivations Inventory-2 and, 1 year later, the Behavioral Regulation in Exercise Questionnaire-2 and Godin Leisure-Time Exercise Questionnaire. Linear mixed effects models were used to examine the longitudinal relationships between exercise goals and autonomous motivation, controlled motivation, and leisure-time exercise., Results: All goals except weight management were significantly associated with autonomous motivation, whereas only weight and appearance goals predicted controlled motivation. Exercising for stress management and revitalization, but not health- or appearance-related goals, was significantly related to exercise behavior over 1 year., Conclusions: Only goals related to immediate affective outcomes were associated with both autonomous motivation and exercise behavior over time. These findings support recent calls to "rebrand exercise" as a means to improve daily well-being. Such goals may drive parents to prioritize exercise because they value the immediate benefits it provides.

Purpose: This study was designed to compare a low versus high theoretical fidelity pedometer intervention applying social-cognitive theory on step counts and self-efficacy., Method: Fifty-six public university employees participated in a 10-week randomized controlled trial with 2 conditions that varied in theoretical fidelity. Participants in the high theoretical fidelity condition wore a pedometer and participated in a weekly group walk followed by a meeting to discuss cognitive-behavioral strategies targeting self-efficacy. Participants in the low theoretical fidelity condition met for a group walk and also used a pedometer as a motivational tool and to monitor steps. Step counts were assessed throughout the 10-week intervention and after a no-treatment follow-up (20 weeks and 30 weeks). Self-efficacy was measured preintervention and postintervention., Results: Participants in the high theoretical fidelity condition increased daily steps by 2,283 from preintervention to postintervention, whereas participants in the low fidelity condition demonstrated minimal change during the same time period (p = .002). Individuals attending at least 80% of the sessions in the high theoretical fidelity condition showed an increase of 3,217 daily steps (d = 1.03), whereas low attenders increased by 925 (d = 0.40). Attendance had minimal impact in the low theoretical fidelity condition. Follow-up data revealed that step counts were at least somewhat maintained. For self-efficacy, participants in the high, compared with those in the low, theoretical fidelity condition showed greater improvements., Conclusion: Findings highlight the importance of basing activity promotion efforts on theory. The high theoretical fidelity intervention that included cognitive-behavioral strategies targeting self-efficacy was more effective than the low theoretical fidelity intervention, especially for those with high attendance.

Motherhood is associated with low rates of physical activity that increase disease risk. Most theory-based approaches to increasing physical activity focus on personal rather than social factors. The purpose of this study was to examine the associations among perceptions of community collective efficacy and objectively measured physical activity, self-efficacy, social support, and health. Mothers completed questionnaires and wore a pedometer for 7 days. There was a significant, positive association between physical activity and collective efficacy-social cohesion subscale. In the regression analysis, only age and social support were independent predictors of physical activity. Future studies should examine relationships among collective efficacy and social support and physical activity.

Background: Many mothers and young children are not meeting physical activity guidelines. Parent-child coparticipation in physical activity (ie, shared physical activity) provides opportunities for social modeling and might be associated with child physical activity. There is very little information about shared physical activity using objective measures., Methods: Participants (N = 17 mother-young child dyads) completed a demographic survey and height/weight measurements, and wore a Bluetooth ® accelerometer for 1 week. Accelerometers were initialized using the proximity function to yield both individual and proximity [a minute-by-minute log of whether the 2 accelerometers were in- or out-of-range (∼50 m or less)] data. Shared physical activity was calculated in MATLAB by overlaying individual and proximity accelerometer data., Results: Mother-child dyads spent approximately 2 hours per day in shared time that was mostly shared sedentary activities. Less than 1% of shared minutes per day were spent in shared moderate to vigorous physical activity., Conclusions: Mothers and young children spent a small portion of their day in shared activities. Most mother-child shared time was spent in sedentary or light activities rather than moderate to vigorous physical activity. This method for objectively measuring shared physical activity provides novel information about the context in which physical activity occurs and could be used to understand patterns of physical activity among other dyads.

Purpose: Many mothers fail to meet the recommended guidelines for physical activity. Popular media magazines targeting mothers provide information about physical activity and health, but little is known about the framing and content of physical activity messages within these sources. The aim of this content analysis was to analyze the framing and content (i.e., benefits, consequences, and sources of self-efficacy) of physical activity messages directed toward mothers in popular magazines., Method: Ten popular magazines were selected for data analysis and coded independently by two researchers in NVivo Version 10.0 for gain- or loss-framed messages, benefits and consequences of physical activity, and sources of self-efficacy., Results: Most of the 164 articles encouraged physical activity by presenting benefits associated with physical activity. These benefits primarily focused on weight loss and fitness gains and few articles used self-efficacy messages to enhance confidence in physical activity participation., Conclusions: It is promising that popular media magazines used gain-framed messages about the benefits of physical activity for mothers. Future research should focus on finding ways of using popular media outlets to promote a more comprehensive set of physical activity benefits, enhance physical activity self-efficacy, and determine the impact of such messages on physical activity participation., (© 2016 Society for Public Health Education.)

Purpose: Single motherhood has been associated with negative health consequences such as depression and cardiovascular disease. Physical activity might reduce these consequences, but little is known about physical activity experiences and beliefs that might inform interventions and programs for single mothers. The present study used social-cognitive theory as a framework to explore physical activity beliefs and experiences among single mothers., Method: Single mothers (N = 14) completed a semistructured interview and the International Physical Activity Questionnaire. Participants were categorized into 3 activity levels, and data were analyzed according to these categories., Results: All participants reported barriers to physical activity. Physically active single mothers seemed to be more confident in their ability to overcome these barriers and more likely to plan physical activity in their daily routine, and they more frequently reported having social support compared with low-active single mothers. Across all activity levels, participants focused on the physical outcomes of physical activity participation such as weight loss., Conclusions: These results provide information that is useful for designing and delivering behavioral interventions for increasing physical activity among single mothers.

Parents face numerous barriers to exercise and exhibit high levels of inactivity. Examining theory-based determinants of exercise among parents may inform interventions for this population. The purpose of this study was to test a social-cognitive model of parental exercise participation over a 12-month period. Mothers (n = 226) and fathers (n = 70) of children <16 completed measures of exercise, barriers self-efficacy, perceived barriers, and exercise planning at baseline and 1 year later. Panel analyses were used to test the hypothesized relationships. Barriers self-efficacy was related to exercise directly and indirectly through perceived barriers and prioritization/planning. Prioritization and planning also mediated the relationship between perceived barriers and exercise. These paths remained significant at 12 months. These results suggest efforts to increase exercise in parents should focus on improving confidence to overcome exercise barriers, reducing perceptions of barriers, and helping parents make specific plans for prioritizing and engaging in exercise.

Background: Mothers are a population that engages in low levels of physical activity due to unique barriers to physical activity. As such, there is a need to develop and implement physical activity interventions for mothers that can be delivered in community settings. The objective of this article is to describe the Moms UNITE (Using Networks to Increase Togetherness and Efficacy) for Health walking intervention. This intervention, based on social cognitive theory, is designed to compare a collective efficacy enhanced intervention to a standard intervention for increasing physical activity and secondary outcomes., Methods: In this 6-week, randomized controlled trial, mothers will be assigned to either the standard or intervention (collective efficacy) group. Both groups will receive the same walking intervention and an evidence-based health education program. Strategies and messages focusing on building collective efficacy will be used in the intervention group. Data will be collected at baseline, post-intervention, and follow-up (after a 3 month no-intervention period) using a mixed methods approach., Results: Quantitative data will include anthropometric measurements, objective physical activity, and questionnaires assessing self- and collective-efficacy. Post-intervention focus groups and weekly process evaluation surveys will describe participants' experiences within the program., Conclusions: This paper will serve as a theoretical framework for researchers and public health practitioners to develop and implement community-based walking programs for mothers., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Behavioral interventions have significantly increased physical activity in people with multiple sclerosis (MS). Nevertheless, there has been interindividual variability in the pattern and magnitude of change. This study documented the efficacy and variability of a behavioral intervention for changing physical activity and examined the possibility that efficacy varied by the characteristics of individuals with MS., Methods: Eighty-two people with MS were randomly assigned to one of two conditions: behavioral intervention (n = 41) or waitlist control (n = 41). We collected information before the study on MS type, disability status, weight status based on body-mass index, and current medications. Furthermore, all participants completed the Godin Leisure Time Exercise Questionnaire and the abbreviated International Physical Activity Questionnaire and wore an accelerometer for 1 week to measure minutes of moderate-to-vigorous physical activity before and after the 6-month intervention period., Results: Analysis of covariance (ANCOVA) indicated that participants in the behavioral intervention had significantly higher levels of physical activity than control participants after the 6-month period (P < .001). There was substantial interindividual variability in the magnitude of change, and ANCOVA indicated that MS type (relapsing vs. progressive) (P < .01), disability status (mild vs. moderate) (P < .01), and weight status (normal weight vs. overweight/obese) (P < .05) moderated the efficacy of the behavioral intervention., Conclusions: The behavioral intervention was associated with improvements in physical activity, particularly for those with mild disability, relapsing-remitting MS, or normal weight status.

Gait impairment is ubiquitous in multiple sclerosis (MS) and is often characterized by alterations in spatiotemporal parameters of gait. There is limited information concerning reliability of spatiotemporal gait parameters over clinical timescales (e.g. 6 months). The current report provides novel evidence that gait parameters of 74 ambulatory persons with MS with mild-to-moderate disability are reliable over 6-months (ICC's for overall sample range from 0.56 to 0.91) in the absence of any intervention above and beyond standard care. Such data can inform clinical decision-making and power analyses for designing RCTs (i.e., sample size estimates) involving persons with MS., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Objective: To examine the efficacy of a physical activity behavioral intervention for improving outcomes of body composition in persons with multiple sclerosis (MS)., Design: Secondary analysis of data from a randomized controlled trial., Setting: University research laboratory., Participants: Ambulatory persons with MS (N=82)., Intervention: A 6-month, internet-delivered physical activity behavioral intervention designed to increase lifestyle physical activity, primarily walking. The behavioral intervention was based on principles of social cognitive theory., Main Outcome Measures: Whole-body bone mineral content (BMC), bone mineral density (BMD), and soft tissue composition, using dual-energy x-ray absorptiometry., Results: There were no significant differences between conditions posttrial on body composition outcomes using the adjusted critical value (P<.008). There was a significant effect of the intervention on whole-body BMC (P=.04, ω(2)<.001) and BMD (P=.01, ω(2)=.003) using the unadjusted critical value (P<.05). The effect of the intervention on percent body fat (P=.09, ω(2)=.001) and whole-body fat mass (P=.05, ω(2)=.003) approached significance using unadjusted criteria. There was not a significant effect on whole-body lean soft tissue (P=.28, ω(2)<.001) or body mass index (P=.86, ω(2)<.001)., Conclusions: Our results provide preliminary evidence that an internet-delivered lifestyle physical activity intervention might improve bone health and body composition in MS. Such findings are important considering that physical activity is a modifiable behavior with the potential to confer long-term benefits for the prevention and management of fracture risk and comorbidities among those with MS., (Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: There has been increased interest in the objective monitoring of free-living walking behavior using accelerometers in clinical research involving persons with multiple sclerosis (MS). The current investigation examined and compared the accuracy of the StepWatch activity monitor and ActiGraph model GT3X+ accelerometer for capturing steps taken during various speeds of prolonged, over-ground ambulation in persons with MS who had mild, moderate, and severe disability., Methods: Sixty-three persons with MS underwent a neurological examination for generation of an EDSS score and undertook two trials of walking on the GAITRite electronic walkway. Participants were fitted with accelerometers, and undertook three modified six-minute walk (6MW) tests that were interspersed with 10-15 minutes of rest. The first 6MW was undertaken at a comfortable walking speed (CWS), and the two remaining 6MW tests were undertaken above (faster walking speed; FWS) or below (slower walking speed; SWS) the participant's CWS. The actual number of steps taken was counted through direct observation using hand-tally counters., Results: The StepWatch activity monitor (99.8%-99.9%) and ActiGraph model GT3X+ accelerometer (95.6%-97.4%) both demonstrated highly accurate measurement of steps taken under CWS and FWS conditions. The StepWatch had better accuracy (99.0%) than the ActiGraph (95.5%) in the overall sample under the SWS condition, and this was particularly apparent in those with severe disability (StepWatch: 95.7%; ActiGraph: 87.3%). The inaccuracy in measurement for the ActiGraph was associated with alterations of gait (e.g., slower gait velocity, shorter step length, wider base of support)., Conclusions: This research will help inform the choice of accelerometer to be adopted in clinical trials of MS wherein the monitoring of free-living walking behavior is of particular value.

Background: Performing a cognitive task while walking results in a reduction of walking performance among persons with MS. To date, very little is known about correlates of this dual task cost (DTC) of walking in MS., Purpose: We examined walking performance, cognitive processing speed, and symptoms of fatigue, depression, anxiety, and pain as correlates of DTC of walking in MS., Methods: 82 persons with MS undertook a 6-min walk test (6MWT) and completed the Symbol Digit Modalities Test (SDMT), Fatigue Severity Scale (FSS), Short-form of the McGill Pain Questionnaire (SF-MPQ), Hospital Anxiety and Depression Scale (HADS), and self-reported Expanded Disability Status Scale (SR-EDSS). The participants completed 4 trials of walking at a self-selected pace on an electronic walkway that recorded spatiotemporal parameters of gait. The first 2 trials were performed without a cognitive task, whereas the second 2 trials were completed while performing a modified Word List Generation task., Results: There were significant and large declines in gait performance with the addition of a cognitive task for velocity (p<.001, η2=.52), cadence (p<.001, η2=.49), and step length (p<.001, η2=.23). 6MWT and SDMT scores correlated with DTC for velocity (r=-.41, p<.001 and r=-.32, p<.001, respectively) and step length (r=-.45, p<.001 and r=-.37, p<.001, respectively); there were no significant associations between FSS, SF-MPQ, and HADS scores with the DTC of walking. Regression analyses indicated that 6MW, but not SDMT, explained variance in DTC for velocity (ΔR2=.11, p<.001) and step length (ΔR2=.13, p<.001), after controlling for SR-EDSS scores., Conclusion: Walking performance might be a target of interventions for reducing the DTC of walking in MS., (Copyright © 2013 Elsevier B.V. All rights reserved.)

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 sample comprised 160 individuals with MS. One group of participants (n = 82) completed a 6MW while wearing a portable metabolic unit (K4b(2), 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.

The present study adopted a randomized controlled trial design and examined the effect of a physical activity behavioral intervention on cognitive and walking performance among persons with MS who have mild or moderate disability status. A total of 82 MS patients were randomly allocated into intervention or wait-list control conditions. The intervention condition received a theory-based program for increasing physical activity behavior that was delivered via the Internet, and one-on-one video chat sessions with a behavior-change coach. Participants completed self-report measures of physical activity and disability status, and underwent the oral Symbol Digit Modalities Test (SDMT) and 6-minute walk (6MW) test before and after the 6-month period. Analysis using mixed-model ANOVA indicated a significant time × condition × disability group interaction on SDMT scores (p = 0.02, partial-η (2) = 0.08), such that persons with mild disability in the intervention condition demonstrated a clinically meaningful improvement in SDMT scores (~6 point change). There was a further significant time × condition interaction on 6MW distance (p = 0.02, partial-η (2) = 0.07), such that those in the intervention condition demonstrated an increase in 6MW distance relative to those in the control group. The current study supports physical activity as a promising tool for managing cognitive impairment and impaired walking performance in persons with MS, and suggests that physical activity might have specific effects on cognition and non-specific effects on walking performance in this population.

The impairment of cognitive processing speed is common, disabling, and poorly managed in multiple sclerosis (MS). This study examined the association between objectively-measured physical activity and cognitive processing speed (CPS) in a large sample of persons with MS. Patients (N=212) underwent two valid neuropsychological tests of CPS, completed the Timed 25-Foot Walk (T25FW), and wore an ActiGraph model GT3X accelerometer during the waking hours of a 7-day period for objectively measuring physical activity as steps/day. Physical activity was significantly associated with CPS (r=.39, p<.01), even when controlling for age, sex, and education (pr=.26, p<.01). This association was attenuated, but still significant after further controlling for T25FW performance (pr=.13, p=.03). Physical activity behavior is positively and independently, albeit weakly, associated with CPS in persons with MS, and may play an important role in managing this aspect of cognition as it does in other outcomes in MS., (© 2013 Elsevier B.V. All rights reserved.)

Background and Objective: 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. This study examined the validity of those MCID values based on capturing corresponding changes in other walking outcomes in persons with multiple sclerosis (MS)., Methods: 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., Results: 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., Conclusions: 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., (© 2014 S. Karger AG, Basel.)

Objectives: To investigate levels of moderate-to-vigorous physical activity (MVPA) in a large sample of persons with multiple sclerosis (MS) and controls using accelerometry as a measure of physical activity, and to compare the rates of meeting public health guidelines for MVPA (ie, 30min/d) between persons with MS and controls., Design: Secondary analysis of a combined data set of persons with MS and healthy controls from 13 previous investigations of physical activity over a 8-year period (2005-2013)., Setting: University., Participants: Participants with MS (n=800) were recruited primarily within Illinois through multiple sources, including print and e-mail flyers and an online advertisement on the National Multiple Sclerosis Society website. Healthy controls (n=137) were recruited via public e-mail postings delivered across the university community., Interventions: Not applicable., Main Outcome Measures: Levels of MVPA and meeting public health guidelines for MVPA between persons with MS and controls., Results: After controlling for covariates (ie, age, sex, education, race, income), there was a moderate (d=.68) and statistically significant (F=47.2, P<.001) difference of 13.1 minutes of MVPA per day (95% confidence interval, 9.4-16.8) between MS and controls. There was a difference in the rates of meeting public health guidelines for MVPA (χ(2)=50.7, P<.001) between MS patients (20%) and controls (47%). Among those with MS, minutes of MVPA significantly differed as a function of education, employment status, clinical course, disease duration, and disability status., Conclusions: We provide data using an objective physical activity measure and a large sample to indicate that only a small proportion of persons with MS are achieving adequate amounts of daily MVPA., (Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

The six-minute walk (6 MW) has been established as a clinic-based, performance measure of walking endurance that reflects community ambulation in multiple sclerosis (MS). Consequently, identifying the contribution of variables to 6 MW performance may provide targets for improving real-life walking in MS, and these variables may differ as a function of disability. This study examined cadence and stride length as gait variables that explain differences in 6 MW performance between persons with MS and controls, and by level of disability. 256 community-residing persons with MS and 49 non-MS controls performed a standard 6 MW test and completed 2 trials of comfortable walking on an electronic walkway for quantifying gait. Regression analyses indicated that cadence and stride length explain differences in 6 MW performance between MS and controls, and by level of disability in MS. The contribution of cadence and stride length to walking endurance differed as a function of disability, such that cadence and to a greater extent stride length explained variance in 6 MW performance in mild MS, whereas cadence and stride length explained approximately an equivalent amount of variance in 6 MW performance in moderate-to-severe MS. We provide evidence for intervention strategies that are specific to disability level to improve walking endurance in MS., (© 2013 Elsevier B.V. All rights reserved.)

Objectives: To identify steps per day in a large sample of persons with multiple sclerosis (MS) and to describe variation by demographic and clinical characteristics and device type., Design: Cross-sectional design., Setting: General community., Participants: Convenience sample of persons with multiple sclerosis (N=645) recruited from the general community who were ambulatory and relapse free for 30 days. Mean age ± SD of the participants was 46.3 ± 10.6 years old. Participants were mostly women (85%), white (93%), and employed (64%)., Interventions: Not applicable., Main Outcome Measure: Step counts measured by a motion sensor during a 7-day period., Results: The average value for the entire sample was 5,903 ± 3,185 steps per day. This value varied by demographic and clinical characteristics, but not device type, and indicated that men, participants who were unemployed, had a high school education or less, progressive MS, a longer disease duration, and higher disability were less physically active based on the metric of steps per day., Conclusions: This study provides an expected value for average steps per day among persons with MS. Such an expected value for this population is an important first step to help researchers and clinicians interested in improving the overall health of persons with MS through physical activity promotion., (Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To examine the association between Multiple Sclerosis Walking Scale-12 (MSWS-12) scores and spatiotemporal parameters of gait as indicators of gait quality among ambulatory persons with multiple sclerosis (MS)., Design: Cross-sectional study., Setting: University research laboratory., Participants: Community-residing persons with MS (N=268)., Intervention: Not applicable., Main Outcome Measures: Main outcome measures included the MSWS-12 and spatial and temporal gait parameters (walking speed, cadence, step length, step time, base of support [ie, the distance between 1 footfall and the line of progression of the opposing foot], and percentage of gait cycle spent in double support). Secondary outcomes included the timed 25-foot walk (T25FW), 6-minute walk (6MW), and Patient-Determined Disease Steps scale., Results: MSWS-12 scores were significantly correlated with walking speed (r=-.59), cadence (r=-.50), step length (r=-.53), step time (r=.46), base of support (r=.29), and percentage of the gait cycle spent in double support (r=.54). MSWS-12 scores further were significantly correlated with T25FW (r=.57) and 6MW (r=-.75) scores., Conclusions: Such findings suggest that the MSWS-12 captures aspects of walking quality, assessed as spatiotemporal parameters of gait, in addition to walking speed and endurance in persons with MS., (Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)