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Physical activity is an evidence-based, safe second-line approach for improved multiple sclerosis (MS) symptoms and disease progression. This study examined the contributions of Capability-Opportunity-Motivation-Behavior (COM-B) factors for understanding engagement in current and long-term physical activity among persons with MS in the United States (U.S.). Adults with MS in the U.S. (N = 854) completed an online survey that included questions regarding demographic and clinical characteristics, COM-B constructs, Godin Leisure Time Exercise Questionnaire (GLTEQ), and Physical Activity Staging Questionnaire (PASQ). Participants were classified into groups based on the GLTEQ regarding current physical activity behavior and PASQ for long-term physical activity behavior. MANOVA and discriminant function analysis (DFA) identified COM-B constructs that differentiated physical activity groups. MANOVA analyses indicated that all COM-B constructs were significantly different for both GLTEQ current physical activity groups (Wilks’s λ = .5, F(44, 1432) = 14.8) and PASQ long-term physical activity groups (Wilks’s λ = .4, F(44, 1464) = 16.9) status except Information Provision. DFA analysis regarding GLTEQ identified a function including exclusively Capability and Motivation sources of behavior that differentiated current physical activity groups such as intention and self-efficacy. DFA for PASQ identified a different function of the Capability and Motivation sources of behavior that differentiated long-term physical activity groups; the primary differentiating variables were action control and intention. Our results identify internal factors as the primary COM-B predictors of current and long-term physical activity among adults with MS in the U.S., and health promotion interventions may focus on assessing individual competencies and behavioral regulation for changing physical activity in MS.

There is a “graying” of the population of persons living with multiple sclerosis (MS), and the effects of normal aging occur on top of those associated with MS itself (i.e., aging with a long-term disabling disease). We develop the perspective that “Lifestyle Behavior Medicine for Healthy Aging with MS” may be an effective strategy for promoting healthy longevity in this immune-mediated, neurodegenerative disease of the central nervous system. The perspective is based on recent evidence regarding (a) outcomes of aging with MS for declines in physical and cognitive functions; (b) lifestyle behaviors as putative influences of those outcomes for yielding healthy aging in MS; and (c) health promotion, largely focused on physical activity, in the context of the patient-provider interaction in comprehensive MS care. The lack of effective pharmacological treatment options combined with evidence for age-related declines in function over-and-beyond MS itself supports implementing Lifestyle, Behavior Medicine for Healthy Aging with MS in the context of comprehensive MS care for older adults with MS.

Restless legs syndrome (RLS) is a neurological disorder that affects 5–15% of the population. There is increasing interest in exercise for managing the symptoms of RLS. To date, no research has examined the duration of acute-exercise intensity effects on RLS. The present study estimated the magnitude and duration of effect of two acute bouts of treadmill exercise at different intensities on severity of RLS. Eight participants (median age 44 years) with RLS completed three different conditions: rest, moderate-intensity exercise [50% heart rate reserve (HRR)], and vigorous-intensity exercise (70% HRR). RLS severity was measured with the International Restless Legs Syndrome Study Group (IRLS) Scale and daytime sleepiness was measured with the Epworth Sleepiness Scale (ESS) pre-condition, 24, and 48 h post-condition. There was no significant effect of time on IRLS or ESS for rest, moderate-intensity exercise, or vigorous-intensity exercise based on the Friedman test per condition. Effect sizes based on the z-value from the Wilcoxon Signed Ranks test indicated that moderate-intensity exercise had a moderate effect (r = 0.350) on IRLS in the first 24 h, but no effect on ESS. Vigorous-intensity exercise had a small effect on both IRLS (r = 0.191) and ESS (r = 0.210) in the first 24 h. Both conditions returned to normal or worsened within 48 h. Our results suggest that acute exercise, at either intensity, may have an immediate effect on RLS symptoms that dissipate within 48 h. These results highlight the importance of continual participation in exercise as a non-pharmacological approach to manage symptoms of RLS.

Evidence supports that physical activity (PA) improves symptoms of multiple sclerosis (MS). Although application of principles from Social Cognitive Theory (SCT) may facilitate positive changes in PA behaviour among people with multiple sclerosis (pwMS), the constructs often explain limited variance in PA. This study investigated the extent to which MS symptoms, including fatigue, depression, and walking limitations combined with the SCT constructs, explained more variance in PA than SCT constructs alone among pwMS. Baseline data, including objectively assessed PA, exercise self-efficacy, goal setting, outcome expectations, 6-min walk test, fatigue and depression, from 65 participants of the Step It Up randomized controlled trial completed in Ireland (2016), were included. Multiple regression models quantified variance explained in PA and independent associations of (1) SCT constructs, (2) symptoms and (3) SCT constructs and symptoms. Model 1 included exercise self-efficacy, exercise goal setting and multidimensional outcomes expectations for exercise and explained ~14% of the variance in PA (R 2=0.144, p

The study and application of exercise in multiple sclerosis (MS) often requires cardiopulmonary exercise testing (CPET) to provide a comprehensive assessment of exercise tolerance and responses, including an evaluation of the pulmonary, cardiovascular, and skeletal muscle systems. Research on CPET in persons with MS has considerable limitations, including small sample sizes, often without controls; not reporting outcomes across disability status; and different modalities of exercise testing across studies. Although some key outcome variables of CPET have been studied in persons with MS, additional calculated variables have not been directly studied. The objective of this study was to provide a comprehensive examination of outcome variables from CPET among persons with MS and healthy controls. We included data from 162 persons with MS and 80 healthy controls who underwent CPET on a leg ergometer and satisfied criteria for valid testing for measuring oxygen uptake (VO2), carbon dioxide production (VCO2), ventilation (VE), respiratory exchange ratio, work rate, and heart rate (HR). Calculated variables [i.e. ventilatory anaerobic threshold (VO2/VCO2), VE/VCO2 slope, VO2/power slope, VO2/HR slope, and oxygen uptake efficiency slope] were processed using standard guidelines. We examined differences in the CPET variables between groups (e.g. MS vs. controls and categories of mild, moderate, and severe disability status) using analysis of covariance (ANCOVA), controlling for age, sex, body mass index, and disease duration. Overall, persons with MS demonstrate alterations in outcomes from CPET compared with controls, and these are generally exacerbated with increasing disability. Our results provide novel information for the evaluation of CPET in MS for developing exercise prescriptions and documenting adaptations with exercise training based on the comprehensive variables obtained during CPET.

The Leeds Multiple Sclerosis Quality of Life (LMSQOL) scale was designed as an 8-item, unidimensional disease-targeted measure of quality of life (QOL). This study (1) tested the unidimensionality of the LMSQOL using confirmatory factor analysis (CFA) and (2) examined the construct validity of scores based on a nomological network. The sample (N = 292) included persons with multiple sclerosis (MS) who were recruited from the Midwest region of the USA. Participants completed questionnaires that were delivered and returned using US Postal Service. We tested the fit of a single-factor model for the LMSQOL using CFA with the diagonally weighted least squares estimator in R. We examined the construct validity of the LMSQOL scores using Spearman rank-order correlations (r s) in SPSS. The single-factor model had a reasonable fit for the 8-item LMSQOL [χ 2 (20) = 83.19, p .05, CFI = .99, SRMR = .05]. LMSQOL scores demonstrated strong correlations with measures of psychological well-being (|r s| = .53–.74) and weak-to-moderate correlations with measures of physical functioning and disability (|r s| = .23–.57). The unidimensional model provides a good fit for the LMSQOL, and its scores provide a valid measure of QOL in MS.

Assessing quality of life (QOL) and health-related quality of life (HRQOL) in older adults is important. Yet, limited research is available on the stability of these constructs and the psychometric properties of QOL [e.g., Satisfaction with Life Scale (SWLS)] and HRQOL [e.g., Short-Form 12 Health Survey (SF-12)] measures in this population. Such knowledge is important for designing and interpreting interventions. We examined stability of QOL (SWLS) and HRQOL (SF-12) and their test–retest reliability, measurement error, and interpretability over 1 year in older Black and White women (n = 230). Stability and reliability were ascertained through paired sample t tests and intraclass correlation coefficients (ICCs). Standard error of measurement and coefficient of variation assessed measurement error. Smallest detectable change estimated score interpretability. QOL and HRQOL remained stable; ICC values indicated moderate reliability for the SWLS and SF-12 (SWLS = 0.73, SF-12 Physical Composite Summary = 0.69, SF-12 Mental Composite Summary = 0.58). Measurement error and interpretability estimates were similar for both the SWLS and SF-12. Interpretability estimates indicated a change in score of around 33 % may represent an important change. We provide novel data for selecting and interpreting QOL and HRQOL measures contributing to a better understanding of intervention efficacy.

Gait variability (i.e., fluctuations in walking) provides unique information about the control of movement and is associated with falls. This investigation examined the association between gait variability and falls in persons with multiple sclerosis (MS) and healthy controls. Traditional distributional metrics of gait variability (i.e., coefficient of variation (CV)) and a novel metric based on Fourier series analysis of footfall placement variability were determined for 41 individuals with MS and 20 age- and sex-matched controls. Spatiotemporal parameters of gait were collected using a 7.9 m electronic walkway that recorded individual footfalls during steady state comfortable walking. Persons with MS were divided into two groups based on fall history (non-fallers and recurrent fallers). Overall, persons with MS had greater gait variability than controls as indexed by CV and Fourier-based variability (p's0.05). Moreover, recurrent fallers with MS had greater Fourier-based variability than non-fallers with MS (p = 0.025), whereas there was no difference in MS groups in traditional gait variability metrics (p0.05). These observations highlight that footfall placement variability is related to fall status in MS. Future work determining the sensitivity of footfall placement variability to dysfunction is warranted.

Physical activity and self-efficacy represent behavioral and psychological factors, respectively, that are compromised in persons with multiple sclerosis (MS), but might be modifiable through intervention and result in better health-related quality of life (HRQOL).The present study adopted a panel research design and examined the associations between individual-level changes in physical activity, self-efficacy, and HRQOL over a one-year period in persons with MS.The sample consisted of 269 persons with relapsing-remitting MS who completed the Godin Leisure-Time Questionnaire (GLTEQ), Multiple Sclerosis Self-Efficacy (MSSE) Scale, and Multiple Sclerosis Quality of Life-29 (MSIS-29) Scale on two occasions that were separated by 1 year. The data were analyzed using panel analysis in Mplus 3.0.The initial panel analysis indicated that individual-level change in physical activity was associated with individual-level change in both physical and psychological HRQOL. The subsequent panel analysis indicated that (a) individual-level change in self-efficacy for functioning with MS was associated with individual-level change in physical HRQOL, whereas individual-level change in self-efficacy for control was associated with individual-level change in psychological HRQOL; (b) individual-level change in self-efficacy for functioning with MS, but not self-efficacy for control, mediated the association between individual-level change in physical activity and physical HRQOL; and (c) individual-level change in self-efficacy for controlling MS was the strongest predictor of individual-level change in HRQOL.Physical activity and self-efficacy both might be important targets of subsequent behavioral and self-management interventions for improving the HRQOL of persons with MS, although self-efficacy is seemingly more important than physical activity.

Walking impairment is a ubiquitous feature of multiple sclerosis (MS) and the O(2) cost of walking might quantify this dysfunction in mild MS. This paper examined the difference in O(2) cost of walking between persons with MS who have mild disability and healthy controls and the correlation between the O(2) cost of walking and disability. Study 1 included 18 persons with mild MS and 18 controls and indicated that the O(2) cost of walking was significantly higher in MS than controls and that disability was significantly associated with the O(2) cost of slow, moderate, and fast treadmill walking. Study 2 included 24 persons with mild MS and indicated that disability was significantly correlated with O(2) cost of comfortable, fast, and slow over-ground walking. We provide evidence that the O(2) cost of walking is an indicator of walking dysfunction in mildly disabled persons with MS and should be considered in clinical research and practice.

Studies proposed that the physical activity and quality of life (QoL) relationship may not be entirely direct but mediated through other variables; however, few studies have examined these relationships in diverse population's older adults.This study aims to examine the roles of self-efficacy and mental health difficulties in the physical activity and QoL relationship and to determine if demographic characteristics alter these relationships.One hundred ninety-six older adults completed measures of physical activity, self-efficacy, mental health difficulties, and QoL. Two-multilevel structural models were tested to determine the relationship between physical activity and QoL.Both structural models suggested that the relationship between physical activity and QoL is indirect, but the models were not significantly different. In model 1, we observed a positive linear relationship between physical activity and self-efficacy. In turn, self-efficacy was negatively associated with poor mental health difficulties and positively associated with QoL. Mental health difficulties were also negatively associated with QoL. In model 2, physical activity was positively associated with self-efficacy and negatively associated with mental health difficulties; in turn, self-efficacy was positively associated with QoL, whereas mental health difficulties were negatively associated with QoL.Overall, our findings suggest that self-efficacy and mental health have intermediary roles in the relationship between physical activity and QoL in a diverse sample of older adults. Prospective studies are needed to determine whether self-efficacy and mental health difficulties are complementary or one or the other accounts for more variance in the relationship between physical activity and QoL.

This study examined the effects of exercise self-efficacy on enjoyment of physical activity in a sample of low to moderately active college-aged women (N = 28). Participants were randomized into a low- or high-efficacy condition, and efficacy beliefs for engaging in moderate intensity physical activity were manipulated by providing bogus feedback after a maximal incremental exercise test. All participants completed a 30-min moderate intensity cycling session 2-3 d after the efficacy manipulation. Enjoyment of physical activity was assessed after both the maximal exercise test and the moderate intensity cycling exercise session. Our results indicated that the efficacy manipulation significantly influenced enjoyment of the maximal incremental exercise test. Participants in the low-efficacy condition reported lower enjoyment scores relative to high-efficacy participants following the maximal exercise test. However, enjoyment after the moderate intensity exercise bout did not differ between the two conditions. These results imply that efficacy may be an important influence of physical activity enjoyment, particularly at higher intensities.

Exercise training represents a behavioral approach for safely managing many of the functional, symptomatic, and quality of life consequences of multiple sclerosis (MS). This topical review paper summarizes evidence from literature reviews and meta-analyses, supplemented by recent individual studies, indicating that exercise training can yield small but important improvements in walking, balance, cognition, fatigue, depression, and quality of life in MS. The paper highlights limitations of research on exercise training and its consequences and future research directions and provides an overview for promotion of exercise training in MS based on recent prescriptive guidelines. Collectively, the evidence for the benefits of exercise training in MS suggests that the time is ripe for the promotion of exercise by healthcare providers, particularly neurologists as a central part of the clinical care and management of MS patients.

Background Multiple sclerosis (MS) is associated with increased risk of cardiovascular disease (CVD) and approximately 25–54% of patients report poor sleep quality. There is evidence from the general population of an association between poor sleep and increased CVD risk, but this is poorly understood in MS. Purpose This study examined the association between self-reported sleep quality and arterial health in persons with MS. Methods MS subjects (n = 31) and control subjects (n = 23) were recruited. Control subjects were age and body size matched. All subjects were administered the Pittsburgh Sleep Quality Index (PSQI) to assess self-reported sleep quality. Subjects with a global score >5 were classified as “poor sleepers”. Blood pressure, arterial stiffness, and the forearm blood flow responses following 5-min ischemic occlusion (endothelial function) were measured. Results Nineteen MS subjects and 5 control subjects were classified as “poor sleepers”. AIx was significantly higher in MS subjects who had poor sleep quality (32.5 ± 8.8 vs 22.0 ± 13.2; P Conclusions Markers of arterial dysfunction were significantly higher in MS subjects with poor sleep quality compared to those with good sleep quality. This study suggests novel evidence for the association of CVD risk and sleep quality in MS.

Background: Poor sleep quality has been related to poor vascular function and higher risk of cardiovascular disease in the general population. Persons with multiple sclerosis (MS) exhibit a high cardiovascular risk, and report poor sleep quality. To date, the association between sleep quality and vascular health in MS has not been investigated. Objective: To investigate differences in vascular health between good and poor quality sleepers with MS. Methods: After a 10 minute rest in the supine position, resting heart rate (HR) and brachial blood pressure (BP) were collected.Aortic SBP, augmentation index (AIX), HR normalized AIX (AIX@HR75), subendocardial viability ratio (SEVR), end systolic pressure (ESP), and central pulse wave velocity (PWVc) were measured with applanation tonometry in individuals with MS (n=49). Carotid intima-media thickness (IMT) and beta-stiffness were measured with carotid ultrasound, and peak forearm blood flow (FBF Peak) was measured with strain gauge plethysmography. Sleep quality was measured with the Pittsburgh Sleep Quality Index (>5 was categorized as poor sleep quality). Age was used as a covariate. Results: AIX@HR75 and SEVR were different between groups, even with age as a covariate, suggesting higher vascular risk for the poor quality sleepers with MS. Conclusions: This study shows that within the MS population, poor quality sleepers have a higher cardiovascular risk than good quality sleepers. Whether poor sleep raises their cardiovascular risk more than in the general population is an area of future investigation. Good quality sleepers with MS (n=23) Poor quality sleepers with MS (n=26) Effect of sleep quality Effect of age Mean (SD) Mean (SD) p Partial Eta2 p Partial Eta2 N Female (%) 18 (75%) 22 (82%) PSQI score 2.9 (1.5) 9.7 (3.1) Age 44 ±13 52 ±10 BMI 26.9 ±5.4 28.1± 5.6 .582 0.007 .584 0.007 HR 64 ±10 65± 8 .136 0.048 .014* 0.125 SBP 116 ±14 122 ±14 .384 0.017 .025* 0.105 DBP 72 ±9 74 ±10 .457 0.012 .559 0.007 MAP 86± 10 90 ±11 .403 0.015 .175 0.040 Aortic SBP 106 ±14 114 ±14 .223 0.032 .001** 0.200 AIX 21.1 ±13.7 30.0± 9.0 .082 0.064

Background Perceptions of one's environment and functional status have been linked to physical activity in older adults. However, little is known about these associations over time, and even less about the possible mediators of this relationship. We examined the roles played by neighborhood satisfaction, functional limitations, self-efficacy, and physical activity in a sample of older women over a 6-month period. Methods Participants (N = 137, M age = 69.6 years) completed measures of neighborhood satisfaction, functional limitations, self-efficacy, and physical activity at baseline and again 6 months later. Results Analyses indicated that changes in neighborhood satisfaction and functional limitations had direct effects on residual changes in self-efficacy, and changes in self-efficacy were associated with changes in physical activity at 6 months. Conclusion Our findings support a social cognitive model of physical activity in which neighborhood satisfaction and functional status effects on physical activity are in part mediated by intermediate individual outcomes such as self-efficacy. Additionally, these findings lend support to the position that individual perceptions of both the environment and functional status can have prospective effects on self-efficacy cognitions and ultimately, physical activity behavior.