Promoting Activity Behaviour in Adults with Multiple Sclerosis: Feasibility, Preliminary Efficacy and Evaluation of Activity Measurement Tools

  • Author / Creator
    Mehrabani, Golnoush
  • Background: Multiple sclerosis (MS) is the largest cause of non-traumatic neurological disability in young adults. Canada has one of the highest rates of MS in the world, with nearly 1 in every 385 Canadians living with the disease. People with MS deal with a broad range of symptoms including fatigue, pain, depression, cognitive impairment, imbalance, and walking disabilities. They, therefore, are less physically active and more sedentary than healthy peers. The physical activity guidelines specific to people with MS emphasize activities of moderate-intensity, however achieving moderate-intensity physical activity targets may be challenging for many individuals with MS due to associated symptoms. There is also growing evidence that prolonged sitting (sedentary behaviour) has harmful effects on health, regardless of physical activity levels in non-disabled populations. Thus, a new approach focusing on whole day activity behaviour (i.e., sedentary behaviour and light-intensity activities) may be more feasible, sustainable and beneficial to manage MS-related symptoms and function.
    Objectives: To test the feasibility and preliminary efficacy of a new physical activity behaviour change intervention on reducing sedentary behaviour, and improving symptoms, quality of life, and physical performance in ambulatory adults with MS. The activity measurement tools used in the intervention have been validated with non-MS populations. To confirm the validity of the tools used, with our sample, two related validity studies were conducted.
    Methods: A single-group repeated measure activity behaviour change intervention with the length of 15 weeks in addition to a 7-week follow-up period was designed. The intervention was internet-based and included two stages – ‘Sit-Less’ stage that focused on interrupting prolonged sitting and ‘Move-More’ stage that was focusing on increasing steps, improving daily activity levels and reducing overall sitting time. Forty-one persons with MS who were able to walk with or without assistive devices for at least 10 meters were included in the study. Participants attended 3 measurement sessions including pre-intervention (baseline), post-intervention (Week 15) and follow-up (Week 22). At each of these 3 data collection times, participants’ activity behaviour and MS-related symptoms, quality of life and physical performance were assessed. They were set up with an ActivPAL3TM to wear for 7 days at each time point. Participants also wore a Fitbit One activity tracker as a motivational and self-monitoring tool for the 15-week intervention period. A laboratory-setting concurrent criterion validity study and a free-living convergent validity study were conducted to evaluate the validity of the 2 activity monitors (ActivePAL3TM and Fitbit One) used in the intervention in people with MS. An unstructured linear mixed-effects model was used to determine change in all outcomes over time. Validity of the ActivPAL3TM and the Fitbit One was tested in several ways including Intraclass correlation coefficients, mean absolute percentage error, and Bland-Altman plots.
    Results: There were significant reductions in total sedentary time (d=0.34) and the number of long (≥ 30 minutes) bouts of sedentary time (d=0.39) as measured by the ActivPAL3TM post-intervention. All symptoms and physical performance outcomes improved significantly after the intervention except cognition (P < 0.05). Those changes were maintained during the 7-week follow-up, except for sedentary behaviour and sleep quality. The ActivPAL3TM demonstrated validity evidence as a measurement tool for sedentary behaviour (sitting time), standing time and steps (ICC: 0.98). The Fitbit one demonstrated validity evidence (ICC: 0.88) for measurement of steps. There was good agreement between steps recorded by Fitbit One and ActivPAL3TM (ICC: 0.86). On average, the Fitbit One was worn for 85 days (i.e., 85% of the full intervention period) showing that participants were willing to monitor their activity behaviour over a long period and indicated the feasibility of wearing the Fitbit activity tracker in interventions that focus on sedentary behaviour and/or physical activity in the MS population.
    Conclusion: This research provides preliminary support for the efficacy of a whole day physical activity behaviour change intervention focused on reducing sitting and increasing light intensity activity for improving outcomes in adults with MS.

  • Subjects / Keywords
  • Graduation date
    Fall 2021
  • Type of Item
  • Degree
    Doctor of Philosophy
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.