A behavioral intervention involving an e-learning approach resulted in immediate improvements in daily step counts among patients with MS.
Engaging in physical activity often represents part of the management plan for patients with MS, yet studies show that this patient population has low physical activity levels that decrease over time. Structured, supervised exercise training has been associated with benefits, but has not changed the rate of physical inactivity in patients with MS over more than two decades.
Results from a phase 3 study suggest a behavioral intervention based on social cognitive theory that uses e-learning approaches may be an effective, widely scalable way to improve moderate-to-vigorous physical activity (MVPA) in MS. The results were published in Multiple Sclerosis Journal.
“We believe that with the right program and content, we can safely encourage behavior change and then sustain it over time in patients with MS,” Robert W. Motl, PhD, says. “If we can do that, we may be able to reduce comorbid conditions, such as vascular diseases that worsen the disease and its outcomes, by improving cognition, walking, and symptoms such as fatigue.”
Behavioral Intervention With E-Learning Approaches
The behavioral intervention involved e-learning approaches, such as interactive video courses, designed to increase physical activity in patients with MS over 6 months. An earlier phase 2 proof-of concept study showed positive effects on both self-reported and device-measured MVPA.
“There are many MS programs that focus on immediate changes in physical activity over short periods, such as 2 to 3 months, and there is often no follow-up after the intervention is complete,” says Dr. Motl. “We opted for a 6-month program as a stronger test of behavior change and a 6-month follow-up period without any intervention or support to examine the sustainability or relatively permanent changes in physical activity.”
Controls in the Phase 3 study received e-learning-based content on health and wellness as a credible condition and they had comparable interaction with the website and coaches. “That was essential for demonstrating that the experimental condition itself was responsible for the change in physical activity rather than other factors, such as social interaction or contact with and attention from the research team,” says Dr. Motl.
Outcomes data for 318 patients with MS were collected every 6 months over a 1-year period. Device-measured minutes per day of MVPA—assessed using ActiGraph accelerometers worn during waking hours in a 7-day baseline period with immediate and 6-month follow-up—served as the primary outcome. “In the intervention group, the focus was on physical activity, whereas in the control group, the focus was on health and wellness,” says Dr. Motl.
Intervention Improves Physical Activity in MS Group
At baseline, there were no significant differences in sociodemographic and clinical characteristics or physical activity between groups. The values in both groups for minutes per day of MVPA were consistent with a physically inactive sample.
The behavioral intervention resulted in an overall increase of 1,664 steps per day between weeks 1 and 24. Most changes happened in the first 12 weeks (Δ1,030 steps/day) and occurred to a smaller extent during the latter 12 weeks (Δ634 steps/day; Figure).
Dr. Motl and colleagues also used the Godin Leisure-Time Exercise Questionnaire (GLTEQ) and the abbreviated International Physical Activity Questionnaire (IPAQ) to assess physical activity. On the GLTEQ, immediate, but not necessarily sustained, changes in self-reported physical activity were noted in patients receiving the intervention versus those in the control group. The intervention group similarly had immediate and sustained changes in self-reported physical activity, notably in days per week of walking, compared with controls on the IPAQ.
“We are now studying this behavioral intervention for improving outcomes in patients with MS who are prescreened for meaningful outcomes, such as cognitive dysfunction,” says Dr. Motl. “Our goal is to see if we can change physical activity in patients with such challenges and also improve cognition, which would move the approach into the realm of treating outcomes of MS with or as an adjuvant to disease-modifying medications.”
