Background. Fatigue is a debilitating symptom in multiple sclerosis (MS) that may be associated with reduced physical activity and increased sedentary behavior. Objective. This study examined the associations among fatigue and device-measured physical activity and sedentary behavior in people with MS. Methods. The participants (n = 252) completed the Patient Determined Disease Steps (PDDS) and Fatigue Severity Scale (FSS) and wore a waist-mounted accelerometer for 7 days. Participants were divided into 2 groups based on fatigue severity as measured by the FSS scale. We compared percentage of wear time spent in sedentary, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) between the 2 groups. Results. Persons in the fatigued group (FSS score ≥ 4) spent a greater percentage of time in sedentary behavior (P = .004) and a lower percentage of time in LPA (P = .035). Persons in the fatigued group further spent a lower percentage of time in nontransformed MVPA (P < .001) and square-root-transformed MVPA (P < .001) than persons in the nonfatigued group. When controlling for PDDS scores and years of education, there were no longer significant differences between groups in sedentary behavior, LPA, or transformed MVPA values; the difference in nontransformed MVPA was still statistically significant but likely the result of nonnormally distributed data. Conclusion. The present study suggests that factors other than fatigue might be associated with physical activity and sedentary behavior in MS, and this group might benefit from focal behavioral interventions that take into account mobility status in persons with MS who have fatigue.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Individuals with physical disabilities have fewer opportunities to participate in enjoyable physical activity. One option for increasing physical activity is playing active video games (AVG), however, many are inaccessible or offer limited play options. Objective: To examine energy expenditure and enjoyment in adults with mobility impairment during AVG play using off-the-shelf (OTS) and adapted versions of the Wii Fit balance board. Methods: During visit 1, participants completed a functional assessment and familiarization period. For visit 2, metabolic data were collected during a 20-minute baseline and four 10-minute bouts of Wii Fit Plus game play, two bouts on each of the boards. During rest participants completed the Physical Activity Enjoyment Scale (PACES). Statistical analyses were computed using SAS and SPSS. Data were analyzed separately for individuals who were able to play standing on both boards (StdStd), those who could not play standing on the OTS board, but were able to play standing on the adapted board (aStd), and for those who could only play seated on the OTS board (aSit). Results: Data were collected for 58 participants (StdStd, n=17; aStd, n=10; aSit, n=31). Sample included 31 men, 27 women with a mean age of 41.21 (±12.70) years. Energy expenditure (METs) during game play was significantly greater than rest for all players. Only 17 participants (StdStd group) were able to play using OTS board. During game play on adapted board average MET values for the two game sets were: aSit = 2.261±0.718, 2.233±0.751 kcal/kg/hour; aStd = 3.151±1.034, 2.990±1.121; StdStd = 2.887±0.823, 2.881±0.898. For game play on the adapted board, self-reported rating of perceived exertion (RPE) on a 0-10 scale suggested greater exercise intensity levels, with median RPE scores ranging from moderate (3) to very hard (7). PACES scores indicated that all players enjoyed using the adapted board with median scores of 4 on a 5-point scale. Conclusions: The adapted Wii Fit balance board provided an opportunity for those with mobility impairments, including wheelchair users, to engage in AVG. All participants were able to utilize the adapted controller and enjoyed the AVG activity. Although average MET values achieved during AVG represented light intensity exercise (<3 METs), 16% of seated participants and 41% of standing participants achieved moderate intensity (3-6 METs) exercise on at least one of the games. Factors not accounted for that may have influenced intensity of exercise include: 1) game selection, 2) limited familiarization period, and 3) discomfort wearing COSMED system for oxygen consumption measurement. Accessible AVG controllers offer an innovative approach to overcoming various barriers to participation in physical activity. Next steps include assessment of an AVG intervention using an adapted board gaming controller on health and fitness outcomes. Clinical Trial: ClinicalTrials.gov Identifier: NCT02994199

Background: As it becomes increasing clear that managing Crohn’s disease (CD) requires more than medical treatment alone, further research to identify second-line approaches for managing CD and its symptoms such as physical activity (PA) are necessary to address this public health concern.Methods: We conducted a scoping review of descriptive, cross-sectional, and experimental studies to synthesize evidence regarding PA rates, determinants, health consequences, and interventions specifically in adults with CD. Adhering to the Preferred Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines, published literature was searched to identify articles that examined PA or exercise in adults with CD.Results: Twenty-eight articles met inclusion criteria: 13 included a cross-sectional design, 4 a case–control design, 2 cohort designs, and 9 intervention designs. Adults with CD appear to be similar to somewhat less physically active than the general population, though self-report and objective rates of PA vary widely by geographical location. PA may be associated with the reduced risk of future active disease in adults with CD in clinical remission, as well as improve health-related quality of life, fatigue, cardiorespiratory fitness, and depression. Preliminary findings from interventional studies demonstrate that moderate-intensity PA is feasible, safe, and may have beneficial effects on disease activity.Conclusions: Overall, the benefits that can be accrued from regular PA are quite diverse; however, a substantially larger body of evidence is needed to provide firmer conclusions on the health benefits of PA that might underlie exercise-related changes in function and disease activity in adults with CD.

Background: Increased physical activity (PA) levels are associated with reduced risk and improved survival for several cancers; however, most Americans engage in less than the recommended levels of PA. Using interactive voice response (IVR) systems to provide personalized health education and counseling may represent a high-reach, low-cost strategy for addressing physical inactivity and cancer disparities in disproportionately burdened rural regions. However, there has been a paucity of research conducted in this area to date. Objective: The aim of this study is to design, develop, and test the usability of an IVR system aimed at increasing PA levels in the rural Alabama Black Belt. Methods: A pilot version of the IVR system was used to assess initial feasibility and acceptability. Detailed exit interviews were conducted to elicit participant feedback, which helped inform the development of a substantially upgraded in-house IVR system. This refined IVR system was then subjected to a sequential explanatory mixed methods evaluation. Participating rural county coordinators and research staff (N=10) tested the usability of the IVR system features for 2 weeks and then completed the System Usability Scale and qualitative semistructured interviews. Results: The study sample comprised mostly African American people, women, rural county coordinators, and research staff (N=10). Participants rated the IVR system with a mean score of 81 (SD 5) on the System Usability Scale, implying excellent usability. In total, 5 overarching themes emerged from the qualitative interviews: likes or dislikes of the intervention, barriers to or facilitators of PA, technical difficulties, quality of calls, and suggestions for intervention improvement. Message framing on step feedback, call completion incentives, and incremental goal-setting challenges were areas identified for improvement. The positive areas highlighted in the interviews included the personalized call schedules, flexibility to call in or receive a call, ability to make up for missed calls, narration, and PA tips. Conclusions: The usability testing and feedback received from the rural county coordinators and research staff helped inform a final round of refinement to the IVR system before use in a large randomized controlled trial. This study stresses the importance of usability testing of all digital health interventions and the benefits it can offer to the intervention.

Background: During spring and summer 2020, US states implemented COVID-19 pandemic restrictions, resulting in the closure of rehabilitation facilities and, with them, some of the clinical trials that were taking place. One such trial was the Supervised Versus Telerehabilitation Exercise Program for Multiple Sclerosis (“STEP for MS”) comparative effectiveness multiple sclerosis (MS) exercise trial. Although 1 study arm was implemented via telerehabilitation, the comparative arm took place in rehabilitation facilities nationwide and was subsequently closed during this time frame. The experience of the STEP for MS participants provides insights into the impact of lockdown restrictions on exercise behavior by mode of exercise delivery (telerehabilitation vs conventional facility based). Objective: This study sought to understand the impact of COVID-19 lockdown restrictions on exercise behavior among people with MS enrolled in an exercise trial at the time of the restrictions. Methods: Semistructured phone and video interviews were conducted with a convenience sample of 8 participants representing both arms of the exercise trial. We applied reflexive thematic analysis to identify, analyze, and interpret common themes in the data. Results: We identified 7 main themes and 2 different narratives describing the exercise experiences during lockdown restrictions. Although the telerehabilitation participants continued exercising without interruption, facility-based participants experienced a range of barriers that impeded their ability to exercise. In particular, the loss of perceived social support gained from exercising in a facility with exercise coaches and other people with MS eroded both the accountability and motivation to exercise. Aerobic exercises via walking were the most impacted, with participants pointing to the need for at-home treadmills. Conclusions: The unprecedented disruption of COVID-19 lockdown restrictions in spring and summer 2020 impacted the ability of facility-based STEP for MS exercise trial participants to exercise in adherence to the intervention protocol. By contrast, the participants in the telerehabilitation-delivered exercise arm continued exercising without interruption and reported positive impacts of the intervention during this time. Telerehabilitation exercise programs may hold promise for overcoming barriers to exercise for people with MS during COVID-19 lockdown restrictions, and potentially other lockdown scenarios, if the participation in telerehabilitation has already been established.