RCT Of a Behavioral Intervention Targeting Physical Activity and Symptoms In MS

Background: There is published evidence indicating that a behavioral intervention based on social-cognitive theory (SCT) and delivered through the Internet increases self-reported physical activity in persons with multiple sclerosis (MS). To date, the effects of this intervention for increasing objectively measured physical activity and improving symptomatic outcomes have not been documented using a randomized controlled trial (RCT) design.

Objectives: This RCT examined the effects of an Internet-delivered, theory-based, behavioral intervention for increasing accelerometer-measured physical activity and improving symptoms of fatigue, mood, sleep, and pain in ambulatory patients with relapsing-remitting MS (RRMS).

Methods: 82 participants with RRMS were randomly allocated into intervention or wait-list control conditions. The intervention condition involved a study website and one-on-one video chat sessions with a behavior-change coach with content that focused on principles of behavior change from SCT (i.e., self-efficacy, outcome expectations, facilitators/barriers, and goal setting). Participants wore an accelerometer during the waking hours of a 7-day period and completed a self-report measure of physical activity, fatigue, depression, anxiety, pain, and sleep before and after the 6-month period.

Results: Mixed model ANOVA indicated that the intervention group participated in significantly more accelerometer-measured (p = .05, d = .28) and self-reported (p = .001, d = .92) physical activity over time compared to controls. The intervention group significantly improved on measures of fatigue severity (p = .01, d = .44), depression (p = .03, d = .36), and anxiety (p = .03, d = .40) when compared to controls. There was no significant change in pain (p = .29, d = .16) or sleep (p = .36, d= .10) between groups over the intervention period.

Conclusions: Our results support behavioral interventions targeting lifestyle physical activity as an effective approach for increasing physical activity behavior and improving symptoms of fatigue, depression, and anxiety in persons with RRMS. Such behavioral interventions can be effective alternatives for exercise training for increasing activity levels and managing symptoms in persons with MS.