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Efficacyofabehavioralinterventionforreducingsedentarybehaviorinpersonswithmultiplesclerosis:Apilotexamination

RachelE.Klaren

ElizabethA.Hubbard

RobertW.Motl

PhysicalActivityBehavioralInterventionsinMS

• BenefitsofPAinpersonswithMS1

• ExceedinglylowlevelsofPAinMS2

• Involveteachingpersonstheskills,resources,andstrategiesforsuccessfulbehaviorchange

• ThreeRCTSofbehavioralinterventionsbasedonsocialcognitivetheory3anddeliveredthroughtheinternethaveincreasedPAandyieldedsymptomaticandfunctionalbenefitsinpersonswithMS4‐6

1Motl&Pilutti,2014;2Klarenetal.,2013;3Bandura,2004;4Motletal.,2011;5Piluttietal.,2014;6Sandroffetal.,2014

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4Motletal.,2011

5Piluttietal.,2014

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SedentaryBehavior• Definedassittingorlyingthatdoesnotincreaseenergyexpenditureduringthewakinghours7

• Sittingtime ST– Adultsonaverageengagein~8hoursofST/day8

– Associatedwithmorbidityandmortalityinthegeneralpopulation,independentofPA9,10

– ReducedthroughabehavioralinterventionbasedonSCTinolderobesewomen11

7SedBehav ResNet,2011;8Matthewsetal.,2008;9Baumanetal.,2011;10Pateletal.,2010;11Adamsetal.,2013

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SedentaryBehavior• PersonswithMSengageinhighamountsofsedentarybehavior12

• Associatedwithmobilitydisability,fatigue,walkingperformance,andcognitiveprocessingspeed inMS13

• ImportanceofexaminingeffectsofbehavioralinterventionsonsedentarybehaviorinMS

12Cavanaughetal.,2011;13Hubbard&Motl,2014

Purpose&Hypothesis

• ThecurrentstudyinvolvedasecondaryanalysisofpreviouslypublisheddatatoexaminetheeffectofabehavioralinterventionbasedonSCTforreducingSTinpersonswithMS– WeexpectedthatpersonswithMSintheinterventionconditionwoulddemonstrateareductioninSTcomparedwiththewaitlistcontrol

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ParticipantInclusionCriteria

• PhysiciandiagnosedMSandapprovalforparticipation• Abilitytowalkwithorwithoutanassistivedevice• Agebetween18‐64years• Physicalinactivitydefinedas 60minutes/week• Relapsefreeforpast30days• LowriskofcontraindicationsbasedonPhysicalActivityReadiness

Questionnaire PAR‐Q 14

14Thomasetal.,1992

Participants• Finalsampleincluded70

participantswhowererandomlyassignedintointervention n 33 orwait‐listcontrol n 37 conditionsandprovidedbaselineSTdata

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PrimaryMeasure

• ST– QuestionsevenoftheabbreviatedInternationalPhysicalActivityQuestionnaire IPAQ 15

– “Duringthelast7days,howmuchtimedidyouspendsittingonaweekday?”

15Craigetal.,2003

Procedure• AllparticipantsprovidedinformedconsentapprovedbyUniversityIRB

• Participantsprovideddemographic/clinicalinformationandcompletedabatteryoftestsduringaone‐hoursessioninthelaboratoryatbaseline pre‐intervention andsix‐months post‐intervention

• ParticipantsweregroupedbasedondisabilityandPAdataandthenrandomlyassignedintointerventionorwait‐listcontrolconditions

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Procedure• Intervention:

– Overasix‐monthperiod,participantsvisitedastudywebsite,woreapedometer,completedalogbookalongwithGoalTrackersoftware,andparticipatedinone‐on‐onevideocoachingsessions

• Wait‐listcontrol:– Participantscompletedthestudymeasuresbeforeandafterthesix‐monthperiodandreceivedtheinterventiononcethestudyreachedcompletion

InterventionComponents• Studywebsite

– ContentbasedonSCTfocusedonteachingbehavioralstrategiesforchangingPAandST

– Outcomeexpectations,goalsettingandself‐monitoring,self‐efficacy,facilitatorsandbarriersforPAandST

– GuidedparticipantstoonlinematerialsandvideosofexamplesandideasforreducingSTandincreasingPA

• Videocoachingsessions– Semi‐scriptedandbasedonprinciplesofsupportiveaccountability– Reviewofgoal‐settingandprogresstowardsgoalattainment– StressedtheimportanceofidentifyingopportunitiesforreducingSTandmovingmoreandco‐developedapproachesforreducingrelevantexamplesofST

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DataAnalysis

• DatawereanalyzedinIBMSPSSv21.0• Examinedbaselinedifferencesbetweengroupsindemographic/clinicalcharacteristicsusingindependentsamplest‐testsandχ2 statistics

• Intent‐to‐treatandcompletersanalyses• ExaminedgroupdifferencesinSTusingANCOVAonpost‐interventionscorescontrollingforpre‐interventionvalues

• Providetheparameterestimate,standarderror SE ,andassociatedt‐valuealongwithp‐valueperanalysis

ParticipantCharacteristicsVariable Intervention (n=33) Control (n=37)

Age (years) 49.4 (9.2) 50.3 (9.1)

Sex (% female) 73% 82%

Race (% Caucasian) 100% 95%

Employment (% employed) 64% 59%

MS Type (% RRMS) 82% 84%

Disease Duration (years) 11.1 (7.1) 13.2 (9.4)

PDDS score (median, IQR) 2.0 (3.0) 3.0 (3.0)

Daily ST (minutes)* 550 (233) 412 (193)

Note.Valuesaremean standarddeviation ,unlessotherwisenoted.*Representsstatisticalsignificance.

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GroupDifferences

• Intent‐to‐treatanalysis:– Significantdifferencebetweengroups F 1,67 4.03,p 0.05,η² 0.06

• Parameterestimateof98.9min SE 49.3,t 2.01,p 0.05• Adjustedmeanscoresforinterventionandcontrolgroupswere429.2

201.2 and528.2 200.7 minutesofST d 0.49

• Completer’sanalysis:– Significantdifferencebetweengroups F1,54 5.15,p 0.05,η² 0.09

• Parameterestimateof128.9min SE 56.8,t 2.27,p 0.05• Adjustedmeanscoresforinterventionandcontrolgroupswere405.4

211.6 and534.3 211.4 minutesofST d 0.61

250

300

350

400

450

500

550

600

Intent‐to‐Treat Completer's

ST (min/day) Post‐Intervention

Intervention

Control

6.8hrs

8.9hrs

0

7.2hrs

8.8 hrs

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PrimaryFindings

• DailySTwasreducedintheinterventiongroupcomparedtothecontrolgroup– Theamountofreductionwas1.65hoursbasedontheintent‐to‐treatanalysis;thedifferencewasevenlargerinthecompleter’sanalysisandexceeded2hours

• Toourknowledge,weprovidethefirstdataoftheefficacyofabehavioralinterventionforreducingSTinpersonswithMS.

Whyisthisimportant?

• SedentarybehavioriscommoninpersonswithMS10‐12

andhasbeenassociatedwithmobilitydisability,fatigue,walkingperformance,andcognitiveprocessingspeedinMS13

• ThesepreliminarydatasupportfutureinvestigationsaimedatreducingSTandothersedentarybehaviorsinMS

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Whattodoweneedtodonext?

• MoreinformationaboutsedentarybehaviorinpersonswithMS– IdentifywhattypesofsedentarybehavioraremostcommoninpersonswithMSandwhoismorelikelytoengageinsedentarybehavior

• DetermineifreductionsinsedentarybehavioraffectotheroutcomesinpersonswithMS

StrengthsandLimitations

• Strengths– Largesamplesizeforapilotstudy– ValidatedSTmeasureinhealthyadults17,18

• Limitations– Secondaryanalysisofexistingdata– Noobjectiveassessmentofsedentarybehavior

17Craigetal.,2003;18Rosenbergetal.,2008

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Acknowledgements

• ENRLdirector:Dr.RobertMotl• Behavioralcoaches:Drs.LaraPilutti andDeeDlugonski• Funding:NationalMultipleSclerosisSocietyPP1695

THANKYOU!

Questions?