Internet intervention for increasing physical activity in persons with multiple sclerosis
Abstract
Background:Physical activity has been associated with improvements in walking mobility and quality of life in persons with multiple sclerosis (MS), and yet this population is largely sedentary and inactive compared with the general population. Objectives:We conducted a pilot, randomized controlled trial (RCT) for examining the effect of an Internet intervention based on social cognitive theory (SCT) for favorably increasing physical activity among persons with MS. We further examined variables from SCT as possible mediators of the Internet intervention. Methods:We randomly allocated 54 persons with MS into either an Internet intervention condition or a waitlist control condition. The participants completed measures of physical activity, self-efficacy, outcome expectations, functional limitations, and goal setting before and after the 12-week period. Results:The intervention group reported a statistically significant ( p = 0.01) and large increase in physical activity over time ( d = 0.72), whereas the control group had a small ( d = 0.04) and non-significant change in physical activity ( p = 0.71). The intervention group further reported a statistically significant ( p = 0.001) and large increase in goal setting over time ( d = 0.97), whereas the control group had a small ( d = −0.13) and non-significant change ( p = 0.17). The change in goal setting over time mediated the effect of the Internet intervention on physical activity behavior. Conclusions:This pilot study sets the stage for a subsequent RCT that includes a larger sample of persons with MS, longer intervention period along with a follow-up, objective measure of physical activity, and secondary outcomes of walking mobility and QOL.
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Social cognitive theory interventions that focus on self-efficacy, outcome expectations, barriers, and goal setting are similar to PP.
“Social cognitive theory interventions that focus on self-efficacy, outcome expectations, barriers, and goal setting are also similar to PP [107, 108].”
From Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development (2015) · cites this paper as [107]
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Self-citationIncreasing Physical Activity in Multiple Sclerosis Using a Behavioral Intervention
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“The 18 persons who did volunteer satisfied the inclusion criteria of (1) definite diagnosis of MS consistent with McDonald criteria10; (2) clinical course of relapsing-remitting MS consistent with Lublin and Reingold criteria11; (3) independently ambulatory or ambulatory with single point assistance; (4) relapse free…”
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“Internet programs for patients with diabetes [21], multiple sclerosis [22] and heart failure [23] have led to the improvement of PA outcomes, even though effect sizes are small.”
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“successfully as part of healthcare interventions among PwMS [38], but also among those with chronic heart failure [39], smokers [40]”
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“We have conducted a series of clinical trials (i.e., Phase I and II) with relatively small samples for examining the efficacy of an Internet-delivered behavioural intervention based on social cognitive theory (SCT) for increasing physical activity among ambulatory persons with MS [16 – 19].”
Self-citationKlaren, R. E., Hubbard, E. A., & Motl, R. W. (2014) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2014.05.036 · Cited by 51 · see citing works
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“[28] Values in GLTEQ were measured in total leisure physical activity in METs per minutes per week (MET/min/week) [26,27,35] or in total leisure physical activity in scores between 0 and 119 in arbitrary units.”
BackgroundMethodResultInfluentialSuh, Y., Weikert, M., Dlugonski, D., Balantrapu, S., & Motl, R. W. (2011) · Behavioral Medicine · doi:10.1080/08964289.2011.603768 · Cited by 49 · see citing works
Self-citationTop 10 Research Questions Related to Physical Activity and Multiple Sclerosis
Motl, R. W., Learmonth, Y. C., Pilutti, L. A., Gappmaier, E., & Coote, S. B. (2015) · Research Quarterly for Exercise and Sport · doi:10.1080/02701367.2015.1023099 · Cited by 49 · see citing works
Self-citationThe descriptive epidemiology of daily sitting time as a sedentary behavior in multiple sclerosis
Hubbard, E. A., Motl, R. W., & Manns, P. J. (2015) · Disability and health journal · doi:10.1016/j.dhjo.2015.06.003 · Cited by 49 · see citing works
Self-citationParticipatory medicine and patient empowerment towards personalized healthcare in multiple sclerosis
Lejbkowicz, I., Caspi, O., & Miller, A. (2012) · Expert Review of Neurotherapeutics · doi:10.1586/ern.11.161 · Cited by 48 · see citing works
McAuley, E., Wójcicki, T. R., Learmonth, Y. C., Roberts, S. A., Hubbard, E. A., Kinnett-Hopkins, D., Fanning, J. T., & Motl, R. W. (2015) · Multiple Sclerosis Journal - Experimental Translational and Clinical · doi:10.1177/2055217315584838 · Cited by 47 · see citing works
Self-citationExercise Training in Progressive Multiple Sclerosis
Pilutti, L. A., Paulseth, J. E., Dove, C., Jiang, S., Rathbone, M. P., & Hicks, A. L. (2016) · International Journal of MS Care · doi:10.7224/1537-2073.2015-067 · Cited by 45 · see citing works
Self-directed exercise in multiple sclerosis: Evaluation of a home automated tele-management system
Conroy, S. S., Zhan, M., Culpepper, W. J., Royal, W., & Wallin, M. T. (2017) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x17702757 · Cited by 46 · see citing works
Dlugonski, D., Joyce, R. J., & Motl, R. W. (2012) · Disability and Rehabilitation · doi:10.3109/09638288.2012.677935 · Cited by 44 · see citing works
“As an example, one recent behavioral intervention in persons with MS taught participants skills such as self-monitoring, goal-setting, and overcoming barriers through an internet delivered intervention and successfully increased walking compared to a control group [17].”
BackgroundSelf-citationBaird, J. F., & Motl, R. W. (2018) · Neurorehabilitation and neural repair · doi:10.1177/1545968318818904 · Cited by 44 · see citing works
“Interindividual variability of the change in physical activity as measured by the Godin Leisure-Time Exercise Questionnaire in response to an internet-based physical activity intervention.(22) Each black bar represents the change in physical activity of an individual participant and the gray bar represents the average…”
Self-citationPilutti, L. A., Dlugonski, D., Sandroff, B. M., Klaren, R. E., & Motl, R. W. (2014) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2014.03.015 · Cited by 42 · see citing works
“This behavioral intervention has been effective for improving self-reported and objectively measured physical activity among individuals with MS who have mild or moderate disability.(18,19,21) Such increases in physical activity might result in improved body composition, if a similar relationship exists in persons wit…”
BackgroundSelf-citationPloughman, M. (2017) · Physical Therapy Reviews · doi:10.1080/10833196.2017.1315212 · Cited by 42 · see citing works
Zasadzka, E., Trzmiel, T., Pieczyńska, A., & Hojan, K. (2021) · Medicina · doi:10.3390/medicina57060549 · Cited by 41 · see citing works
“Moti with co-authors [53,54] showed that the content of web-based programs caused essential and remarkable increase in physical activity in research highlighting self-efficacy and use of a social cognitive-behavior-based framework.”
BackgroundHayes, S., Uszynski, M., Motl, R. W., Gallagher, S. M., Larkin, A., Newell, J., Scarrott, C., & Coote, S. B. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-016336 · Cited by 39 · see citing works
Self-citationCoulter, E. H., Bond, S., Dalgas, U., & Paul, L. (2018) · Disability and Rehabilitation · doi:10.1080/09638288.2018.1503737 · Cited by 39 · see citing works
“The majority of studies recruited participants with all types of MS (relapsing remitting, primary progressive, secondary progressive, benign) (n1⁄4 16) [29–32,34,35,37–42,45–48,52–55,57], five studies recruited only participants with relapsing remitting MS [36,43,44,49,56], and four study did not report MS type [28,33…”
BackgroundA scoping review on interventions to promote physical activity among adults with disabilities
Castro, Ó., Ng, K., Novoradovskaya, E., Bosselut, G., & Hassandra, M. (2017) · Disability and health journal · doi:10.1016/j.dhjo.2017.10.013 · Cited by 41 · see citing works
Motl, R. W., Sandroff, B. M., Wingo, B. C., McCroskey, J., Pilutti, L. A., Cutter, G., Bollaert, R. E., & McAuley, E. (2018) · Contemporary Clinical Trials · doi:10.1016/j.cct.2018.06.017 · Cited by 38 · see citing works
Self-citationPhysical activity is associated with cognitive processing speed in persons with multiple sclerosis
Sandroff, B. M., Dlugonski, D., Pilutti, L. A., Pula, J. H., Benedict, R. H. B., & Motl, R. W. (2013) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2013.04.003 · Cited by 38 · see citing works
Self-citationClare, L., Teale, J. C., Toms, G., Kudlicka, A., Evans, I., Abrahams, S., Goldstein, L. H., Hindle, J. V., Ho, A. K., Jahanshahi, M., et al. (2019) · NeuroRehabilitation · doi:10.3233/nre-172353 · Cited by 37 · see citing works
Plow, M. A., Béthoux, F., McDaniel, C., McGlynn, M. L., & Marcus, B. H. (2013) · Clinical Rehabilitation · doi:10.1177/0269215513494229 · Cited by 37 · see citing works
“Exclusion criteria were (1) exercising ≥ 150 minutes per week, (2) pregnancy, (3) cardiopulmonary disease, (4) ≥ four falls in the past six months, (5) severe cognitive deficits,11 (6) inability to read and speak English at a sixth grade level,12 or a co-morbid condition leading to hospitalization in the past year.”
Bevens, W., Weiland, T. J., Gray, K. M., Jelinek, G. A., Neate, S. L., & Simpson, S. (2021) · Journal of Medical Internet Research · doi:10.2196/27735 · Cited by 38 · see citing works
“In total, 15 of 33 studies contained a self-monitoring component [10,11,15,16,18,21-25,31,32,38,42], which varied from a validated tool integrated within the program to generic mood-related questions and diary entries.”
BackgroundInfluentialWeb-based interventions in multiple sclerosis: the potential of tele-rehabilitation
Tallner, A., Pfeifer, K., & Mäurer, M. (2016) · Therapeutic Advances in Neurological Disorders · doi:10.1177/1756285616640684 · Cited by 36 · see citing works
Rice, I. M., Rice, L. A., & Motl, R. W. (2015) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2015.06.011 · Cited by 36 · see citing works
Self-citationSmith, C., Hale, L. A., Mulligan, H. F., & Treharne, G. J. (2012) · Disability and Rehabilitation · doi:10.3109/09638288.2012.723792 · Cited by 35 · see citing works
“Furthermore, technology is increasingly being used in health to deliver and/or supplement health interventions and also warrants investigation as a useful therapeutic adjunct in exercise delivery and recommendations for PwMS [21,22].”
BackgroundPlow, M. A., Finlayson, M. L., Motl, R. W., & Béthoux, F. (2012) · BMC Neurology · doi:10.1186/1471-2377-12-122 · Cited by 33 · see citing works
“All three questionnaires are validated and have been used in previous MS research on physical activity [45,47].”
BackgroundMethodSelf-citationThe status of telerehabilitation in neurological applications
Hailey, D. M., Roine, R. P., Ohinmaa, A. E., & Dennett, L. (2013) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x13501775 · Cited by 34 · see citing works
Motl, R. W., Dlugonski, D., Pilutti, L. A., & Klaren, R. E. (2014) · International Journal of MS Care · doi:10.7224/1537-2073.2014-016 · Cited by 33 · see citing works
Self-citationFlachenecker, P., Bures, A. K., Gawlik, A., Weiland, A.-C., Kuld, S., Gusowski, K., Streber, R., Pfeifer, K., & Tallner, A. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17124544 · Cited by 32 · see citing works
“In this regard, internet-based approaches seem promising to promote physical activity in PwMS [11,37,38].”
BackgroundBehavioral interventions in multiple sclerosis: a biopsychosocial perspective
Heesen, C., Köpke, S., Kasper, J., Poettgen, J., Tallner, A., Mohr, D. C., & Gold, S. M. (2012) · Expert Review of Neurotherapeutics · doi:10.1586/ern.12.103 · Cited by 32 · see citing works
Self-citationMsetfi, R., Coote, S. B., Gallagher, S., Larkin, A., Newell, J., Motl, R. W., & Hayes, S. (2014) · University of Limerick Institutional Repository (University of Limerick) · doi:10.34961/7898 · Cited by 31 · see citing works
Self-citationKim, Y., Mehta, T. S., Lai, B. W., & Motl, R. W. (2020) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2020.03.017 · Cited by 29 · see citing works
Self-citationNasseri, N., Ghezelbash, E., Zhai, Y., Patra, S., Riemann-Lorenz, K., Heesen, C., Rahn, A. C., & Stellmann, J. (2020) · PeerJ · doi:10.7717/peerj.9303 · Cited by 25 · see citing works
“, 2018) have also been proven as effective in MS (Motl et al., 2011; Moss-Morris et al., 2012; Casey, Coote & Byrne, 2019).”
BackgroundInfluentialOccupational therapy interventions for multiple sclerosis: A scoping review
Quinn, É., & Hynes, S. M. (2020) · Scandinavian Journal of Occupational Therapy · doi:10.1080/11038128.2020.1786160 · Cited by 26 · see citing works
“Telerehabilitation has been used to target other important aspects in MS, such as relationship satisfaction [57], self-management [58], physical activity [59] and cognitive behavioural therapy programme for fatigue [60] with programmes being delivered over the phone or via the internet.”
MethodEvaluation of a Physical Activity Intervention for Adults With Brain Impairment
Clanchy, K., Tweedy, S. M., & Trost, S. G. (2016) · Neurorehabilitation and neural repair · doi:10.1177/1545968316632059 · Cited by 24 · see citing works
“Sex Male, n (%) 27 (63) 12 (52) 15 (75) Female, n (%) 16 (37) 11 (48) 5 (25) Stage of change Stage 1 and 2, n (%) 23 (53) 13 (56) 10 (50) Stage 3, n (%) 20 (47) 10 (44) 10 (50) Driving status No driver’s licence/No car to drive, n (%) 41 (95) 22 (96) 19 (95) Driver’s licence and car to drive, n (%) 2 (5) 1 (4) 1 (5) E…”
Social Cognitive Theory Correlates of Physical Activity in Inactive Adults with Multiple Sclerosis
Uszynski, M., Casey, B., Hayes, S., Gallagher, S. M., Purtill, H., Motl, R. W., & Coote, S. B. (2017) · International Journal of MS Care · doi:10.7224/1537-2073.2016-111 · Cited by 23 · see citing works
Self-citationWilski, M., Brola, W., Koper, M., Gabryelski, J., Łuniewska, M., Fudala, M., & Tomczak, M. (2023) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2023.100415 · Cited by 25 · see citing works
“Moreover, higher levels of generalized self-efficacy may also lead to increased involvement in physical activity, as supported by previous studies (Motl et al., 2010, 2013).”
Ryan, J. M., Fortune, J., Stennett, A., Kilbride, C., Lavelle, G., Hendrie, W., DeSouza, L., Abdul, M., Brewin, D., Lee, D., et al. (2019) · Multiple Sclerosis Journal · doi:10.1177/1352458519886231 · Cited by 21 · see citing works
Bohlen, L. C., Emerson, J. A., Rhodes, R. E., & Williams, D. M. (2021) · Annals of Behavioral Medicine · doi:10.1093/abm/kaab083 · Cited by 21 · see citing works
Clarke, R., & Coote, S. B. (2015) · Rehabilitation Research and Practice · doi:10.1155/2015/123494 · Cited by 20 · see citing works
“in motivating participants to exercise it may be necessary to explore ways for the exercise group to continue to meet with a lay facilitator, or peer facilitator, or indeed to use internet based [32] or teleconference based [33] methods in order to optimise continued adherence to exercise programmes without the contin…”
Caregiver perceptions of accomplishment from assisting people with multiple sclerosis
Buchanan, R. J., & Huang, C. (2011) · Disability and Rehabilitation · doi:10.3109/09638288.2011.587091 · Cited by 20 · see citing works
Dennett, R., Gunn, H., & Freeman, J. A. (2018) · Physical Therapy · doi:10.1093/ptj/pzy060 · Cited by 20 · see citing works
Ensari, I., Adamson, B., & Motl, R. W. (2015) · Journal of Health Psychology · doi:10.1177/1359105315584837 · Cited by 19 · see citing works
“Researchers have provided evidence for the validity of scores based on correlations with survey and objective measures of physical activity in persons with MS (Gosney et al., 2007; Sandroff et al., 2012), and GLTEQ scores have captured intervention effects in persons with MS (Motl et al., 2011).”
BackgroundSelf-citationFakolade, A. O., Lamarre, J., Latimer‐Cheung, A. E., Parsons, T. L., Morrow, S. A., & Finlayson, M. L. (2017) · Health Expectations · doi:10.1111/hex.12600 · Cited by 19 · see citing works
Physical activity and health-related quality of life over time in adults with multiple sclerosis.
Motl, R. W., & McAuley, E. (2014) · Rehabilitation Psychology · doi:10.1037/a0037739 · Cited by 18 · see citing works
Self-citationGunn, H., Endacott, R., Haas, B. M., Marsden, J. F., & Freeman, J. A. (2017) · Disability and Rehabilitation · doi:10.1080/09638288.2017.1362041 · Cited by 18 · see citing works
Social Cognitive Theory and Physical Activity in Older Adults with Multiple Sclerosis
Baird, J. F., Silveira, S. L., & Motl, R. W. (2020) · International Journal of MS Care · doi:10.7224/1537-2073.2019-071 · Cited by 18 · see citing works
Self-citationDobkin, R. D., Durland, L., Interian, A., & Pretzer‐Aboff, I. (2014) · Smart Homecare Technology and TeleHealth · doi:10.2147/shtt.s45044 · Cited by 18 · see citing works
Dennett, R., Coulter, E. H., Paul, L., & Freeman, J. A. (2019) · Disability and Rehabilitation · doi:10.1080/09638288.2019.1582717 · Cited by 17 · see citing works
Silveira, S. L., & Motl, R. W. (2019) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2019.100366 · Cited by 17 · see citing works
“For example, the first pilot study of the Internet-delivered behavioral intervention reported statistically significant improvements in physical activity, but graphically illustrated a pattern of heterogeneous changes within the intervention condition [9].”
BackgroundSelf-citationSilveira, S. L., Richardson, E. V., & Motl, R. W. (2019) · Disability and Rehabilitation · doi:10.1080/09638288.2019.1678073 · Cited by 17 · see citing works
Self-citationMotl, R. W., Kidwell-Chandler, A. L., Sandroff, B. M., Pilutti, L. A., Cutter, G., Aldunate, R. G., & Bollaert, R. E. (2023) · Multiple Sclerosis Journal · doi:10.1177/13524585221146430 · Cited by 17 · see citing works
Self-citation
- Authors
- Motl, R. W., Dlugonski, D., Wójcicki, T. R., McAuley, E., & Mohr, D. C.
- Affiliations
- University of Illinois Urbana-Champaign (US)
- Northwestern University (US)
- Venue
- Multiple Sclerosis Journal
- Publisher
- SAGE Publications
- Published
- 2010-10-04
- Volume
- 17
- Issue
- 1
- Pages
- 116-128
- ISSN
- 1352-4585 (ISSN-L)
- 1477-0970
- OpenAlex
- W2088969218
- Cited by
- 186
- References
- 34
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 3 · 2023: 6 · 2022: 5 · 2021: 12 · 2020: 11 · 2019: 12 · 2018: 19 · 2017: 17 · 2016: 20 · 2015: 17 · 2014: 16 · 2013: 17 · 2012: 13
- FWCI
- 8.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Multiple Sclerosis Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- multiple sclerosis, physical activity, online intervention, social cognitive theory, goal setting, self-efficacy, outcome expectations, sedentary behavior, quality of life
- MeSH terms
- Adult, Choice Behavior, Disability Evaluation, Female, Goals, Humans, Illinois, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Motor Activity, Patient Dropouts, Patient Education as Topic, Pilot Projects, Psychological Theory, Surveys and Questionnaires, Severity of Illness Index, Time Factors, Health Behavior, Exercise, Walking, Treatment Outcome, Self Efficacy, Internet, Multiple Sclerosis, Relapsing-Remitting
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