Accepted for/Published in: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Sep 13, 2023
Date Accepted: Feb 2, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
What are the major barriers to physical activity in persons with multiple sclerosis? An observational longitudinal study
ABSTRACT
Background:
Physical activity (PA) represents a low-cost and readily available means of mitigating multiple sclerosis (MS) symptoms, as well as alleviating the disease course. Nevertheless, persons with multiple sclerosis (PwMS) engage in lower levels of PA than the general population.
Objective:
To enhance the understanding of the barriers to PA engagement in PwMS, and to evaluate the applicability of the Barriers to Health Promoting Activities for Disabled Persons (BHADP) scale for assessing barriers to PA in PwMS by comparing it with self-reported outcomes of fatigue, depression, self-efficacy, and health-related quality of life, as well as sensor-measured PA.
Methods:
Study participants (N = 45; median [interquartile range] age, 46 [40-51]; Expanded Disability Status score, 4.5 [3.5-6]) were recruited among PwMS attending inpatient neurorehabilitation. They wore a Fitbit Inspire HR throughout their stay in the rehabilitation clinic, as well as for the four following weeks back home. Step counts and cumulative minutes in moderate to vigorous PA (MVPA) were computed for the last 7 days in the clinic and back home. Based on the last 7 end-of-study days PA, we grouped the study participants as active (≥10,000 steps/day) and less active (<10,000 steps/day) to explore PA barriers relative to PA level. PA barriers were repeatedly assessed through the BHADP scale. We described the relevance of the 18 barriers of the BHADP scale assessed at end-of-study and quantified their correlations with the Spearman correlation test. We evaluated the associations of the BHADP score with end-of-study reported outcomes of fatigue, depression, self-efficacy, and health-related quality of life with multivariable regression models. We performed various regressions to examine the association of the BHADP score with different sensor-measured outcomes of PA.
Results:
The less active group reported higher scores for the BHADP items feeling what I do doesn't help, no one to help me, and lack of support from family/friends. The BHADP items not being interested in PA and impairment were positively correlated. The BHADP score was positively associated with measures of fatigue and depression, and negatively associated with self-efficacy and health-related quality of life. The BHADP score showed an inverse relationship with the level of PA measured, but not when dichotomized according to the recommended PA level thresholds.
Conclusions:
The BHADP scale is a valid and well-adapted tool for PwMS as it reflects common MS symptoms such as fatigue and depression, as well as self-efficacy, and health-related quality of time. Moreover, decreases in PA levels are often related to increases in specific barriers in the lives of persons with MS and should hence be addressed jointly in healthcare management. Clinical Trial: https://clinicaltrials.gov/study/NCT04746807
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