The feasibility of a patient informed, racially targeted home-based exercise program for black individuals with multiple sclerosis

Background: There has been increasing interest in the occurrence and expression of multiple sclerosis (MS) in minority populations, particularly in black individuals. Black individuals with MS may experience a more aggressive disease course, have a poorer prognosis with disease modifying therapies and have increased odds of physical comorbidities than their white counterparts. There is substantial evidence that suggests exercise training to be a promising approach for managing the manifestations of MS. However, much of this research has been conducted in white individuals. Further, black individuals with MS report lower levels of physical activity compared to white individuals with MS. A randomized controlled trial examining the feasibility of a targeted exercise training program in black individuals with MS is warranted. Objective: The aim of the present study was to assess program feasibility of a three-month, home-based, racially targeted, exercise training program in the four domains of process (e.g., recruitment and retention), recourses (e.g., communication and monetary costs), management (e.g., of data management and safety reporting), and scientific outcomes (e.g., safety, burden, compliance, experience, and treatment effect) in black individuals with MS. Methods: This study recruited 32 black individuals with mild-to-moderate MS related disability to participate in an exercise program. Participants completed a battery of questionnaires assessing demographic and clinical characteristics, and physical activity levels immediately prior to and following the program. Participants received a 3-month, home-based exercise program (i.e., resistance and aerobic training) which contained exercise equipment, a manual, and a log-book. Additionally, participants received periodic newsletters which emphasized social cognitive theory principles for behavior change, and phone calls with a behavioral coach who provided motivation and social accountability. Results: Results indicated that this exercise program was feasible, safe, and well received via data analysis and formative evaluation. Moreover, 24 participants completed post-assessment (75%; two dropped out, six did not return follow up assessments). The exercise program cost a total of \$3,726.57 (personnel costs = \$2128.74 USD,$20.87 USD per/hour; exercise program costs = \$1,597.83 USD, mean cost per person = \$46.93). Total time spent administrating the program was 102 hours. Participants complied with 70% of all exercise sessions via self-reported exercise logs. There was a significant increase (t=-5.1, p <.001, d=-1.0) in self-reported exercise behavior as measured by the Godin Leisure-Time Exercise Questionnaire Health Contribution Score. Conclusion: The results of this study support the feasibility, acceptability, and efficacy of this home-based exercise intervention for black individuals with mild-to-moderate MS

Recommendations for physical activity and exercise in persons living with Systemic Lupus Erythematosus (SLE): consensus by an international task force

Objective: This international task force aimed to provide healthcare professionals and persons living with systemic lupus erythematosus (SLE) with consensus-based recommendations for physical activity and exercise in SLE. Methods: Based on evidence from a systematic literature review and expert opinion, 3 overarching principles and 15 recommendations were agreed on by Delphi consensus. Results: The overarching principles highlight the importance of shared decision-making and the need to explain the benefits of physical activity to persons living with SLE and other healthcare providers. The 15 specific recommendations state that physical activity is generally recommended for all people with SLE, but in some instances, a medical evaluation may be needed to rule out contraindications. Pertaining to outdoor activity, photoprotection is necessary. Both aerobic and resistance training programmes are recommended, with a gradual increase in frequency and intensity, which should be adapted for each individual, and ideally supervised by qualified professionals. Conclusion: In summary, the consensus reached by the international task force provides a valuable framework for the integration of physical activity and exercise into the management of SLE, offering a tailored evidence-based and eminence-based approach to enhance the well-being of individuals living with this challenging autoimmune condition

Targeted ballet program mitigates ataxia and improves balance in females with mild-to-moderate multiple sclerosis.

BACKGROUND:Multiple sclerosis (MS) is a disease of the central nervous system that causes ataxia and deficits in balance. Exercise-based therapies have been identified as integral to the recovery of motor function in MS, but few studies have investigated non-traditional movement interventions. We examined a targeted ballet program (TBP) designed to mitigate ataxia and improve balance in females with mild-to-moderate relapsing-remitting MS. METHODS AND FINDINGS:Twelve females with mild-to-moderate disability due to MS were assessed for study eligibility for the study. Ten participants met the inclusion criteria. Two were lost to unrelated health complications. Eight participants completed the TBP. The TBP met twice a week for 60 minutes for 16 weeks. Assessments included (a) the International Cooperative Ataxia Rating Scale (ICARS), (b) the Mini-Balance Evaluations Systems Test (Mini-BESTest), (c) smoothness of movement during a five-meter walk, and (d) balance in a step to stand task before and after the TBP. There were no TBP-related adverse events. Single-tailed paired samples t-tests and Wilcoxon tests were conducted. Improvements were observed in ICARS (p = 7.11E-05), Mini-BESTest (p = 0.001), smoothness of movement in the left (p = 0.027) and right (p = 0.028) sides of the body, and balance in a step-to-stand task in the back (p = 0.025) direction. Results yielded 42% and 58% improvements in the mean Mini-BESTest and ICARS scores, respectively. CONCLUSIONS:This study adds to current research by providing support for a TBP intervention targeting ataxia and balance in MS. The TBP was well tolerated, improved balance, and mitigated ataxia. Clinical improvements were larger than those of previous studies on physical rehabilitation in MS with similar outcome measures. TRIAL REGISTRATION:ISRCTN ISRCTN67916624