Multiple sclerosis (MS) is an immune-mediated neurological disease that results in a variety of consequences, most notably fatigue and physical inactivity. In fact, 75-90% of people with MS report having fatigue, and 60% describe it as their most disabling symptom
]. Beyond fatigue, persons with MS are highly inactive compared with matched controls
], and this inactivity may increase the risk of developing secondary conditions (e.g., obesity, heart disease, and diabetes) that can accelerate MS-related functional decline
]. We further note that fatigue and physical inactivity may create a cyclical pattern of functional decline over time
One approach for managing fatigue and physical inactivity involves the development of behavioral interventions that focus on teaching self-management tasks and skills
]. For example, a randomized controlled trial (RCT) indicated that a fatigue self-management teleconference program was significantly more effective than a delayed-treatment control group for reducing fatigue impact and improving certain dimensions of health-related quality of life in persons with MS
]. The changes were maintained for six months after the intervention. Another RCT demonstrated that a behavioral intervention delivered via the Internet was effective in promoting and sustaining physical activity behavior change in ambulatory adults with MS
], and this effect was seemingly mediated by self-regulatory strategies of self-monitoring and goal-setting
To date, interventions for managing fatigue and physical inactivity have typically been addressed as separate lines of research, even though these two common consequences of MS are likely interrelated
]. The reciprocal relationship between fatigue and inactivity may accelerate a cycle of functional decline
]. MS fatigue can decrease motivation to engage in physical activity
]. Inactivity is associated with de-conditioning, mobility problems, depression, and further fatigue
], which makes it even more difficult to engage in physical activity
]. No study to date has systematically explored the combined benefits of teaching fatigue management strategies and promoting physical activity. We also note that the population with MS may have limited access to health professionals who can adequately address problems related to fatigue and inactivity, particularly for those who reside in rural communities
]. Therefore, using a telehealth approach to address the reciprocal relationship between MS fatigue and inactivity could increase the intervention’s accessibility and dissemination.
The objective of this proposed study is to conduct a RCT to examine the effectiveness of a telehealth intervention that supports individuals in managing fatigue and increasing physical activity levels. The proposed study is novel in that it represents a multi-disciplinary effort to merge two promising lines of research on MS: fatigue management and physical activity promotion. The proposed fatigue management plus physical activity intervention (FM+) will consist of incorporating a teleconference fatigue management intervention informed by the work of Packer et al.
], Finlayson et al.
], and Mathiowetz et al.
] with a novel, yet simple approach to promote lifestyle physical activity, i.e., encouraging goal-setting and self-monitoring with a pedometer. Our goal is to recruit 189 ambulatory individuals with MS who will be randomized into one of three telehealth interventions: (1) a contact-control social support intervention, (2) a physical activity-only intervention, and (3) a FM + intervention. Below we outline the aims, outcome measures, and associated hypotheses of the study.
Specific aim 1
The first aim is to compare the effects of the three interventions on fatigue impact and physical activity levels. Outcomes will be the Fatigue Impact Scale (FIS)
], the Godin Leisure-Time Exercise Questionnaire (GLTEQ)
], and Actigraph accelerometers. Our hypothesis is that, in comparison to the contact-control condition, both interventions will yield significant improvements in FIS scores and physical activity levels, with the FM+ yielding significantly larger improvements.
Specific aim 2
The second aim is to compare the effects of the three interventions on health-related quality of life, mental health, and participation in life roles. Outcomes will be the SF-12, Mental Health Inventory (MHI), Multiple Sclerosis Impact Scale (MSIS)
], and the Community Participation Indicator (CPI)
]. Our hypothesis is that, in comparison to the contact-control condition, both interventions will yield a significant increase in SF-12, MHI, MSIS, and CPI scores, with the FM + yielding a significantly larger increase.
Specific aim 3
The third aim is to identify potential mediators of the interventions. Psychosocial constructs measures related to fatigue and physical activity (e.g., self-efficacy, goal-setting, and outcome expectations) will be administered to help identify the underlying mechanisms of the interventions’ possible effectiveness. Our hypothesis is that scores on these measures will significantly improve, and that improvements will explain the interventions’ effect on fatigue and physical activity.