Dr. Cederberg's primary research interests focus on studying the efficacy and effectiveness of exercise for managing symptoms of restless legs syndrome (RLS) and co-occurring conditions (e.g., periodic limb movements, insomnia). She is currently an NHLBI T32 funded Postdoctoral Scholar in the Mignot Lab, where she she devotes her time to conducting research aimed at better understanding the relationship among genetics, proteomics, and the presence of and severity of symptoms related to RLS. Her current research is interested in patient's personal experiences with exercise and RLS as well as the relationship between exercise and proteomic biomarkers of RLS. She received her PhD in Rehabilitation Science from the University of Alabama at Birmingham in December 2020, wherein her dissertation utilized a series of methodological approaches to comprehensively examine the relationship between physical activity and RLS in adults with MS. She plans to utilize her experience and training to develop a line of research for informing exercise prescription parameters specifically for managing symptoms of RLS.
Honors & Awards
Trainee Investigator Award, Honorable Mention, American Academy of Sleep Medicine (2022)
Trainee Merit Based Award, Sleep Research Society (2021)
Wayne Hening Young Investigator Award, International Restless Legs Syndrome Study Group (2021)
Samuel B. Barker Award for Excellence in Graduate Studies, University of Alabama at Birmingham (2020)
Trainee Merit Based Award, Sleep Research Society (2019)
Travel Award, Center for Exercise Medicine, University of Alabama at Birmingham (2017)
Boards, Advisory Committees, Professional Organizations
Member, International Restless Legs Syndrome Study Group (2021 - Present)
Member, American Academy of Sleep Research (2020 - Present)
Member, Sleep Research Society (2019 - Present)
Member, Restless Legs Syndrome Foundation (2018 - Present)
PhD, University of Alabama at Birmingham, Rehabilitation Science (2020)
MS, Central Washington University, Exercise Science (2013)
BA, Linfield College, Exercise Science (2011)
Emmanuel Mignot, Postdoctoral Faculty Sponsor
Proteomic Biomarkers of Kleine-Levin Syndrome.
STUDY OBJECTIVES: Kleine-Levin Syndrome (KLS) is characterized by relapsing-remitting episodes of hypersomnia, cognitive impairment, and behavioral disturbances. We quantified cerebrospinal fluid (CSF) and serum proteins in KLS cases and controls.METHODS: SomaScan was used to profile 1133 CSF proteins in 30 KLS cases and 134 controls, while 1109 serum proteins were profiled in serum from 26 cases and 65 controls. CSF and serum proteins were both measured in 7 cases. Univariate and multivariate analyses were used to find differentially expressed proteins (DEPs). Pathway and tissue enrichment analyses (TEA) were performed on DEPs.RESULTS: Univariate analyses found 28 and 141 proteins differentially expressed in CSF and serum, respectively (False Discovery Rate, FDR<0.1%). Upregulated CSF proteins included IL-34, IL-27, TGF-b, IGF-1 and osteonectin, while DKK4 and vWF were downregulated. Pathway analyses revealed microglial alterations and disrupted blood-brain barrier permeability. Serum profiles show upregulation of Src-family kinases (SFKs), proteins implicated in cellular growth, motility and activation. TEA analysis of up- and down-regulated proteins revealed changes in brain proteins (p<6x10 -5), notably from the pons, medulla and midbrain. A multi-variate machine learning classifier performed robustly, achieving a receiver operating curve (ROC) Area Under the Curve of 0.90 (95% CI=0.78-1.0,p=0.0006) in CSF and 1.0 (95% CI=1.0-1.0,p=0.0002) in serum in validation cohorts, with some commonality across tissues, as the model trained on serum sample also discriminated CSF samples of controls versus KLS cases.CONCLUSIONS: Our study identifies proteomic KLS biomarkers with diagnostic potential and provides insight into biological mechanisms that will guide future research in KLS.
View details for DOI 10.1093/sleep/zsac097
View details for PubMedID 35859339
Proteomic Biomarkers of the Apnea Hypopnea Index and Obstructive Sleep Apnea: Insights into the Pathophysiology of Presence, Severity, and Treatment Response.
International journal of molecular sciences
2022; 23 (14)
Obstructive sleep apnea (OSA), a disease associated with excessive sleepiness and increased cardiovascular risk, affects an estimated 1 billion people worldwide. The present study examined proteomic biomarkers indicative of presence, severity, and treatment response in OSA. Participants (n = 1391) of the Stanford Technology Analytics and Genomics in Sleep study had blood collected and completed an overnight polysomnography for scoring the apnea-hypopnea index (AHI). A highly multiplexed aptamer-based array (SomaScan) was used to quantify 5000 proteins in all plasma samples. Two separate intervention-based cohorts with sleep apnea (n = 41) provided samples pre- and post-continuous/positive airway pressure (CPAP/PAP). Multivariate analyses identified 84 proteins (47 positively, 37 negatively) associated with AHI after correction for multiple testing. Of the top 15 features from a machine learning classifier for AHI ≥ 15 vs. AHI < 15 (Area Under the Curve (AUC) = 0.74), 8 were significant markers of both AHI and OSA from multivariate analyses. Exploration of pre- and post-intervention analysis identified 5 of the 84 proteins to be significantly decreased following CPAP/PAP treatment, with pathways involving endothelial function, blood coagulation, and inflammatory response. The present study identified PAI-1, tPA, and sE-Selectin as key biomarkers and suggests that endothelial dysfunction and increased coagulopathy are important consequences of OSA, which may explain the association with cardiovascular disease and stroke.
View details for DOI 10.3390/ijms23147983
View details for PubMedID 35887329
Restless Legs Syndrome Severity and Cognitive Function in Adults With Multiple Sclerosis: An Exploratory Pilot Study.
International journal of MS care
2022; 24 (4): 154-161
BACKGROUND: Restless legs syndrome (RLS) is a sleep disorder present in as many as 26% of persons with multiple sclerosis (MS) and can be associated with cognitive function. The present study examined the relationships between RLS symptoms (severity, frequency, occurrence) and cognitive function in adults with MS who have RLS.METHODS: Twenty-two participants attended 1 laboratory session and completed the International Restless Legs Syndrome Study Group Rating Scale (IRLS), the Restless Legs Syndrome-6 Scale, and then the Brief International Cognitive Assessment for Multiple Sclerosis battery consisting of the Symbol Digit Modalities Test; California Verbal Learning Test, Second Edition; and Brief Visuospatial Memory Test-Revised.RESULTS: Nonparametric bivariate correlations indicated that worse IRLS total severity was associated with slower processing speed (rho = -0.42), worse verbal memory (rho = -0.63), and worse visual memory (rho = -0.61); worse RLS severity at falling asleep was associated with worse verbal memory (rho = -0.45) and worse visual memory (rho = -0.55); and worse RLS severity during the day while active was associated with slower processing speed (rho = -0.58), worse verbal memory (rho = -0.52), and worse visual memory (rho = -0.60).CONCLUSIONS: These results suggest that those with more severe RLS, including worse symptoms at falling asleep and during the day while active, might experience worse cognitive function, particularly processing speed and memory. Future research should evaluate whether treatment of RLS symptoms can offer new opportunities for managing cognitive dysfunction in adults with MS.
View details for DOI 10.7224/1537-2073.2020-120
View details for PubMedID 35875462
Restless legs syndrome severity associated with reduced physical function in adults with multiple sclerosis.
Gait & posture
2022; 97: 56-61
BACKGROUND: Restless legs syndrome (RLS) is a sleep disorder that occurs in approximately 26 % of adults with multiple sclerosis (MS) and may be associated with reduced physical function.RESEARCH QUESTION: The present study examined the relationship between RLS symptomology (i.e., overall severity, frequency, and occurrence) and physical function outcomes in adults with MS who had RLS.METHODS: Participants (N=22) with MS who had RLS came into the laboratory for a single session wherein a rater performed a brief neurological examination for scoring the Expanded Disability Status Scale (EDSS) and completed a demographics questionnaire, the International Restless Legs Syndrome Study Group Scale (IRLS), and the Restless Legs Syndrome Scale-6 (RLS-6) followed by the Short Physical Performance Battery (SPPB) and the Six-minute Walk Test (6MW).RESULTS: Bivariate Spearman's rho correlation analyses indicated total IRLS had a strong, negative association with total distance traveled during the 6MW (rho=-0.50) and a moderate association with SPPB scores (rho=-0.43), but not EDSS scores (rho=0.28). RLS severity during the day while active had strong, negative associations with total distance traveled during the 6MW (rho=-0.61) and SPPB scores (rho=-0.52), but not EDSS scores (rho=0.13).SIGNIFICANCE: We observed associations between worse overall RLS severity and RLS severity during the day while active with reduced performance during the 6MW and lower SPPB scores. The management of RLS may offer an opportunity for mitigating reductions in physical function in adults with MS who have RLS.
View details for DOI 10.1016/j.gaitpost.2022.06.012
View details for PubMedID 35882097
The Genetic Etiology of Periodic Leg Movement in Sleep.
STUDY OBJECTIVES: Periodic Limb Movement in Sleep is a common sleep phenotype characterized by repetitive leg movements that occur during or before sleep. We conducted a Genome-Wide Association Study (GWAS) of periodic limb movements in sleep (PLMS) using a joint analysis (i.e., discovery, replication, and joint meta-analysis) of 4 cohorts (MrOS, the Wisconsin Sleep Cohort Study, HypnoLaus, and MESA), comprised of 6,843 total subjects..METHODS: The MrOS study and Wisconsin Sleep Cohort Study (N=1,745 cases) were used for discovery. Replication in the HypnoLaus and MESA cohorts (1,002 cases) preceded joint meta-analysis. We also performed LD score regression, estimated heritability, and computed genetic correlations between potentially associated traits such as restless leg syndrome (RLS) and insomnia. The causality and direction of the relationships between PLMS and RLS was evaluated using mendelian randomization.RESULTS: We found 2 independent loci were significantly associated with PLMS: rs113851554 (p = 3.51 x 10 -12, beta=0.486), a SNP located in a putative regulatory element of intron eight of MEIS1 (2p14); and rs9369062 (p = 3.06 x10 -22, beta=0.2093), a SNP located in the intron region of BTBD9 (6p12); both of which were also lead signals in RLS GWAS. PLMS is genetically correlated with insomnia, risk of stroke, and RLS, but not with iron deficiency. Pleiotropy adjusted Mendelian randomization analysis identified a causal effect of RLS on PLMS.CONCLUSIONS: Because PLMS is more common than RLS, PLMS may have multiple causes and additional studies are needed to further validate these findings.
View details for DOI 10.1093/sleep/zsac121
View details for PubMedID 35670608
Physical activity and sedentary behavior timing in fatigued and non-fatigued adults with multiple sclerosis.
Archives of physical medicine and rehabilitation
OBJECTIVE: The present study examined device-measured physical activity levels and sedentary behavior participation during different times of the day (i.e., morning, midday, and evening) in adults with multiple sclerosis (MS) who differed in fatigue status.DESIGN: Cross-sectional, survey.SETTING: Remote survey study managed by a university-based research laboratory.PARTICIPANTS: A population-based sample of 1,000 participants with MS were sent recruitment materials by the North American Research Committee on Multiple Sclerosis.MAIN OUTCOME MEASURES: Participants (N=218) completed the Fatigue Severity Scale (FSS) as a measure of fatigue severity and were divided into subgroups of fatigued (FSS score ≥4) and non-fatigued (FSS score <4). Participants wore an ActiGraph GT3X+ on the non-dominant hip for seven days for measuring physical activity(i.e., light physical activity[LPA], moderate-to-vigorous physical activity[MVPA], steps) and sedentary behavior.RESULTS: Fatigued participants engaged in less MVPA(F(1,216)=18.5, p<0.001), fewer steps(F(1,216)=27.8, p<0.001) and more sedentary time (F(1,216)=8.2, p=0.005) than non-fatigued participants. Regardless of group, the highest levels of LPA(F(1.7,355.7)=72.9, p<0.001) and MVPA(F(1.8,395.3)=23.0,p<0.001) occurred in the morning and middle of the day, with the lowest levels in the evening. Regardless of group, the highest levels of sedentary behavior occurred in the evening with similar levels in the morning and evening(F(1.6,354.5)=84.3,p<0.001). Regardless of group, participants had more steps in the middle of the day followed by the morning and then the evening(F(1.8,383.9)=84.7,p<0.001).CONCLUSIONS: Our results suggest that physical activity timing should be considered in future development and delivery of behavior interventions that focus on increasing physical activity and reducing sedentary behavior among adults with MS who have fatigue.
View details for DOI 10.1016/j.apmr.2021.12.022
View details for PubMedID 35063422
Social Cognitive Theory variables as correlates of physical activity in fatigued persons with multiple sclerosis.
Multiple sclerosis and related disorders
2022; 57: 103312
BACKGROUND: There is interest in the application of behavioral interventions based on theory for increasing physical activity among adults with multiple sclerosis (MS). To date, researchers have applied theory such as Social Cognitive Theory (SCT) for identifying correlates of physical activity that can then inform the design and delivery of behavioral interventions. Such research often has been conducted in heterogeneous samples of persons with MS without a focus on those with a specific symptom, such as fatigue, that may be targeted by physical activity behavioral interventions. To that end, this study examined SCT variables (i.e., self-efficacy, barriers, outcome expectations, goal-setting, planning, social support, and functional limitations) as correlates of physical activity in persons with MS who self-reported elevated fatigue.METHODS: Persons with MS (N=210; aged 49.6[13.2] years) who ambulated with or without assistance participated in the study. Participants completed self-report measures of fatigue, physical activity, and SCT variables and wore an ActiGraph GT3X+ accelerometer on a belt around the waist for 7 days. The accelerometer data were processed and delineated into time spent in light and moderate-to-vigorous physical activity (MVPA) based on MS-specific cut-points. We generated groups of fatigued (n=134) and non-fatigued (n=76) persons with MS based on the cut-off score of 4 for the Fatigue Severity Scale.RESULTS: There were differences in physical activity and SCT variables between fatigued and non-fatigued persons with MS. Among those with fatigue, functional limitations (rho=0.52), self-efficacy (rho=0.31), and goal-setting (rho=0.25) were associated with device-measured MVPA, and all SCT variables except outcome expectations were associated with self-reported physical activity. The regression analyses indicated self-efficacy, functional limitations, and goal-setting as significant correlates of MVPA in those with fatigue.CONCLUSION: Self-efficacy, goal-setting, and social support may be important targets of SCT-based behavioral interventions for increasing physical activity among persons with MS who have fatigue.
View details for DOI 10.1016/j.msard.2021.103312
View details for PubMedID 35158422
Demographic, clinical, and symptomatic correlates of subjective sleep quality in adults with multiple sclerosis.
Multiple sclerosis and related disorders
2021; 55: 103204
BACKGROUND: This study examined a comprehensive set of demographic, clinical, and symptomatic variables as correlates of subjective sleep quality in adults with multiple sclerosis (MS).METHODS: Participants with MS(N=485) completed the Pittsburgh Sleep Quality Index(PSQI), a demographics and clinical characteristics questionnaire, the Patient Determined Disease Steps Scale(PDDS), the Fatigue Severity Scale, and the Hospital Anxiety and Depression Scale. We conducted bivariate Spearman's rho (rho) correlation analyses and multiple linear regression analysis for identifying variables associated with PSQI scores.RESULTS: Participants had a mean (standard deviation) age of 55.4 (12.6) years and were mostly female (78%) with a median [interquartile range] PDDS of 2.0[3.0]. Higher levels of fatigue (rho=0.32), more symptoms of anxiety (rho=0.39) and depression (rho=0.36), younger age (rho=-0.12), lower income status (rho=-0.13), shorter MS disease duration (rho=-0.11), being in a minority group (rho=0.09), and being unemployed (rho=-0.10) were associated with worse sleep quality. There were no significant associations between gender, marital status, parental status, education level, disability status, or MS disease type and sleep quality. The overall regression model accounted for 26.3% of variance in sleep quality (F[8,229.8]=20.25) and there were significant coefficients for anxiety(beta=0.25), fatigue(beta=0.18), depression(beta=0.16), and employment status(beta=-0.12), but not disease duration, age, race, or income level.DISCUSSION: Participants with higher levels of anxiety, fatigue, and depression and who were unemployed reported worse sleep quality in our sample of adults with MS. These results may identify specific subgroups of the MS population that experience more sleep problems, and therefore are in greatest need for interventions designed to improve sleep impairment.
View details for DOI 10.1016/j.msard.2021.103204
View details for PubMedID 34392060
Discrepancies between self-reported and device-measured sleep parameters in adults with multiple sclerosis.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
STUDY OBJECTIVES: Sleep problems are a common consequence of multiple sclerosis (MS); however, there is limited evidence regarding the agreement between device-measured and self-reported sleep parameters in adults with MS. The present study examined the agreement between self-reported and device-measured parameters of sleep quality in a sample of adults with MS.METHODS: Participants (N=49) completed a seven-day sleep diary and wore a wrist-worn ActiGraph GT3X+ for seven consecutive nights to quantify self-reported and device-measured sleep parameters, respectively.RESULTS: There was a significant discrepancy between self-reported and device-measured parameters of total time in bed (mean difference=19.8(51.3) min), sleep onset latency (mean difference=22.2(19.5) min), and frequency of awakenings during the night (mean difference=12.8(6.8)). Intraclass correlation (ICC) estimates indicated poor agreement between methods on most parameters, except for total time in bed (ICC=0.80). Bland-Altman plots suggested that total time in bed and total sleep time had acceptable levels of agreement and linear regression analyses indicated that sleep onset latency (F=113.91, B=-1.34, p<0.001), number of awakenings (F=543.34, B=1.85, p<0.001), and sleep efficiency (F=18.39, B=-0.77, p<0.001) had significant proportional bias.CONCLUSIONS: Our results draw attention to the discrepancies between sleep parameter measurements and highlight the importance of including both self-report and device-measured outcomes for a complete and accurate representation of sleep in adults with MS.
View details for DOI 10.5664/jcsm.9586
View details for PubMedID 34338630
Do physical activity and social cognitive theory variable scores differ across symptom cluster severity groups in multiple sclerosis?
Disability and health journal
BACKGROUND: Persons with multiple sclerosis (MS) experience co-occurring symptoms termed "symptom clusters" that can be distinguished based on mild, moderate, or severe symptom severity termed "symptom cluster severity." Physical activity (PA) may be an approach for improving co-occurring symptoms.OBJECTIVE: To examined if PA and social cognitive theory (SCT) variables differed by symptom cluster groups, and if associations between SCT variables and PA were moderated by symptom cluster groups.METHODS: Secondary analysis of participants with MS (N = 205) enrolled in a cross-sectional study. Trend analyses were conducted to determine if device-measured and self-reported PA and SCT variables (i.e., social support, self-efficacy, outcome expectations, goal setting, planning, and impediments) decreased with increased symptom cluster severity. Spearman rho rank-order correlations were conducted between PA measures and SCT variables within each symptom cluster group.RESULTS: Linear trend analyses indicated that self-reported PA declined with increased symptom cluster severity groups (F = 4.90,p = 0.03). Linear trend analyses indicated significant differences among symptom cluster severity groups in social support (F = 31.43,p = 0.001), exercise self-efficacy (F = 22.55,p = 0.001), barrier self-efficacy (F = 11.48,p = 0.001), outcome expectations (F = 6.98,p = 0.009), and impediments (F = 34.41,p = 0.001). There were differential associations of moderate magnitude in correlations, such that three SCT variables were associated with PA in the mild group (i.e., self-efficacy, goal setting and planning), two in the moderate group (i.e., social support and goal setting), and four in the severe group (i.e., self-efficacy, outcome expectations, planning, and social support).CONCLUSIONS: Further research is warranted examining the use of SCT-based behavior change techniques for promoting PA and improving symptom clusters in persons with MS.
View details for DOI 10.1016/j.dhjo.2021.101163
View details for PubMedID 34219037
Accuracy and precision of wrist-worn actigraphy for measuring steps taken during over-ground and treadmill walking in adults with Parkinson's disease.
Parkinsonism & related disorders
2021; 88: 102-107
INTRODUCTION: Step counts represent a straight-forward method of measuring physical activity in adults with Parkinson's disease (PD). The present study examined the absolute and relative accuracy and precision of a wrist-worn research-grade accelerometer (i.e., ActiGraph GT3X+) for measuring step counts during over-ground and treadmill walking in adults with PD and controls without PD.METHODS: Participants (PD: n=29; controls: n=31) wore two ActiGraph GT3X+accelerometers, one on each wrist, and completed an over-ground walking bout followed by a treadmill walking bout at the same speed. Step counts were measured manually using a hand-held tally counter. Accuracy and precision were based on absolute and relative metrics.RESULTS: The ActiGraph GT3X+underestimated step counts in both participants with PD (4.7-11% error) and controls without PD (8.8-17% error), with a greater discrepancy in controls. The ActiGraph GT3X+provided more accurate and precise estimates of step counts when placed on the more affected wrist and non-dominant wrist for participants with PD and controls, respectively, and was more accurate and precise during over-ground walking compared with treadmill walking for both groups.CONCLUSIONS: Our results suggest that placement of the device (i.e., dominant vs. non-dominant), type of activity (i.e., over-ground vs. treadmill walking), and presence of clinical conditions may impact the accuracy and precision of data when using the research-grade ActiGraph GT3X+accelerometer for measuring step counts.
View details for DOI 10.1016/j.parkreldis.2021.06.009
View details for PubMedID 34171566
Validity and reliability of the suggested immobilization test for measurement of restless legs syndrome severity in adults with multiple sclerosis.
2021; 84: 343-351
OBJECTIVE/BACKGROUND: Adults with multiple sclerosis (MS) often present with conditions that mimic restless legs syndrome (RLS), thereby adding complexity into the assessment of RLS severity. The current gold-standard measures of RLS severity rely on a fixed seven-day time frame, which limits the ability of these measures for studying acute changes in RLS severity. The present study examined if subjective and objective scores from the suggested immobilization test (SIT) provide a valid and reliable acute measure of RLS severity in persons with MS.PATIENTS/METHODS: Participants with MS and RLS (n=20) and MS without RLS (n=20) were matched by age, gender, and disability. All participants completed validated questionnaires for RLS severity followed by the SIT, conducted at 18:00 (±15min) on the same day of the week for two consecutive weeks. Participants wore accelerometer devices for seven nights to capture periodic limb movements (PLMs) during the night.RESULTS: Self-reported RLS severity during the SIT had excellent construct validity and convergent validity, but moderate test-retest reliability. Device-measured PLMs, while not themselves a direct measure of RLS severity, were significantly associated with PLMs during the night and had excellent test-retest reliability during the SIT in adults with MS.CONCLUSIONS: Our results suggest that the SIT represents a valid acute measure for capturing self-reported sensory aspects of RLS severity and should be considered in future research and clinical practice as a standardized acute measure of subjective RLS severity in adults with MS who present with RLS.
View details for DOI 10.1016/j.sleep.2021.06.005
View details for PubMedID 34242924
Physical activity and self-reported sleep quality in adults with multiple sclerosis.
Disability and health journal
BACKGROUND: There is a fourfold higher prevalence of sleep problems in multiple sclerosis (MS) than the general population.OBJECTIVE: This study examined cross-sectional associations among device-measured sedentary and physical activity behavior with perceived sleep quality in adults with MS.METHODS: Adults with MS (N=290) completed the Pittsburgh Sleep Quality Index (PSQI) and wore an accelerometer for seven days providing a measure of time spent in sedentary behavior, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) using MS-specific cut-points. We conducted multiple linear regression analysis to identify the independent contributions of variables for explaining PSQI scores.RESULTS: The overall model accounted for 2% of the variance in global PSQI scores, and MVPA was significantly and independently associated with global PSQI scores (beta=─0.123; p=0.045; partial r=─0.118) when accounting for average wear time, sedentary behavior, and time spent in LPA. There were no other significant associations with PSQI global score.CONCLUSIONS: Our results suggest that time spent in MVPA may be associated with better sleep quality in adults with MS, but adults with MS do not spend sufficient time in physical activity. Researchers should evaluate these relationships in longitudinal study designs and behavior change interventions, as physical activity may provide a unique opportunity to improve sleep quality outcomes.
View details for DOI 10.1016/j.dhjo.2021.101133
View details for PubMedID 34193388
EFFICACY OF A PHYSICAL ACTIVITY INTERVENTION FOR MANAGING RESTLESS LEGS SYNDROME IN MULTIPLE SCLEROSIS: A PILOT RCT
OXFORD UNIV PRESS INC. 2021: A209
View details for Web of Science ID 000698984300529
Feasibility and efficacy of a physical activity intervention for managing restless legs syndrome in multiple sclerosis: Results of a pilot randomized controlled trial.
Multiple sclerosis and related disorders
2021; 50: 102836
BACKGROUND: This pilot randomized controlled trial examined the feasibility and efficacy of a physical activity behavior change intervention for improving restless legs syndrome (RLS) severity and secondary sleep outcomes among a sample of adults with multiple sclerosis (MS).METHODS: Participants with MS(N=15) were randomly assigned into intervention(n=8) or waitlist control(n=7) conditions. The physical activity intervention was delivered over a 16-week period and outcomes were assessed at baseline and immediately following the 16-week period in both conditions.RESULTS: There was a significant, positive effect of the intervention on overall RLS severity (p=.01;etarho2=.43), severity during the night(p=.03,etarho2=.35), severity during the day while resting(p=.01,etarho2=.44), and severity during the day while active(p<.01,etarho2=.61), and non-significant improvements in RLS severity while falling asleep (p=.33,etarho2=.09). There were significant positive effects on sleep satisfaction(p<.01,etarho2=.49) and non-significant improvements in self-reported global sleep quality(p=.35,etarho2=.08). There was a significant intervention effect on self-reported time in bed(p=.03,etarho2=.37) and total sleep time(p=.03,etarho2=.36), and non-significant improvements in self-reported sleep latency (p=.08,etarho2=.25), sleep efficiency(p=.27,etarho2=.11), and daytime sleepiness (p=.52,etarho2=.04;p=.35,etarho2=.08;p=.51,etarho2=.04). There was no significant effect of the intervention on device-measured sleep quality.CONCLUSIONS: We provide preliminary evidence for the feasibility and efficacy of a physical activity intervention for reducing RLS severity and potentially improving self-reported sleep outcomes in adults with MS. CLINICALTRIALS.GOV IDENTIFICATION NUMBER: NCT04061681.
View details for DOI 10.1016/j.msard.2021.102836
View details for PubMedID 33618120
Wrist-based accelerometer cut-points for quantifying moderate-to-vigorous intensity physical activity in Parkinson's disease.
Gait & posture
2021; 91: 235-239
Persons with Parkinson's disease (PD) participate in low levels of physical activity. This has prompted interest in developing interventions targeting physical activity behavior in PD. However, the current cut-points to quantify moderate-to-vigorous physical activity (MVPA) developed for PD have been derived from a single, vertical axis using hip-worn accelerometers, and this cut-point may not be applicable for wrist-worn devices. Wrist-worn devices might improve accessibility and compliance with physical activity monitoring in PD.What is the relationship between wrist-based activity counts and energy expenditure during treadmill walking in persons with PD? Do cut-points for quantifying time spent in MVPA differ between persons with PD and controls matched by age and sex?The sample included 26 persons with mild-to-moderate PD (Hoehn and Yahr stages 2-3) and 27 age- and sex-matched controls. Participants completed three, 6-minute bouts of walking on a treadmill at three increasing speeds. Vector magnitude was measured using ActiGraph GT3X+ accelerometer worn on the more affected side for persons with PD and the non-dominant side for controls. The rate of oxygen consumption, or energy expenditure, was measured using a portable, open-circuit spirometry system.Our results indicated a strong association between activity counts and energy expenditure for persons with PD and controls with R2 values of 0.94(0.07) and 0.95(0.06), respectively. Persons with PD had a cut-point of 2883(871) counts·min-1; this was significantly lower than the cut-point of 4389(1844) counts·min-1 for controls.We generated a PD-specific cut-point for wrist-worn ActiGraph accelerometers among persons with PD, and this was lower than controls. This disease-specific cut-point may provide more accurate measurements of time spent in MVPA in PD.
View details for DOI 10.1016/j.gaitpost.2021.10.027
View details for PubMedID 34749075
Accelerometer output and its association with energy expenditure in persons with mild-to-moderate Parkinson's disease
2020; 15 (11): e0242136
This study examined the association between ActiGraph accelerometer output and energy expenditure across different speeds of walking in persons with Parkinson's disease (PD), and further generated cut-points that represent a metric for quantifying time spent in moderate-to-vigorous physical activity (MVPA) among persons with PD.The sample included 30 persons with mild-to-moderate PD (Hoehn and Yahr stages 2-3) and 30 adults without PD matched by sex and age. All participants completed 5 minutes of quiet, seated rest and then underwent three, 6-minute bouts of walking on a treadmill at three different speeds relative to the individual's self-selected pace. Activity counts were measured using an ActiGraph accelerometer worn at the waist level on the least affected side for persons with PD and the dominant side for controls. The rate of oxygen consumption, or energy expenditure, was measured using a portable, open-circuit spirometry system.Our results indicated a strong association between activity counts and energy expenditure for persons with PD (R2 = 0.87) and controls (R2 = 0.89). However, the significant difference in slopes resulted in a lower cut-point of 1,354 counts·min-1 for persons with PD than the cut-point of 2,010 counts·min-1 for controls.Our results support the application of the disease-specific cut-point for quantifying the amount of time spent in MVPA using ActiGraph accelerometers among persons with mild-to-moderate PD. Such an application may provide accurate estimates of MVPA in this population, and better inform future research examining the possible determinants and consequences of physical activity as well as testing of interventions for changing MVPA in PD.
View details for DOI 10.1371/journal.pone.0242136
View details for Web of Science ID 000593946900009
View details for PubMedID 33175904
View details for PubMedCentralID PMC7657517
Symptom clusters and quality of life in persons with multiple sclerosis across the lifespan
QUALITY OF LIFE RESEARCH
2021; 30 (4): 1061-1071
To describe symptom clusters based on severity of co-occurring symptoms among adults with multiple sclerosis (MS) by age groups and to further examine symptom clusters as a correlate of quality of life (QOL) by age groups.This cross-sectional study enrolled persons with MS between 20 and 79 years of age who completed measures of fatigue, depression, anxiety, sleep quality, and QOL using the 36-Item Short Form Health Survey. Bivariate correlation and partial correlation analyses examined associations among symptoms, QOL, and MS characteristics. K-means cluster analyses determined symptom clusters among the full sample and pre-determined age groups (i.e., 20-39, 40-59, and 60-79). One-way ANOVAs examined differences in QOL among clusters for the overall sample and by age groups.Among the overall sample of 205 participants, symptoms were significantly correlated with QOL and three distinct clusters were identified and differentiated by the magnitude of symptom experience (i.e., mild, moderate, and severe). Results were consistent among young and middle-aged adults; however, among older adults two severe sleep problem clusters were identified that were distinguished by moderate versus severe fatigue, depression, and anxiety. ANOVAs among the overall sample indicated that the three symptom clusters varied significantly for both physical component scores, F(2, 202) = 12.03, p < .001, η2 = .10, and mental component scores, F(2, 202) = 137.92, p < .001, η2 = .58; severe symptom cluster was associated with worse QOL. Patterns in the age subgroup ANOVAs were consistent.Given the strong association between severity of symptom clusters and QOL, approaches for targeting co-occurring symptoms are critically needed.
View details for DOI 10.1007/s11136-020-02689-x
View details for Web of Science ID 000586433600001
View details for PubMedID 33155152
View details for PubMedCentralID PMC8005422
Oxygen cost of over-ground walking in persons with mild-to-moderate Parkinson's disease
GAIT & POSTURE
2020; 82: 1-5
Oxygen (O2) cost of walking is a physiological marker of walking dysfunction and reflects the amount of O2 consumed per kilogram of body weight per unit distance walked. The onset of walking dysfunction (i.e., reduced walking speed and shorter stride length) is commonly observed in Parkinson's disease (PD), even in the early stages of the disease. However, the O2 cost of walking has not been assessed in persons with PD.Does O2 cost of walking differ between persons with PD and controls matched by age and sex?The sample included 31 persons with mild-to-moderate PD (Hoehn and Yahr stages 2-3) and 31 age- and sex-matched controls in this cross-sectional study. O2 consumption (VO2) was measured using a portable indirect calorimetry system during a 6-min period of over-ground walking at a normal comfortable speed, and the O2 cost of walking was calculated based on the ratio of net relative VO2 (ml kg-1 min-1) and speed (m min-1).There were no differences in resting VO2, steady-state VO2, and over-ground walking speed between persons with PD and controls (p > 0.05). There was a significant difference in the O2 cost of walking between persons with PD and healthy controls (p < 0.01) such that persons with PD had a higher O2 cost of walking. The mean(SD) O2 cost of walking for persons with PD was 0.179 (0.038) ml kg-1 m-1, and the O2 cost of walking for healthy controls was 0.153 (0.024) ml kg-1 m-1.Persons with PD demonstrated a higher O2 cost of walking compared with controls, and this may reflect worse walking economy in PD. The possibility of worse walking economy under free-living conditions may result in reduced community ambulation and participation.
View details for DOI 10.1016/j.gaitpost.2020.08.108
View details for Web of Science ID 000595604900001
View details for PubMedID 32836026
View details for PubMedCentralID PMC7718302
Restless legs syndrome, sleep quality, and perceived cognitive impairment in adults with multiple sclerosis
MULTIPLE SCLEROSIS AND RELATED DISORDERS
2020; 43: 102176
Restless Legs Syndrome (RLS) is a prominent sleep disorder that often worsens sleep quality and perhaps cognitive function in adults with multiple sclerosis (MS). The present study examined the relationships among RLS prevalence and severity, sleep quality, and perceived cognitive impairment in adults with MS.Participants (N=275) completed the Cambridge-Hopkins Restless Legs Syndrome Questionnaire, the International Restless Legs Syndrome Study Group (IRLS) Scale, the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ), the Pittsburgh Sleep Quality Index (PSQI), the Patient Determined Disease Steps (PDDS), and a demographic and clinical characteristics questionnaire.Persons with MS who had RLS (i.e., MS+RLS; n=74) reported significantly worse perceived cognitive impairment compared with those who did not have RLS (n=201; p=0.015). Bivariate correlation analyses within the MS+RLS group indicated that greater RLS severity was significantly associated with more severe perceived cognitive impairment (r=0.274) and sleep quality (r=0.380), and worse perceived cognitive impairment was significantly associated with worse sleep quality (r=0.438). Linear, step-wise regression analyses indicated that RLS severity significantly predicted perceived cognitive impairment (β=0.274), but the inclusion of sleep quality (β=0.391) accounted for the relationship between RLS severity and perceived cognitive impairment (β=0.126).Our results suggest that sleep impairment may be an intermediary factor in the association between RLS severity and cognitive impairment in persons with MS who present with RLS. The diagnosis and treatment of RLS symptoms and other effectors of sleep quality could improve neuropsychological consequences of MS.
View details for DOI 10.1016/j.msard.2020.102176
View details for Web of Science ID 000548668100002
View details for PubMedID 32498034
View details for PubMedCentralID PMC7363523
Walking and cognitive performance in adults with multiple sclerosis: Do age and fatigability matter?
MULTIPLE SCLEROSIS AND RELATED DISORDERS
2020; 42: 102136
Co-occurring walking and cognitive performance deficits are debilitating consequences of multiple sclerosis (MS) that worsen with age. However, it is unknown if fatigability influences such age-related worsening of walking and cognitive performance.This cross-sectional study examined possible age-related differences in walking-related motor fatigability (incremental six-minute-walk (6MW) performance) and cognitive fatigability (incremental Symbol Digit Modalities Test (SDMT) performance) in adults with MS.196 adults with MS were categorized into age-groups: younger (20-39 years; n = 53), middle-aged (40-59 years; n = 89), and older (60-79 years; n = 54), and completed the 6MW and SDMT. Age-group differences in incremental 6MW and SDMT performance, controlling for disability status, were examined using separate, mixed-factor ANCOVAs.There were no statistically significant age-group-by-time interactions on walking-related motor or cognitive fatigability when controlling for disability. However, there were significant main effects of time on incremental 6MW (p = 0.01) and SDMT (p < 0.01) performance indicating the presence of walking-related motor and cognitive fatigability, respectively, collapsed across age-groups.Fatigability does not exert a primary influence on age-related worsening of walking and cognitive neuroperformance outcomes among adults with MS. This suggests that walking-related motor fatigability and cognitive fatigability may not be optimal targets for mitigating age-related declines in ambulation and cognition among adults with MS.
View details for DOI 10.1016/j.msard.2020.102136
View details for Web of Science ID 000544068100018
View details for PubMedID 32387975
Restless legs syndrome and health-related quality of life in adults with multiple sclerosis
JOURNAL OF SLEEP RESEARCH
2020; 29 (3): e12880
Restless legs syndrome (RLS) is a sleep disorder that may exacerbate many of the symptoms and consequences of multiple sclerosis (MS), and may have further implications for health-related quality of life (HRQOL). The present study examined the relationships among RLS, symptoms and HRQOL in people with MS. Participants with MS (n = 275) completed the Cambridge-Hopkins Restless Legs Syndrome Questionnaire, the International Restless Legs Syndrome Study Group Scale, the Multiple Sclerosis Impact Scale, the Pittsburgh Sleep Quality Index, the Fatigue Severity Scale, the Hospital Anxiety and Depression Scale and the Patient Determined Disease Steps. There were 74 (26.9%) persons with MS who had RLS (MS + RLS). The MS + RLS group reported worse physical and psychological HRQOL (p = 0.020 and p = 0.017, respectively) and greater perceived fatigue (p = 0.006) and anxiety symptoms (p = 0.042) than the MS-only group. Within the MS + RLS group, RLS severity was associated with physical (r = 0.43) and psychological (r = 0.46) HRQOL, sleep quality (r = 0.38), perceived fatigue (r = 0.28), depression (r = 0.38) and anxiety (r = 0.28). The relationships between RLS severity and the domains of HRQOL were attenuated when accounting for fatigue, depression and/or anxiety. Worse RLS severity was associated with reduced HRQOL, which was accounted for by fatigue, depression and anxiety.
View details for DOI 10.1111/jsr.12880
View details for Web of Science ID 000537146200008
View details for PubMedID 31157499
Is Symptomatic Fatigue Associated With Physical Activity and Sedentary Behaviors Among Persons With Multiple Sclerosis?
NEUROREHABILITATION AND NEURAL REPAIR
2020; 34 (6): 505-511
Background. Fatigue is a debilitating symptom in multiple sclerosis (MS) that may be associated with reduced physical activity and increased sedentary behavior. Objective. This study examined the associations among fatigue and device-measured physical activity and sedentary behavior in people with MS. Methods. The participants (n = 252) completed the Patient Determined Disease Steps (PDDS) and Fatigue Severity Scale (FSS) and wore a waist-mounted accelerometer for 7 days. Participants were divided into 2 groups based on fatigue severity as measured by the FSS scale. We compared percentage of wear time spent in sedentary, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) between the 2 groups. Results. Persons in the fatigued group (FSS score ≥ 4) spent a greater percentage of time in sedentary behavior (P = .004) and a lower percentage of time in LPA (P = .035). Persons in the fatigued group further spent a lower percentage of time in nontransformed MVPA (P < .001) and square-root-transformed MVPA (P < .001) than persons in the nonfatigued group. When controlling for PDDS scores and years of education, there were no longer significant differences between groups in sedentary behavior, LPA, or transformed MVPA values; the difference in nontransformed MVPA was still statistically significant but likely the result of nonnormally distributed data. Conclusion. The present study suggests that factors other than fatigue might be associated with physical activity and sedentary behavior in MS, and this group might benefit from focal behavioral interventions that take into account mobility status in persons with MS who have fatigue.
View details for DOI 10.1177/1545968320916159
View details for Web of Science ID 000533109600001
View details for PubMedID 32340521
Step-rate threshold for physical activity intensity in Parkinson's disease
ACTA NEUROLOGICA SCANDINAVICA
2020; 142 (2): 145-150
To examine the relationship between step-rate and energy expenditure during treadmill walking in persons with PD and then further develop a step-rate cut-point for moderate-to-vigorous physical activity (MVPA) for persons with PD.The sample consisted of 30 persons with mild-to-moderate PD and 30 controls matched by age and sex. Participants performed a 6-minute bout of over-ground walking at comfortable speed, and then completed three, 6-minute bouts of treadmill walking at 13.4 m/min slower, comfortable, and 13.4 m/min faster than comfortable speeds. The three treadmill speeds were based on the initial over-ground walking speed. The total number of steps per treadmill walking bout was recorded using a hand-tally counter, and energy expenditure was measured using a portable, indirect spirometry system.The results indicated a strong association between step-rate and energy expenditure for persons with PD (R2 = .92) and controls (R2 = .92). The analyses further indicated a steeper slope of the association for persons with PD compared with controls (t(58) = -1.87, P < .05), resulting in a lower step-rate threshold (t(58) = 2.19, P < .05) for persons with PD (~80 steps·per minutes) than controls (~93 steps·per minutes).Collectively, these results support the application of this disease-specific step-rate threshold for MVPA among persons with PD. This has important implications for physical activity promotion, prescription, and monitoring using accelerometers and pedometers for persons with PD to manage health and symptoms of PD.
View details for DOI 10.1111/ane.13250
View details for Web of Science ID 000527385300001
View details for PubMedID 32255504
View details for PubMedCentralID PMC7357721
Quantitative Synthesis of Timed 25-Foot Walk Performance in Multiple Sclerosis
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
2020; 101 (3): 524-534
To provide a meta-analysis of articles that have included the timed 25-foot walk (T25FW) in persons with multiple sclerosis (MS), quantify differences in T25FW scores between those with MS and controls without MS, and quantify differences between categories of disability status and clinical disease courses within MS.The literature search was conducted using 4 databases (Google Scholar, PubMed, Cumulative Index to Nursing and Allied Health, EBSCO Host). We searched reference lists of published articles to identify additional articles.A systematic literature search identified articles reporting average T25FW performance in seconds between those with MS and controls without MS, between those with MS who had mild and moderate and/or severe disability status, and between relapsing-remitting and progressive clinical courses of MS.Information was extracted and categorized based on reported data: comparisons of controls without MS and MS, comparisons of mild and moderate and/or severe MS based on study-defined Expanded Disability Status Scale groups, and comparisons of relapsing-remitting and progressive MS clinical courses.We performed a random effects meta-analysis to quantify differences between groups as estimated by effect sizes (ESs). We expressed the differences in Cohen d as well as the original units of the T25FW (ie, seconds).There was a large difference in T25FW performance in MS compared with controls without MS (ES=-0.93, mean difference=2.4s, P<.01). Persons with moderate and/or severe disability walked substantially slower compared with mild disability (ES=-1.02, mean difference=5.4s, P<.01), and persons with progressive courses of MS walked substantially slower than relapsing-remitting MS (ES=-1.4, mean difference=13.4s, P<.01).
View details for DOI 10.1016/j.apmr.2019.08.488
View details for Web of Science ID 000520949900014
View details for PubMedID 31669296
Accuracy and Precision of Three Consumer-Grade Motion Sensors During Overground and Treadmill Walking in People With Parkinson Disease: Cross-Sectional Comparative Study.
JMIR rehabilitation and assistive technologies
2020; 7 (1): e14059
Wearable motion sensors are gaining popularity for monitoring free-living physical activity among people with Parkinson disease (PD), but more evidence supporting the accuracy and precision of motion sensors for capturing step counts is required in people with PD.This study aimed to examine the accuracy and precision of 3 common consumer-grade motion sensors for measuring actual steps taken during prolonged periods of overground and treadmill walking in people with PD.A total of 31 ambulatory participants with PD underwent 6-min bouts of overground and treadmill walking at a comfortable speed. Participants wore 3 devices (Garmin Vivosmart 3, Fitbit One, and Fitbit Charge 2 HR), and a single researcher manually counted the actual steps taken. Accuracy and precision were based on absolute and relative metrics, including intraclass correlation coefficients (ICCs) and Bland-Altman plots.Participants walked 628 steps over ground based on manual counting, and Garmin Vivosmart, Fitbit One, and Fitbit Charge 2 HR devices had absolute (relative) error values of 6 (6/628, 1.0%), 8 (8/628, 1.3%), and 30 (30/628, 4.8%) steps, respectively. ICC values demonstrated excellent agreement between manually counted steps and steps counted by both Garmin Vivosmart (0.97) and Fitbit One (0.98) but poor agreement for Fitbit Charge 2 HR (0.47). The absolute (relative) precision values for Garmin Vivosmart, Fitbit One, and Fitbit Charge 2 HR were 11.1 (11.1/625, 1.8%), 14.7 (14.7/620, 2.4%), and 74.4 (74.4/598, 12.4%) steps, respectively. ICC confidence intervals demonstrated low variability for Garmin Vivosmart (0.96 to 0.99) and Fitbit One (0.93 to 0.99) but high variability for Fitbit Charge 2 HR (-0.57 to 0.74). The Fitbit One device maintained high accuracy and precision values for treadmill walking, but both Garmin Vivosmart and Fitbit Charge 2 HR (the wrist-worn devices) had worse accuracy and precision for treadmill walking.The waist-worn sensor (Fitbit One) was accurate and precise in measuring steps with overground and treadmill walking. The wrist-worn sensors were accurate and precise only during overground walking. Similar research should inform the application of these devices in clinical research and practice involving patients with PD.
View details for DOI 10.2196/14059
View details for PubMedID 31944182
View details for PubMedCentralID PMC6996761
Exercise and multiple sclerosis: Benefits, participation rates, determinants, and opportunities
The Handbook of Sport Psychology, Fourth Edition
John Wiley & Sons, Inc.. 2020
View details for DOI 10.1002/9781119568124.ch41
Physical activity, sedentary behavior, and restless legs syndrome in persons with multiple sclerosis
JOURNAL OF THE NEUROLOGICAL SCIENCES
2019; 407: 116531
The present study examined the relationships among parameters (i.e., volume and pattern) of physical activity and sedentary behavior with the presence and severity of restless legs syndrome(RLS) in adults with multiple sclerosis(MS). Participants with MS (N = 253) wore an accelerometer for a 7-day period and completed the Cambridge-Hopkins Restless Legs Syndrome Questionnaire, the International Restless Legs Syndrome Study Group Scale (IRLS), and the Patient Determined Disease Steps scale. Sixty-six (26%) persons with MS had RLS (MS + RLS). There were no differences between the MS + RLS and MS group for parameters of physical activity or sedentary behavior. Among participants with IRLS scores in the mild range (n = 26), more time spent in light physical activity (rs = 0.39), fewer sedentary bouts per day (rs = 0.55), less time in sedentary bouts per day (rs = 0.51), and fewer breaks in sedentary time per day (rs = 0.57) were associated with lower RLS severity. This study represents the first step toward recognizing a relationship between physical activity, patterns of sedentary behavior, and RLS severity in MS and these results suggest that light physical activity and the pattern of sedentary behavior may be important targets for prospective behavioral interventions that target the management of RLS in persons with MS who have mild RLS severity.
View details for DOI 10.1016/j.jns.2019.116531
View details for Web of Science ID 000503097600016
View details for PubMedID 31654833
View details for PubMedCentralID PMC6891217
Validity of Sitting Time Scores From the International Physical Activity Questionnaire-Short Form in Multiple Sclerosis
2019; 64 (4): 463-468
The current study examined the validity of scores from the sitting time item on the International Physical Activity Questionnaire-Short Form (IPAQ-SF) in a sample of persons with multiple sclerosis (MS).Persons with MS were recruited through the distribution of printed letters to a random sample of 1,000 persons from the North American Research Committee on MS registry. Two hundred ninety-five persons with MS were interested and volunteered to wear an ActiGraph accelerometer for a 7-day period and complete a battery of questionnaires that included the IPAQ-SF and Godin Leisure-Time Exercise Questionnaire over this period of time.IPAQ-SF sitting time scores were consistently and moderately correlated with all of the sedentary behavior metrics from the accelerometer (range of r between .295 and .431), and the correlations were stronger than those between self-reported physical activity and sedentary metrics from the accelerometer (range of r between -.087 and .163). The correlations between IPAQ-SF sitting time scores with the accelerometer-derived sedentary behavior metrics were still statistically significant in the analyses controlling for physical activity (range of parametric correlations between .281 and .411).The correlation analysis indicated consistent, moderate correlations between IPAQ-SF sitting time scores and device-measured estimates of both the volume and pattern of sedentary behavior, and the correlations were (a) stronger than those for self-reported physical activity and (b) independent of self-reported physical activity. Such results provide initial evidence for the validity of inferences from IPAQ-SF sitting time scores as an overall measure of sedentary behavior in persons with MS. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
View details for DOI 10.1037/rep0000280
View details for Web of Science ID 000491284200008
View details for PubMedID 31107044
View details for PubMedCentralID PMC6803020
Does restless legs syndrome impact cognitive function via sleep quality in adults with Parkinson's disease?
INTERNATIONAL JOURNAL OF NEUROSCIENCE
2020; 130 (4): 322-329
Purpose: Restless legs syndrome (RLS) is a sleep disorder that results in sleep dysfunction. Sleep disruption can have profound negative consequences in adults with Parkinson's disease (PD), potentially including cognitive dysfunction. This study examined the relationships among RLS, cognition, and sleep quality in persons with PD.Materials and methods: Participants (N = 79) with idiopathic PD completed six questionnaires evaluating RLS, sleep quality, daytime sleepiness, global cognitive function, sleep apnea risk, and depression. Participants were further examined for body mass index composition and motor symptom severity (MDS-UPDRS Part III).Results: Persons with RLS (n = 25) had significantly worse cognitive function (p = 0.035, d = -0.56) and sleep quality (p < 0.0001, d = -1.19), and more daytime sleepiness (p = 0.009, d = 0.67) than those without RLS (n = 54). Cognitive function was not significantly correlated with sleep quality (rs = 0.113) or daytime sleepiness (rs = -0.001). The association between RLS and cognition was not attenuated by controlling for sleep quality or daytime sleepiness.Conclusions: This study is unique as it is the first to consider the possibility that RLS in PD may be associated with cognitive deficits through a pathway involving sleep quality. Persons with RLS and PD have greater deficits in both sleep quality and cognitive function than individuals without RLS; however, cognitive dysfunction among those with PD and RLS in this sample is not accounted for by sleep quality.
View details for DOI 10.1080/00207454.2019.1681423
View details for Web of Science ID 000492498100001
View details for PubMedID 31625438
View details for PubMedCentralID PMC7101254
Self-efficacy and walking performance across the lifespan among adults with multiple sclerosis
NEURODEGENERATIVE DISEASE MANAGEMENT
2019; 9 (5): 267-275
Aim: We examined associations between self-efficacy and walking mobility across the lifespan in multiple sclerosis (MS). Methods: This study included 39 young, 44 middle-aged and 41 older adults with MS who completed the Six-Minute Walk (6MW), Timed 25-foot Walk (T25FW), MS Walking Scale-12 (MSWS-12) and MS Self-efficacy Scale. Results: Self-efficacy for function explained 45 and 48% of variance in MSWS-12 scores for young and older adults with MS, respectively; 13, 29 and 23% of variance in T25FW for young, middle-aged and older adults, respectively; and 28, 31 and 28% of variance in 6MW for young, middle-aged and older adults with MS, respectively. Conclusion: This study highlights self-efficacy as a target of in-walking mobility interventions across the lifespan in MS.
View details for DOI 10.2217/nmt-2019-0007
View details for Web of Science ID 000498821700005
View details for PubMedID 31580224
Social-cognitive theory variables as correlates of sedentary behavior in multiple sclerosis: Preliminary evidence
DISABILITY AND HEALTH JOURNAL
2019; 12 (4): 622-627
Persons with multiple sclerosis(MS) engage in substantially more sedentary behavior than adults from the general population.Hypothesis: This preliminary, cross-sectional study examined social-cognitive theory(SCT) variables as correlates of sedentary behavior in MS. We hypothesized that scores from SCT variables for sedentary behavior change would correlate with scores from self-reported and device-measured volumes of sedentary behavior in MS. We further hypothesized that the correlations would be stronger for self-reported than device-measured sedentary behavior, and that the primary correlate of sedentary behavior would be self-efficacy.We recruited participants through a random sample of 1,000 persons enrolled in the North American Research Committee on MS registry, and 275 of the 296 persons who underwent screening volunteered for the study. Participants wore an ActiGraph accelerometer on a belt around the waist for measuring minutes per day of sedentary behavior. Participants further completed a newly-created, study-specific measure of SCT variables for reducing sedentary behavior(i.e., self-efficacy, outcome expectations, barriers, goal setting, & planning) and the abbreviated International Physical Activity Questionnaire as a self-report measure of sitting time.Self-reported sedentary behavior was associated with self-efficacy(r = -0.47), goal setting(r = -0.31), planning(r = -0.35), and barriers(r = 0.39) for reducing sedentary behavior. Device-measured sedentary behavior was associated with self-efficacy(r = -0.32), goal setting(r = -0.21), planning(r = -0.18), and barriers(r = 0.20). Self-efficacy(β = -0.29), barriers(β = 0.26), and planning(β = -0.24) independently explained variance in self-reported sedentary behavior(R2 = 0.33). Only self-efficacy(β = -0.32) independently explained variance in device-measured sedentary behavior(R2 = 0.10).SCT constructs might be reasonable targets of a behavioral intervention for reducing sedentary behavior in MS.
View details for DOI 10.1016/j.dhjo.2019.05.002
View details for Web of Science ID 000488612100014
View details for PubMedID 31130491
Physical activity and walking performance across the lifespan among adults with multiple sclerosis
MULTIPLE SCLEROSIS AND RELATED DISORDERS
2019; 35: 36-41
There is consistent evidence of an association between physical activity and walking performance in persons with multiple sclerosis (MS). To date, this relationship has been predominantly examined in young and middle-aged adults rather than in the rapidly-growing population of older adults with MS who often times have greater walking problems and are less physically active. This study examined whether physical activity was differentially associated with walking performance across three age groups of young (20-39 years), middle-aged (40-59 years), and older (60-79 years) adults with MS.The sample included 124 persons with MS who attended one testing session and provided demographic information, completed the Timed 25-Foot Walk (T25FW) and the Six Minute Walk (6MW) as measures of walking speed and walking endurance, respectively, and wore an accelerometer for a 7-day period.Trend analysis indicated light physical activity did not significantly differ with increasing age; however, moderate-to-vigorous physical activity (MVPA), walking speed, and walking endurance declined with increasing age. Partial spearman's rank-order correlations between physical activity and walking outcomes that controlled for disease duration, race, and ambulatory disability within each age group indicated that the relationship between MVPA and walking performance was strong among older adults with MS (prs for MVPA and T25FW: young = -0.01, middle-aged = -0.16, older = -0.63*; prs for MVPA and 6MW: young = 0.10, middle-aged = 0.08, older = 0.68*).Interventions targeting MVPA may be an appropriate approach for managing walking impairment, particularly in older adults with MS.
View details for DOI 10.1016/j.msard.2019.07.003
View details for Web of Science ID 000495743000009
View details for PubMedID 31302502
Changes in Cognitive Performance With Age in Adults With Multiple Sclerosis
COGNITIVE AND BEHAVIORAL NEUROLOGY
2019; 32 (3): 201-207
Cognitive impairment is one of the most common consequences of multiple sclerosis (MS), yet there is a shortage of data regarding how cognition changes during the life span of individuals with MS. This information is of increasing importance given the growing proportion of older adults with MS.To study possible changes in cognitive function in correlation with increasing age in individuals with MS.Participants (N=129) were recruited and a priori allocated into one of three age groups (young, middle-aged, and older). All participants completed the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) during a single laboratory testing session. The BICAMS measures cognitive processing speed as well as verbal and visuospatial learning and memory.A multivariate analysis of variance indicated that cognitive function significantly differed by age group, and these differences were not explained by amount of physical activity, years of education, years since diagnosis, or race. Older adults displayed significantly worse cognitive processing speed than young and middle-aged adults. The older and middle-aged adults also demonstrated significantly worse visuospatial learning and memory than the younger adults. Effect sizes indicated that cognitive processing speed and verbal learning and memory were more affected in late adulthood than early adulthood, whereas visuospatial learning and memory was affected similarly in early and late adulthood.Older adults with MS demonstrated significant impairments in cognitive function compared to young and middle-aged adults with MS. Future studies should determine the predictors of cognitive decline in this age cohort.
View details for DOI 10.1097/WNN.0000000000000200
View details for Web of Science ID 000490483700007
View details for PubMedID 31517704
View details for PubMedCentralID PMC6750025
Walking endurance in multiple sclerosis: Meta-analysis of six-minute walk test performance
GAIT & POSTURE
2019; 73: 147-153
The 6-minute walk (6 MW) is the most commonly applied measure of endurance walking capacity in persons with multiple sclerosis (MS); however, we are not aware of a quantitative synthesis of 6 MW performance in MS.We undertook a meta-analysis quantifying the overall magnitude of difference in 6 MW performance between MS and healthy controls (HCs), and then within MS as a function of disability status. We further examined possible moderator variables of 6 MW performance.The systematic search was conducted for articles that included the 6 MW in persons with MS and involved comparison groups (i.e., HCs or MS disability subgroups (i.e., mild vs moderate-to-severe disability status)). The mean and standard deviation of the distance traveled during the 6 MW as well as sample sizes were entered into Comprehensive Meta-Analysis software and we estimated the overall effect size (Cohen's d) using a random effects model and examined categorical variables as possible moderators (e.g., instruction protocol, provision of encouragement, method of distance measurement, and course description).Thirty-four studies met inclusion criteria with a total sample size of 3204 persons (MS: 2683; HC: 521) yielding 42 total comparisons. Persons with MS walked a shorter distance than HCs (mean difference = -177.2 ± 19.1 m) with a large effect size (d = - 1.87). Persons with mild disability walked further than those with moderate-to-severe disability (mean difference = 185.19 ± 9.2 m) with a large effect (d = 1.83). The categorical variables of provision of encouragement and course layout moderated the effect of MS and course layout moderated the effect of disability status on 6 MW performance.This meta-analysis of 6 MW performance defines mean difference in 6 MW performance in MS compared with HCs and provides an estimate of the disease-related effect of MS on endurance walking capacity for application within clinical research and practice.
View details for DOI 10.1016/j.gaitpost.2019.07.125
View details for Web of Science ID 000481610500021
View details for PubMedID 31326830
Use of the Godin leisure-time exercise questionnaire in multiple sclerosis research: a comprehensive narrative review
DISABILITY AND REHABILITATION
2019; 41 (11): 1243-1267
The Godin Leisure-Time Exercise Questionnaire has been a commonly applied measure of physical activity in research among persons with multiple sclerosis over the past decade. This paper provides a comprehensive description of its application and inclusion in research on physical activity in multiple sclerosis.This comprehensive, narrative review included papers that were published between 1985 and 2017, written in English, involved participants with multiple sclerosis as a primary population, measured physical activity, and cited one of the two original Godin papers.There is a broad scope of research that has included the Godin Leisure-Time Exercise Questionnaire in persons with multiple sclerosis. Overall, 8 papers evaluated its psychometric properties, 21 evaluated patterns of physical activity, 24 evaluated correlates or determinants of physical activity, 28 evaluated outcomes or consequences of physical activity, and 15 evaluated physical activity interventions. The Godin Leisure-Time Exercise Questionnaire is a valid self-report measure of physical activity in persons with multiple sclerosis, and further is an appropriate, simple, and effective tool for describing patterns of physical activity, examining correlates and outcomes of physical activity, and provides a sensitive outcome for measuring change in physical activity after an intervention. Implications for rehabilitation There is increasing interest in physical activity and its benefits in multiple sclerosis. The study of physical activity requires appropriate and standardized measures. The Godin Leisure-Time Exercise Questionnaire is a common self-report measure of physical activity for persons with multiple sclerosis. Godin Leisure-Time Exercise Questionnaire scores are reliable measures of physical activity in persons with multiple sclerosis. The Godin Leisure-Time Exercise Questionnaire further is an appropriate, simple, and effective tool for describing patterns of physical activity, examining correlates and outcomes of physical activity participation, and is an advantageous primary outcome for measuring change in physical activity in response to an intervention.
View details for DOI 10.1080/09638288.2018.1424956
View details for Web of Science ID 000465206300001
View details for PubMedID 29343122
Sociodemographic and clinical correlates of device-measured sedentary behaviour in multiple sclerosis
DISABILITY AND REHABILITATION
2021; 43 (1): 42-48
This study examined sociodemographic and clinical variables as correlates of device-measured volume and pattern of sedentary behaviour in persons with multiple sclerosis (MS).Participants were recruited through a standardised invitation letter distributed among 1000 persons randomly selected from the North American Research Committee on MS registry. Those who volunteered wore an accelerometer for 7 d and provided sociodemographic and clinical information.There were 233 persons with MS who were included in the analyses. Linear regression analyses indicated that age and MS type explained significant variance in total sedentary time per day as well as number of breaks in sedentary time. Only disability status explained significant variance in sedentary bout length, whereas age explained significant variance in both number of long sedentary bouts per day. Both age and disability status explained significant variance total time spent in long sedentary bouts per day.Persons of older age, progressive MS, and higher disability status spend prolonged, uninterrupted periods of time sedentary. Such results highlight the need for targeted interventions in sub-populations of MS that reduce time spent sedentary and break up the pattern of sedentary behaviour. Implications for Rehabilitation Sedentary behaviour is highly prevalent in multiple sclerosis and may be associated with comorbid conditions. The majority of research on sedentary behaviour in multiple sclerosis has been derived from self-report instruments that only measure the volume of sitting time per day. This study indicates that persons with multiple sclerosis spend a significant amount of time sedentary, and those who are older, have progressive multiple sclerosis, and have higher disability status spend prolonged, uninterrupted periods of time sedentary. Such results highlight the need for targeted behavioural interventions in these sub-populations of multiple sclerosis to reduce time spent sedentary and break the pattern of sedentary behaviour to manage its consequences.
View details for DOI 10.1080/09638288.2019.1614683
View details for Web of Science ID 000470553900001
View details for PubMedID 31094587
View details for PubMedCentralID PMC6858518
Characteristics of Adults With Neurologic Disability Recruited for Exercise Trials: A Secondary Analysis
ADAPTED PHYSICAL ACTIVITY QUARTERLY
2018; 35 (4): 476-497
This review examined demographic and clinical characteristics of participants from exercise trials in 3 neurologic disability conditions (multiple sclerosis, spinal cord injury, and traumatic brain injury) and compared these data with population-based statistics. The authors included 75 published studies from 2006 to 2016: 53 studies for multiple sclerosis (n = 2,034), 14 for spinal cord injury (n = 302), and 8 for traumatic brain injury (n = 272). Pooled data resembled some heterogeneous aspects of population data sets. However, many characteristics were not reported; samples were small and predominantly White, and 48.1% of the people screened were excluded. Thus, findings from these studies may not be translatable across the range of people with these three conditions, which warrant efforts to target the inclusion of underrepresented subgroups in future exercise trials.
View details for DOI 10.1123/apaq.2017-0109
View details for Web of Science ID 000449693700009
View details for PubMedID 30382753
- Magnitude and duration of acute-exercise intensity effects on symptoms of restless legs syndrome: a pilot study SLEEP AND BIOLOGICAL RHYTHMS 2018; 16 (3): 337-344
Self-Regulatory Strategies as Correlates of Physical Activity Behavior in Persons With Multiple Sclerosis
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
2018; 99 (5): 920-926
To examine self-regulation strategies as correlates of physical activity in persons with multiple sclerosis (MS).Cross-sectional, or survey, study.University-based research laboratory.Convenience sample of persons with MS (N=68).Not applicable.Exercise Self-Efficacy Scale (EXSE), 12-item Physical Activity Self-Regulation Scale (PASR-12), and Godin Leisure-Time Exercise Questionnaire (GLTEQ).Correlation analyses indicated that GLTEQ scores were positively and significantly associated with overall self-regulation (r=.43), self-monitoring (r=.45), goal-setting (r=.27), reinforcement (r=.30), time management (r=.41), and relapse prevention (r=.53) PASR-12 scores. Regression analyses indicated that relapse prevention (B=5.01; SE B=1.74; β=.51) and self-monitoring (B=3.65; SE B=1.71; β=.33) were unique predictors of physical activity behavior, and relapse prevention demonstrated a significant association with physical activity behavior that was accounted for by EXSE.Our results indicate that self-regulatory strategies, particularly relapse prevention, may be important correlates of physical activity behavior that can inform the design of future behavioral interventions in MS.
View details for DOI 10.1016/j.apmr.2017.12.037
View details for Web of Science ID 000431387000014
View details for PubMedID 29428345
Physical Activity, Sedentary Behavior, and Physical Function in Older Adults With Multiple Sclerosis
JOURNAL OF AGING AND PHYSICAL ACTIVITY
2018; 26 (2): 177-182
Older adults with multiple sclerosis (MS) experience the combined effects of aging and a chronic, disabling neurological disease on physical activity, sedentary behavior, and physical function. This study examined associations among light and moderate-to-vigorous physical activity (LPA and MVPA), sedentary behavior, and physical function in older adults with MS. Forty older adults with MS (median age = 60 years) who had a median Expanded Disability Status Scale score of 4.5 wore an accelerometer for a 7-day period and completed the Short Physical Performance Battery (SBBP), 6-minute walk (6MW), and timed 25-foot walk (T25FW). LPA was associated with SPPB (rs = .551, p < 0.01), 6MW (rs = .660, p < 0.01), and T25FW (rs = .623, p < 0.01) scores; MVPA was associated with 6MW (rs = .529, p < 0.01) and T25FW (rs = .403, p < 0.01) scores. There were significant associations between LPA, but not MVPA, with SPPB (β = .583, p < 0.01), 6MW (β = .613, p < 0.01), and T25FW (β = .627, p < 0.01) scores in linear regression analyses. Older adults with MS who engaged in more LPA demonstrated better physical function and therefore LPA might be a target of future behavioral interventions.
View details for DOI 10.1123/japa.2016-0358
View details for Web of Science ID 000435081600003
View details for PubMedID 28605269
- Fluid Intake and Sweat Rate During Hot Yoga Participation INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2017; 10 (5): 721-733
- Restless legs syndrome in multiple sclerosis: A call for better understanding and non-pharmacological management CURRENT TRENDS IN NEUROLOGY 2016; 10: 65-73