Behavior and Activity Monitoring in MS

Behavior and Activity Monitoring in Multiple Sclerosis

The investigators propose to conduct a randomized 6-month intervention study comparing cognitive functioning in individuals with relapsing-remitting multiple sclerosis assigned to either a physical activity or an active water-intake control group. Individuals will complete pre-, mid- and post-assessments of cognitive, physical, and behavioral functioning.

Study Overview

• Status: Completed
• Conditions: Relapsing-Remitting Multiple Sclerosis
• Intervention / Treatment: Behavioral: Step Tracking; Behavioral: Water Tracking

Detailed Description

Interventions to increase physical activity through aerobic exercise are some of the only known treatment options to improve domains of cognition such as executive function. While increased physical activity is associated with preserved cortical functioning during exogenous executive functioning tasks in older adults, little is known about the relationship between physical activity and executive functioning in multiple sclerosis. Thus, the investigators propose to conduct a randomized 6-month accelerometry-based intervention designed to increase overall physical activity in sedentary relapsing-remitting multiple sclerosis with known cognitive challenges. The overall objective is to determine how a 6-month activity tracking intervention impacts the behavioral, neural and mechanistic associations between physical activity and cognitive functioning. All individuals who contact the Clinical Neuroscience Laboratory (CNL) with interest in this study will undergo a phone/online screening assessing inclusion/exclusion criteria. Those participants meeting I/E criteria will be invited to the lab for 2 pre-assessment sessions, one session at midpoint, and 2 post-assessment sessions at the completion of the 6 month intervention. Participants will also be asked to complete a number of online questionnaires following the first assessment session. The two pre-assessments will involve a through measure of cognitive functioning, both through the use of neuropsychological batteries and neuroimaging, and inflammatory markers through collection of a blood sample. Following the pre-assessment sessions, conducted by blind personnel, participants will be randomized to one of the two groups. Participants will be asked to self-monitor their assigned health behavior with the aid of a behavioral tracker (accelerometer or smart water bottle). Via a mobile application designed by the laboratory, participants will receive daily and weekly summaries of their health behavior progress, and motivational materials to encourage goal attainment. The 6-month intervention will involve minimal contact from study coordinators. Participants who do not adhere to study goals will be contacted by a study coordinator via phone who will use motivational interviewing to promote behavior change. Following the 6-month intervention the 2 assessment sessions will be repeated to obtain post-intervention data for comparison.

• Study Type: Interventional
• Enrollment (Actual): 87
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Ohio
    • Columbus, Ohio, United States, 43210
      • Department of Psychology, The Ohio State University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 30 years to 59 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Clinically definite diagnosis of Relapsing-Remitting Multiple Sclerosis
• Score higher than 23 on the Mini-Mental Status Examination (MMSE)
• Expanded Disability Status Scale (EDSS) under 5.5
• Right-handed

Exclusion Criteria:

• Clinically isolated syndrome or progressive MS subtype
• Presence of any other neurological disorders
• Presence of psychiatric disorder diagnosed by a licensed mental health provider in the last two years
• Clinically definite relapse or use of high dose corticosteroids within the last 30 days
• Recreational drug use in the last 6 months
• Without access to a smart phone or no access to the internet
• Current use of accelerometer, pedometer, and/or physical activity monitoring equipment
• Presence of ferromagnetic implanted devices or self-reported claustrophobia

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Step Tracking; Participants will track their physical activity in steps using an accelerometer for a period of 6 months. Participants will monitor their overall step-count using the accelerometer, and daily and weekly summaries of their progress provided by the experimenters.	Behavioral: Step Tracking; The step tracking intervention is designed to increase physical activity through the use of self-monitoring and brief motivational materials. The motivational materials will be delivered at various points during the intervention. Participants are not required to access and read these materials, however, the hope is these materials will aid in study and goal adherence. Engagement in the intervention will be tracked by the experimenters using the behavioral data gathered by the tracker.
Active Comparator: Water Tracking; Participants will track their water-intake using a smart water bottle for a period of 6 months. Participants will monitor their overall water consumption using a smart water bottle, and daily and weekly summaries of their progress provided by the experimenters.	Behavioral: Water Tracking; The water tracking intervention is designed to increase water intake, to a healthy level, through the use of self-monitoring and brief motivational materials.The motivational materials will be delivered at various points during the intervention. Participants are not required to access and read these materials, however, the hope is these materials will aid in study and goal adherence. Engagement in the intervention will be tracked by the experimenters using the behavioral data gathered by the tracker.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Cognitive Performance on a Latent Measure of Working Memory/Processing Speed	Change in a latent factor of working memory/processing speed will be examined from pre to post intervention. This latent factor will be created using baseline performance on measures from the Minimal Assessment of Cognitive Functioning in Multiple Sclerosis battery (MACFIMS), the NIH Toolbox Cognition Battery (NIHTB-CB), and the processing speed and working memory measures from the Wechsler Adult Intelligence Scale (WAIS-IV) before, during (at midpoint), and after the intervention. Higher scores on this factor represent better working memory/processing speed performance. Investigators hypothesize changes in cognitive performance, specifically in the domains of working memory and processing speed.	Baseline, 3 months, and 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in the Functional Architecture of the MS Brain during Working Memory	Before and after the intervention, participants will undergo a brain imaging scan using functional Magnetic Resonance Imaging (fMRI) technology. Network strength in the working memory connectome during the NBack task will be the primary fMRI-based neuroimaging measure. Higher network strength in the working memory connectome represent greater connections between brain edges associated with high working memory performance. Participants in the physical activity group will show increased network strength in a connectome-based model of working memory performance.	Baseline and 6 months
Changes in the Functional Architecture of the MS Brain during Processing Speed	Before and after the intervention, participants will undergo a brain imaging scan using functional Magnetic Resonance Imaging (fMRI) technology. Network strength in the processing speed neuromaker during the Symbol Digit Modalities Test will be the outcome variable. Higher network strength in the processing speed neuromarker represent greater connections between brain edges associated with high processing speed performance. Participants in the physical activity group will show increased network strength in this neuromarker of processing speed.	Baseline and 6 months
Changes on a Self-Report Measure of Depression	Participants will be administered Beck Depression Inventory-II before, at mid-point, and after the intervention. This measure assesses self-reported depressive symptoms with a range of 0-63 with higher scores characterizing higher endorsement of depressive symptoms. Changes in scores will indicate effects of the intervention on symptoms of depression.	Baseline, 3 months, and 6 months
Changes on a Self-Report Measure of Anxiety	Participants will be administered the Penn State Worry Questionnaire before, at mid-point and after the intervention. This measure assesses self-reported worry symptoms with a range of 16-80. High scores on this measure represent higher levels of chronic worrying. Change on this measure will be assessed to determine the impact of the intervention on symptoms of worry.	Baseline, 3 months and 6 months
Changes on a Self-Report Measure of Perceived Stress	Participants will be administered the Perceived Stress Scale before, at mid-point and after the intervention. This measure assesses perceived stress with a range of 0-40. High scores on the perceived stress scale represent higher levels of stress. Change on this measure will indicate impact of the intervention on symptoms of stress.	Baseline, 3 months and 6 months
Changes on a Self-Report Measure of Quality of Life	Participants will be administered the Satisfaction with Life Scale and the World Health Organization Quality of Life Scale before, at mid-point, and after the intervention. Standardized scores for the two measures will be merged to create a composite score for quality of life. High scores on this composite measure would represent higher quality of life. Differences in the composite score of quality of life will reveal changes in quality of life as a function of the intervention.	Baseline, 3 months and 6 months
Changes on a Self-Report Measure of Sleep Quality	Participants will be administered the Pittsburgh Sleep Quality Index before, at mid-point, and after the intervention. This measure assesses sleep quality with a range of 0-21. Higher score on this measure represents greater difficulty with sleep. Score changes on this measure will indicate changes in sleep quality as a function of the intervention.	Baseline, 3 months and 6 months
Changes on a Self-Report Measure of Fatigue	Participants will be administered the Modified Fatigue Impact Scale before, at mid-point and after the intervention. This measure assesses self-reported fatigue with a range of 0-84. High scores on this measure represent higher levels of experienced fatigue. Differences in scores on this measure will indicate changes in fatigue as a function of the intervention.	Baseline, 3 months and 6 months

Collaborators and Investigators

• Sponsor: Ohio State University
• Collaborators: National Multiple Sclerosis Society
• Investigators: Principal Investigator: Ruchika S Prakash, PhD, Ohio State University

Publications and helpful links

General Publications

• Manglani HR, Fountain-Zaragoza S, Shankar A, Nicholas JA, Prakash RS. Employing Connectome-Based Models to Predict Working Memory in Multiple Sclerosis. Brain Connect. 2022 Aug;12(6):502-514. doi: 10.1089/brain.2021.0037. Epub 2021 Sep 28.

Study record dates

Study Major Dates

• Study Start (Actual): November 2, 2017
• Primary Completion (Actual): June 28, 2021
• Study Completion (Actual): June 28, 2021

Study Registration Dates

• First Submitted: August 7, 2017
• First Submitted That Met QC Criteria: August 7, 2017
• First Posted (Actual): August 9, 2017

Study Record Updates

• Last Update Posted (Actual): March 24, 2023
• Last Update Submitted That Met QC Criteria: March 22, 2023
• Last Verified: March 1, 2023

More Information

Terms related to this study

• Keywords: Multiple Sclerosis; Physical Activity; Immune System Diseases; Nervous System Diseases; Neurodegenerative Disease; Hydration; Lifestyle Intervention; Walking; Sclerosis; Demyelinating Diseases; Inflammatory Biomarkers; Autoimmune Diseases of the Nervous System; Demyelinating Autoimmune Diseases, Central Nervous System; Health Behavior Tracking
• Additional Relevant MeSH Terms: Pathologic Processes; Nervous System Diseases; Immune System Diseases; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Demyelinating Diseases; Autoimmune Diseases; Multiple Sclerosis; Sclerosis; Multiple Sclerosis, Relapsing-Remitting
• Other Study ID Numbers: 2014H0483

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No