Feasibility of Remote Exercise Training for Hispanics/Latinos With MS (FERLAMS)
The Feasibility and Efficacy of a Remotely Delivered Exercise Training Intervention for the Hispanic/Latino Community With Multiple Sclerosis
The goal of this clinical trial is to investigate the potential benefits of a specially designed exercise program for Hispanics/Latinos with multiple sclerosis (MS). The main questions it aims to answer are:
- Can a 4-month remotely-delivered exercise training program improve physical function, symptom management, and quality of life in Hispanics/Latinos with MS?
- How do social determinants of health, such as income, education, access to healthcare, and social support, influence the feasibility and effectiveness of the exercise intervention?
Participants in this study will engage in a 4-month remotely-delivered exercise training intervention that includes flexibility, or aerobic and resistance exercise training sessions. They will work with experienced coaches who will guide and support them throughout the program. The researchers will compare the participants who receive the exercise intervention with a control group to see if the exercise program leads to significant improvements in physical function, fatigue, mood, and overall well-being for Hispanics/Latinos with MS. The study aims to empower this underserved population and provide insights for future healthcare and research initiatives.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The FERLA MS study is a randomized controlled trial aimed at investigating the feasibility and effectiveness of a remotely-delivered exercise training intervention for Hispanics/Latinos with MS. This study aims also aims to address the significant health disparities faced by this underserved population and provide insights into the potential benefits of exercise training in managing MS symptoms and improving quality of life.
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system, affecting millions of adults in the United States. Hispanics/Latinos with MS are particularly vulnerable to more aggressive disease progression and greater long-term disability compared to other racial/ethnic groups. These disparities are likely influenced by social determinants of health (SDOH), such as limited access to healthcare, medical services, and underrepresentation in medical research. The FERLA MS study seeks to explore the role of exercise training as a disease-modifying and symptom-managing intervention for enhancing health outcomes and overall well-being in this marginalized population.
The study has three main aims:
Aim #1: Assess the Feasibility of the Exercise Intervention. This aim focuses on evaluating the feasibility of a 4-month remotely-delivered exercise training intervention for Hispanics/Latinos with MS. The research team will assess the process, resource, management, and scientific measures to determine the practicality, safety, and efficacy of the intervention.
Aim #2: Evaluate the Efficacy of the Exercise Intervention. The second aim involves evaluating the effectiveness of the exercise intervention in improving physical function, symptom management, and overall quality of life compared to an active control condition. Specific outcomes include the 30-second sit-to-stand test, neuropsychological measures of cognition, fatigue, depression, anxiety, and self-reported health-related quality of life.
Aim #3: Explore the Impact of SDOH Factors. The third aim is to explore the influence of SDOH, such as income, education, access to healthcare, and social support, on the feasibility and potential efficacy of the exercise intervention for improving outcomes in Hispanics/Latinos with MS.
The study is guided by the following hypotheses:
Hypothesis 1: The remotely-delivered exercise training intervention will be feasible for Hispanics/Latinos with MS, as evidenced by high recruitment, enrollment, adherence, and retention rates, along with reasonable time, space, and monetary costs, and safe and effective delivery leading to improvements in MS symptoms and outcomes.
Hypothesis 2: Participants in the intervention condition will demonstrate significant improvements in physical function, cognition, fatigue, mood, and quality of life compared to the active control.
Hypothesis 3: Social determinants of health will significantly influence the feasibility and effectiveness of the exercise intervention in improving physical and mental health outcomes for Hispanics/Latinos with MS.
The FERLA MS study follows a parallel group, randomized controlled trial design. Eligible participants will be randomly assigned to either the remotely-delivered exercise intervention condition or the control condition. The exercise intervention will be based on the Guidelines for Exercise in Multiple Sclerosis (GEMS) and will include both aerobic and resistance training sessions. Aerobic Exercise: Participants will engage in moderate-intensity walking for 30+ minutes three days per week. The progression of the aerobic exercise will follow different trajectories based on individual needs and abilities. Resistance Exercise: The resistance training will consist of 1-2 sets of 10-15 repetitions of 5-10 exercises targeting different muscle groups, performed three days per week using elastic resistance bands. One-on-One Coaching: The exercise program involves one-on-one semi-structured sessions with MS exercise specialists (behavioral coaches) who will provide guidance, oversight, and support to participants. Coaches will also help with action planning, self-monitoring, and deliver content-relevant newsletters based on social cognitive theory. Control Condition: Participants in the control condition will engage in flexibility exercises through telerehabilitation, aimed at improving range of motion and stretching.
The primary endpoint is the feasibility of the remotely-delivered exercise program. Secondary outcomes include physical function, cognitive function, fatigue, mood, and health-related quality of life. The study will also explore the impact of social determinants of health as tertiary outcomes.
Participants' total time commitment for the study will be approximately 5 months, including recruitment, screening, baseline measures, the 4-month exercise or control intervention, and post-intervention measures. Enrollment duration for all study subjects is anticipated to take approximately 2-3 months, with the study projected to be completed by December 1, 2024. Participants must be aged between 18-65 years, diagnosed with MS, relapse-free for at least 30 days, able to walk with or without an assistive device, have no contraindications to exercise, and self-identify as Hispanic/Latino. Individuals with severe cognitive impairments, other neurological conditions, or medical conditions limiting exercise participation will be excluded.
The FERLA MS study will be conducted in compliance with all relevant institutional review board (IRB) regulations and ethical principles outlined in the Declaration of Helsinki. Participants will provide informed consent before enrollment, and all data will be kept confidential and anonymized to protect participants' privacy.
The study findings will be disseminated through peer-reviewed publications, scientific conferences, and presentations to the public, healthcare providers, and patient advocacy groups. The research team aims to leverage the study results to promote awareness, inform clinical practice, and advocate for more equitable access to healthcare and evidence-based interventions for Hispanics/Latinos with MS.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Illinois
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Chicago, Illinois, United States, 60612
- University of Illinois at Chicago
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age between 18-65 years
- Diagnosis of MS
- Relapse-free for at least 30 days
- Able to walk with or without an assistive device
- Insufficient physical activity (i.e., not meeting current physical activity guidelines of 150 minutes of moderate to vigorous physical activity per week)
- Willingness to complete all required testing procedures, outcome questionnaires, and randomization
- Identify as Hispanic/Latino
- Able to speak, read, and understand English
- Currently reside in Chicago
- Access to the internet and email
- Safe for exercise based on the Physical Activity Readiness Questionnaire (PAR-Q)
Exclusion Criteria:
- Not between 18-65 years
- No diagnosis of MS
- Not relapse-free for at least 30 days
- Not able to walk with or without an assistive device
- Too much physical activity (i.e. 150 minutes or more of moderate to vigorous physical activity per week)
- Not willing to complete all required testing procedures, outcome questionnaires, and randomization
- Do not identify as Hispanic/Latino
- Unable to speak, read, and understand English
- Not currently residing in Chicago
- No access to the internet and email
- Not safe for exercise based on the PAR-Q
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
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Experimental: Exercise Training Program
Participants will receive a theory-based, remotely-delivered exercise training program that includes aerobic and resistance exercise training.
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The intervention group will be encouraged to complete aerobic and resistance training exercises three times a week, and either at home, in the community (e.g., park, shopping mall), or any suitable environment of the participant's choice.
Exercise equipment for monitoring walking and complete resistance training will be provided to the intervention group.
The exercise training prescription involves 30+ minutes of moderate-intensity walking (≥100 steps/min) monitored by a waist-worn pedometer, and resistance training consisting of 1-2 sets, 10-15 repetitions of 5-10 exercises targeting lower and upper body, and core muscle groups using elastic bands.
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Active Comparator: Flexibility Program
Participants will receive a remotely-delivered flexibility program, focusing on improving flexibility and range of motion.
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The control group will be encouraged to complete stretching and range of motion exercises three times a week, and either at home, in the community (e.g., park, shopping mall), or any suitable environment of the participant's choice.
Exercise equipment (yoga mat) for monitoring walking and complete flexibility training will be provided to the control group.
The flexibility training prescription involves stretches from the Stretching for People with MS: An Illustrated Manual from the National MS Society.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Process: Participant Recruitment and Retention
Time Frame: Before, During, and After 16 weeks, pre-, intra- and post-Intervention
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Participant retention during the 16-week intervention period, reported as number of randomized participants who completed or did not complete the assigned program by study arm.
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Before, During, and After 16 weeks, pre-, intra- and post-Intervention
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Lower Extremity Function
Time Frame: Post-intervention at 16 weeks
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Lower extremity function assessed by the 30-second sit-to-stand test (30STS).
Values shown are adjusted post-intervention means from ANCOVA models controlling for baseline value, age, sex, and education.
Higher scores indicate better lower extremity function.
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Post-intervention at 16 weeks
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Visual Processing Speed
Time Frame: Post-intervention at 16 weeks
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Visual processing speed was assessed using the Symbol Digit Modalities Test (SDMT).
Participants were shown a key pairing symbols with numbers and were asked to verbally identify the number corresponding to each symbol as quickly as possible.
The outcome is the total number of correct responses completed in 90 seconds.
Higher values indicate better visual processing speed.
Values shown are adjusted post-intervention means from ANCOVA models controlling for baseline SDMT score, age, sex, and education.
The raw score ranges from 0 to 110 points.
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Post-intervention at 16 weeks
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Verbal Learning and Memory
Time Frame: Post-intervention at 16 weeks
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Verbal learning and memory assessed by the California Verbal Learning Test II (CVLT-II).
A list of 16 words was read aloud by the examiner and participants were asked to immediately recall as many of the words as possible, in any order.
Five trials were given, and the same list of words were read aloud by the examiner at the beginning of each trial.
The number of correct responses from each trial 1 through 5 (T1 to T5) was summed for a total score out of 80 max (range 0-80).
Values shown are adjusted post-intervention means from ANCOVA models controlling for baseline value, age, sex, and education.
Higher scores indicate better verbal learning and memory.
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Post-intervention at 16 weeks
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Fatigue Severity
Time Frame: Post-intervention at 16 weeks
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Fatigue severity assessed by the Fatigue Severity Scale (FSS).
Values shown are adjusted post-intervention means from ANCOVA models controlling for baseline value, age, sex, and education.
Scores range from 1 to 7, with higher scores indicating greater fatigue severity.
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Post-intervention at 16 weeks
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Depression and Anxiety Symptoms
Time Frame: Post-intervention at 16 weeks
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Depression and Anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale Depression subscale (HADS-Depression and HADS-Anxiety).
Values shown are adjusted post-intervention means from ANCOVA models controlling for baseline value, age, sex, and education.
The HADS includes 14 items which can be subscored for depression (7 items) and anxiety (7 items) as separate measures.
Statements in the scale are self-reported by participants as experienced "Most of the time", "A lot of the time", "From time to time, occasionally", or "Not at all".
Scores for anxiety and depression subscales range from 0-21 and are categorized as 'normal' (0-7), 'mild' (8-10), 'moderate' (11-14), and 'severe' (15-21).
Overall, scores range from 0 to 42 with higher scores indicating higher anxious and depressive symptoms.
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Post-intervention at 16 weeks
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Exercise Behavior
Time Frame: Post-intervention at 16 weeks
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Exercise behavior was assessed by Godin Leisure-Time Exercise Questionnaire (GLTEQ) total (TOT) and health contribution scores (HCS).
GLTEQ TOT includes all 3 activity intensity categories (strenuous, moderate, and mild), and GLTEQ HCS with 2 (strenuous and moderate).
Both scores are derived from the same frequency data (# of times per week for each activity type) and the same point values for each intensity level.
Since mild activity contributes only 3 points per occurrence, removing it in the GLTEQ HCS calculation shifts the total upward but does not change the maximum possible value.
The highest possible GLTEQ TOT score (999) is also the highest possible GLTEQ HCS score, and the lowest possible TOT (0) is the same as the lowest possible HCS score (0).
For both, higher scores indicate greater exercise participation and represent a better outcome; lower scores indicate less exercise participation and represent a worse outcome.
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Post-intervention at 16 weeks
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Health-related Quality of Life
Time Frame: Post-intervention at 16 weeks
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Health-related Quality of Life assessed by the Short Form -12 (SF-12), a shortened version of the short-form 36-item health survey, which measures overall health status.
There are 2 composite scores, physical component summary (PCS) and mental component summary (MCS), reported as T-scores, that reflect overall perceived physical and mental health status, respectively.
Both components are qualitatively measured and adjusted based on relative average (general average population is 50 with a standard deviation of 10).
Both PCS and MCS T-scores are norm-based; the US population average is 50 with a standard deviation of 10.
PCS and MCS T-scores above 50 are considered above average and scores below 50 are considered below average.
Values shown are adjusted post-intervention means from ANCOVA models controlling for baseline value, age, sex, and education.
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Post-intervention at 16 weeks
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Social Determinants of Health Factors
Time Frame: Before and after 16 weeks, baseline and post-intervention
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Assessed with the PhenX Toolkit, a consensus measurement for phenotypes and exposures in human research (Cox et al., 2021).
Individual SDOH will assess 12 factors (access to health services, health technology, prescription affordability, discrimination in health care, English proficiency, health literacy, job insecurity, neighborhood environment, racial/ethnic discrimination, religious behaviors, spirituality, and wealth), and structural SDOH factors will assess 7 factors (educational attainment, social vulnerability, neighborhood walking and biking environment, water access and sanitation, air quality index, concentrated poverty, and food).
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Before and after 16 weeks, baseline and post-intervention
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Collaborators and Investigators
Investigators
- Principal Investigator: Robert Motl, Ph.D, University of Illinois at Chicago
Publications and helpful links
General Publications
- Flores VA, Silveira SL, Marquez DX, Kinnett-Hopkins D, Miravalle A, Sierra-Morales F, Hernandez-Peraza Z, Motl RW. Rationale for a 4-month, parallel-group, randomized controlled trial to assess the Feasibility and Efficacy of a Remotely delivered exercise training intervention for Hispanics/Latinos with Multiple Sclerosis (FERLA MS). Pilot Feasibility Stud. 2025 May 8;11(1):62. doi: 10.1186/s40814-025-01641-5.
- Flores VA, Silveira SL, Marquez DX, Kinnett-Hopkins D, Miravalle A, Sierra-Morales F, Motl RW. Feasibility and preliminary outcomes of a remotely-delivered exercise training intervention for English-speaking Hispanics/Latinos with multiple sclerosis: Results from the FERLA MS study. Mult Scler J Exp Transl Clin. 2026 Apr 30;12(2):20552173261448001. doi: 10.1177/20552173261448001. eCollection 2026 Apr-Jun.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- Study2023-0665
- P50MD017349 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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