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Randomized Controlled Trial of the Behavioral Intervention for Physical Activity in Multiple Sclerosis Project: Response Heterogeneity and Predictors of Change

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Abstract

Background

We reported that a social cognitive theory-based (SCT), Internet-delivered behavioral intervention increased device-measured minutes/day of moderate-to-vigorous physical activity (MVPA) over a 6-month period among persons with multiple sclerosis (MS). This paper examined the pattern and predictors of heterogeneity in change for MVPA. Based on previous research, we hypothesized that mild MS disability, fewer MS symptoms, lower baseline MVPA, and positive SCT characteristics (e.g., high exercise self-efficacy) would be associated with greater change in MVPA.

Method

Persons with MS (N = 318) were randomized into behavioral intervention (n = 159) or attention/social contact control (n = 159) conditions that were administered via Internet websites and supported with behavioral coaching. Demographic, clinical, symptom, behavioral, and SCT data were from before the 6-month period of delivering the conditions, and MVPA data were from before and after the 6-month period. We examined heterogeneity based on waterfall plots, box plots, and the Levene statistic. We identified predictors of MVPA change using bivariate correlation and multiple, linear regression analyses per condition.

Results

The Levene statistic indicated statistically significant heterogeneity of variances for MVPA change between conditions (p = .003), and the waterfall plots and box plots indicated greater heterogeneity in MVPA change for the behavioral intervention. MVPA change score was correlated with baseline MVPA (r =  − .33 and r =  − .34, p = .0004 and p = .0001) in both conditions and walking impairment (r =  − .188, p = .047) and race (r = .233, p = .014) in the behavioral intervention condition. The regression analysis indicated that baseline MVPA (Standardized B =  − .449, p = .000002), self-reported walking impairment (Standardized B =  − .310, p = .0008), and race (Standardized B = .215, p = .012) explained 25.6% of variance in MVPA change for the behavioral intervention condition.

Conclusion

We provide evidence for walking impairment, baseline MVPA, and race as predictors of the heterogeneity in the pattern of MVPA change with a behavioral intervention.

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Funding

This study was funded by a grant from the National Multiple Sclerosis Society (RG 5144A6/1).

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Authors and Affiliations

  1. Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX, 77030, USA

    Stephanie L. Silveira

  2. Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, USA

    Robert W. Motl

  3. Center for Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, USA

    Brian M. Sandroff

  4. Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada

    Lara A. Pilutti

  5. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA

    Gary R. Cutter

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  1. Stephanie L. Silveira
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  2. Robert W. Motl
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Corresponding author

Correspondence to Stephanie L. Silveira.

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Informed Consent

Informed consent was obtained from all individual participants included in the study.

Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Conflict of Interest

Dr. Cutter serves on the following Data Safety Monitoring Boards: Applied Therapeutics, AI therapeutics, AMO Pharma, Astra-Zeneca, Avexis Pharmaceuticals, Bristol Meyers Squibb/Celgene, CSL Behring, Horizon Pharmaceuticals, Immunic, Karuna Therapeutics, Kezar Life Sciences, Mapi Pharmaceuticals LTD, Merck, Mitsubishi Tanabe Pharma Holdings, Opko Biologics, Prothena Biosciences, Novartis, Regeneron, Sanofi-Aventis, Reata Pharmaceuticals, Teva Pharmaceuticals, NHLBI (Protocol Review Committee), University of Texas Southwestern, University of Pennsylvania, Visioneering Technologies, Inc. Dr. Cutter is a consultant for Alexion, Antisense Therapeutics, Avotres, Biogen, Clene Nanomedicine, Clinical Trial Solutions LLC, Entelexo Biotherapeutics, Inc., Genzyme, Genentech, GW Pharmaceuticals, Hoya Corporation, Immunic, Immunosis Pty Ltd, Klein-Buendel Incorporated, Linical, Merck/Serono, Novartis, Perception Neurosciences, Protalix Biotherapeutics, Regeneron, Roche, SAB Biotherapeutics. Dr. Cutter is employed by the University of Alabama at Birmingham, Institute for Human and Machine Cognition and President of Pythagoras, Inc., a private consulting company located in Birmingham, AL.

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Silveira, S.L., Motl, R.W., Sandroff, B.M. et al. Randomized Controlled Trial of the Behavioral Intervention for Physical Activity in Multiple Sclerosis Project: Response Heterogeneity and Predictors of Change. Int.J. Behav. Med. (2024). https://doi.org/10.1007/s12529-024-10265-7

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