Special Exercise App Wins Favor in Progressive MS Study, But Little More

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by Steve Bryson PhD |

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MR-004 and walking skills

A multimedia smartphone application designed to precisely inform about exercise and track physical activity led primary or secondary progressive multiple sclerosis (MS) patients to be more active — but no more than a comparison patient group given only a “simple leaflet” about exercise, a pilot study reported. 

Those who used the app, however, reported greater motivation to adapt a more active lifestyle, and appreciated its use. 

The study, “Feasibility of a smartphone app to enhance physical activity in progressive MS: a pilot randomized controlled pilot trial over three months,” was published in the journal PeerJ, Life & Environment

A possible treatment approach for people with progressive MS may be lifestyle interventions, such as greater physical activity. Clinical research has shown that exercise promotes neuroregeneration, and improves heart and lung fitness, walking ability, muscular strength, endurance, cognition, and health-related quality of life. 

With the wide availability of smartphones, specific applications (apps) can be used to provide evidence-based patient information. Smartphones are also able to track and capture physical activity data using accelerometry, which serves as a more objective feedback mechanism to validate the effects of an intervention. 

Researchers at the University Medical Center Hamburg-Eppendorf in Germany created an app that can provide updated information directly to the smartphone, as well as collect physical activity data, with a goal of increasing physical activity in people with primary or secondary progressive MS.

A total of 38 adults, with an average age of 51, were randomized to either a control group of 20 patients or an intervention group of 18 patients. Two control patients left the study before it finished.

Those in the intervention group received access to the app, which had text, figures and videos, along with activity feedback. The evidence-based information in the app came from studies in which MS patients evaluated the effects of exercising. 

Control group participants received a two-page leaflet with unspecific, general information about exercise.

All underwent a clinical assessment at baseline (study start) and at three months, including assessments of their expanded disability status scale (EDSS; a measure of disability) and 2 and 6 minute walking tests (a measure of exercise capacity).

Patient-reported outcomes included changes in mobility and walking, along with daily activity assessments. All were given an accelerometer — an ActiGraph activity monitor — to measure physical activity for seven days.

An increase of 20% in the average steps walked in a minute or a 20% increase in physical activity was the study’s main goal. Participants who reached this goal were referred to as “responders.”

Results showed that four of the intervention group patients were responders, as were seven in the control group, indicating that the responder rate — the study’s main goal — did not differ between the two groups.

While patients in the intervention group tended to be more motivated toward an active lifestyle as measured by a questionnaire, a significant increase in the proportion of moderate to vigorous physical activity was found in both these groups. 

Tracking metrics and all clinical tests remained stable within the two groups, and there were no differences in patients’ reported perceived mobility, physical activity, or daily activities. 

At the study’s end, a questionnaire was given to assess participants’ understanding of the medical information provided. No differences, again, were found; while the scores were poor, both groups showed the same levels of knowledge about the safety and efficacy of exercising with MS. 

The overall usability of the app was rated in seven questions, with scores ranging from 1 to 5. The average rating was 3.7 points, indicating the app was perceived as helpful. When asked for app feedback, participants mentioned the need for more hyperlinks to relevant websites, pictures and videos, and also more interactivity. But they emphasized that the app helped them make lifestyle changes and supported their way of living.

“Just providing information in a multimedia smartphone app did not enhance physical activity more than a simple leaflet in this small pilot trial in [progressive MS],” the researchers wrote. “However, the group of app users tended to have a higher motivation towards a more active lifestyle.”

“Overall, the concept of a smartphone app to support an active lifestyle in MS is highly appreciated by participants,” they added. 

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