Efficacy of a behavioral intervention for reducing ...
Transcript of Efficacy of a behavioral intervention for reducing ...
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Efficacyofabehavioralinterventionforreducingsedentarybehaviorinpersonswithmultiplesclerosis:Apilotexamination
RachelE.Klaren
ElizabethA.Hubbard
RobertW.Motl
PhysicalActivityBehavioralInterventionsinMS
• BenefitsofPAinpersonswithMS1
• ExceedinglylowlevelsofPAinMS2
• Involveteachingpersonstheskills,resources,andstrategiesforsuccessfulbehaviorchange
• ThreeRCTSofbehavioralinterventionsbasedonsocialcognitivetheory3anddeliveredthroughtheinternethaveincreasedPAandyieldedsymptomaticandfunctionalbenefitsinpersonswithMS4‐6
1Motl&Pilutti,2014;2Klarenetal.,2013;3Bandura,2004;4Motletal.,2011;5Piluttietal.,2014;6Sandroffetal.,2014
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4Motletal.,2011
5Piluttietal.,2014
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SedentaryBehavior• Definedassittingorlyingthatdoesnotincreaseenergyexpenditureduringthewakinghours7
• Sittingtime ST– Adultsonaverageengagein~8hoursofST/day8
– Associatedwithmorbidityandmortalityinthegeneralpopulation,independentofPA9,10
– ReducedthroughabehavioralinterventionbasedonSCTinolderobesewomen11
7SedBehav ResNet,2011;8Matthewsetal.,2008;9Baumanetal.,2011;10Pateletal.,2010;11Adamsetal.,2013
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SedentaryBehavior• PersonswithMSengageinhighamountsofsedentarybehavior12
• Associatedwithmobilitydisability,fatigue,walkingperformance,andcognitiveprocessingspeed inMS13
• ImportanceofexaminingeffectsofbehavioralinterventionsonsedentarybehaviorinMS
12Cavanaughetal.,2011;13Hubbard&Motl,2014
Purpose&Hypothesis
• ThecurrentstudyinvolvedasecondaryanalysisofpreviouslypublisheddatatoexaminetheeffectofabehavioralinterventionbasedonSCTforreducingSTinpersonswithMS– WeexpectedthatpersonswithMSintheinterventionconditionwoulddemonstrateareductioninSTcomparedwiththewaitlistcontrol
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ParticipantInclusionCriteria
• PhysiciandiagnosedMSandapprovalforparticipation• Abilitytowalkwithorwithoutanassistivedevice• Agebetween18‐64years• Physicalinactivitydefinedas 60minutes/week• Relapsefreeforpast30days• LowriskofcontraindicationsbasedonPhysicalActivityReadiness
Questionnaire PAR‐Q 14
14Thomasetal.,1992
Participants• Finalsampleincluded70
participantswhowererandomlyassignedintointervention n 33 orwait‐listcontrol n 37 conditionsandprovidedbaselineSTdata
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PrimaryMeasure
• ST– QuestionsevenoftheabbreviatedInternationalPhysicalActivityQuestionnaire IPAQ 15
– “Duringthelast7days,howmuchtimedidyouspendsittingonaweekday?”
15Craigetal.,2003
Procedure• AllparticipantsprovidedinformedconsentapprovedbyUniversityIRB
• Participantsprovideddemographic/clinicalinformationandcompletedabatteryoftestsduringaone‐hoursessioninthelaboratoryatbaseline pre‐intervention andsix‐months post‐intervention
• ParticipantsweregroupedbasedondisabilityandPAdataandthenrandomlyassignedintointerventionorwait‐listcontrolconditions
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Procedure• Intervention:
– Overasix‐monthperiod,participantsvisitedastudywebsite,woreapedometer,completedalogbookalongwithGoalTrackersoftware,andparticipatedinone‐on‐onevideocoachingsessions
• Wait‐listcontrol:– Participantscompletedthestudymeasuresbeforeandafterthesix‐monthperiodandreceivedtheinterventiononcethestudyreachedcompletion
InterventionComponents• Studywebsite
– ContentbasedonSCTfocusedonteachingbehavioralstrategiesforchangingPAandST
– Outcomeexpectations,goalsettingandself‐monitoring,self‐efficacy,facilitatorsandbarriersforPAandST
– GuidedparticipantstoonlinematerialsandvideosofexamplesandideasforreducingSTandincreasingPA
• Videocoachingsessions– Semi‐scriptedandbasedonprinciplesofsupportiveaccountability– Reviewofgoal‐settingandprogresstowardsgoalattainment– StressedtheimportanceofidentifyingopportunitiesforreducingSTandmovingmoreandco‐developedapproachesforreducingrelevantexamplesofST
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DataAnalysis
• DatawereanalyzedinIBMSPSSv21.0• Examinedbaselinedifferencesbetweengroupsindemographic/clinicalcharacteristicsusingindependentsamplest‐testsandχ2 statistics
• Intent‐to‐treatandcompletersanalyses• ExaminedgroupdifferencesinSTusingANCOVAonpost‐interventionscorescontrollingforpre‐interventionvalues
• Providetheparameterestimate,standarderror SE ,andassociatedt‐valuealongwithp‐valueperanalysis
ParticipantCharacteristicsVariable Intervention (n=33) Control (n=37)
Age (years) 49.4 (9.2) 50.3 (9.1)
Sex (% female) 73% 82%
Race (% Caucasian) 100% 95%
Employment (% employed) 64% 59%
MS Type (% RRMS) 82% 84%
Disease Duration (years) 11.1 (7.1) 13.2 (9.4)
PDDS score (median, IQR) 2.0 (3.0) 3.0 (3.0)
Daily ST (minutes)* 550 (233) 412 (193)
Note.Valuesaremean standarddeviation ,unlessotherwisenoted.*Representsstatisticalsignificance.
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GroupDifferences
• Intent‐to‐treatanalysis:– Significantdifferencebetweengroups F 1,67 4.03,p 0.05,η² 0.06
• Parameterestimateof98.9min SE 49.3,t 2.01,p 0.05• Adjustedmeanscoresforinterventionandcontrolgroupswere429.2
201.2 and528.2 200.7 minutesofST d 0.49
• Completer’sanalysis:– Significantdifferencebetweengroups F1,54 5.15,p 0.05,η² 0.09
• Parameterestimateof128.9min SE 56.8,t 2.27,p 0.05• Adjustedmeanscoresforinterventionandcontrolgroupswere405.4
211.6 and534.3 211.4 minutesofST d 0.61
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Intent‐to‐Treat Completer's
ST (min/day) Post‐Intervention
Intervention
Control
6.8hrs
8.9hrs
0
7.2hrs
8.8 hrs
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PrimaryFindings
• DailySTwasreducedintheinterventiongroupcomparedtothecontrolgroup– Theamountofreductionwas1.65hoursbasedontheintent‐to‐treatanalysis;thedifferencewasevenlargerinthecompleter’sanalysisandexceeded2hours
• Toourknowledge,weprovidethefirstdataoftheefficacyofabehavioralinterventionforreducingSTinpersonswithMS.
Whyisthisimportant?
• SedentarybehavioriscommoninpersonswithMS10‐12
andhasbeenassociatedwithmobilitydisability,fatigue,walkingperformance,andcognitiveprocessingspeedinMS13
• ThesepreliminarydatasupportfutureinvestigationsaimedatreducingSTandothersedentarybehaviorsinMS
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Whattodoweneedtodonext?
• MoreinformationaboutsedentarybehaviorinpersonswithMS– IdentifywhattypesofsedentarybehavioraremostcommoninpersonswithMSandwhoismorelikelytoengageinsedentarybehavior
• DetermineifreductionsinsedentarybehavioraffectotheroutcomesinpersonswithMS
StrengthsandLimitations
• Strengths– Largesamplesizeforapilotstudy– ValidatedSTmeasureinhealthyadults17,18
• Limitations– Secondaryanalysisofexistingdata– Noobjectiveassessmentofsedentarybehavior
17Craigetal.,2003;18Rosenbergetal.,2008
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Acknowledgements
• ENRLdirector:Dr.RobertMotl• Behavioralcoaches:Drs.LaraPilutti andDeeDlugonski• Funding:NationalMultipleSclerosisSocietyPP1695
THANKYOU!
Questions?