Reducing Sedentary Behaviour: A Novel Opportunity for Managing Comorbidity in MS?
Condition: Multiple Sclerosis
MeSH terms: Multiple Sclerosis
Study type: Interventional

Summary: 
      Activity recommendations for the general population and those with multiple sclerosis (MS)
      focus on the promotion of activity that has a moderate intensity - in other words, activity
      intense enough to breathe heavily and sweat. Most adults do not achieve the recommended 150
      minutes of moderate-intensity activity per week. Even fewer persons with MS meet the
      recommendations. Those with MS often have problems with walking and fatigue, thus it is not
      difficult to understand that moderate intensity activity is challenging. Our study will test
      the feasibility of a new approach focusing on activity over the whole day - promoting light
      activity such as standing or walking around the house while reducing prolonged sitting
      (sedentary behaviour). This approach is supported by research evidence showing that too much
      sedentary time, especially prolonged bouts of sitting, is associated with health risk factors
      such as obesity and cholesterol level. Recent work with persons with MS confirms that
      prolonged sitting is a problem for this population and emphasises the potential importance of
      this approach.

      This study tests the feasibility of an internet-based intervention designed to decrease
      sedentary behaviour and to increase upright time in people with MS.
    

Detailed description: 
      Background: The health risks of sedentary behaviour or 'sitting too much' for the general
      population are receiving widespread media attention, with bylines that include, "comfy chairs
      are killing us very softly" or "don't just sit there!" Others have suggested that sitting is
      the new smoking! This media attention reflects the exponential growth of research on
      sedentary behaviour in the last 10 years [1-4]. The investigators believe that learning more
      about sedentary behaviour and its health risks may be particularly relevant for those with
      multiple sclerosis (MS). People with MS are substantially less active than persons without MS
      and have co-morbidities such as walking disability and fatigue that may make achieving the
      'typical' moderate to vigorous intensity exercise targets very difficult. The investigators
      will test a new approach to activity promotion that focuses on reducing sedentary behaviour
      and moving more during the day. This approach is likely to be more feasible and lead to more
      sustainable activity behaviour change in persons with MS. It's broad applicability - to
      persons with MS who move well, to those who need help to walk, and perhaps only walk at home
      - is a major strength of this new approach. In the end, if found to be effective, it could
      mean that a large majority of those with MS could receive the benefits of activity that they
      may be missing out on if only the usual moderate to vigorous activity programme is
      recommended.

      Purpose: The purpose of this project is to test the feasibility of a sedentary behaviour
      intervention program on reducing sedentary behaviour and improving co-morbidities such as
      walking disability and fatigue in people with MS.

      Methods: Forty persons with MS will be recruited from the community (mostly from Edmonton
      through our collaboration with the MS Society of Alberta) and the MS Clinic (University of
      Alberta Campus). The participants will be involved with the study for 24 weeks, including a
      16-week intervention and an 8-week follow-up. The intervention includes two 8-week stages; 1)
      Sit Less Stage- Interruptions to prolonged sitting, and 2) Move More Stage- Reduction in
      total sitting time through replacing sitting with light physical activities.

      Baseline testing will consist of demographic, anthropometric, impairment and functional
      testing. Subsequently, participants will be set up with an activity monitor (ActivPAL) to
      wear for 7 days. All outcomes, including those from the ActivPAL, will be assessed at
      three-time points: Baseline (Week 0), Post-intervention (Week 16), and Follow-up (Week 24).
      However, at mid-intervention (Week 8), data will be collected only from the ActivPAL activity
      monitor. A log book will be used by participants to record their wake-time and sleep-time and
      times when they didn't wear the monitor.

      Intervention: Once baseline testing is completed, in the first week of intervention a Fitbit
      monitor will be attached to each participant's waist, and the participants will be asked to
      do the activities that they normally do every day. This information will be used to determine
      usual activity behaviour. Also, participants will be asked to wear the Fitbit throughout the
      entire 16 weeks of the intervention. A program manual will be provided to the participants to
      guide them throughout the 16 weeks of the intervention. In addition to the program manual,
      participants will receive (via email) a weekly newsletter that emphasises an aspect of
      behaviour change from social cognitive theory and Skype chats will be conducted as well.

      Analysis: Most of the feasibility outcomes will be descriptive related to recruitment (e.g.,
      number of participants enrolled/number of participants approached) and adherence to the
      intervention. Descriptive statistics (mean, SD) will be used to characterize the sample. A
      two-way mixed factor ANOVA will be used to determine whether there are main (time, level of
      disability) and/or interaction effects for two primary sedentary behaviour outcomes - the
      average number of sedentary interruptions, and average sedentary time per day. Effect sizes
      will be calculated for each of the sedentary behaviour and the co-morbidity outcomes. Where
      clinically meaningful change benchmarks are available, we will determine if changes achieved
      from the intervention were clinically significant.
    

Intervention name(s): Sit Less with MS
Intervention type(s): Behavioral
Intervention description(s): The Sit Less with MS intervention has a total duration of 16 weeks and consists of two stages: sit less and move more stages. During the first stage (sit less), we will conduct coaching sessions with participants every week and the focus will be on interrupting their sitting time every 30 minutes. Facebook and Twitter will be also used to provide information and supplement coaching sessions. During the second stage, the focus will be on encouraging the participants to move more by replacing sitting with light intensity activities frequently throughout waking hours.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: Sedentary behaviour; Co-morbidity; Intervention