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      An Intervention for Changing Sedentary Behavior Among African Americans With Multiple Sclerosis: Protocol

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          Abstract

          Background

          Sedentary behavior is a major concern among patients with multiple sclerosis (MS), as it may accelerate disease progression and exacerbate physical disability. This is especially concerning among African Americans, a segment of the MS population who present with greater neurological disability and higher odds of physical comorbidities than their Caucasian counterparts.

          Objective

          To date, researchers have not proposed interventions that focus on changing sedentary behavior in African Americans with MS.

          Methods

          This paper describes a pilot study that examines the feasibility and efficacy of using text messaging along with theory-driven newsletters and behavioral coaching for changing sedentary behavior in African Americans with MS. We herein present the methods, procedures, and outcomes for our ongoing study.

          Results

          Enrollment began in February 2018 and is expected to conclude in April 2019. Study results will be reported in the fall of 2019.

          Conclusions

          After completion of this pilot intervention, we will summarize our study results in manuscripts for publication in peer-reviewed journals that will provide critical information on the feasibility and efficacy of our strategy. These results will inform future studies and, potentially, larger interventions for remotely reducing sedentary behavior in African Americans with MS.

          Trial Registration

          ClinicalTrials.gov NCT03671499; https://clinicaltrials.gov/ct2/show/NCT03671499 (Archived by WebCite at http://www.webcitation.org/77MZnxyNy)

          International Registered Report Identifier (IRRID)

          DERR1-10.2196/12973

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          Most cited references35

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          Design and analysis of pilot studies: recommendations for good practice.

          Susanna Dodd, G Lancaster, Paula Williamson … (2004)
          Pilot studies play an important role in health research, but they can be misused, mistreated and misrepresented. In this paper we focus on pilot studies that are used specifically to plan a randomized controlled trial (RCT). Citing examples from the literature, we provide a methodological framework in which to work, and discuss reasons why a pilot study might be undertaken. A well-conducted pilot study, giving a clear list of aims and objectives within a formal framework will encourage methodological rigour, ensure that the work is scientifically valid and publishable, and will lead to higher quality RCTs. It will also safeguard against pilot studies being conducted simply because of small numbers of available patients.
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            Sedentary Behavior and Health Outcomes: An Overview of Systematic Reviews

            Leandro de Rezende, Maurício Rodrigues Lopes, Juan Rey-López … (2014)
            Objective 1) To synthesize the current observational evidence for the association between sedentary behavior and health outcomes using information from systematic reviews. 2) To assess the methodological quality of the systematic reviews found. Methodology/Principal Findings Medline; Excerpta Medica (Embase); PsycINFO; and Web of Science were searched for reviews published up to September 2013. Additional publications were provided by Sedentary Behaviour Research Network members. The methodological quality of the systematic reviews was evaluated using recommended standard criteria from AMSTAR. For each review, improper use of causal language in the description of their main results/conclusion was evaluated. Altogether, 1,044 review titles were identified, 144 were read in their entirety, and 27 were included. Based on the systematic reviews with the best methodological quality, we found in children and adolescents, strong evidence of a relationship between time spent in sedentary behavior and obesity. Moreover, moderate evidence was observed for blood pressure and total cholesterol, self-esteem, social behavior problems, physical fitness and academic achievement. In adults, we found strong evidence of a relationship between sedentary behavior and all-cause mortality, fatal and non-fatal cardiovascular disease, type 2 diabetes and metabolic syndrome. In addition, there is moderate evidence for incidence rates of ovarian, colon and endometrial cancers. Conclusions This overview based on the best available systematics reviews, shows that sedentary behavior may be an important determinant of health, independently of physical activity. However, the relationship is complex because it depends on the type of sedentary behavior and the age group studied. The relationship between sedentary behavior and many health outcomes remains uncertain; thus, further studies are warranted.
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              Lifestyle interventions based on the diabetes prevention program delivered via eHealth: A systematic review and meta-analysis

              Kevin Joiner, Soohyun Nam, Robin Whittemore (2017)
              The objective was to describe Diabetes Prevention Program (DPP)-based lifestyle interventions delivered via electronic, mobile, and certain types of telehealth (eHealth) and estimate the magnitude of the effect on weight loss. A systematic review was conducted. PubMed and EMBASE were searched for studies published between January 2003 and February 2016 that met inclusion and exclusion criteria. An overall estimate of the effect on mean percentage weight loss across all the interventions was initially conducted. A stratified meta-analysis was also conducted to determine estimates of the effect across the interventions classified according to whether behavioral support by counselors post-baseline was not provided, provided remotely with communication technology, or face-to-face. Twenty-two studies met the inclusion/exclusion criteria, in which 26 interventions were evaluated. Samples were primarily white and college educated. Interventions included Web-based applications, mobile phone applications, text messages, DVDs, interactive voice response telephone calls, telehealth video conferencing, and video on-demand programing. Nine interventions were stand-alone, delivered post-baseline exclusively via eHealth. Seventeen interventions included additional behavioral support provided by counselors post-baseline remotely with communication technology or face-to-face. The estimated overall effect on mean percentage weight loss from baseline to up to 15 months of follow-up across all the interventions was −3.98%. The subtotal estimate across the stand-alone eHealth interventions (−3.34%) was less than the estimate across interventions with behavioral support given by a counselor remotely (−4.31%), and the estimate across interventions with behavioral support given by a counselor in-person (−4.65%). There is promising evidence of the efficacy of DPP-based eHealth interventions on weight loss. Further studies are needed particularly in racially and ethnically diverse populations with limited levels of educational attainment. Future research should also focus on ways to optimize behavioral support.
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                Author and article information

                Contributors
                Robert W Motl:
                University of Alabama at Birmingham1716 9th Ave SBirmingham, AL, 35233United States1 205 934 5905robmotl@uab.edu
                ORCID: http://orcid.org/0000-0002-5894-2290
                Journal
                Journal ID (nlm-ta): JMIR Res Protoc
                Journal ID (iso-abbrev): JMIR Res Protoc
                Journal ID (publisher-id): ResProt
                Title: JMIR Research Protocols
                Publisher: JMIR Publications (Toronto, Canada )
                ISSN (Electronic): 1929-0748
                Publication date Collection: May 2019
                Publication date (Electronic): 01 May 2019
                Volume: 8
                Issue: 5
                Electronic Location Identifier: e12973
                Affiliations
                [1 ] University of Alabama at Birmingham Birmingham, AL United States
                [2 ] Federal University of Triangulo Mineiro Uberaba Brazil
                Author notes
                Corresponding Author: Robert W Motl robmotl@ 123456uab.edu
                Author information
                http://orcid.org/0000-0002-0691-049X
                http://orcid.org/0000-0002-2083-4104
                http://orcid.org/0000-0002-2013-7632
                http://orcid.org/0000-0002-8455-980X
                http://orcid.org/0000-0002-5894-2290
                Article
                Publisher ID: v8i5e12973
                DOI: 10.2196/12973
                PMC ID: 6658278
                PubMed ID: 31042149
                SO-VID: ac04f20d-9dbe-4c78-8f27-9228cdec063b
                Copyright © ©Jessica F Baird, Jeffer Eidi Sasaki, Brian M Sandroff, Gary Cutter, Robert W Motl. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 01.05.2019.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org.as well as this copyright and license information must be included.

                History
                Date received : 28 November 2018
                Date revision requested : 28 February 2019
                Date revision received : 13 March 2019
                Date accepted : 24 March 2019
                Categories
                Subject: Protocol
                Subject: Protocol

                Keywords: african americans,multiple sclerosis,sedentary behavior,intervention
                Data availability:
                Keywords: african americans, multiple sclerosis, sedentary behavior, intervention

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