# Internet-Delivered Lifestyle Physical Activity Intervention for Cognitive Processing Speed in Multiple Sclerosis

> **NIH NIH R01** · UNIVERSITY OF ALABAMA AT BIRMINGHAM · 2021 · $461,751

## Abstract

Cognitive impairment is prevalent, disabling, and poorly-managed among the 1 million Americans living with
multiple sclerosis (MS). Indeed, 67% of adults with MS have cognitive impairment, particularly slowed cognitive
processing speed (CPS), and this is associated with impaired learning and memory and worse fatigue,
depression, anxiety, pain, and quality of life (QOL). This underscores the importance of identifying efficacious
approaches for managing CPS impairment and its consequences among those with MS. There is merit in a
remotely-delivered physical activity (PA) intervention for managing MS-related CPS dysfunction in MS. We
have provided Class II evidence from a pilot, randomized controlled trial (RCT) that an Internet-delivered PA
intervention resulted in a clinically meaningful improvement in CPS among those with mild MS-related
ambulatory disability; there were additional improvements in fatigue, depression, anxiety, pain, and QOL. The
pilot RCT did not a priori recruit persons with MS who had objective CPS impairment nor examine
sustainability of CPS changes over time, and it involved a waitlist control that did not account for the effects of
attention and social contact. We leverage our experiences and preliminary results, and propose an
appropriately-powered, Phase-II, RCT of a highly-developed and highly-refined Internet-delivered PA
intervention that focuses on walking during ambulatory activities of daily living (steps/day) for yielding
immediate and sustained improvements in remotely-assessed CPS among persons with mild MS-related
ambulatory disability who demonstrate impaired CPS. The proposed study, if successful, will provide Class I
evidence regarding the efficacy of a 6-month, Internet-delivered, PA intervention compared with an active
control condition for improving important outcomes in 300 adults with MS who present with both mild MS
ambulatory disability and impaired CPS. The primary outcome is the remotely-delivered Symbol Digit
Modalities Test as a measure of CPS; the secondary outcomes include a remotely-delivered, objective
measure of learning and memory and self-reports of fatigue, depression, anxiety, pain, and QOL; the tertiary
outcome is accelerometry as an objective, device-based measure of PA. The conditions will be delivered by
persons who are uninvolved in screening, recruitment, random assignment, and outcome assessment. We will
collect outcomes on 3 occasions over a 12-month period (i.e., pre-intervention, immediately post-intervention,
and 6-month follow-up). The outcomes will be collected using a blinded assessor. Data analyses will involve
intent-to-treat principles, and mixed-effects models and logistic regression. The proposed research may yield
“real-world” guidelines for free-living PA change that can be implemented for the treatment of CPS impairment
in MS. Such an opportunity for rehabilitation of cognitive function using an approach with broad reach and
scalability is paramount considering the prev...

## Key facts

- **NIH application ID:** 10296565
- **Project number:** 1R01HD103812-01A1
- **Recipient organization:** UNIVERSITY OF ALABAMA AT BIRMINGHAM
- **Principal Investigator:** Robert Wayne Motl
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $461,751
- **Award type:** 1
- **Project period:** 2021-09-01 → 2021-10-11

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10296565

## Citation

> US National Institutes of Health, RePORTER application 10296565, Internet-Delivered Lifestyle Physical Activity Intervention for Cognitive Processing Speed in Multiple Sclerosis (1R01HD103812-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10296565. Licensed CC0.

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