Delivery of a Culturally Tailored Exercise Training Intervention for Hispanics with Multiple Sclerosis

About This Grant

Multiple sclerosis (MS) is a common neurological disease, typically diagnosed in young and middle-aged adults with a current estimate of one million cases in the United States. Exercise training is established as a safe, effective second-line therapy for improving MS symptoms and slowing disease progression, however Hispanics with MS are virtually absent from the MS exercise training literature. This is alarming given the growing prevalence of MS among Hispanics and established health disparities associated with a more severe disease course including significant mobility impairment and cognitive dysfunction with a younger age of onset among Hispanics with MS. The proposed study creates the first culturally tailored exercise training program for Hispanic adults with MS using the Exploration, Preparation, Implementation, and Sustainability (EPIS) implementation science framework. The foundational exercise training program, STEP for MS, is based on Social Cognitive Theory and Supportive Accountability behavior change principles for promoting exercise behavior change that meets the Guidelines for Exercise for persons with MS. This proposal builds upon iterations of STEP for MS including testing for feasibility and efficacy among non-Hispanic Blacks with MS. The research team will begin the proposed research by partnering with two Community Advisory Boards to culturally tailor the STEP for MS program specifically for Hispanics. Subsequently, a hybrid type 1 effectiveness-implementation trial is proposed wherein we will recruit 66 Hispanic adults with MS in the Greater Houston Area. Those persons will be randomized into exercise training intervention or attention/social contact control stretching conditions delivered over 16 weeks. Both conditions will be delivered by a Spanish-speaking community health worker from the Houston community and participants will complete the program in their preferred language. Client outcomes of interest will be assessed at baseline, 16-weeks post-intervention, and 32-week follow-up and directly align with meaningful consequences that disproportionately impact Hispanics with MS (i.e., mobility disability and well-being). Implementation outcomes will be collected throughout the study to guide future research and dissemination efforts. The proposed research team is comprised of the leading experts in exercise science, psychology, health disparities, implementation science, and biostatistics ideally suited to lead and implement this innovative line of research that may substantially move the needle in treatment strategies for Hispanics with MS. The proposed study directly aligns with the NIMHD Mission to lead scientific research to improve minority health and reduce health disparities by providing low cost, accessible approaches for addressing the compounding health disparities experienced by Hispanics with chronic disabling conditions and promoting overall health.