People living with multiple sclerosis (MS) face many barriers to physical activity, leading to longer periods of sitting. This can cause an increase in factors like disability, fatigue, walking difficulties, and conditions like heart disease and stroke.
The iStep-MS programme has shown potential for increasing physical activity and reducing sitting time. This study aims to evaluate the clinical effectiveness and cost-effectiveness of the programme when delivered across the MS care pathway.
People with MS live with a range of symptoms, such as fatigue, muscle weakness and balance issues, which can make them more susceptible to reduced physical activity and increased sedentary behaviour in their daily routine. These changes in behaviour are associated with additional health risks, such as type 2 diabetes, heart disease and stroke, in addition to worsening of MS symptoms.
The iStep-MS intervention involves delivery of behaviour change techniques through four consultations with different healthcare professional across a range of healthcare settings, supported by a handbook and a Smartwatch activity tracker.
If iStep-MS is found to be effective for reducing fatigue and improving quality of life when delivered by different staff across the MS healthcare pathway, it could lead to greater accessibility to sedentary behaviour and physical activity interventions and improve the management of MS on a wide scale.
Most commonly, physical activity- and sedentary behaviour-focussed interventions are delivered by physiotherapists within an NHS or therapy setting, limiting wide-scale accessibility. The iStep-MS intervention, however, can be delivered across the MS care pathway (e.g. from NHS acute care to MS charities) by a range of healthcare staff, such as allied health professionals, rehabilitation assistants, and exercise therapists. This research will demonstrate if such an intervention can be delivered in a flexible way to make it more accessible for individuals with MS. This will give greater equality of delivery and scope for expansion across healthcare and support services in the UK. Additionally, this study is unique in that it will evaluate cost-effectiveness of the iStep-MS intervention to determine if it is value-for-money. This will help with decisions for healthcare commissioning and services for MS in the future to support the inclusion of interventions like iStep-MS for better care.
The main aim of this study is to determine the clinical effectiveness and cost-effectiveness of the iStep-MS intervention for reducing fatigue in people with MS, when delivered in an accessible way across the MS care pathway.
The objectives of the project are to investigate the effect of the iStep-MS intervention on the following outcomes at 3 and 9 months:
- Fatigue
- Stepping time and number of steps per day
- Standing time
- Daily sitting and prolonged sitting time
- Quality of life
- Walking capability
- Pain
- Self-efficacy
- Cost per quality adjusted life year
- Cost per change in fatigue
Participants will be adults aged 18 years and over, with a diagnosis of MS who have recently experienced fatigue and are able to walk over 10 metres independently with or without a walking aid.
This is a multi-centre, two-arm, parallel group randomised control trial, consisting of an intervention group (iStep-MS) and a control group (usual care). Following randomisation, participants in the intervention group will receive an intervention pack, which will include the iStep-MS handbook and a Smartwatch activity tracker (Fitbit Charge). To increase accessibility to the intervention, the four iStep-MS consultation sessions will be delivered by healthcare staff qualified to different levels.
Prior to each consultation, participants will complete a pre-reading section in the handbook and to record their sedentary behaviour and physical activity. The iStep handbook contains information and worksheets to support the consultation activities. There is content dedicated to each of the four sessions that provides (1) session overview, (2) pre-session reading and reflection, (3) session-specific content e.g. barriers and facilitators for physical activity, (4) goal setting, and (5) a diary to record and monitor goals.
Study assessments will happen at baseline, 3 months and 9 months. This will include completing questionnaires and wearing an activity monitor on the thigh to measure sitting, standing and stepping time..
Funding body
The trial is being funded by the Multiple Sclerosis (MS) Society.
Meet the Principal Investigator(s) for the project
Dr Daniel Bailey - Dr Daniel Bailey is a Reader in Sedentary Behaviour and Health in the Department of Sport, Health and Exercise Sciences. He is Director of Research for the Department having previously been Director of the Centre for Physical Activity in Health and Disease. Dr Bailey's research investigates the relationship between sedentary behaviour and chronic health conditions, with a particular focus on non-communicable disease. This research includes the epidemiology of sedentary behaviour and associations with non-communicable disease risk, controlled laboratory studies examining the acute effects of breaking up prolonged sitting on cardiometabolic biomarkers, and the development and evaluation of interventions to reduce sedentary behaviour and increase physical activity in a range of population groups and long-term conditions including Type 2 diabetes, office workers, spinal cord injury, multiple sclerosis, Fabry disease and frailty.
Dr Bailey has been awarded multiple research grants from funding bodies and industry partners to support his research and has published many research articles in his field of research. He has delivered multiple conference presentations and invited talks across the UK and Europe and was Technical Advisor for the Qatar National Physical Activity Guidelines 2nd edition, 2021. Dr Bailey is Chair of the Chartered Association of Sport and Exercise Sciences (CASES) Physical Activity for Health Division and was Chair of the CASES 2024 Conference Planning Group. Dr Bailey was also a member of the scientific global leadership committee for the 8th International Society for Physical Activity and Health (ISPAH) Congress.
Dr Bailey has a wealth of experience teaching physical activity, sedentary behaviour and health topics at undergraduate and postgraduate level and uses innovative teaching approaches in his practice including research-informed teaching, bleneded and authentic learning, and flipped classrooms.
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Project last modified 27/08/2025