{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T12:15:05Z","timestamp":1780056905664,"version":"3.54.0"},"reference-count":44,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurol Belg"],"published-print":{"date-parts":[[2025,10]]},"DOI":"10.1007\/s13760-025-02851-7","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T16:40:24Z","timestamp":1754325624000},"page":"1319-1325","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Neurocognitive correlates of physical activity in multiple sclerosis: metacognition and cognitive flexibility"],"prefix":"10.1007","volume":"125","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8336-953X","authenticated-orcid":false,"given":"Emine","family":"\u0130pek Halatc\u0131","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6944-0595","authenticated-orcid":false,"given":"Hilal","family":"Aslan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4090-1817","authenticated-orcid":false,"given":"Aybike","family":"Erko\u00e7","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2314-0738","authenticated-orcid":false,"given":"Nezehat \u00d6zg\u00fcl","family":"\u00dcnl\u00fcer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1245-7273","authenticated-orcid":false,"given":"G\u00f6n\u00fcl","family":"Vural","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"issue":"12","key":"2851_CR1","doi-asserted-by":"publisher","first-page":"1139","DOI":"10.1016\/S1474-4422(08)70259-X","volume":"7","author":"ND Chiaravalloti","year":"2008","unstructured":"Chiaravalloti ND, DeLuca J (2008) Cognitive impairment in multiple sclerosis. Lancet Neurol 7(12):1139\u20131151","journal-title":"Lancet Neurol"},{"key":"2851_CR2","unstructured":"Umphred DA, Lazaro RT, Roller ML, Burton GU (2013) Umphred\u2019s Neurological Rehabilitation. 6th Edition, Elsevier Mosby, St. Louis"},{"key":"2851_CR3","doi-asserted-by":"crossref","unstructured":"Rosti-Otaj\u00e4rvi EM, H\u00e4m\u00e4l\u00e4inen PI (2014) Neuropsychological rehabilitation for multiple sclerosis. Cochrane Database Syst Reviews (2)","DOI":"10.1002\/14651858.CD009131.pub3"},{"issue":"4","key":"2851_CR4","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1191\/026921501678310243","volume":"15","author":"T Stapleton","year":"2001","unstructured":"Stapleton T, Ashburn A, Stack E (2001) A pilot study of attention deficits, balance control and falls in the subacute stage following stroke. Clin Rehabil 15(4):437\u2013444","journal-title":"Clin Rehabil"},{"issue":"1","key":"2851_CR5","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1146\/annurev-psych-113011-143750","volume":"64","author":"A Diamond","year":"2013","unstructured":"Diamond A (2013) Executive functions. Ann Rev Psychol 64(1):135\u2013168","journal-title":"Ann Rev Psychol"},{"issue":"1","key":"2851_CR6","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1146\/annurev-clinpsy-072319-024242","volume":"16","author":"PD Zelazo","year":"2020","unstructured":"Zelazo PD (2020) Executive function and psychopathology: A neurodevelopmental perspective. Ann Rev Clin Psychol 16(1):431\u2013454","journal-title":"Ann Rev Clin Psychol"},{"key":"2851_CR7","doi-asserted-by":"publisher","first-page":"852","DOI":"10.1007\/s00426-013-0537-1","volume":"78","author":"C Titz","year":"2014","unstructured":"Titz C, Karbach J (2014) Working memory and executive functions: effects of training on academic achievement. Psychol Res 78:852\u2013868","journal-title":"Psychol Res"},{"key":"2851_CR8","first-page":"100142","volume":"19","author":"PH Lysaker","year":"2020","unstructured":"Lysaker PH, Minor KS, Lysaker JT, Hasson-Ohayon I, Bonfils K, Hochheiser J, Vohs JL (2020) Metacognitive function and fragmentation in schizophrenia: relationship to cognition, self-experience and developing treatments. Schizophrenia Research: Cognition 19:100142","journal-title":"Schizophrenia Research: Cognition"},{"issue":"2","key":"2851_CR9","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1006\/ccog.2000.0447","volume":"9","author":"D Fernandez-Duque","year":"2000","unstructured":"Fernandez-Duque D, Baird JA, Posner MI (2000) Executive attention and metacognitive regulation. Conscious Cogn 9(2):288\u2013307","journal-title":"Conscious Cogn"},{"issue":"2","key":"2851_CR10","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1016\/j.ncl.2010.12.003","volume":"29","author":"LJ Julian","year":"2011","unstructured":"Julian LJ (2011) Cognitive functioning in multiple sclerosis. Neurol Clin 29(2):507\u2013525","journal-title":"Neurol Clin"},{"key":"2851_CR11","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1007\/s13760-024-02677-9","volume":"125","author":"T Bozkurt","year":"2025","unstructured":"Bozkurt T, Unal M, Salci Y (2025) Factors influencing adherence to physical exercise in patients with multiple sclerosis: a systematic review focusing on exercise over general physical activity. Acta Neurol Belg 125:335\u2013345. https:\/\/doi.org\/10.1007\/s13760-024-02677-9","journal-title":"Acta Neurol Belg"},{"issue":"9","key":"2851_CR12","doi-asserted-by":"publisher","first-page":"1800","DOI":"10.1016\/j.apmr.2013.04.020","volume":"94","author":"AE Latimer-Cheung","year":"2013","unstructured":"Latimer-Cheung AE, Pilutti LA, Hicks AL, Ginis KAM, Fenuta AM, MacKibbon KA, Motl RW (2013) Effects of exercise training on fitness, mobility, fatigue, and health-related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development. Arch Phys Med Rehabil 94(9):1800\u20131828","journal-title":"Arch Phys Med Rehabil"},{"issue":"9","key":"2851_CR13","doi-asserted-by":"publisher","first-page":"720","DOI":"10.3390\/genes10090720","volume":"10","author":"CM Di Liegro","year":"2019","unstructured":"Di Liegro CM, Schiera G, Proia P, Di Liegro I (2019) Physical activity and brain health. Genes 10(9):720","journal-title":"Genes"},{"issue":"3","key":"2851_CR14","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1002\/jnr.24524","volume":"98","author":"LY Guo","year":"2020","unstructured":"Guo LY, Lozinski B, Yong VW (2020) Exercise in multiple sclerosis and its models: focus on the central nervous system outcomes. J Neurosci Res 98(3):509\u2013523","journal-title":"J Neurosci Res"},{"issue":"10","key":"2851_CR15","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1080\/13803395.2012.715144","volume":"34","author":"BM Sandroff","year":"2012","unstructured":"Sandroff BM, Motl RW (2012) Fitness and cognitive processing speed in persons with multiple sclerosis: a cross-sectional investigation. J Clin Exp Neuropsychol 34(10):1041\u20131052","journal-title":"J Clin Exp Neuropsychol"},{"issue":"7","key":"2851_CR16","doi-asserted-by":"publisher","first-page":"1328","DOI":"10.1016\/j.apmr.2014.02.017","volume":"95","author":"M Beier","year":"2014","unstructured":"Beier M, Bombardier CH, Hartoonian N, Motl RW, Kraft GH (2014) Improved physical fitness correlates with improved cognition in multiple sclerosis. Arch Phys Med Rehabil 95(7):1328\u20131334","journal-title":"Arch Phys Med Rehabil"},{"issue":"3","key":"2851_CR17","first-page":"167","volume":"9","author":"WW Beatty","year":"1995","unstructured":"Beatty WW, Blanco CR, Wilbanks SL, Paul RH, Hames KA (1995) Demographic, clinical, and cognitive characteristics of multiple sclerosis patients who continue to work. J Neurologic Rehabilitation 9(3):167\u2013173","journal-title":"J Neurologic Rehabilitation"},{"key":"2851_CR18","doi-asserted-by":"crossref","unstructured":"Briken, S., Gold, S. M., Patra, S., Vettorazzi, E., Harbs, D., Tallner, A.,\u2026 Heesen,C (2014) Effects of exercise on fitness and cognition in progressive MS: a randomized,controlled pilot trial. Multiple Sclerosis Journal 20(3), 382\u2013390","DOI":"10.1177\/1352458513507358"},{"key":"2851_CR19","doi-asserted-by":"crossref","unstructured":"Barry, A., Cronin, O., Ryan, A. M., Sweeney, B., O\u2019Toole, O., Allen, A. P.,\u2026 Downer,E. J (2018) Impact of short-term cycle ergometer training on quality of life, cognition and depressive symptomatology in multiple sclerosis patients: a pilot study. Neurological Sciences 39, 461\u2013469","DOI":"10.1007\/s10072-017-3230-0"},{"issue":"12","key":"2851_CR20","doi-asserted-by":"publisher","first-page":"4421","DOI":"10.1007\/s10072-023-06953-z","volume":"44","author":"H Abedi","year":"2023","unstructured":"Abedi H, Matinnia N, Yazdi-Ravandi S (2023) Investigating the effectiveness of cognitive behavioral group therapy on psycho-social and emotional adaptability and cognitive flexibility in people with multiple sclerosis in hamedan, Iran. Neurol Sci 44(12):4421\u20134428","journal-title":"Neurol Sci"},{"issue":"11","key":"2851_CR21","doi-asserted-by":"publisher","first-page":"1444","DOI":"10.1212\/WNL.33.11.1444","volume":"33","author":"JF Kurtzke","year":"1983","unstructured":"Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33(11):1444\u20131444","journal-title":"Neurology"},{"issue":"1","key":"2851_CR22","doi-asserted-by":"publisher","first-page":"278","DOI":"10.2466\/06.08.PMS.111.4.278-284","volume":"111","author":"M Saglam","year":"2010","unstructured":"Saglam M, Arikan H, Savci S, Inal-Ince D, Bosnak-Guclu M, Karabulut E, Tokgozoglu L (2010) International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills 111(1):278\u2013284","journal-title":"Percept Mot Skills"},{"issue":"2","key":"2851_CR23","first-page":"75","volume":"2","author":"S Karaka\u015f","year":"1999","unstructured":"Karaka\u015f S, Erdo\u011fan E, Sak L, Soysal A\u015e, Ulusoy T, Ulusoy \u0130Y, Alkan S (1999) Stroop test TBAG form: standardisation for Turkish culture, reliability and validity. J Clin Psy 2(2):75\u201388","journal-title":"J Clin Psy"},{"issue":"3","key":"2851_CR24","first-page":"189","volume":"26","author":"N T\u00fcrke\u015f","year":"2015","unstructured":"T\u00fcrke\u015f N, Can H, Kurt M, Elmasta\u015f Dike\u00e7 B (2015) A study to determine the norms for the trail making test for the age range of 20\u201349 in Turkey. Turkish J Psychiatry 26(3):189\u2013196","journal-title":"Turkish J Psychiatry"},{"key":"2851_CR25","unstructured":"Tosun A, Irak M (2008) Adaptation, validity, and reliability of the metacognition Questionnaire-30 for the Turkish population, and its relationship to anxiety and Obsessive-Compulsive symptoms. Turkish J Psychiatry 19(1)"},{"issue":"1","key":"2851_CR26","first-page":"143","volume":"46","author":"F Sapmaz","year":"2013","unstructured":"Sapmaz F, Do\u011fan T (2013) Assessment of cognitive flexibility: reliability and validity studies of Turkish version of the cognitive flexibility inventory. Ankara Univ J Fac Educational Sci (JFES) 46(1):143\u2013162","journal-title":"Ankara Univ J Fac Educational Sci (JFES)"},{"key":"2851_CR27","doi-asserted-by":"publisher","first-page":"91","DOI":"10.2165\/00007256-200838020-00001","volume":"38","author":"LJ White","year":"2008","unstructured":"White LJ, Castellano V (2008) Exercise and brain health\u2014implications for multiple sclerosis: part 1\u2014neuronal growth factors. Sports Med 38:91\u2013100","journal-title":"Sports Med"},{"key":"2851_CR28","doi-asserted-by":"crossref","unstructured":"Kr\u00fcger, T., Behrens, J. R., Grobelny, A., Otte, K., Mansow-Model, S., Kayser, B.,\u2026 Schmitz-H\u00fcbsch, T (2017) Subjective and objective assessment of physical activity in multiple sclerosis and their relation to health-related quality of life. BMC neurology 17, 1\u201312","DOI":"10.1186\/s12883-016-0783-0"},{"issue":"8","key":"2851_CR29","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.2522\/ptj.20120479","volume":"93","author":"RW Motl","year":"2013","unstructured":"Motl RW, McAuley E, Sandroff BM (2013) Longitudinal change in physical activity and its correlates in relapsing-remitting multiple sclerosis. Phys Ther 93(8):1037\u20131048","journal-title":"Phys Ther"},{"issue":"12","key":"2851_CR30","doi-asserted-by":"publisher","first-page":"2342","DOI":"10.1016\/j.apmr.2013.07.011","volume":"94","author":"RE Klaren","year":"2013","unstructured":"Klaren RE, Motl RW, Dlugonski D, Sandroff BM, Pilutti LA (2013) Objectively quantified physical activity in persons with multiple sclerosis. Arch Phys Med Rehabil 94(12):2342\u20132348","journal-title":"Arch Phys Med Rehabil"},{"issue":"1","key":"2851_CR31","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.dhjo.2007.11.001","volume":"1","author":"EA Vanner","year":"2008","unstructured":"Vanner EA, Block P, Christodoulou CC, Horowitz BP, Krupp LB (2008) Pilot study exploring quality of life and barriers to leisure-time physical activity in persons with moderate to severe multiple sclerosis. Disabil Health J 1(1):58\u201365","journal-title":"Disabil Health J"},{"issue":"1","key":"2851_CR32","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/j.msard.2013.04.003","volume":"3","author":"BM Sandroff","year":"2014","unstructured":"Sandroff BM, Dlugonski D, Pilutti LA, Pula JH, Benedict RH, Motl RW (2014) Physical activity is associated with cognitive processing speed in persons with multiple sclerosis. Multiple Scler Relat Disorders 3(1):123\u2013128","journal-title":"Multiple Scler Relat Disorders"},{"issue":"3","key":"2851_CR33","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1177\/1545968314541331","volume":"29","author":"BM Sandroff","year":"2015","unstructured":"Sandroff BM, Pilutti LA, Benedict RH, Motl RW (2015) Association between physical fitness and cognitive function in multiple sclerosis: does disability status matter? Neurorehabilit Neural Repair 29(3):214\u2013223","journal-title":"Neurorehabilit Neural Repair"},{"key":"2851_CR34","unstructured":"Rao SM (1997) Neuropsychological aspects of multiple sclerosis. Multiple sclerosis: Clinical and pathogenic basis 357\u2013362"},{"key":"2851_CR35","doi-asserted-by":"crossref","unstructured":"Rao SM (2019) Cognitive dysfunction in multiple sclerosis. Multiple sclerosis and related disorders: Clinical guide to diagnosis, medical management, and rehabilitation 191\u2013198","DOI":"10.1891\/9780826125941.0022"},{"issue":"3","key":"2851_CR36","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/S0303-8467(02)00042-2","volume":"104","author":"D Janculjak","year":"2002","unstructured":"Janculjak D, Mubrin Z, Brinar V, Spilich G (2002) Changes of attention and memory in a group of patients with multiple sclerosis. Clin Neurol Neurosurg 104(3):221\u2013227","journal-title":"Clin Neurol Neurosurg"},{"key":"2851_CR37","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1016\/j.cortex.2018.11.012","volume":"111","author":"A Mazancieux","year":"2019","unstructured":"Mazancieux A, Souchay C, Casez O, Moulin CJ (2019) Metacognition and self-awareness in multiple sclerosis. Cortex 111:238\u2013255","journal-title":"Cortex"},{"issue":"8","key":"2851_CR38","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1080\/13803390801888733","volume":"30","author":"MR Basso","year":"2008","unstructured":"Basso MR, Shields IS, Lowery N, Ghormley C, Combs D, Arnett PA, Johnson J (2008) Self-reported executive dysfunction, neuropsychological impairment, and functional outcomes in multiple sclerosis. J Clin Exp Neuropsychol 30(8):920\u2013930","journal-title":"J Clin Exp Neuropsychol"},{"issue":"6","key":"2851_CR39","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1016\/S0163-8343(00)00100-6","volume":"22","author":"N Mills","year":"2000","unstructured":"Mills N, Allen J (2000) Mindfulness of movement as a coping strategy in multiple sclerosis: A pilot study. Gen Hosp Psychiatry 22(6):425\u2013431","journal-title":"Gen Hosp Psychiatry"},{"issue":"2","key":"2851_CR40","first-page":"315","volume":"35","author":"Y Goverover","year":"2014","unstructured":"Goverover Y, Genova H, Griswold H, Chiaravalloti N, DeLuca J (2014) Metacognitive knowledge and online awareness in persons with multiple sclerosis. NeuroRehabilitation 35(2):315\u2013323","journal-title":"NeuroRehabilitation"},{"key":"2851_CR41","doi-asserted-by":"crossref","unstructured":"Ciurli, P., Bivona, U., Barba, C., Onder, G., Silvestro, D., Azicnuda, E.,\u2026 Formisano,R (2010) Metacognitive unawareness correlates with executive function impairment after severe traumatic brain injury. Journal of the International Neuropsychological Society 16(2), 360\u2013368","DOI":"10.1017\/S135561770999141X"},{"issue":"1","key":"2851_CR42","first-page":"1","volume":"10","author":"MR Brenjestanaki","year":"2020","unstructured":"Brenjestanaki MR, Abbasi G, Mirzaian B (2020) Effectiveness of compassion-focused therapy on psychological flexibility recovery and self-criticism decrease in mothers with mentally retarded children. Biannu J Appl Couns JAC 10(1):1\u201318","journal-title":"Biannu J Appl Couns JAC"},{"issue":"1","key":"2851_CR43","first-page":"2941","volume":"1","author":"A Aghayousefi","year":"2012","unstructured":"Aghayousefi A, Shaghaghi F, Dehestani M, Barghi Irani Z (2012) The relationship between quality of life (QoL) and psychological capital with illness perception in MS patients. Health Psychol 1(1):2941","journal-title":"Health Psychol"},{"issue":"3","key":"2851_CR44","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1007\/s13760-018-0935-2","volume":"118","author":"J Kockrich","year":"2018","unstructured":"Kockrich J, Jacobs M, Ceccarelli A (2018) Thalamic atrophy and cognitive dysfunction in relapsing\u2013remitting multiple sclerosis: an MRI study. Acta Neurol Belgica 118(3):451\u2013457. https:\/\/doi.org\/10.1007\/s13760-018-0935-2","journal-title":"Acta Neurol Belgica"}],"container-title":["Acta Neurologica Belgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13760-025-02851-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13760-025-02851-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13760-025-02851-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T10:40:14Z","timestamp":1760352014000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13760-025-02851-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,4]]},"references-count":44,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["2851"],"URL":"https:\/\/doi.org\/10.1007\/s13760-025-02851-7","relation":{},"ISSN":["0300-9009","2240-2993"],"issn-type":[{"value":"0300-9009","type":"print"},{"value":"2240-2993","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,4]]},"assertion":[{"value":"15 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study protocol was approved by Ankara Y\u0131ld\u0131r\u0131m Beyaz\u0131t University University Health Sciences Scientific Research and Publication (01.07.2024 with decision number 06-813) in agreement with the Declaration of Helsinki and informed consent was obtained from all patients.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Neither this article nor any data in this article has been published elsewhere.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Submission declaration and verification"}},{"value":"Participants were informed about the study in detail and written \u201cInformed Consent\"was obtained from the individuals who voluntarily participated in the study.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}