Addressing Physical Activity Behavior in Multiple Sclerosis Management

Abstract

Background: Physical activity (PA) is considered the most important non-pharmaceutical intervention for persons living with multiple sclerosis (PwMS). Less than 20% of PwMS are engaging in sufficient amounts of PA to accrue benefits. PA promotion is most effective when combined with additional behavior change strategies (BCS), but this is not routinely done in clinical practice. The purpose of this study is to increase our understanding of current practice and perspectives of health care providers (HCPs) in Canada regarding their use of interventions to address PA behavior in the management of MS. Investigating HCPs' perspectives on implementing PA behavior change with PwMS will provide insight into this knowledge-to-practice gap. Methods: Semi-structured focus groups were conducted with HCPs (n=31) working with PwMS in Saskatchewan. Based on Interpretive Description, data were coded individually by three researchers, who then collaboratively developed themes. Analysis was inductive and iterative, triangulation and member reflections were used. Results: Five themes were established: 1) Prescribing, promoting and impacting wellness with PA; 2) Coordinating communication and continuity in practice; 3) Being proactive rather than reactive: timely access to relevant care; 4) Enhancing programming and community-based resources and 5) Reconciling the value of PA with clinical practice. Conclusions: HCPs value PA and desire more support with application of BCS to deliver PA behavioral interventions, but due to acute and reactive nature of health care systems, feel this cannot be prioritized in practice. Both individual- and systems-level changes are needed to support consistent and effective use of PA behavioral interventions in MS.

The role of multidisciplinary MS care teams in supporting lifestyle behaviour changes to optimise brain health among people living with MS: A qualitative exploration of clinician perspectives

“…These findings corroborate those of previous studies which have long showed that knowledge does not always translate into action, 28 and further, that MS knowledge is not always associated with self‐efficacy 29 . One qualitative study addressing physical activity behaviours in MS management reported that initiatives to increase engagement with health behaviours in populations such as MS, should also include behaviour change strategies to ensure optimal effectiveness of healthy lifestyle promotion 30 . Strategies may include self‐efficacy assessment, barrier identification and problem solving 31 .…”

The Neurologist as an Agent of Exercise Rehabilitation in Multiple Sclerosis

“…The systematic development of exercise promotion through the patient-provider interaction has evolved extensively through a series of nine articles by our group over the last 5 yr (29)(30)(31)(34)(35)(36)(37)(38)(39) that are buttressed by formative research from others on this topic (40)(41)(42)(43)(44)(45). This line of research was designed using a novel approach whereby we implemented a "bottom-up" strategy focusing on the needs and wants of patients with MS as a foundation (40).…”

“…The reality of the aforementioned interest by patients in exercise promotion by health care providers is tenuous, unless it aligns with the needs and interests of providers (i.e., neurologists, nurses, physical therapists, and occupational therapists) for undertaking exercise promotion, as the needs and wants of patients might not be feasible for delivery within MS clinical care settings. To that end, other studies recently have been published on the provider's perspective of exercise promotion in MS (34,(43)(44)(45). For example, one study involved semistructured interviews with 44 health care providers that included similar numbers of neurologists, nurse practitioners, physical therapists, and occupational therapists (34).…”

“…Providers further described a need for the development of specific resources for promoting exercise among patients that could provide information on specific exercise prescriptions, as well as on local facilities or outside exercise professionals that could be accessible among patients (34). Relatedly, other research suggests that the implementation of such resources, in conjunction with behavior change strategies, might improve the value of exercise within the context of comprehensive MS clinical practice (44,45). Within that context, it has been suggested that the clarification of conflicting terminology regarding exercise in MS further might enhance the promotion of exercise by providers (43).…”

“…Those research endeavors further should involve multidisciplinary research teams for providing Another major class of challenges in this area involves the application of the aforementioned line of research into clinical practice across comprehensive MS care centers in Europe and beyond. This is an obvious challenge as much of the emerging research on exercise promotion in clinical settings has been based on health care models and systems in North America (44,45), yet comprehensive MS care is not a one-size-fits-all model across the world. Indeed, the roles, responsibilities, and degree of collaboration among clinicians likely vary across countries, perhaps based on different sociopolitical structures and governmental regulations.…”