Effect of Group Counseling Plus Tailored Exercise on Mobility Function in Multiple Sclerosis

Abstract

Background: Multiple sclerosis (MS) is a chronic disabling disease of the central nervous system which impairs muscular function and limits individuals' ability to carry out everyday activities requiring mobility. People with MS frequently exhibit mobility problems (i.e., slower walking speed, shorter strides). General exercise training (e.g., resistance, aerobic) provides modest physiological and walking mobility benefits. However, reviewers suggest tailoring of interventions to address mobility specifically. We conducted a Phase IIa pre-post intervention development study (ORBIT intervention development model) of a mobility exercise plus cognitive behavioral counselling intervention to improve function and social cognitions known to encourage exercise. Methods: The intervention was conducted twice per week for 8 weeks followed by 1 month of self-managed mobility exercise. Participants (N = 29, mean age = 52.24 ± 11.36 years, mean time since MS diagnosis = 11+ years) were assessed at baseline and post follow-up on mobility function, social cognitions, and intervention fidelity indicators. Results: Results indicated significant improvements in a number of valid measures of mobility function (e.g., 400m walk), self-regulatory efficacy for mobility exercise and symptom control, and fidelity measures with small to medium effect sizes. Conclusions: Positive findings suggest that the intervention appears to merit testing as a randomized pilot study following the ORBIT model.

Predicting physical activity for people with multiple sclerosis: The role of exercise-related cognitive errors.

“…Our findings further refine the predictive relationship between selfregulatory efficacy and perceived walking impairment (Hobart et al, 2003;Motl, Balto, et al, 2017;Sessford et al, 2013;Sikes et al, 2019) by showing that self-regulatory efficacy was most strongly predictive of walking impairment when ECEs were low. ECEs positively predicted perceived walking impairment beyond the contribution of self-report disability status.…”

Exercise Self-Efficacy and Fatigue as Predictors of Adherence to Home-Based Exercise Among Patients with Multiple Sclerosis

“…A previous study that applied a group counseling approach to help individuals interact with peers during the intervention phase revealed that group counseling impacts individuals’ self-efficacy, which helps maintain the behaviors required to sustain outcomes and improve function in patients with MS. 45 Patients were most likely to adhere to their home-based exercise programs when they performed the exercises under the supervision of physical therapists. 11 , 14 Moreover, remote online supervision by physical therapists may help patients with MS improve their adherence to home-based exercise programs.…”

“…11,25,30,42 A high level of exercise self-efficacy may help improve adherence to home-based exercise programs, symptoms including fatigue, and health-related quality of life in patients with MS. 3,6,42,43 A randomized controlled trial showed that including exercise self-efficacy in the intervention of patients with MS resulted in 90% of the participants feeling confident they would adhere to exercise after completing their supervised exercise programs. 44 A previous study that applied a group counseling approach to help individuals interact with peers during the intervention phase revealed that group counseling impacts individuals' self-efficacy, which helps maintain the behaviors required to sustain outcomes and improve function in patients with MS. 45 Patients were most likely to adhere to their home-based exercise programs when they performed the exercises under the supervision of physical therapists. 11,14 Moreover, remote online supervision by physical therapists may help patients with MS improve their adherence to homebased exercise programs.…”