Motivational Interviewing May Improve Exercise Experience for People with Multiple Sclerosis: A Small Randomized Trial

Abstract

People with multiple sclerosis (MS) are likely to benefit from regular exercise, but physical inactivity is more common among people with MS than among the general population. This small randomized study evaluated whether motivational interviewing (MI) affects adherence to and personal experience in an exercise program. Inactive people with MS participating in an eight-week exercise program were randomized to either three brief MI (n = 7) or three health coaching (n = 6) sessions. Session attendance for both conditions was high, and MI fidelity was rigorously and reliably measured using the Motivational Interviewing Treatment Integrity Scales. The feasibility of using this approach was demonstrated with a small sample. Large effects favoring the MI condition were found for physical exertion, affect during exercise, and fatigue, but no effects were found for adherence to the exercise program. Treatment integrity measures of MI were correlated with outcomes in expected directions. Although this study demonstrated the feasibility of this MI approach, the large effect sizes found should be viewed with substantial skepticism and replicated in sufficiently powered studies using objective measures of exercise adherence.

How to Measure Motivational Interviewing Fidelity in Randomized Controlled Trials: Practical Recommendations

“…[24] (25%); [25] (16%); [26] (11%); [27] (28%); [28] (25%); [29] (23%); [30] (32%)). However, the study of Smith et al (2012) is an exception to this since 100% of recorded sessions were assessed, although the total number of sessions in this study only comprised 38 [31]. In studies where the intervention was delivered by more than one practitioner, 10-17 sessions per practitioner were selected for assessment ([32], (n = 17); [26] (n = 10)) to represent a reliable overview of the quality of the individual practitioner throughout the study period.…”

“…El-Mallakh et al (2012) Some studies require a comparison of overall group results (average of multiple practitioners), for example, when usual care conditions containing an attention control intervention without an MI component and an MI intervention condition are compared (e.g. [31]), or when practitioners with different backgrounds/experience are compared (e.g. [29] (n = 19)).…”

“…[29] (n = 19)). In the study of Smith et al (2012), one practitioner delivered both the intervention and the control arm of the study [31]. Here, it was examined if MI was more pronounced in the intervention group than in the control group by assessing 20 intervention sessions and 18 control sessions.…”

“…students) to use the MITI is possible [25,27,29,31,38]. However, training people to use the MITI is time consuming (more than 40 h).…”

“…[38] (32%; n = 11); [32] (4%; n = 6); [39] (20%; n = 19); [27] (8%; n = 115); [25] (30%; n = 54); [40] (10%; n unknown); [22] (25%; n unknown) [36] (27%: n = 15)). However, in some studies, all sessions were coded by at least two of the coders [28,31,41,42]. Having a large proportion, or indeed all sessions, double-coded will of course increase the validity of the results, but will not always be feasible were the total number of audio-recorded sessions is large.…”