DISCUSSION: Fewer than 20% of persons with MS engage in sufficient physical activity

[ActiveMSers]

Physical activity in MS: theory, determinants, and behavioral interventions

R.W. Motl (Urbana-Champaign, US)

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There is substantial evidence for the benefits of physical activity, particularly exercise training, among persons with multiple sclerosis (MS). Paradoxically, persons with MS are substantially less physically active than the general population, and, in some cases, persons with other chronic disease. Of note, recent data indicate that fewer than 20% of persons with MS engage in sufficient physical activity for meeting public health recommendations, and the level of physical activity continually decreases over time. This underscores the importance of adopting techniques from the social and behavioral sciences for understanding determinants of physical activity in MS. Such determinants then become targets of behavioral interventions for increasing physical activity. To that end, this presentation has three objects.

The presentation will first outline the major tenants and components of Social-Cognitive Theory (SCT), one of the most common and powerful approaches for understanding and change behavior, including physical activity, in the general population. The presentation will then review cross-sectional and longitudinal research on the application of SCT for understanding physical activity behavior in persons with MS. The last component of the presentation will review recent research on the efficacy of behavioral interventions based on SCT for increasing physical activity and the possible secondary outcomes in persons with MS. The overarching goal of the presentation involves developing an appreciation of the contribution affording by social and behavioral sciences for changing one of the most important health behaviors in MS, namely physical activity. This represents a new rehabilitation paradigm based on the promotion of physical activity rather than focusing on structured and supervised exercise training in MS.

[ActiveMSers]

This is being presented at ECTRIMS in a few days. I would like to be in the audience for this discussion! What can be done to increase exercise participation?

[JerryD]

Dave,
I believe one of the reasons MSer's aren't exercising is because the medical establishment only pays lip service to this part of treating MS patients. MS treatment needs to include DMT's as well as PT, OT and some sort of exercise routine.

[AMFADVENTURES]

You should be at ECTRIMS Dave. In fact, you should be involved in this presentation since you probably are the worlds leading expert in the application of SCT towards increasing physical activity behavior in PWMS. Correct me if I'm wrong but I think this is the ONLY web site around which is dedicated to keeping MSers active.

I also agree, Dr's and clinics could do more to stress the value of physical activity to their patients. Of course so could NMSS and other MS specific web sites. How to make that happen? We probably need more studies run on it. Unfortunately, in the absence of an economic incentive, I don't see that happening to any great extent. Even ECTRIMS seems to be deficient in the quality and quantity of studies concerning PWMS and exercise this year.

AMF

[teena marie]

Doctors and those involved in working with MS need to be more proactive about physical activity. As well, insitutions, such as the Montreal Neurological Institute, where I go on occasion, need to have facilities where they can help with the process, especially if there is any adaptation needed. When I was first diagnosed in 2006 (things had started in 1998-misdiagnosed), I requested seeing physio and OT. The phsio did an excellent job of asessing me, said to come back in 6 months and continue what I was doing. Perhaps,as an example, it may have been helpful to mention foot drop is experienced by a large percentage of people with MS and doing regular dorsiflexion exercises may help. Even better a few follow up appointments to assess technique and provide feedback and encouragement may help. I realize I'm dreaming in technicolor, but if ever I came into some serious cash, this is what I'd like to do.
But for sure, there is a behavioral aspect to consider. Even with cadillac support, there will be some who don't embrace it. It's human nature.
Maybe we need to develop interventions to train the medical establishment!

Take care all,

Teena Marie

[Veronica]

I agree with all of this. I personally think that neurologists need to add to the "You have MS" talk, that their patients must see "exercise as medicine for your MS" ( As my PT so strongly stresses). I've heard too many stories of others who, since they did not have any noticeable physical issues, felt that they did not need to connect with a good PT. All of us on this website know how exercise helps us in so many ways, but how to reach those who never were into physical activity before the disease is the challenge. Yes, behavioral interventions could be helpful, but I think it needs to start with the treating physician to set the tone that treating one's MS is a team action, and the patient has to assume a very active role in this. I have heard others say that exercising on one's own every day is too hard, tedious, time consuming. This is the hurdle to get over ....and not easy to do so.