Researchers: The key to MSers exercising? Motivation

[ActiveMSers]

Let's help each other get fit and stay fit. Feed off the success of others here. Keep it up! - D

A qualitative investigation of exercise perceptions and experiences in people with multiple sclerosis before, during and after participation in a personally-tailored exercise program

Helen Crank, PhD, Anouska Carter, PhD, Liam Humphreys, MSc, Nicky Snowdon, MSc, Amanda Daley, PhD, Nicola Woodroofe, PhD, Basil Sharrack, MD, PhD, FRCP, FAAN, Jane Petty, BSc, John M. Saxton, PhD

DOI: http://dx.doi.org/10.1016/j.apmr.2017.05.022

Abstract

Objective
To undertake a qualitative investigation of exercise perceptions and experiences in people with MS (PwMS) before, during and after participation in a personally-tailored program designed to promote long-term maintenance of self-directed exercise.

Design
Focus groups and semi-structured telephone interviews.

Setting
University Exercise Science Department close to the recruiting hospital.

Participants
PwMS (N=33; aged 47.6±7.9 y).

Interventions
Participants were recruited after participation in a randomized controlled exercise trial; all had been allocated to a 12-week exercise programme, comprising supervised and self-directed exercise sessions.

Main outcome measure
Exercise perceptions and experiences before, during and after participation in the program.

Results
Four themes emerged from the analysis: (1) the transition to inactivity; (2) lack of knowledge and confidence; (3) positive exercise experiences; (4) perspectives on exercise adherence.

Conclusion
Lack of confidence and exercise knowledge, coupled with negative perceptions about physical capabilities after an MS diagnosis, are clear barriers to exercise participation in PwMS. These issues are not being adequately addressed as part of the healthcare pathway or in community settings. Perceptions of improved posture, ability to overcome everyday difficulties, acute mood enhancements during and after exercise and increased opportunities for social interaction were amongst the reported benefits of exercise participation. Despite the provision of a personally-tailored exercise plan and use of cognitive behavioural strategies, self-directed exercise continued to present challenges to PwMS and the importance of seeking cost-effective ways to maintain motivational support was implicit in participant responses.

[garyp]

Motivation

"the importance of seeking cost-effective ways to maintain motivational support was implicit in participant responses"

People will ask me what type of exercise is best for MS. I always tell them that is not the most optimal form of exercise that is important - it is your desire to do it. If you don't enjoy it, you will not do it. If you enjoy gardening - do that. If you enjoy walking in a park, do that.

I also tell people to find some deeply emotional reason for wanting to stay active. On the day my daughter was born (a year post diagnosis) I promised her in my head that I would walk into her high school graduation without assistance. Made the same promise to her brother when he was born 2 years later. I knew this was a stretch objective. I have reached both goals. Now there are a couple of college graduations I will need to walk into, without assistance. And one day, if my daughter chooses to do so, walk her down the aisle. That is what motivates me.

[Suebee]

I couldn't access more than the abstract so my comments are on abstract

Of course motivatation is important to MSers and non MSers alike! GAry, I agree. MSers have to dig deep inside to stay motivated- what ever it takes. That is why I feel the researchers missed the boat, and actually did MSers a big disservice if Future PT programs incorporate more motivational techniques instead of developing better rehabilitation techniques.

I noticed some judgmental language in abstract that MSers lack confidence and knowlege about exercise. Also that despite well made at home plans there was lack of compliance. Let's turn the lens around shall we....PT rehab programs generally instruct MSers to monitor fatigue with an awkward numerical scale and keep activity at slow and steady. BUT MSers have independently found this to be difficult to achieve much at slow and steady and HITT works great to increase strenghth and endurance for
MSers. Or my favorite issue, FES, which has shown to improve strenght and endurance for stroke and paralysis victims but is used rarely for mobile MSers. Also, insurance covers rehab, if you get worse. Not to mantain or improve. What incentive is provided to MSer if one can only get more PT support if one gets worse???

This paper focus on percieved faults of the MSer, instead of faults in exercise method, duration of rehab, and insurance coverage.
Again, I'm in total agreement that motivation is important. But the MSers I know are motivated to live the best quality of life possible. The researched overlooked perseverance, never giving up, access to insurance and a rehab center, a program which incorpotates excercise especially taylored to a person witn MS such as HITT, cool pool aqua therapy, and FES. Seems to me it is researchers and insurance coverage who need to be motivated to give gold standard or at least effective care... just sayin'. Hope you researchers read this....