Exploration of the Physical Activity Guidelines for People with Multiple Sclerosis

Background Despite the numerous benefits of exercise and the publication of the physical activity guidelines (PAG) in 2013, most people with multiple sclerosis (PWMS) remain physically inactive. Appropriately supported opportunities to engage in physical activity in the community remain scarce, so the extent to which the PAGs inform practice is unclear. The overarching aim of the thesis was to explore what helps PWMS engage in exercise in the community, using the physical activity guidelines as a guide. To achieve this, the thesis explored the exercise experiences, preferences, and support needs of PWMS. Methods The research programme included four connected studies using a range of methodologies. Study 1 (Chapter 3) adopted a qualitative approach to explore the thoughts of people with high MS disability. Study 2 (chapter 4) was a mixed-methods feasibility study to explore high-intensity interval training in PWMS. Study 3 (chapter 6) was a qualitative study exploring the opinions of healthcare professionals and PWMS. Study 4 (chapter 8) was a mixed-methods evaluation of a community-based exercise intervention. Additionally, the thesis includes a scoping review (chapter 5) and a systematic intervention development process using the behaviour change wheel (chapter 7). A pragmatic theoretical perspective underpins the research programme as findings were pursued that are applicable in practice and the community. Key Findings The PAGs for PWMS lack inclusivity and provide little detail of exercise prescription and application. High-intensity exercise was safe and feasible for PWMS but with limited long-term appeal. For PWMS and some healthcare professionals, there is a need to change their perception of exercise professionals' competence in working with PWMS. Additionally, healthcare professionals state that discussing exercise with their patients is not a priority. Within the community, interventions are primarily aimed at people with mild MS. Also, PAGs and behaviour change theory are used sporadically in community interventions. Encouragingly, a community-based intervention underpinned by BCT and structured using the PAGs was well attended by participants, improved constructs of the COM-B model, and may improve physical activity levels, fatigue, quality of life, self-efficacy, and physical function. Conclusions The PAGs exist to help support PWMS to exercise in the community. The deep understanding of the exercise experiences, preferences, and needs of PWMS gleaned through this body of work suggests that the PAGs are currently ineffective, as the infrastructure is not in place for PWMS to enact the behaviour. Theory-informed community-based interventions show promise and need to be used to create an ecosystem where PWMS feel capable, and have the opportunities, and motivation to engage in exercise.