Original article| Volume 37, 101441, January 2020

Physician referral improves adherence to the physical activity guidelines for adults with MS: A randomized controlled trial

Published:October 22, 2019DOI:


      • Physician referral enhances adherence to physical activity.
      • Higher exercise self-efficacy is associated with higher physical activity adherence.
      • Baseline fitness, function or EDSS score did not affect physical activity adherence.



      Commitment and adherence to community-based physical activity can be a challenge for clinical populations. The aim of this study was to explore the effectiveness of physician referral on adherence to the Physical Activity Guidelines (PAGs) for adults with MS.


      Ninety-one participants with MS (age: 47.9 ± 10.4 years, EDSS score: 3.5 ± 1.8) were randomized into a direct referral to PAGs from a physician (REF) or control (CON) group (given a print copy of PAGs). After 16 weeks participants were categorized as either PAG “Adherers” (n = =30) or “Non-Adherers” (n = =49), based on achieving an adherence rate of ≥ 75%.


      Adherence to the PAGs was significantly higher in REF (68.0 ± 28.6%) compared with CON (35.1 ± 35.0%) (p < 0.05). There were no differences in EDSS scores, time since diagnosis, fitness, fatigue, mobility or QOL between those who adhered or did not adhere to the PAGs (p > 0.05), but greater self-efficacy for exercise at baseline was associated with higher adherence (p < 0.0001).


      Direct referral to physical activity from a physician is twice as effective as simply providing information about physical activity for adherence to the PAG in people with MS. As physical activity is recognized as an effective therapeutic option for adults with MS it is important that physicians play a role in prescribing it to their patients.

      Trial registration Identifier: NCT02100020


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