Highlights
- •Exercise is an essential strategy for improving symptoms of MS.
- •Neurologists are under resourced to provide this information.
- •We addressed gaps in knowledge and practice in the paper.
- •Time, training and insurance constraints were barriers to exercise promotion.
- •Exercise guidelines, resources and a team approach facilitate exercise promotion.
Abstract
Background
Fewer than 20% of persons with multiple sclerosis (MS) engage in sufficient amounts
of exercise for experiencing health and wellness benefits. Neurologists have a powerful
and influential relationship among patients, highlighting the potential for the patient-provider
interaction to be a gateway for promoting exercise behavior. Neurologists, however,
are under-supported and under-resourced for promoting exercise in comprehensive MS
care. The purpose of this study was to determine the priorities of neurologists for
exercise promotion among patients in comprehensive MS care and, where possible, provide
suggestions for how each priority may be addressed in practice.
Methods
Priority areas were identified through deductive content analysis of 20 semi-structured
interviews with practicing neurologists.
Results
Seven priority areas were identified regarding promotion of exercise among patients
in comprehensive MS care. These included 1). How do I fit exercise promotion into
a patient's appointment? 2). What resources should I give my patients about exercise?
3). What are the benefits of exercise for people with MS? 4). What training can I
do to be better informed about exercise? 5). What are the prescriptions/guidelines
for exercise among persons with MS? 6). What kind of services can I rely on to support
me in promoting and supporting exercise behavior? 7). How do I negotiate reimbursement
and insurance restrictions when I promote exercise?
Conclusions
This research sets an agenda regarding approaches for exercise promotion among patients
with MS through interactions with neurologists in comprehensive care settings.
Keywords
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References
- Effect of exercise on depressive symptoms in adults with neurologic disorders: a systematic review and meta-analysis.Arch. Phys. Med. Rehab. 2015; 96: 1329-1338
- Feasibility study design and methods for project GEMS: guidelines for exercise in multiple sclerosis.Contemp. Clinl. Trials. 2016; 47: 32-39
- Immunopathology of multiple sclerosis.Nat. Rev. Immunol. 2015; 15: 545-558
- Exercise training guidelines for multiple sclerosis, stroke, and Parkinson disease: rapid review and synthesis.Am. J. Phy. Med. Rehab. 2019; 98: 613-621
- Objectively quantified physical activity in persons with multiple sclerosis.Arch. Phys. Med. Rehab. 2013; 94: 2342-2348
- et al. development of evidence-informed physical activity guidelines for adults with multiple sclerosis.Arch Phys. Med. Rehab. 2013; 94: 1829-1836
- Multiple sclerosis patients need and want information on exercise promotion from healthcare providers: a qualitative study.Health. Expect. 2017; 20: 574-583
- Investigating the needs and wants of healthcare providers for promoting exercise in persons with multiple sclerosis: a qualitative study.Disabil. Rehabil. 2018; 40: 2172-2180
- Qualitative content analysis.A Companion to Qualitative Research. 1. 2004: 159-176 ([online])
- Exercise-induced changes in neurotrophic factors and markers of blood-brain barrier permeability are moderated by weight status in multiple sclerosis.Neuropeptides. 2018; 70: 93-100
- Transient increase in symptoms associated with cytokine release in patients with multiple sclerosis.Brain. 1996; 119: 225-237
- Rationale and design of the STEP for MS trial: comparative effectiveness of supervised versus telerehabilitation exercise programs for multiple sclerosis.Contemp. Clinl. Trials. 2019; 81: 110-122
- Promotion of exercise in multiple sclerosis through HCPs.Exerc. Sport. Sci. Rev. 2018; 46: 105-111
- The benefits of exercise training in multiple sclerosis.Nat. Rev. Neurol. 2012; 8: 487-497
- Is physical exercise a multiple sclerosis disease modifying treatment.Expert. Rev. Neurother. 2016; 18: 951-960
- Exercise in patients with multiple sclerosis.Lancet. Neurol. 2017; 16: 848-856
National Multiple Sclerosis Society. https://www.nationalmssociety.org/Resources-Support/Find-Doctors-Resourcesretrieved on 28th June 2019.
- Symptom management of multiple sclerosis in adults.UpToDate. 2015; (Accessed 18 July 2019)
- Exercise as a therapy for improvement of walking ability in adults with multiple sclerosis: a meta-analysis.Arch. Phys. Med. Rehab. 2015; 96: 1339-1348
- Effects of exercise training on fatigue in multiple sclerosis: a meta-analysis.Psychosom. Med. 2013; 75: 575-580
- The safety of exercise training in multiple sclerosis: a systematic review.J. Neurol. Sci. 2014; 343: 3-7
- The safety of exercise training in multiple sclerosis: a systematic review.J. Neurol. Sci. 2014; 343: 3-7
- Randomized controlled trial of a behavioral intervention targeting symptoms and physical activity in multiple sclerosis.Mult. Scler. J. 2014; 20: 594-601
- Effect of exercise training on fitness in multiple sclerosis: a meta-analysis.Arch. Phys. Med. Rehab. 2016; 97: 1564-1572
- How are community health workers trained to deliver physical activity to adults? A scoping review.Transl. J. ACSM. 2019; 4: 34-44
- Evaluation of a conceptual model regarding exercise promotion through the patient–provider interaction in multiple sclerosis: health care provider perspectives.Qual. Health. Res. 2018; ([online]Available at)
- A narrative exploration of the evolving perception of exercise among people with multiple sclerosis.Qual. Res. Sport. Exerc. Health. 2019; 11: 119-137
- Exercise promotion in multiple sclerosis through the patient-provider interaction: development and quality improvement of practice models.Transl. J. ACSM. 2018; (in press)
- Systematic, evidence based review of exercise, physical activity, and physical fitness effects on cognition in persons with multiple sclerosis.Neuropsychol. Rev. 2016; 26: 271-294
- Interviews: qualitative interviewing in the sport and exercise.in: Smith A. Sparkes A. Routledge Handbook of Qualitative Research in Sport and Exercise. Routledge, London2016: 37-48
Article info
Publication history
Published online: October 30, 2019
Accepted:
October 27,
2019
Received in revised form:
October 4,
2019
Received:
July 19,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
