Barriers and Facilitators To Exercise In People With Multiple Sclerosis

Background:

There is increasing evidence in favour of exercise for health outcomes for people with Multiple Sclerosis (PwMS). However, studies evaluating follow-up to exercise interventions demonstrate conflicting results, which suggest that there may be challenges to maintaining exercise behaviours over time. There is a need to explore barriers and facilitators to exercise in this population to inform health-promoting interventions over the lifetime of people with MS.

Objectives:

This study explores the barriers and facilitators to exercise, in people with Multiple Sclerosis, using a focus group study and an on-line questionnaire.

Methods:

A review of the literature and 2 focus groups were conducted to inform the content of a questionnaire. The focus groups took place in an urban and rural area of Ireland and were audio recorded and transcribed verbatim. Thematic content analysis was conducted. Members of Multiple Sclerosis Society of Ireland were invited to complete the on-line questionnaire that consisted of closed questions based on the themes of the focus groups and literature review. Five point Likert scales were used to rate the frequency of barriers. Facilitators were ranked on a on a scale of 1-5. Descriptive statistics were used to analyse the data.

Results:

Twelve participants volunteered in 2 separate focus groups. Environmental, psychological and disease specific barriers and facilitators to exercise were identified. Forty-eight participants responded to the questionnaire. The majority (71.7%, 33/48) of respondents reported using no assistive device to mobilise. The main barriers to exercise identified were symptom related. Fatigue (36.2%,17/47) and balance (25.5%,12/47) were the most commonly cited barriers “most of the time”. Motivation (34%,16/47) and time constraints (28.3%,13/46) were also cited as barriers “some of the time”. Environmental factors were “never” a barrier for between 37.8% (17/45) - 82.2% (37/45) of participants. Fifty per cent (12/24) of respondents ranked a reduction in MS symptoms as the most important facilitator of exercise. Enjoyable exercises were rated 2^nd highest by 32% (8/25) of respondents.

Conclusions:

This study suggests that balance and fatigue are the greatest barriers to exercise for this population who have minimal disability due to MS. Reducing these MS related symptoms is key in facilitating exercise for this group. A multifaceted approach that aims to improve fatigue and balance and that considers motivation and creating time to exercise may be warranted. Exercise interventions should be enjoyable for participants. These findings suggest that tailored exercise programmes should be considered.