Perspectives of physical activity in persons with multiple sclerosis who are wheelchair users: Informing the design of future interventions

Background:  It has been established that physical activity and exercise offer many benefits to those with multiple sclerosis (MS) who have minimal disability. However, limited research has been conducted to examine the impact on individuals with advanced MS who use a wheelchair. To inform the design and delivery of physical activity and exercise interventions in this segment of the MS population, qualitative inquiry is needed.  

Objectives: To explore the meanings, motivations and barriers for physical activity and exercise in wheelchair users with MS.  

Methods: Fifteen wheelchair users with MS were evaluated. Clinical status (MS type and years since diagnosis) and demographic variables (age, sex and ethnicity) were established using surveys. Individual semi-structured interviews lasted approximately 45 minutes and concentrated on the meanings, motivations and barriers to physical activity and exercise. Interviews were audio recorded and transcribed verbatim, thematic analysis was performed on the data by two researchers.

Results: Participants represented a typical sample of people with advanced MS. Three interrelated subthemes emerged: 1) meanings of physical activity and exercise, 2) benefits of physical activity and exercise and 3) barriers and facilitators to exercise. Many participants acknowledged differences between physical activity and exercise, and further acknowledged physical and psychological benefits from both, including improvement in fatigue, strength, mobility and everyday function alongside improved self-control and mood. Common barriers to physical activity and exercise were; symptoms, internal motivations, the environment and professional input. Results suggest that participants would be more likely to increase their physical activity and exercise levels if interventional facilitators were incorporated, and included; symptom appropriate physical activity and exercise, behavioral management strategies, use of appropriate environments and good professional guidance.  

Conclusions: Clinicians and researchers designing physical activity and exercise interventions for those with advanced MS must develop interventions which are; symptom appropriate, inclusive of behavioural change strategies, undertaken in appropriate environments and delivered through appropriate professional interaction.