Effects of an 8-Week Self-Efficacy Plus Exercise Intervention on Physical Activity, Quality of Life, and Fatigue in an Individual with Progressive MS

Background: Increasing self-efficacy to exercise and minimizing disease-related barriers has been shown to improve physical activity levels and quality of life (QOL) in persons with multiple sclerosis (MS). Currently, little research has examined exercise self-efficacy in persons with more advanced MS. 

Objectives: To analyze the effects of a self-efficacy plus exercise intervention on physical activity endurance, QOL, fatigue and physical activity level in a middle-aged individual with advanced MS and low self-reported self-efficacy. 

Methods: One 60 year old, severely disabled female with secondary progressive MS participated in an 8-week intervention consisting of weekly discussions and MS-related educational presentations; 4 one-on-one sessions with a MS “mentor”, and daily documentation in a journal to record sleep quality, fatigue level, and physical activity.  Outcome measures included a modified 5 meter walk test (5MWT), MS Impact Scale (MSIS-29), Exercise Self-Efficacy Scale (ESES), Modified Fatigue Impact Scale (MFIS), MS Self-Efficacy Scale (MS-SES), Patient Health Questionnaire-9 (PHQ-9), and daily physical activity monitoring using an accelerometer. Outcomes were assessed at baseline (wk 0), post-intervention (wk 8), and 2-months post intervention (wk 16). The participant’s current exercise routine was modified to maximize adherence. A semi-structured interview determined intervention usefulness.

Results: The participant demonstrated improved pre-post intervention scores for measures of ESES, MSIS-29, MFIS, and PHQ-9 demonstrating higher self-rated exercise self-efficacy and health, and reduced disability and fatigue. Gait speed was unchanged. Sleep quality and morning fatigue improved from wk 1 to 16, while evening fatigue was unchanged. Activity monitoring data will also be presented. The participant reported the educational presentations and “mentor” sessions to be very valuable with the daily journal perceived as the least valuable component of the intervention.

Conclusion: Preliminary results from this case study suggest that an 8-week self-efficacy intervention can increase exercise self-efficacy, QOL, and reduce perceived fatigue in a severely disabled individual with secondary progressive MS. Future research should examine self-efficacy interventions in a larger sample size of persons with progressive MS.