Understanding Exercise Benefits, Barriers, and Needs of People with Multiple Sclerosis Who Are Nonambulatory

Background: Approximately 30% of people with multiple sclerosis (MS) experience significant mobility limitations requiring wheelchair assistance in daily life. Given the limited efficacy of pharmacological therapies for disease management in people with MS with advanced disability, alternative strategies such as exercise training are an important component of comprehensive care. However, few studies have explored the perceived benefits of and barriers to exercise engagement for nonambulatory people with MS. Further, there have been no comprehensive assessments of the exercise needs of this population. Such inquiries would be valuable for informing strategies to promote community exercise engagement in nonambulatory people with MS.

Objectives: (1) Identify perceived benefits of and barriers to community exercise for nonambulatory people with MS; and (2) Identify and rank the most important exercise needs for nonambulatory people with MS.

Methods: 101 people with MS (Patient Determined Disease Steps score = 6–7; mean age = 60.1 [SD=8.4] years; disease duration = 25.6 [SD=9.1] years) participated in a cross-sectional survey study. Perceived exercise benefits and barriers were measured with the Exercise Benefits and Barriers Scale (EBBS). Needs for community exercise engagement were assessed using a comprehensive needs assessment protocol guided by the Concerns Report Methodology.

Results: Nonambulatory people with MS identified health improvements and personal accomplishment as the top benefits of exercise participation. Environmental (physical) barriers and symptom exacerbation were identified as the top challenges to engaging in community exercise for this population. Further, nonambulatory people with MS reported that exercise facilities were failing to accommodate their exercise needs, specifically citing exercise equipment shortcomings. Additionally, participants conveyed high satisfaction with exercise professionals, specifically expressing that professionals were knowledgeable about exercise.

Conclusions: Exercise promotion efforts in people with MS who are nonambulatory should reinforce the physical health benefits of exercise and promote opportunities for personal accomplishment. Knowledgeable exercise professionals may play a valuable role in the delivery of such initiatives in community settings. Results highlight the need to increase program and facility access, and opportunities to support participation in community exercise for this population.