Breaking down the barriers to physical activity among people with multiple sclerosis – a narrative review

References

• Federation MSI . Atlas of MS 2013 [cited 2016]. Available from: http://www.msif.org/about-us/advocacy/atlas/.
   Google Scholar
• UK PS . About Parkinsons Unitied Kingdom [cited 2016]. Available from: http://www.parkinsons.org.uk/content/about-parkinsons.
   Google Scholar
• Prevention CfDCa . Prevalence of amyotrophic lateral sclerosis-United States 2010-11 2014 [cited 2016]. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6307a1.htm.
   Google Scholar
• Tremlett H , Paty D , Devonshire V . Disability progression in multiple sclerosis is slower than previously reported. Neurol. 2006;66(2):172–7. 10.1212/01.wnl.0000194259.90286.fe. PubMed PMID: 16434648.
   PubMed Web of Science ®Google Scholar
• D’Amico E , Leone C , Caserta C , Patti F . Oral drugs in multiple sclerosis therapy: an overview and a critical appraisal. Expert Rev Neurother. 2015;15(7):803–24. 10.1586/14737175.2015.1058162. PubMed PMID: 26098146.
   PubMed Web of Science ®Google Scholar
• Stuifbergen AK , Blozis S , Becker H , Harrison T , Kullberg V . Selected health behaviors moderate the progression of functional limitations in persons with multiple sclerosis: eleven years of annual follow-up. Disabil Health J. 2016;9(3):472–8. 10.1016/j.dhjo.2016.01.006. PubMed PMID: 26905974.
   PubMed Web of Science ®Google Scholar
• Ploughman M , Austin MW , Murdoch M , Kearney A , Fisk JD , Godwin M , et al . Factors influencing healthy aging with multiple sclerosis: a qualitative study. Disabil Rehabil. 2012;34(1):26–33. 10.3109/09638288.2011.585212. PubMed PMID: 21902450.
   PubMed Web of Science ®Google Scholar
• Ploughman M , Austin MW , Murdoch M , Kearney A , Godwin M , Stefanelli M . The path to self-management: a qualitative study involving older people with multiple sclerosis. Physiother Can. 2012;64(1):6–17. 10.3138/ptc.2010-42. PubMed PMID: 23277680; PubMed Central PMCID: PMC3280705
   PubMed Web of Science ®Google Scholar
• Ploughman M , Beaulieu S , Harris C , Hogan S , Manning OJ , Alderdice PW , et al . The Canadian survey of health, lifestyle and ageing with multiple sclerosis: methodology and initial results. BMJ Open. 2014;4(7):e005718. 10.1136/bmjopen-2014-005718. PubMed PMID: 25011993; PubMed Central PMCID: PMC4120418.
   PubMed Web of Science ®Google Scholar
• Austin MW , Ploughman M , Glynn L , Corbett D . Aerobic exercise effects on neuroprotection and brain repair following stroke: a systematic review and perspective. Neurosci Res. 2014;87:8–15. 10.1016/j.neures.2014.06.007. PubMed PMID: 24997243.
   PubMed Web of Science ®Google Scholar
• Ploughman M , Austin MW , Glynn L , Corbett D . The effects of poststroke aerobic exercise on neuroplasticity: a systematic review of animal and clinical studies. Transl Stroke Res. 2015;6(1):13–28. 10.1007/s12975-014-0357-7. PubMed PMID: 25023134.
   PubMed Web of Science ®Google Scholar
• Ploughman M . Exercise is brain food: the effects of physical activity on cognitive function. Dev Neurorehabil. 2008;11(3):236–40. 10.1080/17518420801997007. PubMed PMID: 18781504.
   PubMed Web of Science ®Google Scholar
• Dishman RK , Berthoud HR , Booth FW , Cotman CW , Edgerton VR , Fleshner MR , et al . Neurobiology of exercise. Obesity (Silver Spring). 2006;14(3):345–56. 10.1038/oby.2006.46. PubMed PMID: 16648603.
   PubMed Web of Science ®Google Scholar
• Learmonth YC , Motl RW . Physical activity and exercise training in multiple sclerosis: a review and content analysis of qualitative research identifying perceived determinants and consequences. Disabil Rehabil. 2015;1–16. 10.3109/09638288.2015.1077397. PubMed PMID: 26314587.
   Web of Science ®Google Scholar
• Nosek MA , Hughes RB , Robinson-Whelen S , Taylor HB , Howland CA . Physical activity and nutritional behaviors of women with physical disabilities: physical, psychological, social, and environmental influences. Women’s Health Issues. 2006;16(6):323–33. 10.1016/j.whi.2006.08.002. PubMed PMID: 17188215.
   PubMed Web of Science ®Google Scholar
• Zalewski K . Exploring barriers to remaining physically active: a case report of a person with multiple sclerosis. J Neurol Phys Ther. 2007;31(1):40–5. PubMed PMID: 17419888.10.1097/01.NPT.0000260570.69863.da
   PubMedGoogle Scholar
• Latimer-Cheung AE , Martin Ginis KA , Hicks AL , Motl RW , Pilutti LA , Duggan M , et al . Development of evidence-informed physical activity guidelines for adults with multiple sclerosis. Disabil Rehabil. 2013;94(9):1829–36, e7. 10.1016/j.apmr.2013.05.015. PubMed PMID: 23770262.
   Web of Science ®Google Scholar
• Learmonth YC , Rice IM , Ostler T , Rice LA , Motl RW . Perspectives on physical activity among people with multiple sclerosis who are wheelchair users: informing the design of future interventions. Int J MS Care. 2015;17(3):109–19. 10.7224/1537-2073.2014-018. PubMed PMID: 26052256; PubMed Central PMCID: PMC4455863
   PubMedGoogle Scholar
• Dalgas U , Stenager E , Jakobsen J , Petersen T , Hansen HJ , Knudsen C , et al . Resistance training improves muscle strength and functional capacity in multiple sclerosis. Neurol. 2009;73(18):1478–84. 10.1212/WNL.0b013e3181bf98b4. PubMed PMID: 19884575.
   PubMed Web of Science ®Google Scholar
• Ahmadi A , Arastoo AA , Nikbakht M , Zahednejad S , Rajabpour M . Comparison of the effect of 8 weeks aerobic and yoga training on ambulatory function, fatigue and mood status in MS patients. Iran Red Crescent Med J. 2013;15(6):449–54. 10.5812/ircmj.3597. PubMed PMID: 24349740; PubMed Central PMCID: PMC3840829
   PubMed Web of Science ®Google Scholar
• Sangelaji B , Nabavi SM , Estebsari F , Banshi MR , Rashidian H , Jamshidi E , et al . Effect of combination exercise therapy on walking distance, postural balance, fatigue and quality of life in multiple sclerosis patients: a clinical trial study. Iran Red Crescent Med J. 2014;16(6):e17173. 10.5812/ircmj.17173. PubMed PMID: 25068045; PubMed Central PMCID: PMC4102978
   PubMed Web of Science ®Google Scholar
• Petajan JH , Gappmaier E , White AT , Spencer MK , Mino L , Hicks RW . Impact of aerobic training on fitness and quality of life in multiple sclerosis. Ann Neurol. 1996;39(4):432–41. 10.1002/ana.410390405. PubMed PMID: 8619521.
   PubMed Web of Science ®Google Scholar
• Tarakci E , Yeldan I , Huseyinsinoglu BE , Zenginler Y , Eraksoy M . Group exercise training for balance, functional status, spasticity, fatigue and quality of life in multiple sclerosis: a randomized controlled trial. Clin Rehabil. 2013;27(9):813–22. 10.1177/0269215513481047. PubMed PMID: 23543341.
   PubMed Web of Science ®Google Scholar
• Carter A , Daley A , Humphreys L , Snowdon N , Woodroofe N , Petty J , et al . Pragmatic intervention for increasing self-directed exercise behaviour and improving important health outcomes in people with multiple sclerosis: a randomised controlled trial. Mult Scler. 2014;20(8):1112–22. 10.1177/1352458513519354. PubMed PMID: 24421303.
   PubMed Web of Science ®Google Scholar
• Straudi S , Martinuzzi C , Pavarelli C , Sabbagh Charabati A , Benedetti MG , Foti C , et al . A task-oriented circuit training in multiple sclerosis: a feasibility study. BMC Neurol. 2014;14:1430. 10.1186/1471-2377-14-124. PubMed PMID: 24906545; PubMed Central PMCID: PMC4059088
   Web of Science ®Google Scholar
• Hogan N , Kehoe M , Larkin A , Coote S . The effect of community exercise interventions for people with MS who use bilateral support for gait. Mult Scler Int. 2014;2014:109142. 10.1155/2014/109142. PubMed PMID: 24575302; PubMed Central PMCID: PMC3910069
   PubMedGoogle Scholar
• Asano M , Duquette P , Andersen R , Lapierre Y , Mayo NE . Exercise barriers and preferences among women and men with multiple sclerosis. Disabil Rehabil. 2013;35(5):353–61. 10.3109/09638288.2012.742574. PubMed PMID: 23347461.
   PubMed Web of Science ®Google Scholar
• Kasser SL , Kosma M . Health beliefs and physical activity behavior in adults with multiple sclerosis. Disabil Health J. 2012;5(4):261–8. 10.1016/j.dhjo.2012.07.001. PubMed PMID: 23021737.
   PubMed Web of Science ®Google Scholar
• Kayes NM , McPherson KM , Schluter P , Taylor D , Leete M , Kolt GS . Exploring the facilitators and barriers to engagement in physical activity for people with multiple sclerosis. Disabil Rehabil. 2011;33(12):1043–53. 10.3109/09638288.2010.520801. PubMed PMID: 20874658.
   PubMed Web of Science ®Google Scholar
• Motl RW , Mullen S , Suh Y , McAuley E . Does physical activity change over 24 months in persons with relapsing-remitting multiple sclerosis? Health Psychol. 2014;33(4):326–31. 10.1037/a0032700. PubMed PMID: 23668848.
   PubMed Web of Science ®Google Scholar
• Chiu CY , Lynch RT , Chan F , Berven NL . The health action process approach as a motivational model for physical activity self-management for people with multiple sclerosis: a path analysis. Rehabil Psychol. 2011;56(3):171–81. 10.1037/a0024583. PubMed PMID: 21767037.
   PubMed Web of Science ®Google Scholar
• Stroud N , Minahan C , Sabapathy S . The perceived benefits and barriers to exercise participation in persons with multiple sclerosis. Disabil Rehabil. 2009;31(26):2216–22. 10.3109/09638280902980928. PubMed PMID: 19903131.
   PubMed Web of Science ®Google Scholar
• Kosma M , Ellis R , Bauer JJ . Longitudinal changes in psychosocial constructs and physical activity among adults with physical disabilities. Disabil Health J. 2012;5(1):1–8. 10.1016/j.dhjo.2011.09.002. PubMed PMID: 22226292.
   PubMed Web of Science ®Google Scholar
• Suh Y , Joshi I , Olsen C , Motl RW . Social cognitive predictors of physical activity in relapsing-remitting multiple sclerosis. Int J Behav Med. 2014;21(6):891–8. 10.1007/s12529-013-9382-2. PubMed PMID: 24407400.
   PubMed Web of Science ®Google Scholar
• Vanner EA , Block P , Christodoulou CC , Horowitz BP , Krupp LB . Pilot study exploring quality of life and barriers to leisure-time physical activity in persons with moderate to severe multiple sclerosis. Disabil Health J. 2008;1(1):58–65. 10.1016/j.dhjo.2007.11.001. PubMed PMID: 21122712.
   PubMed Web of Science ®Google Scholar
• Motl RW , McAuley E , Doerksen S , Hu L , Morris KS . Preliminary evidence that self-efficacy predicts physical activity in multiple sclerosis. Int J Rehabil Res. 2009;32(3):260–3. PubMed PMID: 19685577.10.1097/MRR.0b013e328325a5ed
   PubMed Web of Science ®Google Scholar
• Plow M , Bethoux F , Mai K , Marcus B . A formative evaluation of customized pamphlets to promote physical activity and symptom self-management in women with multiple sclerosis. Health Educ Res. 2014;29(5):883–96. 10.1093/her/cyu034. PubMed PMID: 24989822; PubMed Central PMCID: PMC4165989
   PubMed Web of Science ®Google Scholar
• Dlugonski D , Joyce RJ , Motl RW . Meanings, motivations, and strategies for engaging in physical activity among women with multiple sclerosis. Disabil Rehabil. 2012;34(25):2148–57. 10.3109/09638288.2012.677935. PubMed PMID: 22533641.
   PubMed Web of Science ®Google Scholar
• Hundza S , Quartly C , Kim JM , Dunnett J , Dobrinsky J , Loots I , et al . Similar barriers and facilitators to physical activity across different clinical groups experiencing lower limb spasticity. Disabil Rehabil. 2016;1–12. 10.3109/09638288.2015.1101789. PubMed PMID: 26726762.
   Web of Science ®Google Scholar
• Brown C , Kitchen K , Nicoll K . Barriers and facilitators related to participation in aquafitness programs for people with multiple sclerosis: a pilot study. Int J MS Care. 2012;14(3):132–41. 10.7224/1537-2073-14.3.132. PubMed PMID: 24453744; PubMed Central PMCID: PMC3882997
   PubMedGoogle Scholar
• Borkoles E , Nicholls AR , Bell K , Butterly R , Polman RC . The lived experiences of people diagnosed with multiple sclerosis in relation to exercise. J Health Psychol. 2008;23(4):427–41. 10.1080/14768320701205309. PubMed PMID: 25160577.
   Web of Science ®Google Scholar
• Hall-McMaster SM , Treharne GJ , Smith CM . ‘The positive feel’: unpacking the role of positive thinking in people with multiple sclerosis’s thinking aloud about staying physically active. J Health Psychol. 2016;21(12):3026–3036. 10.1177/1359105315592047. PubMed PMID: 26169440
   PubMed Web of Science ®Google Scholar
• Polman CH , Reingold SC , Banwell B , Clanet M , Cohen JA , Filippi M , et al . Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011;69(2):292–302. 10.1002/ana.22366. PubMed PMID: 21387374; PubMed Central PMCID: PMCPMC3084507
   PubMed Web of Science ®Google Scholar
• Nickerson M , Marrie RA . The multiple sclerosis relapse experience: patient-reported outcomes from the North American Research Committee on multiple sclerosis (NARCOMS) Registry. BMC Neurol. 2013;13:938. 10.1186/1471-2377-13-119. PubMed PMID: 24016260; PubMed Central PMCID: PMCPMC3848753
   Web of Science ®Google Scholar
• Scalfari A , Neuhaus A , Degenhardt A , Rice GP , Muraro PA , Daumer M , et al . The natural history of multiple sclerosis: a geographically based study 10: relapses and long-term disability. Brain. 2010;133(7):1914–29. 10.1093/brain/awq118. PubMed PMID: 20534650; PubMed Central PMCID: PMCPMC2892939
   PubMed Web of Science ®Google Scholar
• Mayo NE , Bayley M , Duquette P , Lapierre Y , Anderson R , Bartlett S . The role of exercise in modifying outcomes for people with multiple sclerosis: a randomized trial. BMC Neurol. 2013;13:1760. 10.1186/1471-2377-13-69. PubMed PMID: 23809312; PubMed Central PMCID: PMC3706216
   Web of Science ®Google Scholar
• Mulligan H , Treharne GJ , Hale LA , Smith C . Combining self-help and professional help to minimize barriers to physical activity in persons with multiple sclerosis: a trial of the ‘Blue Prescription’ approach in New Zealand. J Neurol Phys Ther. 2013;37(2):51–7. 10.1097/NPT.0b013e318292799e. PubMed PMID: 23645142.
   PubMed Web of Science ®Google Scholar
• Salbach NM , Howe JA , Brunton K , Salisbury K , Bodiam L . Partnering to increase access to community exercise programs for people with stroke, acquired brain injury, and multiple sclerosis. J Phys Act Health. 2014;11(4):838–45. 10.1123/jpah.2012-0183. PubMed PMID: 23676952.
   PubMed Web of Science ®Google Scholar
• Ploughman M , Shears J , Harris C , Hogan SH , Drodge O , Squires S , et al . Effectiveness of a novel community exercise transition program for people with moderate to severe neurological disabilities. NeuroRehabilitation. 2014;35(1):105–12. 10.3233/NRE-141090. PubMed PMID: 24990000.
   PubMed Web of Science ®Google Scholar
• Plow M , Finlayson M . A qualitative study exploring the usability of Nintendo Wii Fit among persons with multiple sclerosis. Occup Ther Int. 2014;21(1):21–32. 10.1002/oti.1345. PubMed PMID: 23613154.
   PubMed Web of Science ®Google Scholar
• Khan F , Amatya B , Kesselring J , Galea MP . Telerehabilitation for persons with multiple sclerosis. A Cochrane review. Eur J Phys Med Rehabil. 2015;51(3):311–25. PubMed PMID: 25943744.
   PubMed Web of Science ®Google Scholar
• Dlugonski D , Motl RW , Mohr DC , Sandroff BM . Internet-delivered behavioral intervention to increase physical activity in persons with multiple sclerosis: sustainability and secondary outcomes. Psychol Health Med. 2012;17(6):636–51. 10.1080/13548506.2011.652640. PubMed PMID: 22313192.
   PubMed Web of Science ®Google Scholar
• Motl RW , Dlugonski D , Wójcicki TR , McAuley E , Mohr DC . Internet intervention for increasing physical activity in persons with multiple sclerosis. Mult Scler. 2011;17(1):116–28. 10.1177/1352458510383148. PubMed PMID: 20921239.
   PubMed Web of Science ®Google Scholar
• Stuifbergen AK , Becker H , Blozis S , Timmerman G , Kullberg V . A randomized clinical trial of a wellness intervention for women with multiple sclerosis. Arch Phys Med Rehabil. 2003;84(4):467–76. 10.1053/apmr.2003.50028. PubMed PMID: 12690582.
   PubMed Web of Science ®Google Scholar
• Coote S , Gallagher S , Msetfi R , Larkin A , Newell J , Motl RW , et al . A randomised controlled trial of an exercise plus behaviour change intervention in people with multiple sclerosis: the step it up study protocol. BMC Neurol. 2014;14:108. 10.1186/s12883-014-0241-9. PubMed PMID: 25528262; PubMed Central PMCID: PMC4311502
   PubMed Web of Science ®Google Scholar
• Stuifbergen AK , Becker H , Timmerman GM , Kullberg V . The use of individualized goal setting to facilitate behavior change in women with multiple sclerosis. J Neurosci Nurs 2003;35(2):94–9, 106. PubMed PMID: 12795036. 10.1097/01376517-200304000-00005
   PubMedGoogle Scholar
• Ng A , Kennedy P , Hutchinson B , Ingram A , Vondrell S , Goodman T , et al . Self-efficacy and health status improve after a wellness program in persons with multiple sclerosis. Disabil Rehabil. 2013;35(12):1039–44. 10.3109/09638288.2012.717586. PubMed PMID: 23004028.
   PubMed Web of Science ®Google Scholar
• Plow MA , Mathiowetz V , Lowe DA . Comparing individualized rehabilitation to a group wellness intervention for persons with multiple sclerosis. Am J Health Promot. 2009;24(1):23–6. 10.4278/ajhp.071211128. PubMed PMID: 19750959.
   PubMed Web of Science ®Google Scholar
• Geertz W , Dechow AS , Patra S , Heesen C , Gold SM , Schulz KH . Changes of motivational variables in patients with multiple sclerosis in an exercise intervention: associations between physical performance and motivational determinants. Behav Neurol. 2015;2015:248193. 10.1155/2015/248193. PubMed PMID: 26246692; PubMed Central PMCID: PMC4515276
   PubMed Web of Science ®Google Scholar
• Trojan DA , Arnold D , Collet JP , Shapiro S , Bar-Or A , Robinson A , et al . Fatigue in multiple sclerosis: association with disease-related, behavioural and psychosocial factors. Mult Scler. 2007;13(8):985–95. 10.1177/1352458507077175. PubMed PMID: 17468448.
   PubMed Web of Science ®Google Scholar
• Alvarenga-Filho H , Sacramento PM , Ferreira TB , Hygino J , Abreu JE , Carvalho SR , et al . Combined exercise training reduces fatigue and modulates the cytokine profile of T-cells from multiple sclerosis patients in response to neuromediators. J Neuroimmunol. 2016;293:91–99. 10.1016/j.jneuroim.2016.02.014. PubMed PMID: 27049568.
   PubMed Web of Science ®Google Scholar
• Kaminska M , Kimoff RJ , Benedetti A , Robinson A , Bar-Or A , Lapierre Y , et al . Obstructive sleep apnea is associated with fatigue in multiple sclerosis. Mult Scler. 2012;18(8):1159–69. 10.1177/1352458511432328. PubMed PMID: 22183937.
   PubMed Web of Science ®Google Scholar
• Kaminska M , Kimoff RJ , Schwartzman K , Trojan DA . Sleep disorders and fatigue in multiple sclerosis: evidence for association and interaction. J Neurol Sci. 2011;302(1–2):7–13. 10.1016/j.jns.2010.12.008. PubMed PMID: 21241993.
   PubMed Web of Science ®Google Scholar
• Feinstein A , Magalhaes S , Richard JF , Audet B , Moore C . The link between multiple sclerosis and depression. Nat Rev Neurol. 2014;10(9):507–17. 10.1038/nrneurol.2014.139. PubMed PMID: 25112509.
   PubMed Web of Science ®Google Scholar
• Tur C . Fatigue management in multiple sclerosis. Curr Treat Options Neurol. 2016;18(6):1502. 10.1007/s11940-016-0411-8. PubMed PMID: 27087457; PubMed Central PMCID: PMCPMC4834309
   Web of Science ®Google Scholar
• Beckerman H , Blikman LJ , Heine M , Malekzadeh A , Teunissen CE , Bussmann JB , et al . The effectiveness of aerobic training, cognitive behavioural therapy, and energy conservation management in treating MS-related fatigue: the design of the TREFAMS-ACE programme. Trials. 2013;14:250. 10.1186/1745-6215-14-250. PubMed PMID: 23938046; PubMed Central PMCID: PMCPMC3751829
   PubMed Web of Science ®Google Scholar
• Blikman LJ , Huisstede BM , Kooijmans H , Stam HJ , Bussmann JB , van Meeteren J . Effectiveness of energy conservation treatment in reducing fatigue in multiple sclerosis: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2013;94(7):1360–76. 10.1016/j.apmr.2013.01.025. PubMed PMID: 23399455.
   PubMed Web of Science ®Google Scholar
• Kos D , Duportail M , D'hooghe M , Nagels G , Kerckhofs E . Multidisciplinary fatigue management programme in multiple sclerosis: a randomized clinical trial. Mult Scler. 2007;13(8):996–1003. 10.1177/1352458507078392. PubMed PMID: 17623738.
   PubMed Web of Science ®Google Scholar
• Turner AP , Hartoonian N , Sloan AP , Benich M , Kivlahan DR , Hughes C , et al . Improving fatigue and depression in individuals with multiple sclerosis using telephone-administered physical activity counseling. J Consult Clin Psychol. 2016;84(4):297–309. 10.1037/ccp0000086. PubMed PMID: 26913621.
   PubMed Web of Science ®Google Scholar
• Pilutti LA , Dlugonski D , Sandroff BM , Klaren R , Motl RW . Randomized controlled trial of a behavioral intervention targeting symptoms and physical activity in multiple sclerosis. Mult Scler. 2014;20(5):594–601. 10.1177/1352458513503391. PubMed PMID: 24009162.
   PubMed Web of Science ®Google Scholar
• Asano M , Finlayson ML . Meta-analysis of three different types of fatigue management interventions for people with multiple sclerosis: exercise, education, and medication. Mult Scler Int. 2014;2014:798285. 10.1155/2014/798285. PubMed PMID: 24963407; PubMed Central PMCID: PMCPMC4052049
   PubMedGoogle Scholar
• Kayes NM , McPherson KM , Taylor D , Schlüter PJ , Kolt GS . Facilitators and barriers to engagement in physical activity for people with multiple sclerosis: a qualitative investigation. Disabil Rehabil. 2011;33(8):625–42. 10.3109/09638288.2010.505992. PubMed PMID: 20695816.
   PubMed Web of Science ®Google Scholar
• Smith CM , Hale LA , Olson K , Baxter GD , Schneiders AG . Healthcare provider beliefs about exercise and fatigue in people with multiple sclerosis. J Rehabil Res Dev. 2013;50(5):733–44. PubMed PMID: 24013920.10.1682/JRRD.2012.01.0012
   PubMed Web of Science ®Google Scholar
• Kersten S , Mahli M , Drosselmeyer J , Lutz C , Liebherr M , Schubert P , et al . A pilot study of an exercise-based patient education program in people with multiple sclerosis. Mult Scler Int. 2014;2014:306878. 10.1155/2014/306878. PubMed PMID: 25587449; PubMed Central PMCID: PMC4283388
   PubMedGoogle Scholar
• Plow M , Bethoux F , McDaniel C , McGlynn M , Marcus B . Randomized controlled pilot study of customized pamphlets to promote physical activity and symptom self-management in women with multiple sclerosis. Clinl Rehabil. 2014;28(2):139–48. 10.1177/0269215513494229. PubMed PMID: 23864516.
   PubMed Web of Science ®Google Scholar
• Sweet SN , Perrier MJ , Podzyhun C , Latimer-Cheung AE . Identifying physical activity information needs and preferred methods of delivery of people with multiple sclerosis. Disabil Rehabil. 2013;35(24):2056–63. 10.3109/09638288.2013.800915. PubMed PMID: 23763468.
   PubMed Web of Science ®Google Scholar
• Catalano T , Kendall E , Vandenberg A , Hunter B . The experiences of leaders of self-management courses in Queensland: exploring Health Professional and Peer Leaders’ perceptions of working together. Health Soc Care Community. 2009;17(2):105–15. 10.1111/j.1365-2524.2008.00801.x. PubMed PMID: 19040700.
   PubMed Web of Science ®Google Scholar