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

Abstract

Background: It is recommended that people with multiple sclerosis (MS) exercise at least 30 min three times per week at a moderate level. Exercise trials have shown that when outcomes are reassessed weeks or months after cessation of the program, the benefits gained are lost with values returning to baseline. Clearly, innovative approaches are required to foster continued participation.

Objectives: The objective of this narrative review was to consolidate the evidence examining the barriers to physical activity among people with MS, describe innovative methods to overcome barriers, while discussing the physical therapist’s role as the physical activity promotion specialist.

Major findings: The search yielded 135 articles and after removing duplicates, there were 12 quantitative (total N = 2627) and nine qualitative (total N = 97) studies. The barriers to physical activity were categorized into five domains from greatest to least frequently predictive, (1) MS-related impairment and disability, (2) Attitude and outlook, (3) Fatigue, (4) Knowledge/Perceived benefits of exercise, and (5) Logistical factors: finances, support, and accessibility. Several approaches to break down barriers such as behavioral modification, peer support, use of technology and adapted community exercise show promise in improving physical activity participation. All require the physical therapist to extend their role beyond the patient–provider relationship to become coach, educator, and community liaison.

Conclusions: Physical therapists, other health team members, and volunteers are more likely to be successful in breaking the barriers to physical activity in MS by working together. Barriers can be addressed concurrently by employing tailored and combined approaches using education, motivational interviewing, exercise practice, and problem-solving.

Keywords:

• Multiple sclerosis
• Neurodegenerative disease
• Rehabilitation
• Exercise
• Predictors