Possible determinants of long-term adherence to physical activity in multiple sclerosis—theory-based development of a comprehensive questionnaire and results from a German survey study

Abstract

Purpose

To examine the possible contributions of capability, opportunity, and motivation for explaining long-term physical activity among people with multiple sclerosis and to report the results of a German survey study.

Methods

The questionnaire, which was based on an expert interview study and behavior change theory, was structured and detailed applying the Theoretical Domains Framework. A total of 1027 people with multiple sclerosis provided data on sociodemographics, disease-related characteristics, and a set of constructs possibly related to long-term adherence. Participants were assigned to three groups: not regularly active, currently regularly active, and long-term regularly active. Eta squared was calculated to assess the magnitude of differences between groups using ANOVA.

Results

Moderate or large differences between groups were identified for many domains within capability, opportunity, and motivation. For the following theoretical domains, large differences (η² ≥0.140) were observed: Intention, Behavioural Regulation, Beliefs about Capabilities and Goals.

Conclusions

Our results suggest that capability, opportunity, and motivation should be targeted simultaneously when designing future interventions. Inactive people with multiple sclerosis might benefit most from interventions increasing action self-efficacy and intention. Boosting autonomous motivation, goal setting, action planning as well as maintenance and recovery self-efficacy could have a positive effect on long-term adherence.

IMPLICATIONS FOR REHABILITATION

• This study applied the COM-B model and Theoretical Domains Framework to identify a set of constructs for explaining long-term physical activity among people with MS.

• Behaviour change and maintenance interventions for people with MS should include techniques that foster intention, perceived self-efficacy and self-regulatory skills, and promote goal setting and autonomy of motivation for regular physical activity.

• Although barriers of the physical and social environmental context did not seem to be that important in our sample, scientists should consider addressing them in interventions for inactive and more disabled people with MS.

• Information about the benefits of physical activity should be regularly provided in MS rehabilitation, while further research should explore the relevance of information provision and knowledge for behaviour change in different groups of people with MS.

Keywords:

• Multiple sclerosis
• physical activity
• adherence
• behaviour change
• health psychology
• Capability-Opportunity-Motivation-Behaviour (COM-B) Model

Acknowledgements

This work was part of the RIMS AD@MS initiative (Bruce J, Dalgas U, Feys P, Finlayson M, Hamalainen P, Heesen C, Köpke S, Kos D, Matthews V, Moss-Morris R, Motl R, Sastre-Garriga J, Solari A) to study adherence to pharmacological and non-pharmacological interventions in MS. AD@MS was financially supported by Novartis Pharma. The authors would like to thank all participants for their time and effort. We would also like to thank the German Multiple Sclerosis Society (DMSG Bundesverband and Landesverbände) for sharing our call for participants on their websites as well as René Streber from Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Sport Science and Sport for sharing our survey via email-lists. Additionally, we would like to thank Sascha Köpke, Jana Pöttgen and Anne Rahn from the Heesen work group for fruitful discussions about the project.

Disclosure statement

No potential conflict of interest was reported by the author(s).