Andrea M. Stennett PhD.
Research Neuro-Physiotherapist with a keen interest in the management of long term neurological conditions. Her research interests include exploring the exercise and physical activity priorities of people with Multiple Sclerosis.
Key messages for clinical practice:
- Health professionals should be aware of and understand the individuals’ priorities as these are key drivers to sustain physical activity in community dwelling people with MS.
- Physiotherapists should design flexible physical activity programmes which are meaningful, engaging and foster the necessar y environment to sustain physical activity participation in people with multiple sclerosis.
The benefits of exercise and physical activity in people with Multiple Sclerosis (MS) are widely documented. These include improved muscle strength, fitness and quality of life 1,2; yet uptake is poor placing people with MS at an increased risk of developing the secondary complications associated with inactivity, such as stroke, type 2 diabetes and cardiovascular disease3,4. Indeed, there is evidence to suggest that only 20% of people with MS meet the recommended levels of physical activity3. It is therefore crucial that health professionals develop strategies to help change this trajectory as it is a public health concern.
But how do we engage people with MS, a progressive neurological condition, to sustain physical activity overtime? Many attempts have been made to address this issue but with limited success. Perhaps there is a need to examine this topic from another perspective.That is, understanding the prioritisation and meaning of exercise and physical activity both from the perspective of people with MS and health professionals such as physiotherapists.
Physiotherapists, the third most contacted healthcare professionals by people with MS in the United Kingdom5, play an important role in improving health and wellbeing through the promotion of exercise and physical activity6-8.
A recent study, using focus groups underpinned by the principles of framework analysis, explored physiotherapists’ interpretation of exercise and physical activity; examined physiotherapists’ views and opinions about the meanings and prioritised physical activity as reported by people with MS; and discussed the implications for clinical practice. Here physical activity was defined as “any bodily movement produced by skeletal muscles that result in energy expenditure”9 and would include domestic, occupational and sports related activities. Exercise on the other hand was defined as “a subset of physical activity that is planned, structured and repetitive”9 and aims to either improve or maintain physical fitness.
Physiotherapists were asked to reflect on the prioritised exercise and physical activity practices of people with MS in the community (see table below).The full description of the study along with participants’ quotes can be found here: https://doi.org /10.1080/09638288.2019.1585969
Overall four themes were developed from the analysis namely, “Blurred terminologies”, “Influencing factors for the meaning of exercise and physical activity”,“When professional expertise meets experiential expertise” and “The resolve: resolving professional and experiential tensions”.
The study highlights that physiotherapists drew on the underlying physiological attributes of exercise (intensive) and physical activity (less intensive) as a way to differentiate the two terms. Interestingly, the findings highlight that whilst the use of exercise is embedded into clinical practice, physical activity, while considered, was less routine in application. This tendency to focus predominantly on exercise that led to fitness might be limiting the scope of physiotherapists in clinical practice and risks excluding other types of activities used by people with MS, that might be meaningful and necessary for sustaining physical activity in the longer term.
The professionals’ perspective provided some insight into the attitudes of physiotherapists. It highlighted the gap that exists between professional expertise and experiential expertise.Whilst physiotherapists considered their views and opinions within the context of activities done to and for the body, people with MS did not limit their responses to expressions about activities to the body but reflected a broader and more holistic view of exercise and physical activity. People with MS expounded the concept of exercise and physical activity within the context of their lives10 .
This supports previous findings where health professionals by nature seek to prioritise health whereas the complexity of the lived experiences of the patient might prioritise other areas of life, such as family roles11.Therefore, understanding both perspectives might facilitate greater collaboration between physiotherapists and people with MS.
The study highlights the need for greater clarity about key benefits of physical activity for people with MS. Physiotherapists were found to be confident with the effects of exercise and fitness but less confident about the impact of physical activity. This could be a reflection of the evidence base as the majority of studies in people with MS are reflective of those mildly or moderately affected with the condition. Also, it calls for written physical activity clinical guidance for people with MS which can provide a frame of reference for physiotherapists working in the community.
In summary, physiotherapists value exercise and physical activity as a method to manage the symptoms associated with MS. Physiotherapists are strategically placed in the community to initiate discussions, assess, and create opportunities to enhance the physical activity practices of people with MS. This study demonstrates that for this to happen, greater clarity of the message around the benefits of physical activity to people with MS is required and the importance of priority goal setting, as these might be key drivers for engaging and motivating people with MS in physical activity.
For more information about this study please find link below: