Physical activity programs for people with MS show promise, review finds
Programs were well received, but routine clinical use has not been tested
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Healthcare professionals can help people with multiple sclerosis stay physically active by offering personalized guidance and support, a research review found. (Image from iStock)
- Multiple sclerosis is a chronic condition in which the immune system attacks the protective coverings of nerve fibers, potentially leading to disability.
- People with MS often face barriers to staying active, but physical activity programs led by healthcare professionals appear acceptable and feasible, with high participant retention.
- More research is needed to determine whether these personalized physical activity programs can be widely adopted and sustained as part of routine clinical care.
Physical activity programs led by healthcare professionals appear acceptable and feasible for adults with multiple sclerosis (MS), a review found. However, more research is needed to determine whether these programs can be successfully used in everyday clinical care.
The findings were published in the study, “The implementability of healthcare professional-led physical activity promotion interventions for people living with multiple sclerosis: A scoping review,” in Clinical Rehabilitation. The researchers wrote that “it remains unclear whether these interventions can be effectively implemented, sustained, and disseminated within routine clinical services.”
MS occurs when the immune system mistakenly attacks the protective covering around nerve fibers in the brain and spinal cord. This causes damage over time that can lead to disability. In addition to disease-modifying medications, treating MS often includes lifestyle changes, such as exercising and eating a healthy diet.
Despite the benefits of physical activity, people with MS still face barriers that can make it difficult to stay active.
Challenges of bringing physical activity programs into MS care
The researchers wrote that “multiple sclerosis requires physical activity support that is flexible, pragmatic, and responsive to changing needs. Delivering such support requires a broad skill set and the ability to identify appropriate providers across the disease course.”
People with MS often see healthcare professionals as trusted sources of physical activity advice. However, how well these professionals can deliver physical activity programs as part of routine care remains unclear.
To investigate this, researchers in the U.K. and Australia reviewed published studies of adults with a confirmed diagnosis of MS. The studies examined physical activity programs delivered by healthcare professionals or considered suitable for them to deliver.
The researchers identified 25 studies, including eight from the U.S., that evaluated 28 different physical activity programs involving 1,662 adults with MS. Most studies included mainly women and people with mild disability. Most also focused on adults with relapsing-remitting MS.
The researchers used two frameworks to evaluate the programs. The National Institutes of Health Stage Model tracks how far a program has progressed, from early development and testing to use in routine care and wider adoption. The Implementability Framework examines whether programs are acceptable, delivered as intended, feasible to carry out, and able to be expanded and sustained over time.
Eighteen studies focused on early program development or testing, while seven evaluated programs in community settings under closely controlled research conditions. None evaluated how well the programs worked in routine clinical care or examined their widespread implementation. As a result, whether these programs can be expanded and sustained over time remains uncertain.
Personalized support helps people with MS stay engaged
Patients valued personalized guidance, healthcare professionals’ expertise, and encouragement from professionals they trusted. They also appreciated programs tailored to their abilities, goals, and motivation. Flexible schedules and the freedom to make their own choices helped them stay engaged. However, some felt they were not doing well enough when tracking their progress or worried about disappointing their healthcare professionals.
Despite this positive feedback, the researchers cautioned that “inconsistent assessment of implementability outcomes and limited real-world evaluation leave important implementation requirements underexplored, limiting confidence in scalability and wider adoption.”
Healthcare professionals saw promoting physical activity as part of their role but faced challenges, including heavy workloads and a need for more training. Eight programs used checklists, audio or video recordings, or therapist reports to track whether they were delivered as planned. Four studies reported results on this measure, known as fidelity. Some found at least 70% agreement between planned and delivered content, while others found that delivery met established competency standards.
Across the programs reporting these measures, recruitment rates averaged 76%, while retention, or the proportion of participants who remained in a study, averaged 88%. Adherence, which measures how consistently participants took part in a program, averaged 81%. Compliance with program content, such as prescribed exercise intensity, averaged 58% across five programs. Thirteen programs reported adverse events, averaging 5.4 events per reporting program. Eleven programs did not report safety data.
Although healthcare professional-led physical activity programs for people with MS appear acceptable and feasible, the researchers noted that “many interventions have been developed without adequately considering the contextual and organisational factors that affect routine implementation.”
The researchers recommended changes to how future programs are developed, writing, “Future intervention development should include early assessment of contextual determinants, engagement with service managers, and targeted provider training.”
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