Physical activity engagement in people with Multiple Sclerosis
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There is a growing body of evidence confirming the benefits of physical activity and exercise in people with Multiple Sclerosis (MS). However, most engage in low levels of physical activity when compared to the general population and other chronic illness groups. Despite this, there is a paucity of research aiming to better understand physical activity behaviour and exploring factors potentially influencing physical activity engagement in this population. The key aims of this research were therefore to gain a more in-depth understanding of the barriers and facilitators to physical activity from the perspective of people with MS, and use this information to inform the development of a novel approach to activity engagement for people with MS: The Facilitating Activity for well-Being (FAB) Programme. However, it became clear early on that prior to undertaking this work it would be necessary to carry out some preliminary research exploring physical activity measurement for this population. As a result, three phases make up this doctoral work, in which six research projects were carried out. Phase I of this PhD focused on physical activity measurement in people with MS and included three studies exploring both self-report and objective measurement. Phase II focused on exploring the barriers and facilitators to physical activity engagement for people with MS and incorporated two studies: a questionnaire study and a qualitative inquiry. Phase III was the final phase of this work and involved developing The FAB Programme, informed by existing literature and findings from earlier phases of this research. This phase also included the final study conducted as a part of this doctorate where the FAB Programme was piloted in people with MS and revised in response to feedback from participants and their clinicians. Several findings from this work challenge and/or augment existing knowledge in this field. In Phase I, a key contribution was the development of a conceptually sound self-report measure of physical activity for people with MS (the PADS-R). In contrast, despite their intuitive appeal, Actical accelerometers did not appear to be a valid and reliable objective measure of physical activity in people with MS; challenging assumptions about the accuracy of these devices in populations with chronic disabling conditions. A number of novel findings were determined in Phase II, including: a) that beliefs and perceptions about physical activity appear to play an important role in the decision to engage in physical activity for people with MS; b) the decision to engage in physical activity is complex, fluid and individual; challenging the notion of intention-behaviour continuity (a basic assumption of many existing theories of behaviour change; and c) that health professionals appear to play an important role in shaping physical activity behaviour in people with MS. A key contribution of Phase III to the field was the development of a theoretically driven, evidence based approach to activity engagement for people with MS – The FAB Programme. This programme was found to be acceptable to both people with MS and their clinicians and perceived benefits reported by participants indicated it has the potential to effectively facilitate physical activity engagement in this comparatively sedentary population. Findings also indicated that engagement of clinicians in a new way of working is challenging and something to be grappled with due to the paradigm shift required and perceived threats to their scope of practice. The body of work presented here has contributed significantly to the field of physical activity engagement for people with MS in terms of conceptual clarity, measure development, improved understanding of the complexity regarding physical activity engagement and through the development of a novel approach to activity engagement for people with MS. The development of an intervention, such as the FAB Programme, which facilitates people with MS to engage in physical activity should result in considerable health gains, and is likely to enhance the positive effects achievable in more traditional exercise programmes due to the expectation that adherence will improve.