Noting a disconnect between evidence of benefit and uptake of exercise in patients with multiple sclerosis (MS), researchers offer behavioral science, specifically Social Cognitive Theory, as an approach to increasing participation.
While multiple sclerosis (MS) is typically treated with disease-modifying drugs, physical activity has been explored as an additional approach to manage symptoms, restore function, and improve quality of life. With a disconnect between evidence of these benefits and uptake of exercise in the patient population, researchers offer behavioral science, specifically Social Cognitive Theory (SCT), as an approach to increasing participation.
In addition to aiding in the management of symptoms, function, and quality of life, physical activity in patients with MS has been tied to reduced rates of MS relapses and slowed disability progression. “The evidence base has yielded guidelines for prescribing exercise behavior in patients with MS who have mild or moderate neurological disability that can be implemented within comprehensive MS care,” wrote the researchers of the study.
Despite the evidence, the majority of people with MS do not participate in an appropriate amount of physical activity and participate at a significantly lower rate than the general population. As the disease progresses, rates of exercise drop even lower.
Reasons for the disconnect could be explained by poor quality of the scientific evidence—underpowered and unblinded studies without intention-to-treat analyses—or insufficient promotion of physical activity in the patient population. Exploring the latter, the researchers assessed the impact of the inclusion of behavior change therapy.
They identified research that examined 4 key components of SCT for influencing physical activity in people with MS: self-efficacy, outcome expectations, sociostructutal factors, and goals. They cited an early cross-sectional study that showed self-efficacy and enjoyment were directly associated with physical activity in 196 patients. Subsequent research points to self-efficacy having an indirect effect on physical activity through the 3 other elements.
Since then, multiple prospective and longitudinal studies have determined self-efficacy and goal-setting to be primary correlates of physical activity in patients with MS. The researchers note that there has been an emerging focus on randomized controlled trials (RCTs) developed based on the principles of SCT and delivered as behavioral interventions for changing physical activity patterns in these patients.
The first RCT compared the impact of efficacy-enhancement exercise condition with a control exercise condition in 26 patients, and found that those in the efficacy-enhancement condition cohort went to more exercise sessions (24.2 vs 18.6) and exercised for a longer period of time (576.8 vs 425.6 minutes) during the 12-week program.
Looking ahead, the researchers gave recommendations for further research. “We adopted the perspective that behavioral science and the application of theories of behavior change can provide the missing link in the promotion and sustainability of exercise and physical activity participation in MS,” wrote the researchers.
They note that prior research has typically examined SCT, and much less is known about the impact of other behavioral theories, such as the Transtheoretical Model and Health Action Process Approach for understanding physical activity in the patient population.
Motl R, Pekmezi D, Wingo B. Promotion of physical activity and exercise in multiple scerosis: importance of behavioral science and theory [published online July 9, 2018]. SAGE Open. doi: https://doi.org/10.1177/2055217318786745.