Targeting Physical Activity Behaviour Change in the Management of Multiple Sclerosis

Purpose: The purpose of this thesis is to investigate how physical activity behaviour can be optimized in routine care for persons living with multiple sclerosis in Saskatchewan. Physical activity is an important behavioural intervention in the management of multiple sclerosis; however, persons living with multiple sclerosis are far less active than needed to accrue health benefits. We aimed to explore the local context from the perspectives of key end-users (persons living with multiple sclerosis and health care providers), as a starting point to address this disconnect between evidence on physical activity and rates of participation. 
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\nMethods: Three studies were conducted as part of this manuscript style thesis. 
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\nStudy 1 used Interpretive Description, a qualitative research methodology to investigate health care providers’ current practices and perspectives regarding physical activity behavioural interventions in the management of multiple sclerosis. Focus groups were conducted with 31 multi-disciplinary health care providers in Saskatchewan working with individuals living with multiple sclerosis. 
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\nStudy 2 also used Interpretive Description to explore the perspectives of persons living with multiple sclerosis with regards to their priorities and proposed solutions for optimizing physical activity behaviour in the management of multiple sclerosis. Focus groups were conducted with 24 individuals living with multiple sclerosis in Saskatchewan. 
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\nFor both Study 1 and 2 inductive thematic analysis, triangulation and member checking were applied in data analysis. Data were coded individually by three researchers, who then collaboratively developed themes. 
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\nBuilding on key findings from Study 1 and 2, Study 3 was a systematic review conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Study 3’s objective was to identify and synthesize the existing literature that describes methods used to train health care providers to deliver behaviour change strategies for physical activity interventions in neurological populations, including multiple sclerosis. 
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\nResults: This preliminary research showed that physical activity behaviour is not currently being targeted in routine management of multiple sclerosis in Saskatchewan. Persons living with multiple sclerosis want support from their health care providers regarding physical activity behaviour change. Health care providers believe physical activity is important, but they are not currently prioritizing it in practice. Physical activity as a management strategy does not exist in isolation. Findings suggest the problem is greater than just low physical activity levels – care needs to be improved. Individual and systems level change are needed. Essential components hypothesized to optimize physical activity behaviour in the management of MS found in this thesis include support, training, model of care and communication. Both health care providers and persons living with multiple sclerosis suggested the need to address individual level change through increasing the use of behaviour change strategies.
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\nTraining health care providers on behaviour change strategies is one approach at the individual level to improve physical activity behaviour change in multiple sclerosis. Based on our systematic review, there is currently insufficient evidence for consensus on what should be included in and how to structure training for HCP to increase ability, confidence and use of BCS for PA with neurological populations. With a growing number of studies showing effectiveness of BCS to increase PA in neurological populations, there is a need for future work to highlight the most important strategies as well as how to best implement their use into clinical practice. 
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\nConclusion and Significance: This PhD research is a starting point to help improve health care providers and persons living with multiple sclerosis knowledge, use and ultimately change in physical activity behaviour. The findings of this thesis show that future efforts (both research and interventions) need to acknowledge that there are barriers to utilizing PA behaviour change for PwMS at several levels (individual, health care system, community and policy), and work is needed at each of these levels in order to implement change. Taking an integrated knowledge translation approach to further the next steps in research is recommended to promote concurrent and complimentary change needed. Future efforts should target the key factors of support, training, model of care and communication found in this thesis to address localized priorities, to maximize potential applicability to end-users and to effect meaningful change.

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