Delivering a remote exercise program embedded with behaviour change theory to persons with multiple sclerosis (MS): a randomised feasibility trial

Introduction: Multiple sclerosis (MS) is a chronic, autoimmune, and demyelinating disease of the central nervous system. Exercise has shown to be an effective treatment; however, those with MS often do not adhere to the recommended exercise guidelines. Our study investigated the feasibility of a remote exercise program embedded with behaviour change to increase exercise participation (primary outcome) and adherence among persons with MS and improve MS symptomatology and quality of life (secondary outcomes). Methods: Thirty-six adults with mild to moderate MS were stratified according to previous exercise levels and block-randomised into one of three groups: Control, General Exercisers (GE, who were not previously engaged in 30 or more minutes of moderate-intensity aerobic exercise 2+ days/week and 30 or more minutes of resistance training on 2+ days/week), and Advanced Exercisers (AE, who were previously engaged in 30 or more minutes of moderate-intensity aerobic exercise 2+ days/week and 30 or more minutes of resistance training on 2+ days/week). A four-month online exercise program including aerobic, resistance, balance, and flexibility training was delivered to GE and AE. We assessed four aspects of feasibility – process (recruitment), resources (monetary cost), management (staff time), and scientific (outcomes). At baseline, four months, and five months participants completed questionnaires to assess all outcomes. Participants logged exercise sessions using online exercise diaries and undertook video coaching calls. Clinical findings: GE (n=12) and control (n=12) participants increased their exercise participation, whereas AE (n=12) participants did not in 16 weeks (p =.06; GE, d=0.38, D=1.6 ; AE, d= -0.15, D=-2.9 ; CON, d=0.85, D=6; ‘D’ is change score). The adherence rate of coaching calls for the intervention was 92% for the GE and 83% for AE. Seventy-three per cent of GE and 38% of AE participants adhered to the prescribed exercise sessions. The total study intervention costs were AUD 1512.00, excluding projected personnel costs. The total personnel time required for the study was equal to 289 hours. Discussion: We found that a remote exercise program embedded with behaviour interventions is feasible and safe for persons with mild to moderate MS and helps increase their exercise participation and quality of life, but maybe less effective for those who are already active