A qualitative and quantitative exploration of sedentary behaviour, physical activity and exercise in people with multiple sclerosis

Multiple sclerosis (MS) is a chronic neurological disease affecting motor and sensory nerve function and leading to a range of symptoms. Physically, gait, balance and vision can be impaired, with fatigue and depression being common mental health symptoms. People with MS have high levels of sedentary behaviour and low levels of physical activity. Despite the well-researched benefits of exercise for the symptoms of MS, uptake and participation in exercise programmes is low, particularly in those with higher disability. This thesis investigated a number of research questions relating to activity behaviours in people with MS using both qualitative and quantitative methodologies. Qualitative studies explored the measurement of sedentary behaviour, and perspectives of people with MS and health professionals around barriers and facilitators to exercise. This provided recommendations for exercise programmes. Communication was a key aspect, which included communication to the person with MS tailored to their individual circumstances and acceptance of MS, as well as communication within the multidisciplinary team. Appropriate knowledge of health professionals about exercise for people with MS was essential as well as suitable behavioural support for exercise. This support should be individualised to the patient, depending on their stage of acceptance of the disease. Cross-sectional analyses of associations between subjective and objective assessments of behaviour, physical function, and wellbeing revealed differences, such as objective but not subjective sedentary behaviour being associated with depression. Greater self-reported but not objective physical activity was associated with higher fitness. This highlighted the need to assess activity and function both subjectively and objectively. Subsequently, the effects of a twelve-week home exercise programme which included balance, strengthening and aerobic exercise, on physical activity, sedentary behaviour, functional ability, and wellbeing were explored. The outcomes of those with higher and lower disability from their MS were compared, as well as an internet group with access to web-based resources to support their programme, and a control group without these online resources. The exercise programme achieved good self-reported adherence. However, there were no significant changes in physical activity, function, wellbeing or behavioural measures, which suggests that more intensive behavioural support might be needed to ensure that participants exercise at the right intensity. Future research could investigate the effectiveness of different ways to provide additional support to encourage exercise in people with MS