All ETDs from UAB

Advisory Committee Chair

Tapan Mehta

Advisory Committee Members

Elizabeth Barstow

Robert W Motl

Dorothy W Pekmezi

James H Rimmer

Document Type

Dissertation

Date of Award

2021

Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions

Abstract

People with multiple sclerosis (MS) can benefit from physical activity, specifically exercise, for the management of disease symptoms, including walking impairments, fatigue, and depression, and improvements in quality of life. However, people with MS do not engage in adequate amounts of physical activity for the accrual of health benefits. Researchers have focused on the delivery of exercise training and behavioral interventions to improve levels of physical activity in MS. To date, there is an emerging body of research supporting the efficacy of these interventions for increasing and potentially sustaining physical activity behavior in people with MS. Yet, people with MS often have varying rates of physical activity change after completion of these programs. For example, some individuals can experience large improvements in physical activity, whereas others may demonstrate no change or even a decrease in physical activity. Reasons for these differences may include certain participant-specific characteristics, such as MS type, disease severity, knowledge, efficacy, goals, and perceived barriers to exercise. Collectively, this affirms the importance of identifying targets for tailored programs (i.e., delivery methods, intervention strategies) for people with MS. We identified factors that influenced participants’ response to the interventions using quantitative and qualitative methods. Interventions for physical iv activity promotion in MS should be tailored and targeted based on specific participant characteristics, perhaps theory-based constructs (e.g., goal setting), to provide differentiated levels and types of support, such as a self-directed exercise program or one-on-one behavioral coaching. Furthermore, interventions should incorporate various support methods for engagement (e.g., autonomous, one-on-one, group exercise sessions), self-regulatory strategies (e.g., reporting and monitoring progress via email, app), and long-term engagement (e.g., post-intervention resources). Overall, these findings can help clinicians and researchers in the design of optimized program and intervention strategies to increase and sustain exercise and physical activity participation in people with MS.

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