Restricted accessResearch articleFirst published online 2016-6
The effectiveness of behaviour change interventions to increase physical activity participation in people with multiple sclerosis: a systematic review and meta-analysis
A systematic review and meta-analysis was conducted to illustrate whether people with multiple sclerosis engage in more physical activity following behaviour change interventions.
Data resources:
MEDLINE, CINAHL, PubMed, Web of Sciences, Cochrane Library, SCOPUS, EMBASE and PEDro were searched from their inception till 30 April 2015.
Trial selection:
Randomized and clinical controlled trials that used behaviour change interventions to increase physical activity in people with multiple sclerosis were selected, regardless of type or duration of multiple sclerosis or disability severity.
Data extraction:
Data extraction was conducted by two independent reviewers and the Cochrane Collaboration’s recommended method was used to assess the risk of bias of each included study.
Results:
A total of 19 out of 573 studies were included. Focusing on trials without risk of bias, meta-analysis showed that behaviour change interventions can significantly increase physical activity participation (z = 2.20, p = 0.03, standardised main difference 0.65, 95% confidence interval 0.07 to 1.22, 3 trials, I2 = 68%) (eight to 12 weeks’ duration). Behaviour change interventions did not significantly impact on the physical components of quality of life or fatigue.
Conclusion:
Behaviour change interventions provided for relatively short duration (eight to 12 weeks) may increase the amount of physical activity people with multiple sclerosis engage in, but appear to have no effect on the physical components of quality of life and fatigue. Further high quality investigations of the efficacy of behaviour change interventions to increase physical activity participation that focus on dose, long-term impact and method of delivery are warranted for people with multiple sclerosis.
CarterAMDaleyAJKestertonSWWoodroofeNMSaxtonJMSharrackB. Pragmatic exercise intervention in people with mild to moderate multiple sclerosis: A randomised controlled feasibility study. Contemp Clin Trials2013; 35(2): 40–47.
2.
DlugonskiDMotlRWMohrDCSandroffBM. Internet-delivered behavioral intervention to increase physical activity in persons with multiple sclerosis: Sustainability and secondary outcomes. Psychol Health Med2012; 17(6): 636–651.
3.
EnnisMThainJBoggildMBakerGAYoungCA. A randomized controlled trial of a health promotion education programme for people with multiple sclerosis. Clin Rehabil2006; 20(9): 783–792.
4.
FeysPTytgatKGijbelsDDe GrooteLBaertIVan AschP. Effects of an 1-day education program on physical functioning, activity and quality of life in community living persons with multiple sclerosis. Neurorehabil2013; 33(3): 439–448.
5.
HaleLAMulliganHFTreharneGJSmithCM. The feasibility and short-term benefits of blue prescription: A novel intervention to enable physical activity for people with multiple sclerosis. Disabil Rehabil2013; 35(14): 1213–1220.
6.
PlowMBethouxFMcDanielCMcGlynnMMarcusB. Randomized controlled pilot study of customized pamphlets to promote physical activity and symptom self-management in women with multiple sclerosis. Clin Rehabil2014; 28(2): 139–148.
7.
SandroffBMKlarenREPiluttiLADlugonskiDBenedictRHBMotlRW. Randomized controlled trial of physical activity, cognition, and walking in multiple sclerosis. J Neurol2014; 261(2): 363–372.
8.
SmithDCLanesskogDCleelandLMotlRWeikertMDlugonskiD. Motivational interviewing may improve exercise experience for people with multiple sclerosis: A small randomized trial. Health & Social Work2012; 37(2): 99–109.
9.
ThomasSThomasPWKerstenP. A pragmatic parallel arm multi-centre randomised controlled trial to assess the effectiveness and cost-effectiveness of a group-based fatigue management programme (FACETS) for people with multiple sclerosis. J Neurol Neurosurg Psychiatry2013; 84(10): 1092–1099.
10.
SangelajiBNabaviSMEstebsariF. Effect of combination exercise therapy on walking distance, postural balance, fatigue and quality of life in multiple sclerosis patients: A clinical trial study. Iranian Red Crescent Med J2014; 16(6): e17173.
11.
MotlRMcAuleyEWynnDSuhYWeikertM. Effects of change in fatigue and depression on physical activity over time in relapsing-remitting multiple sclerosis. Psychol Health Med2011; 16(1): 1–11.
12.
MotlRSuhYWeikertMDlugonskiDBalantrapuSSandroffB. Fatigue, depression, and physical activity in relapsing-remitting multiple sclerosis: Results from a prospective, 18-month study. Mult Scler and Relat Disord2012; 1(1): 43–48.
13.
MotlRW. Lifestyle physical activity in persons with multiple sclerosis: The new kid on the MS block. Mult Scler J2014; 20(8): 1025–1029.
14.
StroudNMinahanCSabapathyS. The perceived benefits and barriers to exercise participation in persons with multiple sclerosis. Disabil Rehabil2009; 31(26): 2216–2222.
15.
MurphyAMBethouxFStoughDGoldmanHB. Prevalence of stress urinary incontinence in women with multiple sclerosis. Int Neurourol J2012; 16(2): 86–90.
16.
McAuleyEMotlRWMorrisKS. Enhancing physical activity adherence and well-being in multiple sclerosis: A randomised controlled trial. Mult Scler2007; 13(5): 652–659.
JaarsmaEADijkstraPUGeertzenJHBDekkerR. Barriers to and facilitators of sports participation for people with physical disabilities: A systematic review. Scand J Med Sci Sports2014; 24(6): 871–881.
19.
PiluttiLADlugonskiDSandroffBMKlarenREMotlRW. Internet-delivered lifestyle physical activity intervention improves body composition in multiple sclerosis: Preliminary evidence from a randomized controlled trial. Arch Phys Med Rehabil2014; 95(7): 1283–1288.
20.
BrugJOenemaAFerreiraI. Theory, evidence and intervention mapping to improve behavior nutrition and physical activity interventions. Int J Behav Nutrit Phys Activity2005; 2: 2–2.
21.
BartlettYKSheeranPHawleyMS. Effective behaviour change techniques in smoking cessation interventions for people with chronic obstructive pulmonary disease: A meta-analysis. Br J Health Psychol2014; 19(1): 181–203.
22.
HankonenNSuttonSPrevostAT. Which behavior change techniques are associated with changes in physical activity, diet and body mass index in people with recently diagnosed diabetes?Annals Behav Med2014; 49(1): 7–17.
23.
MartinJChaterALorencattoF. Effective behaviour change techniques in the prevention and management of childhood obesity. Int J Obesity2013; 37(10): 1287–1294.
24.
ProcterSMutrieNDavisAAudreyS. Views and experiences of behaviour change techniques to encourage walking to work: A qualitative study. BMC Public Health2014; 14: 868.
WebbTLJosephJYardleyLMichieS. Using the internet to promote health behavior change: A systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res2010; 12(1): e4.
27.
CraigPDieppePMacintyreSMichieSNazarethIPetticrewM. Developing and evaluating complex interventions: The new Medical Research Council guidance. BMJ2008; 337: a1655.
28.
MichieSJohnstonMFrancisJHardemanWEcclesM. From theory to intervention: Mapping theoretically derived behavioural determinants to behaviour change techniques. Applied Psychol2008; 57(4): 660–680.
29.
DennisonLMoss-MorrisR. Cognitive-behavioral therapy: What benefits can it offer people with multiple sclerosis?Expert Rev Neurother2010; 10(9): 1383–1390.
30.
FirthN. Effectiveness of psychologically focused group interventions for multiple sclerosis: A review of the experimental literature. J Health Psychol2014; 19(6): 789–801.
31.
HindDCJThakeABradburnMCooperCIsaacCHouseA. Cognitive behavioral therapy for the treatment of depression in people with multiple sclerosis: A systematic review and meta-analysis (Provisional abstract), Centre for Reviews and Dissemination. BMC Psychiatry2014; 14(1): 5.
AbrahamCMichieS. A taxonomy of behavior change techniques used in interventions. Health Psychol2008; 27(3): 379–387.
34.
MichieSAshfordSSniehottaFFDombrowskiSUBishopAFrenchDP. A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: The CALO-RE taxonomy. Psychol Health2011; 26(11): 1479–1498.
35.
MichieSRichardsonMJohnstonM. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Annals Behav Med2013; 46(1): 81–95.
36.
KurtzkeJF. Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology1983; 33(11): 1444–1452.
37.
KurtzkeJF. Historical and clinical perspectives of the expanded disability status scale. Neuroepidemiology2008; 31(1): 1–9.
38.
Bahram SangelajiLHSmithCPaulLSampathKKTreharneG. The effectiveness of behavior change interventions to increase physical activity participation in people with multiple sclerosis: A systematic review and meta-analysis protocol. Available at: http://wwwcrdyorkacuk/PROSPERO/display_recordasp?ID=CRD42014014736#VLwux0eUceE (accessed 12 November 2014).
39.
BoosmanHVisser-MeilyJMMeijerJWElsingaAPostMW. Evaluation of change in fatigue, self-efficacy and health-related quality of life, after a group educational intervention programme for persons with neuromuscular diseases or multiple sclerosis: A pilot study. Disabil Rehabil2011; 33(8): 690–696.
40.
GiacobbiPRDietrichFLarsonRWhiteLJ. Exercise and quality of life in women with multiple sclerosis. Adapted Phys Activity Quart2012; 29(3): 224–242.
41.
HartSFonarevaIMerluzziNMohrDC. Treatment for depression and its relationship to improvement in quality of life and psychological well-being in multiple sclerosis patients. Qual Life Res2005; 14(3): 695–703.
42.
McCabeMPStokesMMcDonaldE. Changes in quality of life and coping among people with multiple sclerosis over a 2 year period. Psychol Health Med2009; 14(1): 86–96.
43.
MathiowetzVGFinlaysonMLMatuskaKMChenHYLuoP. Randomized controlled trial of an energy conservation course for persons with multiple sclerosis. Mult Scler2005; 11(5): 592–601.
44.
FinlaysonM. Pilot study of an energy conservation education program delivered by telephone conference call to people with multiple sclerosis. Neurorehabil2005; 20(4): 267–277.
45.
FinlaysonMPreissnerKChoCPlowM. Randomized trial of a teleconference-delivered fatigue management program for people with multiple sclerosis. Mult Scler2011; 17(9): 1130–1140.
46.
HugosCLCoppermanLFFullerBEYadavVLoveraJBourdetteDN. Clinical trial of a formal group fatigue program in multiple sclerosis. Mult Scler J2010; 16(6): 724–732.
47.
MotlR. Physical activity and its measurement and determinants in multiple sclerosis. Minerva Medica2008; 99(2): 157–165.
48.
MotlRW. Physical activity in MS: Theory, determinants, and behavioral interventions. Mult Scler J2013; 19(11): 40.
49.
MotlRWMcAuleyEKlarenR. Reliability of physical-activity measures over six months in adults with multiple sclerosis: Implications for designing behavioral interventions. Behav Med2014; 40(1): 29–33.
50.
GodinGShephardRJ. A simple method to assess exercise behavior in the community. Can J Applied Sport Sci1985; 10(3): 141–146.
51.
RichardsonMTAinsworthBEJacobsJr DRLeonAS. Validation of the Stanford 7-day recall to assess habitual physical activity. Annals Epidemiol2001; 11(2): 145–153.
52.
WashburnRAZhuWMcAuleyEFrogleyMFigoniSF. The physical activity scale for individuals with physical disabilities: Development and evaluation. Arch Phys Med Rehabil2002; 83(2): 193–200.
53.
WalkerSNSechristKRPenderNJ. The health-promoting lifestyle profile: Development and psychometric characteristics. Nursing Res1987; 36(2): 76–81.
54.
BoothMLAinsworthBEPrattM. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exercise2003; 195(9131/03): 3508–1381.
55.
JenkinsonCCoulterAWrightL. Short form 36 (SF36) health survey questionnaire: Normative data for adults of working age. BMJ1993; 306(6890): 1437.
56.
VickreyBHaysRDHarooniRMyersLWEllisonGW. A health-related quality of life measure for multiple sclerosis. Qual Life Res1995; 4(3): 187–206.
57.
HobartJLampingDFitzpatrickRRiaziAThompsonA. The multiple sclerosis impact scale (MSIS-29) a new patient-based outcome measure. Brain2001; 124(5): 962–973.
58.
FiskJDPontefractARitvoPGArchibaldCJMurrayT. The impact of fatigue on patients with multiple sclerosis. Can J Neurological Sci1994; 21(1): 9–14.
59.
KosDKerckhofsECarreaIVerzaRRamosMJansaJ. Evaluation of the Modified Fatigue Impact Scale in four different European countries. Mult Scler2005; 11(1): 76–80.
60.
FransenMMcConnellSHernandez-MolinaGReichenbachS. Exercise for osteoarthritis of the hip. 2014;
61.
HigginsJPAltmanDGGøtzschePC. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ2011; 343: d5928.
62.
de BruinM. Risk of bias in randomised controlled trials of health behaviour change interventions: Evidence, practices and challenges. Psychol Health2014; 30(1): 1–7.
63.
de BruinMMcCambridgeJPrinsJM. Reducing the risk of bias in health behaviour change trials: Improving trial design, reporting or bias assessment criteria? A review and case study. Psychol Health2014; 30(1): 8–34.
64.
KhanFPallantJFBrandCKilpatrickTJ. Effectiveness of rehabilitation intervention in persons with multiple sclerosis: A randomised controlled trial. J Neurol Neurosurg Psychiatry2008; 79(11): 1230–1235.
65.
BorensteinMHedgesLVHigginsJPRothsteinHR. Introduction to Meta-analysis. John Wiley & Sons, 2011.
66.
SterneJASuttonAJIoannidisJP. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ2011; 343: d4002.
67.
BombardierCCunniffeMWadhwaniRGibbonsLBlakeKKraftG. The efficacy of telephone counseling for health promotion in people with multiple sclerosis: A randomized controlled trial. Arch Phys Med Rehabil2008; 89(10): 1849–1856.
68.
CarterADaleyAHumphreysL. Pragmatic intervention for increasing self-directed exercise behaviour and improving important health outcomes in people with multiple sclerosis: A randomised controlled trial. Mult Scler J2014; 20(8): 1112–1122.
69.
FormanACLincolnNB. Evaluation of an adjustment group for people with multiple sclerosis: A pilot randomized controlled trial. Clin Rehabil2010; 24(3): 211–221.
70.
JalonEGGLennonSPeoplesLMurphySLowe-StrongA. Energy conservation for fatigue management in multiple sclerosis: A pilot randomized controlled trial. Clin Rehabil2013; 27(1): 63–74.
71.
MotlRWDlugonskiDWojcickiTRMcAuleyEMohrDC. Internet intervention for increasing physical activity in persons with multiple sclerosis. Mult Scler J2011; 17(1): 116–128.
72.
PiluttiLADlugonskiDSandroffBMKlarenRMotlRW. Randomized controlled trial of a behavioral intervention targeting symptoms and physical activity in multiple sclerosis. Mult Scler2014; 20(5): 594–601.
73.
PlowMAMathiowetzVLoweDA. Comparing individualized rehabilitation to a group wellness intervention for persons with multiple sclerosis. Am J Health Promot2009; 24(1): 23–26.
74.
RietbergMBvan WegenEEHEyssenIKwakkelGGrpMSS. Effects of multidisciplinary rehabilitation on chronic fatigue in multiple sclerosis: A randomized controlled trial. PLoS One2014; 9(9): 9.
75.
StuijbergenAKBeckerHBlozisSTimmermanGKullbergV. A randomized clinical trial of a wellness intervention for women with multiple sclerosis. Arch Phys Med Rehabil2003; 84(4): 467–476.
76.
BombardierCHEhdeDMGibbonsLE. Telephone-based physical activity counseling for major depression in people with multiple sclerosis. J Consult Clin Psychol2013; 81(1): 89–99.
77.
American Psychological Association. Telephone-based physical activity counseling for major depression in people with multiple sclerosis [press release]. US: American Psychological Association, 2013.
78.
AdamsJWhiteM. Are activity promotion interventions based on the transtheoretical model effective? A critical review. Br J Sports Med2003; 37(2): 106–114.
79.
ConnVHafdahlAMehrD. Interventions to increase physical activity among healthy adults: Meta-analysis of outcomes. Am J Public Health2011; 101: 751–758.
80.
DaviesCASpenceJCVandelanotteCCaperchioneCMMummeryWK. Meta-analysis of internet-delivered interventions to increase physical activity levels. Int J Behav Nutr Phys Act2012; 9(1): 52.
81.
HobbsNGodfreyALaraJ. Are behavioral interventions effective in increasing physical activity at 12 to 36 months in adults aged 55 to 70 years? A systematic review and meta-analysis. BMC Med2013; 11(1): 75.
82.
Introduction to Health Behavior Theory. Sudbury, MA: Jones and Bartlett, 2014.
83.
BizeRJohnsonJAPlotnikoffRC. Physical activity level and health-related quality of life in the general adult population: A systematic review. Prevent Med2007; 45(6): 401–415.
84.
PiluttiLAGreenleeTAMotlRWNickrentMSPetruzzelloSJ. Effects of exercise training on fatigue in multiple sclerosis: A meta-analysis. Psychosomatic Med2013; 75(6): 575–580.
85.
NeillJBelanIRiedK. Effectiveness of non-pharmacological interventions for fatigue in adults with multiple sclerosis, rheumatoid arthritis, or systemic lupus erythematosus: A systematic review. J Advd Nursing2006; 56(6): 617–635.
86.
MillsRJYoungCAPallantJFTennantA. Rasch analysis of the Modified Fatigue Impact Scale (MFIS) in multiple sclerosis. J Neurol, Neurosurg Psychiatry2010; 81(9): 1049–1051.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
