Changing physical activity behaviour among people with multiple sclerosis

Increasing physical activity (PA) through exercise is associated with improvements in many of the symptoms associated with Multiple Sclerosis (MS) such as fatigue, strength, balance and mobility. Despite this, people with MS remain largely inactive. Interventions that are grounded in theory and that aim to change PA behaviour need to be developed. The aim of this thesis was to develop a web-based intervention to increase PA levels among people with MS, namely, ‘Activity Matters’. The thesis was underpinned by the development stage of the MRC Framework for the Development of Complex Interventions and the Behaviour Change Wheel process. Specific objectives of this thesis included: 1) Identifying the Evidence Base, 2) Identifying and Developing the Theory and 3) Modelling Process and Outcomes of the ‘Activity Matters’ intervention. The evidence base for the ‘Activity Matters’ intervention was identified through a meta-analysis of objective PA levels among people with MS. This was the first metaanalysis of objective PA levels only in this population. Results showed that people with MS are significantly less active than their healthy counterparts across PA outputs of steps per day and minutes of MVPA per day. These findings support the need for future PA intervention development. This thesis contributed to identifying and developing the theory base for the ‘Activity Matters’ intervention and ultimately aimed to understand PA behaviour among people with MS. Four chapters in the thesis provided crucial quantitative and qualitative data that met this aim. In summary, previous interventions have not been successful in changing medium-long-term PA behaviour among people with MS and factors such as self-efficacy, goal-setting, mood and knowledge were recognised as important to include in future interventions. The final objective of this thesis was to model the process and outcomes of the ‘Activity Matters’ intervention using the steps outlined by the BCW. Data from this thesis informed this process. Results showed that the ‘Activity Matters’ intervention is theoretically based and constructs including, knowledge, memory, attention and decision processes, skills, social influences, environmental context and resources, beliefs about capabilities, beliefs about consequences, goals and emotions were recognised as important. Intervention functions and techniques that will be used on the website include education, enablement, environmental restructuring, persuasion, incentivisation, action planning, goal-setting, social-support and problem-solving. Future research directions include refining the content and design of ‘Activity Matters’ intervention through usability testing and the development of a patient-public stakeholder group. Once refined, a pilot randomised control trial will be conducted to test procedures, estimate recruitment and determine the sample size for a large scale evaluation that will test effectiveness.