Qualitative exploration of tele-exercise program to inform adaptive intervention design for adults with multiple sclerosis

Research Objectives: To examine the experiences and perceptions of people with multiple sclerosis (MS) who completed a 3-month tele-exercise program regarding the program components and implementation procedures.
To identify modifiable factors that could be used to develop an adaptive tele-exercise intervention.

Design: This qualitative study was nested within a pragmatic, cluster-randomized controlled effectiveness trial that compared a 3-month, home-based complementary and alternative medicine exercise intervention (yoga, Pilates, and neurorehabilitation activities) to the same intervention delivered in clinic by a therapist among 761 people with MS. The participants of this qualitative study were a convenience sample recruited from the tele-exercise arm of the main trial.

Setting: The interview was conducted via Zoom conference call.

Participants: Twenty-two people with MS were included in a semi-structured, single one-on-one interview.

Interventions: The 1-year main trial includes the 3-month (20 sessions) CAM intervention and a 9-month follow-up period. The intervention was delivered through a tablet with preloaded videos. The participants received weekly educational articles and automated phone calls that aligned with the key constructs of social cognitive theory (self-efficacy, outcome expectation, knowledge, self-regulatory strategies, facilitators/barriers).

Main Outcome Measures: Each interview was audio-recorded and then transcribed verbatim. Using interpretive thematic analysis, we identified desirable components and delivery mechanisms of the tele-exercise program.

Results: Our analysis indicated the importance of individualized, ongoing modification of exercise program content to accommodate changes in participants’ functional abilities and health status. Participants reported an ideal time point of human support, preferably every 3 weeks, to capture the intervention modification needs (e.g., exercise position, intensity, and clarification of exercise instruction). We further identified desirable components for behavioral modifications, such as the inclusion of an exercise companion and self-monitoring tool and post-intervention resources for sustaining exercise participation during follow-up periods.

Conclusions: The findings of this study offer insights into tailoring future adaptive tele-exercise intervention designs aimed at promoting engaging and sustainable exercise participation in people with MS.

Author(s) Disclosures: The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.