Exercise participation and promotion in the multiple sclerosis community; perspectives across varying socio-ecological levels.

Purpose: We undertook a qualitative study that explored exercise participation and exercise promotion in the multiple sclerosis (MS) community who live in regional or remote areas of Australia. By simultaneously gathering views from persons with MS, carers, healthcare providers and healthcare managers we aimed to gather unique perspectives which represented views from across socio-ecological levels of MS healthcare.

Methods: We used interpretive description methodology, and conducted semi-structured interviews or focus groups with people with MS ( = 28), carers ( = 8), healthcare providers ( = 12) and managers/supervisors of MS healthcare systems ( = 16). Data were analysed using thematic analysis.

Results: We identified three themes with 10 subthemes. The first theme was "Factors associated with exercise engagement" for the people with MS, from individual, interpersonal, organisational and community/public policy perspectives. The second theme was "Factors influencing the MS community's promotion of exercise" focusing on carers, healthcare providers and healthcare systems. The third theme was "Motivators to increase exercise promotion" which should be delivered by the MS community across varying socio-ecological levels of healthcare to encourage exercise participation.

Conclusion: We identified new evidence on the factors which influence the MS community's promotion of exercise and we now better understand that training on exercise should be provided to the wider MS community, and exercise services should be considered locally and perhaps delivered via teleheath.IMPLICATIONS FOR REHABILITATIONCohesive healthcare campaigns, and clinical guidelines based on empirical evidence should be established for symptom management in MS with a focus on the role of exercise.Symptom management strategies should consider the whole MS community, including patients, carers, healthcare professional and healthcare co-ordinators.Internal factors (e.g., emotion and motivation) and broader factors (e.g., funding and location) must be considered when designing exercise interventions in persons with MS.