Long-term physical activity in people with multiple sclerosis: exploring expert views on facilitators and barriers

<b>Purpose:</b> To explore the views of experts on facilitators and barriers of long-term physical activity among people with multiple sclerosis living in different European countries. <b>Methods:</b> We conducted semi-structured telephone or face to face interviews with twelve multiple sclerosis and physical activity experts (scientists, practitioners, patient representatives) from five European countries. Interviews were audio-recorded, transcribed verbatim and analyzed using thematic analysis. <b>Results:</b> We identified 20 themes and categorized them into environmental and personal factors. The most frequently mentioned and intensively discussed themes were environmental factors. The themes were structured according to possible intervention level: organizational, interpersonal and intrapersonal level themes. Themes at the organizational level comprised availability, access and quality of exercise/physical activity options; health system characteristics like services and organization, health professionals and information provision. The interpersonal level comprised social support and peer support. Disease related factors were the most frequently mentioned intrapersonal level theme. In our study, more codes were obtained for environmental factors than for personal factors. <b>Conclusions:</b> The results suggested that environmental factors may need to be addressed in particular to increase long-term physical activity adherence. This study will inform the design of a survey questionnaire assessing possible barriers and facilitators among people with multiple sclerosis. Implications for rehabilitationLong-term physical activity among people with multiple sclerosis is subject to a number of modifiable determinants: personal and environmental factors.Multiple sclerosis exercise experts emphasized the importance of environmental factors on the organizational and interpersonal level.Future physical activity interventions should be guided by a social-ecological perspective.Addressing environmental and personal factors simultaneously to reach optimal long-term outcomes should be considered in future interventions. Long-term physical activity among people with multiple sclerosis is subject to a number of modifiable determinants: personal and environmental factors. Multiple sclerosis exercise experts emphasized the importance of environmental factors on the organizational and interpersonal level. Future physical activity interventions should be guided by a social-ecological perspective. Addressing environmental and personal factors simultaneously to reach optimal long-term outcomes should be considered in future interventions.

**研究目的**：本研究旨在调研不同欧洲国家境内的多发性硬化（multiple sclerosis）患者群体中，长期体育运动（physical activity）的促进因素与阻碍因素相关专家的看法。
**研究方法**：本研究面向来自5个欧洲国家的12名多发性硬化与体育运动领域专家（含科研人员、从业者及患者代表）开展半结构化电话或面对面访谈。访谈内容采用音频录制、逐字转录的方式留存，并通过主题分析法（thematic analysis）进行编码分析。
**研究结果**：本研究共识别出20个主题，并将其划分为环境因素与个人因素两大类。其中被提及频次最高、讨论最为深入的主题属于环境因素范畴。本研究依据干预层级对主题进行分类，分为组织层面、人际层面与个体内部层面三类。组织层面主题涵盖体育运动选项的可获得性、可及性与质量；卫生系统特征，包括服务与组织架构、卫生专业人员配置及信息供给等内容。人际层面主题则包含社会支持与同伴支持。疾病相关因素是个体内部层面中被提及最多的主题。本研究中，环境因素所对应的编码数量多于个人因素。
**研究结论**：结果显示，若要提升多发性硬化患者长期体育运动的依从性，需重点关注环境因素的优化。本研究可为用于评估多发性硬化患者体育运动阻碍因素与促进因素的调查问卷设计提供参考。
### 康复领域启示
多发性硬化患者的长期体育运动受多项可调节的决定因素影响，涵盖个人因素与环境因素。多发性硬化运动领域专家强调了组织层面与人际层面环境因素的重要性。未来的体育运动干预项目应以社会生态学视角（social-ecological perspective）为指导原则。在后续干预中，应考虑同时兼顾环境因素与个人因素，以实现最佳的长期干预效果。
多发性硬化患者的长期体育运动受多项可调节的决定因素影响，涵盖个人因素与环境因素。多发性硬化运动领域专家强调了组织层面与人际层面环境因素的重要性。未来的体育运动干预项目应以社会生态学视角为指导原则。在后续干预中，应考虑同时兼顾环境因素与个人因素，以实现最佳的长期干预效果。