Tele-Exercise and Multiple Sclerosis

There are few primary care and multiple sclerosis (MS) clinics that provide full exercise and
rehabilitation services for patients with MS, especially in mostly rural, low‐income areas
such as Alabama, Mississippi, and Tennessee. Telerehabilitation, or the delivery of
rehabilitation services over the telephone and/or the Internet, can help fill service gaps
for underserved MS patient populations in this region. The proposed study will determine if
our evidence‐based rehabilitation and exercise program produces similar health outcomes when
delivered in clinic or at home, using pre‐loaded tablets and Interactive Voice Response (IVR)
system technology among 820 participants with MS from 38 clinics across Alabama, Mississippi,
and Tennessee.

Outcomes we hope to achieve through the proposed rehabilitation and exercise program,
referred to as complementary alternative medicine, are improved physical activity, decreased
pain and fatigue, and quality of life. We also seek to improve attitudes and behaviors
related to physical activity, such as outcome expectations for physical activity, social
support from family and friends for physical activity, self‐efficacy (i.e., confidence in one's
ability to be active), and self‐regulation (i.e., setting exercise goals). We will examine
the variation in outcomes by patient characteristics such as age and severity of disability
to determine for whom the intervention is effective.

This project is important to patients with MS because it seeks to reduce their barriers to
receiving exercise treatment and increase the convenience and appeal of such programs through
technology. Furthermore, findings and resources from this study will be quickly provided to
MS patients and clinicians across the United States (e.g., via training webinars through our
National Center on Health, Physical Activity, and Disability [NCHPAD]) and thereby improve
the quality and reach of exercise treatment for patients with MS.

The patient and stakeholder partners include MS patients, caretakers, and clinicians, who
have been actively guiding the development of this project. In stakeholder meetings, members
have provided insight into exercise treatment needs and preferences (e.g., individually
tailored approaches that account for varying levels of mobility); outcomes of interest to the
patient population (e.g., pain, fatigue, quality of life); and strategies for
engaging/motivating participants with MS who may be discouraged and experiencing fatigue and
pain (e.g., IVR calls and feedback). Moreover, their ongoing program satisfaction feedback
will be important to our recruitment and retention success. Finally, the stakeholders will
help make this project successful by continuing to emphasize the importance of long‐term
gains in health outcomes and promote (through NCHPAD) the sustainability of the program.

Inclusion Criteria:

- Physician permission to participate in the study

- Mild to moderate disability (i.e., ambulate with/without assistive device,
Patient-Determined Disease Steps [PDDS] 0 - 7

- Able to use arms/legs for exercise

Exclusion Criteria:

- Significant visual acuity that prevents seeing a tablet screen to follow home exercise
program

- Cardiovascular disease event within the last six months, several pulmonary disease,
and/or renal failure

- Active pressure ulcers

- Currently pregnant

- Within 30 days of receiving a rehabilitation program

- Already meeting physical activity guidelines (GLTEQ > 24)