Physical inactivity is more common among patients with multiple sclerosis (MS) than the general public—even though studies have shown that exercise can reduce the frequency and intensity of MS symptoms.
A recently published small study conducted at the University of Illinois tested whether motivational interviewing could affect adherence to an exercise program among patients with MS.1 Here, lead researcher Douglas C. Smith, PhD, discusses motivational interviewing and briefly discusses key findings of the new study.
What is motivational interviewing and how might it help encourage patients with MS to exercise?
Motivational interviewing involves helping patients resolve ambivalence about making behavior changes. This approach acknowledges that people may not make beneficial changes and that they have their reasons for not doing so. We try to draw out their reasons for wanting to make the behavior change—which in our study was to get more exercise. We ask individuals to state their reasons for making this change out loud. This is completely different from us as professionals telling them why or how they should make changes.
Motivational interviewing stresses compassion for individuals and respect for their decisions. It simultaneously strives to influence decisions by having patients articulate the benefits of the change; it then reinforces that language instead of dwelling on their reasons for staying the same. With motivational interviewing, when a person talks about why they would not change a given behavior, we may briefly empathize, but we do not dwell on the subject. To do so could mire the patient in indecision.
Readers can learn more about motivational interviewing at the Motivational Interviewing Network of Trainers Web site.
Has motivational interviewing been shown to have lasting effects on behavior?
In my opinion, people move in and out of readiness to make changes. So, just like any other intervention, the effects of motivational interviewing may wear off. However, motivational interviewing is usually delivered as a brief intervention (in 1 or 2 sessions); we have found that it often has the same clinically meaningful effects as treatments that are administered in 5 to 10 sessions.
In short, motivational interviewing has shown excellent potential as a brief treatment for starting the process of behavioral change. In our study, however, we did not follow up to see if motivational interviewing had a lasting effect on adherence to the exercise habits patients began forming. We hope to do so.
In your study, you found that motivational interviewing had large effects on physical exertion, but it didn’t translate into adherence to the exercise program.
Our small study involved 13 inactive people with MS who participated in an 8-week exercise program; 7 were randomized to 3 brief motivational interviewing sessions and 6 received 3 health coaching sessions.
Usually motivational interviewing does have an impact on treatment adherence, but we think that the allure of receiving a supervised exercise program with experts in the multiple sclerosis field was so attractive that we didn’t see much variation in how many exercise sessions were attended. Participants in both the motivational interviewing and control groups attended an average of 19 (out of 24 possible) sessions over 8 weeks.
Prior studies that have used motivational interviewing in patients with MS have found effects on exercise adherence. So, we wonder if using an objective measure of exercise adherence and finding no effect may mean that it has something to do with how adherence was measured, and whether objective measures, such as attendance records or accelerometers, may be preferable to self-reported data. Finally, this finding could also have been due to the small sample size. Perhaps with a larger sample size we would have seen differences in adherence between the group that received motivational interviewing and the group that received generic tips on starting an exercise program.
Was there any assessment of how the exercise benefitted the subjects during the study?
Yes, my colleague and co-author Dr Robert Motl, studies whether and how exercise benefits individuals with multiple sclerosis. We published a study in the Journal of Neurologic Physical Therapy that involved a small sample of individuals with MS who were starting to experience problems with their gait.2 We found that a moderately intense, comprehensive, combined exercise training program was associated with improved walking mobility in this group.
1. Smith DC, Lanesskog D, Cleeland L, et al. Motivational interviewing may improve exercise experience for people with multiple sclerosis: a small randomized trial. Health Social Work. 2012;37:99-109.
2. Motl RW, Smith DC, Elliot J, et al. Combined training improves walking mobility in persons with significant disability from multiple sclerosis: a pilot study. J Neurologic Physical Ther. 2012;36:32-37.