Understanding and Optimising activity pacing to promote a physically active lifestyle in people with multiple sclerosis

The way in which an individual habitually approaches physical activity has long been thought to have an impact on his/her daily functioning, with both underactivity and overactivity linked to disability. The experience of fatigue draws adaptations such as underactivity and periods of overactivity in people with multiple sclerosis. This emphasises the need to explore ways to facilitate physically active lifestyle in this population. Activity pacing is a novel goal-directed behavioural process of dividing activities into small manageable pieces to lessen the effect of symptoms, which then allows gradual progressive increases in activity. However, activity pacing as a potentially adaptive behaviour to stimulate physically active lifestyle has not been researched. This thesis consequently explored this. A literature review and meta-analysis were done to evaluate the influence of activity pacing on fatigue and physical activity, and potential moderator effects. Findings revealed activity pacing had beneficial but varied effects on fatigue and physical activity; suggesting that individual or intervention characteristics may have moderated effects. Consequently, we explored relations between activity pacing, fatigue, physical activity and health-related quality of life in daily life and found fatigue was related to low health-related quality of life. Also, engagement in pacing and perceived risk of overactivity were associated with low activity and high activity respectively. These findings suggest that people with multiple sclerosis might benefit from individualised guidance on efficient approach to activity and adequate fatigue management. These insights were used to develop and evaluate the efficacy of a tailored activity pacing intervention based on individual’s attitudes towards physical activity and fatigue experience. Results revealed the approach effectively increased activity level and reduced activity variability without exacerbating fatigue. These findings provide the basis to incorporate tailored activity pacing approach in standard care to manage fatigue and promote longitudinal engagement in physical activity among people with multiple sclerosis.