Healthcare provider beliefs about exercise and fatigue in people with multiple sclerosis

This study describes the experiences of four groups of healthcare providers who facilitate exercise interventions for people with multiple sclerosis (MS)-related fatigue. Fatigue is a complex symptom frequently experienced by people with MS, yet it is poorly understood by clinicians and clinical researchers. Historically, clinicians have recommended less physical activity in order to limit fatigue; however, recent experimental studies suggest that regular exercise provides health benefits with little increase in fatigue. We used interpretive description methodology to guide data collection and analysis. Four groups of healthcare providers participated in either focus group discussions or individual interviews. Transcripts were analyzed for key meanings. Healthcare providers described their perceptions of the "nature of fatigue" and how this raised "professional challenges," specifically "barriers to implementation" of interventions, "stirring conflict" among interdisciplinary members, and "modifying roles." The nature of fatigue and professional challenges influenced clinician practice by "demanding creativity" with regard to exercise prescription and advice. Healthcare providers are encouraged to consider strategies of active listening and careful observation when providing individualized exercise programs for people with MS-related fatigue. In addition, recognition and understanding of the complex nature of fatigue by the interdisciplinary team might facilitate more positive exercise experiences for this population.