Physical Activity as a Tool for Social Inclusion in Multiple Sclerosis: A Systematic Review of Qualitative,...

Area of Science:

• Rehabilitation Science
• Social Science
• Public Health

Background:

• People with multiple sclerosis (PwMS) encounter significant social barriers like stigma and inaccessibility, limiting physical activity (PA) participation.
• While PA benefits physical and mental health, its impact on reducing social barriers for PwMS remains underexplored.
• Existing research lacks a synthesized understanding of how PA influences social participation and inclusion for individuals with multiple sclerosis.

Purpose of the Study:

• To systematically synthesize evidence on the relationship between physical activity and social barriers for people with multiple sclerosis.
• To identify mechanisms through which physical activity can mitigate social restrictions and enhance social outcomes in multiple sclerosis.
• To inform the development of effective PA interventions that address social inclusion for PwMS.

Main Methods:

• A systematic literature search was conducted across PubMed, Scopus, and Web of Science databases (1997-2025), adhering to PRISMA 2020 guidelines.
• Included studies encompassed qualitative, quantitative, and mixed-methods designs investigating PA's role in social barriers, facilitators, or outcomes for PwMS.
• Thematic synthesis was employed due to study heterogeneity, with risk of bias assessed using multiple established tools (JBI, NIH, RoB 2.0, MMAT).

Main Results:

• Twenty-nine studies were included, revealing three key mechanisms: 1) Peer support and shared experiences in group PA reduced isolation and normalized symptoms.
• 2) Guidance from knowledgeable professionals fostered trust, confidence, and safety.
• 3) PA facilitated a shift in social identity from a "sick role" to active roles like "exerciser" or "athlete," supported by qualitative insights and quantitative data on self-efficacy and social support.

Conclusions:

• Physical activity acts as a socially transformative practice for people with multiple sclerosis, particularly in group-based, supervised, and accessible settings.
• Interventions intentionally fostering peer connections, professional support, and positive identity development are crucial for overcoming social barriers.
• Targeted PA programs can significantly enhance social inclusion and participation for individuals living with multiple sclerosis.