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This paper offers new insights into the promotion of the Exercise is Medicine (EIM) framework for mental illness and chronic disease. Utilising the Syndemics Framework, which posits mental health conditions as corollaries of social conditions, we argue that medicalized exercise promotion paradigms both ignore the social conditions that can contribute to mental illness and can contribute to mental illness via discrimination and worsening self-concept based on disability. We first address the ways in which the current EIM framework may be too narrow in scope in considering the impact of social factors as determinants of health. We then consider how this narrow scope in combination with the emphasis on independence and individual prescriptions may serve to reinforce stigma and shame associated with both chronic disease and mental illness. We draw on examples from two distinct research projects, one on exercise interventions for depression and one on exercise interventions for multiple sclerosis (MS), in order to consider ways to improve the approach to exercise promotion for these and other, related populations. [ABSTRACT FROM AUTHOR]

Purpose: We undertook a qualitative study that explored the needs of healthcare providers for promoting exercise behaviour among persons with mild or moderate multiple sclerosis (MS). Methods: We used interpretive description methodology, and conducted semi-structured interviews with Neurologists (n = 13), occupational therapists (n = 10), physical therapists (n = 11), and nurses (n = 10). The interviews were analysed using thematic analysis. Results: We identified three themes with multiple subthemes regarding exercise promotion by healthcare providers. The first theme was "opportunities for exercise promotion" through the healthcare system, healthcare team, and clinical appointment. The second theme was "healthcare provider education" that included professional training, training among healthcare providers, and clear and defined exercise promotion protocols. The third theme was "patient tools/strategies" that should be delivered among persons with MS as part of the exercise prescription. Conclusions: Providers in MS healthcare consider the patient-provider interaction within the healthcare system, healthcare team, and clinical appointment as a novel opportunity for exercise promotion. Such an opportunity requires education of healthcare providers and provision of tools and strategies for exercise promotion among persons with MS. [ABSTRACT FROM AUTHOR]

Background There is growing recognition of the benefits and safety of exercise and its importance in the comprehensive care of persons with multiple sclerosis ( MS), yet uptake is low. Objective We explored the needs and wants of patients with MS regarding exercise promotion through healthcare providers. Setting and participants Participants were adults with MS who had mild-or-moderate disability and a range of exercise levels. All participants lived in the Midwest of the United States. Methods Fifty semi-structured interviews were conducted and analysed using thematic analysis. Two themes emerged, namely interactions between patients and healthcare providers and needs and wants of patients. Results Analysis of participant accounts illustrate that current exercise promotion by healthcare providers does not meet patient needs and wants. The identified needs and wants of persons with MS involved (i) information and knowledge on the benefits of exercise and exercise prescription, (ii) materials to allow home and community exercise and (iii) tools for initiating and maintaining exercise behaviour. Discussion and conclusion Patients with MS frequently interact with healthcare providers and are generally unsatisfied with exercise promotion during interactions. Healthcare providers can address the low uptake of exercise among persons with MS by acting upon the identified unmet needs involving materials, knowledge and behaviour change strategies for exercise. [ABSTRACT FROM AUTHOR]

Worsening depressive symptoms and walking impairment are significant burdens in multiple sclerosis. We explored the reciprocal relationship between depressive symptoms and walking impairment in a cohort of 269 people with relapsing-remitting multiple sclerosis over 2 years. The data were examined using longitudinal panel analysis in Mplus. Baseline depressive symptoms predicted change in walking impairment at 1-year follow-up (path coefficient = .074), and change in walking impairment at 1-year follow-up predicted change in depressive symptoms at 2-year follow-up (path coefficient = .177). Our study provides preliminary evidence for initiation of a reciprocal relationship between depressive symptoms and walking impairment in relapsing-remitting multiple sclerosis. [ABSTRACT FROM AUTHOR]

Background: Internet-delivered, behavioral interventions represent a cost-effective, broadly disseminable approach for teaching persons with multiple sclerosis (MS) the theory-based skills, techniques, and strategies for changing physical activity., Objectives: This pilot, randomized controlled trial examined the efficacy of a newly developed Internet website based on e-learning approaches that delivered a theory-based behavior intervention for increasing physical activity and improving symptoms, walking impairment, and neurological disability., Methods: Participants with MS ( N  = 47) were randomly assigned into behavioral intervention ( n  = 23) or waitlist control ( n  = 24) conditions delivered over a six-month period. Outcomes were administered before and after the six-month period using blinded assessors, and data were analyzed using analysis of covariance in SPSS., Results: There was a significant, positive intervention effect on self-reported physical activity ( P  = 0.05, [Formula: see text]   = 0.10), and non-significant improvement in objectively measured physical activity ( P  = 0.24, [Formula: see text]   = 0.04). There were significant, positive effects of the intervention on overall ( P  = 0.018, [Formula: see text]   = 0.13) and physical impact of fatigue ( P  = 0.003, [Formula: see text]   = 0.20), self-reported walking impairment ( P  = 0.047, [Formula: see text]   = 0.10), and disability status ( P  = 0.033, [Formula: see text]   = 0.11). There were non-significant improvements in fatigue severity ( P  = 0.10, [Formula: see text]   = 0.06), depression ( P  = 0.10, [Formula: see text]   = 0.07) and anxiety ( P  = 0.06, [Formula: see text]   = 0.09) symptoms, and self-reported disability ( P  = 0.10, [Formula: see text]   = 0.07)., Conclusions: We provide evidence for the efficacy of an Internet-based behavioral intervention with content delivered through interactive video courses grounded in e-learning principles for increasing physical activity and possibly improving secondary outcomes of fatigue, depression, anxiety, and walking impairment/disability in persons with MS.