JMIR Publications

ABSTRACT

Background:

During spring and summer 2020, states implemented COVID-19 pandemic restrictions resulting in the closure of rehabilitation facilities and with them some of the clinical trials taking place. One such trial is the “STEP for MS” comparative effectiveness multiple sclerosis (MS) exercise trial. While one study arm was implemented via telerehabilitation, the comparative arm took place in rehabilitation facilities nationwide, subsequently closed during this timeframe. The experience of STEP for MS participants provides insights about the impact of lockdown restrictions on exercise by mode of exercise delivery (telerehabilitation versus conventional facility-based).

Objective:

This study sought to identify the impact of COVID-19 lockdown restrictions on exercise behavior among STEP for MS study participants actively engaged in the intervention at the time of the restrictions.

Methods:

The authors conducted semi-structured phone and video interviews with a convenience sample of eight participants representing both arms of the exercise trial. We applied reflexive thematic analysis (RTA) to identify, analyze, and interpret common themes in the data.

Results:

We identified seven main themes and two different narratives describing the exercise experience during lockdown restrictions. While the telerehabilitation participants continued exercising without interruption, facility-based participants experienced a range of barriers that impeded their ability to exercise. In particular, the loss of perceived social support gained from exercising in a facility with exercise coaches and other people with MS eroded both accountability and motivation to exercise. Aerobic exercises via walking were most impacted with participants pointing to the need for at-home treadmills.

Conclusions:

The unprecedented disruption of COVID-19 lockdown restrictions in spring and summer 2020 impacted the ability of facility-based STEP for MS exercise trial participants to exercise. In contrast, participants in the telerehabilitation-delivered exercise arm continued exercising without interruption and reported positive impacts of the intervention during this time. Telerehabilitation exercise programs hold promise for overcoming barriers to exercise for people with MS during an endemic COVID-19 era.