Quality statement 4: Physical activity | Multiple sclerosis | Quality standards

Quality statement

Adults with multiple sclerosis (MS) who have problems with mobility or fatigue are offered support to remain physically active.

Rationale

Remaining physically active can improve mobility and fatigue, which are common problems experienced by adults with MS. It can also help to reduce the secondary complications of inactivity, such as pressure sores, and help adults with MS to regain or maintain their strength.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that adults with MS who have problems with mobility or fatigue are supported to remain physically active.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from service protocols.

Process

Proportion of adults with MS who are offered support to remain physically active.

Numerator – the number in the denominator who are offered support to remain physically active.

Denominator – the number of adults with MS who have problems with mobility or fatigue.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

a) Adults with MS who have problems with mobility or fatigue feel supported by healthcare professionals to remain physically active.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from surveys.

b) Levels of physical activity among adults with MS.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from surveys.

What the quality statement means for different audiences

Service providers (GPs, community health teams and neurology services) ensure that adults with MS who have problems with mobility or fatigue are offered support to remain physically active. It may be useful to compile information about local exercise classes, groups and facilities, so that people can be given information about any that are suitable.

Healthcare professionals (members of the multidisciplinary team) ensure that they offer adults with MS who have problems with mobility or fatigue support to remain physically active.

Commissioners (NHS England, integrated care systems and clinical commissioning groups) ensure that they commission services in which adults with MS who have problems with mobility or fatigue are offered support to remain physically active. The services commissioned should include provision of supervised exercise programmes for adults with MS who may benefit because of problems with mobility or fatigue.

Adults with MS who have problems with movement or fatigue are helped to do some exercise because this can improve these symptoms. Healthcare professionals should explain what types of exercise are suitable, what activities are available and ask which the person prefers.

Source guidance

Multiple sclerosis in adults: management. NICE guideline NG220 (2022), recommendations 1.5.7, 1.5.9, 1.5.20, 1.5.21 and 1.5.23

Definitions of terms used in this quality statement

Support to remain physically active

Healthcare professionals should discuss the potential benefits of exercise with adults with MS who have problems with mobility or fatigue. Programmes or courses of exercise therapy should be supported by a competent professional, such as a physiotherapist with expertise in MS, who can suggest the most suitable exercises and monitor the effects. Types of suitable physical activity may include the following:

aerobic, resistive and balance exercises, including yoga and pilates
a combination of a programme of supervised aerobic and moderate progressive resistance activity and cognitive behavioural techniques for people with MS with moderately impaired mobility (an EDSS [Expanded Disability Status Scale] score of greater than or equal to 4)
supervised exercise programmes involving moderate progressive resistance training and aerobic exercise
exercise referral schemes.

People with MS should also be encouraged to keep exercising after programmes end for longer term benefits. [Adapted from NICE's guideline on multiple sclerosis in adults, recommendations 1.5.7, 1.5.9, 1.5.20, 1.5.21 and 1.5.23, 2014 full guideline, sections 10.3.6 and 10.4.6 and expert opinion]