Abstract
BackgroundTo provide a nationwide overview of the attitudes, social pressure, perceived ability and intentions of health professionals toward exercise prescription for people living with ALS (pALS).MethodsAn online survey of physician and non-physician health professionals (HPs) working in academic ALS clinics across Canada.ResultsThe response rate was 48% (84/176) with 30% of respondents identifying as physicians, 63% as other HPs and the remainder as administrative or research personnel. Respondents were sharply divided in their intentions to provide exercise counsel: 24% unlikely and 45% likely. Respondents with low intentions were HPs that considered this activity outside their scope of practice. Measures of intention and attitude were more positive for flexibility compared to strength and aerobic exercise. Perceptions of social pressure and ability to provide exercise counsel were significantly correlated with intention across the three exercise modes in all respondents. Qualitative themes identified as barriers to exercise prescription were lack of confidence or competence (31% physicians, 32% HP), patient tolerance (30% HP), lack of evidence (22% physicians) and lack of infrastructure (22% physicians).ConclusionsWhile “lack of evidence” for the benefit of exercise was a deterrent for physicians, the larger issue for all respondents was building competence and confidence in exercise prescription for pALS.
Highlights
To provide a nationwide overview of the attitudes, social pressure, perceived ability and intentions of health professionals toward exercise prescription for people living with ALS
The total number of potential respondents established in the sampling frame was 176: 48 were classified as physicians, 104 as non-physician health professionals (HPs), and 24 individuals classified as administrative, support or research staff
While there was no difference in the number of years employed in their profession, the physician group had significantly more experience working with people living with ALS (pALS): 14.3 ±11.1 compared to 7.8 ±7.4 years for other HP
Summary
To provide a nationwide overview of the attitudes, social pressure, perceived ability and intentions of health professionals toward exercise prescription for people living with ALS (pALS). Evidence-based guidelines for exercise management in people living with ALS (pALS) are available as part of this initiative [1] but it is not. The most recent epidemiological evidence concludes that recreational physical activity may be protective rather than a risk factor [9,10,11] but a possible direct association between strenuous exercise and risk for ALS mortality remains [12, 13]. The most recent Cochrane review on the topic points out the need for more rigorous randomized controlled trials (RCT) while acknowledging the moderate benefit of exercise and lack of reported adverse effects. While the evidence for modest beneficial effects of exercise on the progression of ALS accumulates, the lack of reported adverse effects in RCTs is consistent. Anecdotal experiences conveyed by pALS on the PatientsLikeMe website [17] as well as published editorial commentary [18] suggest that this issue remains controversial and that there may be a lingering perception that exercise is contraindicated for pALS
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