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Control, Choice, Support

Thursday 23 June 2016 5:02pm

Physical activity is important for our mental and physical wellbeing, however many people find it difficult to develop a daily exercise habit. Life gets in the way. For people with physical disabilities this barrier to entry is even greater.

Professor Leigh Hale, the Dean of Physiotherapy at the University of Otago, wanted to find a way to lessen that barrier. Along with colleagues (Dr Cath Smith, Dr Hilda Mulligan, and Dr Gareth Treharne) she developed a programme called ‘Blue Prescription’ which focused on finding ways to sustainably integrate physical activity into the daily lives of people with multiple sclerosis.

Until recently people with multiple sclerosis were discouraged from exercising at all, as it was believed that exercise would exacerbate their muscle weakness and fatigue. More recently it has been accepted that moderate to high intensity exercise can help people suffering from the condition however, unsurprisingly, many people suffering from MS find it difficult to form a moderate to high intensity exercise habit. These people are being asked to go from 0-100 with minimal support, and while the exercise has real benefits for them it is simply too much, too fast.

In speaking to people with MS Professor Hale and her team learned that what they really wanted were three simple things: control, choice, and support. One of the disabling qualities of chronic illness is having your life prescribed to you; it is a lack of choice, a lack of control over, not only your body, but your experiences. These people wanted to be able to decide how and when they would exercise, decisions which had previously not belonged to them. Under Blue Prescription they reclaimed those choices, and they were supported by Professor Hale and her team.

Many of the participants started out small with daily tasks like cleaning or, in one person’s case, grooming their horse. Professor Hale remarked on one man’s surprise that he was allowed to go for a daily walk as his exercise choice. Progressively each person was supported in increasing the intensity of their daily activity and found that it was easy to maintain this new level of physical activity.

By the end of the Blue Prescription trial participants felt that they had more control over their bodies, and had a more positive view of exercise in general. For some there was also a reduction in feelings of fatigue, and while that is clearly a positive impact of the study it wasn’t the focus for the researchers. Their intention was to develop a way for people with MS to form healthy exercise habits, and they succeeded in doing that.

We all want to have control in our lives, and for individuals with physical disability that control is sometimes hard to find. Struggling with immobility and fatigue limits your choices and, sometimes, your experiences. Professor Hale and her team have shown us that some choices can be given back, that allowing people control over their own rehabilitation can be beneficial. This research reminds us to see a person, rather than a disabled body, and to ask “what does this person need?” instead of “what do they need to do?”


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