Intentions of Canadian health professionals towards recommending exercise for people living with ALS

Abstract

Background: 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). Methods: An online survey of physician and non-physician health professionals (HPs) working in academic ALS clinics across Canada. Results: The 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). Conclusions: While "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.

I Want to Row Across the Atlantic. But You Have Amyotrophic Lateral Sclerosis!

“…The literature supports a moderate-intensity exercise program for strength and endurance 6,7 but with a caveat to monitoring fatigue and safety. 8 Individualized programs must consider amount and type of exercise, site of ALS onset, stage and progression of disease, respiratory status, patient tolerance, history of exercise, and patient expectations. [8][9][10] No harmful effects are reported with moderate resistive and endurance exercise (24 weeks) or intensive regimens (5 session/week), 6 but exercise has not slowed rates of progression assessed by the ALSFRS-R.…”

“…8 Individualized programs must consider amount and type of exercise, site of ALS onset, stage and progression of disease, respiratory status, patient tolerance, history of exercise, and patient expectations. [8][9][10] No harmful effects are reported with moderate resistive and endurance exercise (24 weeks) or intensive regimens (5 session/week), 6 but exercise has not slowed rates of progression assessed by the ALSFRS-R. Although not applicable to most ALS patients, for our patient, high-intensity resistance and endurance training was feasible and may have an "advantageous impact on the quality of life of ALS patients without extending life expectancy".…”