title: Perspectives on Physical Activity Among People with Multiple Sclerosis Who Are Wheelchair Users: Informing the Design of Future Interventions.
abstract: BACKGROUND
  People with advanced multiple sclerosis (MS) are less physically active than those with milder forms of the disease, and wheelchair use has a negative association with physical activity participation. Thus, wheelchair users with MS are doubly disadvantaged for accruing the benefits of physical activity and exercise. Appropriate physical activity and exercise interventions are needed for this population.
  
  
  METHODS
  We undertook a qualitative study to explore the meanings, motivations, and outcomes of physical activity in wheelchair users with MS. We sought to understand daily opportunities to accumulate physical activity and exercise, and to identify perceived barriers, facilitators, and benefits that might inform the design of future interventions.
  
  
  RESULTS
  We interviewed 15 wheelchair users (mean age, 52 ± 8.8 years; n = 12 women). Data were transcribed and analyzed to identify and explore common themes. Our first theme was the reduced opportunity to participate in physical activity due to participants' dependence on mobility devices, environmental adaptations, and tangible support. Our second theme was the importance of incorporating physical activity and exercise into the everyday environment, highlighting the need for adaptive exercise and accessible environments. This indicated the need to incorporate behavior change modulators into physical activity and exercise interventions for those with advanced MS. Health-care professionals played an important role in promoting increased physical activity and exercise participation in those with advanced MS.
  
  
  CONCLUSIONS
  Our findings may inform future interventions to increase initiation and maintenance of physical activity and exercise among people with advanced MS.
authors.affiliation: Department of Kinesiology and Community Health (YCL, IMR, LAR, RWM) and the School of Social Work (TO), University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA.
authors.forename: Yvonne C
authors.initials: YC
authors.lastname: Learmonth
authors.affiliation: Department of Kinesiology and Community Health (YCL, IMR, LAR, RWM) and the School of Social Work (TO), University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Rice
authors.affiliation: Department of Kinesiology and Community Health (YCL, IMR, LAR, RWM) and the School of Social Work (TO), University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Ostler
authors.affiliation: Department of Kinesiology and Community Health (YCL, IMR, LAR, RWM) and the School of Social Work (TO), University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Rice
authors.affiliation: Department of Kinesiology and Community Health (YCL, IMR, LAR, RWM) and the School of Social Work (TO), University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Motl