Impact case study database

Sheffield Hallam research has influenced national best practice (NICE Guidelines, 2014) and significantly enhanced quality of life for people with MS. It has enabled them to benefit from bespoke exercise guidance from health care professionals in clinical settings. Specifically the research led to the development of an exercise referral pathway, and the upskilling of exercise specialists in neurological conditions through the UK's first nationally accessible level 4 training course. By 2020 the findings of ExIMS had improved services for the c.5,000 MS patients supported by health professionals at Sheffield Teaching Hospitals, 150 of whom have directly benefitted from exercise referrals. Approximately 100 national and international exercise professionals have undergone the training programme. This work has in turn provided evidence to Sport England for a future national roll-out of the programme.

R3 and R4 informed the NICE Guidelines Multiple Sclerosis in Adults: Treatment and Management (2014) ( E1). Previously exercise only had a minor mention but, in this, exercise and behaviour change became core to the non-pharmacological management of fatigue. These guidelines influence the support provided by health practitioners across the UK and the 130,000 people with MS that they care for. NICE also influences international practice through widespread adoption of their guidelines by international health organisations, ministries and government agencies.

The new emphasis on exercise in the guidelines and a specific prioritisation for implementation also led, in 2016, to the development of a NICE Quality Standard for MS, supporting people with mobility issues and fatigue to remain physically active ( E2).

The ExIMS research programme enabled the development of strong regional and national relationship with the MS Society. Sheffield Hallam’s expertise supported the National MS Society's aim to improve services for people with MS, by contributing to their 'Models of Excellence' programme as an independent expert on physical activity ( E6). This has been a key strand for delivering their ‘Together to Beat MS’ five-year strategy.

Although exercise was from 2014 being recommended for people with MS, there remained two main barriers to them accessing this: i) an inadequacy of exercise referral provision (formal mechanisms for medical professionals to refer patients to a fitness programme with an appropriately trained exercise practitioner) for people with neurological conditions and, ii) a lack of suitably trained exercise professionals. Sport England confirm:

“There was a significant gap in exercise referral schemes for people with neurological conditions. There was no industry recognised training for leisure service staff to support work with people with a neurological condition. This lack of training means people living with these conditions report being referred to leisure services under weight management or other programmes not tailored to their needs”. ( E10)

The ExIMS research informed a series of collaborative projects, supported by organisation such as the MS Society and Sport England, that began to address these gaps. These included HEIF Fellowship 2017 ( E7), Active for Health Rotherham 2017-2019 ( E8, E9), MS Society Tasters 2018, and Sport England’s MS Access to Exercise 2018-19 ( E10, E11).

The HEIF Fellowship project enabled SHU to build strategic relationships with industry partners involved in the exercise referral pathway for people with MS. MS Access to Exercise then provided the evidence needed to demonstrate the demand for a neurology specific qualification to our partners ( E4). This directly resulted in the creation in 2019 of the first nationally available level 4 neurological fitness qualification, developed by the Wright Foundation (UK brand leader in exercise referral and specialist populations exercise qualifications) and accredited by CIMSPA (professional development body for the UK’s sport and physical activity sector).

The Active for Health Rotherham and MS Access to Exercise projects also enabled the Sheffield Hallam research team to design, evaluate and implement exercise tasters and referral pathways for people with MS. This has enabled more people with MS to access tailored exercise advice through improvements in exercise referral, both locally and nationally, as a result of the research and evaluation evidence collected. These referrals have already enabled 150 people with MS to gain better access to tailored exercise advice.

In addition the level 4 neurological fitness training has been provided to over 100 exercise professionals in the UK. There has also been international uptake, with students from the United Arab Emirates. ( E4, E9 and E11).

This work is now providing the evidence to Sport England for national roll-out of an improved exercise referral pathway. Training of exercise professionals both nationally and internationally is also ongoing. Combined, these two interventions are enhancing access to and standards of exercise provision for people with neurological conditions.

ExIMS has resulted in enhanced clinical and health professional practice on exercise for the treatment and management of MS, both nationally and internationally.

The strength of evidence provided by ExIMS has directly influenced the technical and applied knowledge of health practitioners in South Yorkshire and led to significant changes in practice:

"This research was also incorporated in our departmental guidelines at STH on the management of multiple sclerosis and in national guidelines produced by NICE, as well those promoted by the UK MS Society and MS Trust (the UK's leading MS charities)… leading to changes nationally in the use of exercise to manage symptoms." (Clinician at STH) ( E3).

The provision of the first nationally available accredited course for exercise professionals ( E4) has enabled GPs and other health professionals to refer patients to an exercise professional with experience in neurology, through the exercise referral scheme:

“It gives you confidence because safety is a big one. You want to know instructors are using evidence-based practice. The qualification gives you a lot of that confidence.” (MS Specialist Nurse, Chester)

Findings from our clinical trials, and subsequent patient experience studies, have been disseminated at regional and national events organised for health professionals working with people with MS. Dr Carter was an invited speaker at both the national Physiotherapy UK conference (attended by over 1100 physiotherapists from across the world), and the British Association of Sport and Exercise Science conference. Internationally, our research has been published by Academic Press as a book chapter on exercise for MS, aimed at healthcare professionals worldwide ( E5), presenting the role of non-pharmacological treatment for MS.

During our research and community work, a total of 300 people with MS have received direct benefit (150 in the trials, including post-study interventions with the control groups, and 150 from the subsequent implementation). In addition, the influence of our impact programme has gone on to benefit many more, through the better advice and support now provided by health professionals and exercise specialists across the UK. Benefits from exercise for these patients include improvements in cardiovascular fitness, reduced fatigue, pain and enhanced quality of life.

ExIMS qualitative research provided contextual impact evidence:

“I feel as though I'm less fatigued. I don't have as many floppy days. I still get the odd one, but nowhere near like it was” and “I do find simple things like turning over in bed, which isn't a very easy task, and picking things up off the floor without collapsing; things of that nature are a lot easier.” ( R5)

Benefits also extended to family members, with people with MS more able to participate in family activities: “I try harder. My little boy will be surprised when I say yeah, alright I'll go swimming or yeah OK let's go for a walk, and he'll think oh, that doesn't sound quite right.” ( R5)

The project and its findings have therefore enhanced the health of individuals, as well as exercise practitioners’ competence, and therefore confidence, in recommending and delivering tailored exercise interventions.