Step It Up

Step It Up is a physiotherapy-led exercise and education programme for people with

multiple sclerosis (MS). Step It Up has been developed in response to the successful

University of Limerick research project, Getting the Balance Right. Results from Getting

the Balance Right demonstrated improvements in fatigue, walking endurance and other

MS symptoms following a 10-week strengthening and aerobic exercise programme.

However, 3 months after completing the programme results showed that the progress

made during programme had not been maintained among the participants, who reported

having difficulty continuing to be physically active outside of the exercise classes. Step It Up,

which combines a 10-week exercise programme with an educational component to enable

participants to become physically active and to personally sustain this level of activity long-term.


What was involved?

65 people with MS (who had an EDSS average of 3.3, required no aid to walk and were inactive) who were interested in taking part in the Step It Up programme underwent an initial assessment which included questionnaires and some physical functioning tests. Participants then wore a physical activity monitor for the week before the exercise class starts. The Step It Up programme took place over 10 weeks involving six sessions with an exercise class followed by an education session and four sessions where the participants spoke with the physiotherapist over the phone regarding their home exercise programme. Participants were also asked to do exercise independently in between classes. In order to keep a record of progress made throughout the Step It Up programme, participants completed a log of the exercise they completed during the study. Assessments took place after the 10-week programme and then 3 and 6 months later at which participants completed all of the same questionnaires and physical tests.


What were the findings?

Statistically significant and clinically meaningful improvements in were found in walking, and were maintained 6 months after the classes ended. Significant improvements in strength, physical activity, mood and fatigue were also seen after the classes, and were maintained 6 months later. Exercising in groups, seeing benefits in yourself and others, setting exercise goals, recording what you do, and using a pedometer to track progress, in addition to exercise may help to start, and maintain, a good exercise habit.


Who was involved?

Dr. Susan Coote was the principal investigator of the Step it Up programme. Dr. Coote is a Lecturer in the Department of Clinical Therapy and is member of the Centre for Physical Activity and Health Research at the University of Limerick. Dr. Sara Hayes is a Health Research Board post-doctoral research fellow with a background in neurological physiotherapy clinical practice and research. Dr. Stephen Gallagher is a health psychologist and Lecturer in psychology at the University of Limerick. Dr. John Newell is a Senior Lecturer in Biostatistics and head of the Biostatistics Unit in the HRB Clinical Research Facility, NUI Galway. Aidan Larkin is a National Services Development Manager with the Multiple Sclerosis Society of Ireland. Dr. Rachel Msfeti is a Senior Lecturer in Psychology at the University of Limerick. Dr. Rob Motl is an Associate Professor with a background in Kinesiology and Neurosicience, who has been conducting research on exercise, physical activity, and MS for over a decade.


Who funded this project?

The Step it Up programme was supported by the Irish Health Research Board Health Research Award, grant number: HRA_PHR/2013-264.



Coote S, Gallagher S, Msetfi R, Larkin A, Newell J, Motl R, Hayes S (2014). A randomised controlled trial of an exercise plus behaviour change intervention in people with multiple sclerosis: the Step it Up study protocol. BMC Neurology

Hayes S, Uszynski M, Motl R, Gallagher S, Larkin A, Newell J, Scarrot, C and Coote S (2017). Randomised controlled pilot trial of an exercise plus behaviour change intervention in people with multiple sclerosis: the Step it Up study. BMJ Open

Coote S, Uszynski M, Herring M, Hayes S, Scarrott C, Newell J, Gallagher S, Larkin A and Motl R (2017).  Effect of exercising at minimum recommendations of the multiple sclerosis exercise guideline combined with structured education or attention control education – secondary results of the step it up randomised controlled trial. BMC Neurology