Spinal cord injury and physical activity: health, well-being and (false) hope

It is vital that people with spinal cord injury (SCI) maintain a physically active lifestyle to promote lifelong health and well-being. Yet despite these benefits, within hospital rehabilitation and upon discharge into the community, people with SCI are largely inactive. Physiotherapists in SCI rehabilitation have been identified as the healthcare professionals (HCPs) ideally placed to promote a physically active lifestyle. However, to successfully engage people with SCI in physical activity (PA), physiotherapists have to manage their hopes and expectations of SCI rehabilitation. With all this in mind, the purpose of this thesis was to explore the role of PA for people with SCI in hospital rehabilitation and in the community. The first aim of this research was to explore the barriers, benefits and facilitators of PA for people with SCI. The second aim was to examine how hopes and expectations are managed by the physiotherapists in SCI rehabilitation and by health practitioners in a community-based leisure time physical activity (LTPA) setting. The third aim was to propose improvement to LTPA promotion for people with SCI. These aims were addressed through: 1) a meta-synthesis of the qualitative literature to identify the barriers, benefits and facilitators of LTPA for people with SCI; 2) an examination of the role of LTPA in SCI rehabilitation; and 3) an exploration of experiences of participants with SCI, and their trainers in a new type of LTPA; activity-based rehabilitation (ABR). Framed by interpretivism, data were analysed by thematic analysis and dialogical narrative analysis. This thesis has made an original and significant contribution to the literature by revealing a deep understanding of factors that constrain and facilitate physically active lifestyles for people with SCI. For example, this research has uniquely demonstrated the role of pleasure in facilitating continued engagement in LTPA. Furthermore, this thesis identified that despite valuing the role of PA for people with SCI, active promotion of PA remains largely absent from physiotherapy practice. The dilemmas of promoting PA for the physiotherapists in SCI centres included a lack of training and education in health promotion and a concern over the false hope of recovery from LTPA opportunities such as ABR. To try and avoid false hope of recovery, the physiotherapists drew upon the therapeutic plot of acceptance and employed therapeutic actions to guide patients towards realistic hopes and expectations. An identification of three narrative types operating in ABR did reveal that some clients were exercising in the hope to walk again. However, the trainers were not preoccupied with acceptance as they also tried to avoid false hopes of ABR. In light of these findings there are several practical recommendations for people with SCI, HCPs such as physiotherapists, the health care system and other health practitioners in community based LTPA opportunities. These practical implications are aimed at improving PA promotion and reducing the barriers to PA for people with SCI. For example, there is a need for more effective knowledge translation across the macro, meso and micro fields. At the macro level meaningful guidelines on PA for people with SCI need to be developed and embedded into UK and Ireland policies if they are to be received and utilised by physiotherapists in SCI rehabilitation and health practitioners in the community. At the meso and micro level appropriate training and education need to be delivered to physiotherapists on PA and SCI to equip them with sufficient knowledge to prescribe and promote PA. Furthermore, the knowledge on PA shared with physiotherapists needs to include the diversity of LTPA opportunities available to people with SCI including ABR. Closer communication and engagement should be implemented at the micro level between physiotherapists in SCI centres and the health practitioners working in community initiatives such as ABR to confront issues regarding hope. In addition to knowledge translation practices, there needs to be support within the healthcare system to facilitate a physically active lifestyle for people with SCI. Equally, a more critical attitude to PA promotion is called for in terms of the possible adverse consequences

Understanding physical activity participation in spinal cord injured populations: three narrative types for consideration

The aim of this study was to identity the types of physical activity narratives drawn upon by active spinal injured people. More than 50 h of semi-structured life-story interview data, collected as part of larger interdisciplinary program of disability lifestyle research, was analysed for 30 physically active male and female spinal cord injury (SCI) participants. A structural narrative analysis of data identified three narrative types which people with SCI draw on: (1) exercise is restitution, (2) exercise is medicine, and (3) exercise is progressive redemption. These insights contribute new knowledge by adding a unique narrative perspective to existing cognitive understanding of physical activity behaviour in the spinal cord injured population. The implications of this narrative typology for developing effective positive behavioural change interventions are critically discussed. It is concluded that the identified narratives types may be constitutive, as well as reflective, of physical activity experiences and therefore may be a useful tool on which to base physical activity promotion initiatives

Exercise is medicine? Most of the time for most; but not always for all

Based on extensive research on the relationship between exercise and health, exercise as a form of medicine is a powerful concept of growing popularity within healthcare, academia and policy. Proponents of this exercise is medicine (EiM) movement frame exercise as a panacea for a variety of health issues and uncritically promote exercise as good for all. Two clinical populations particularly influenced by the EiM agenda are spinal cord injury (SCI) and arthritis. The purpose of this research was to explore how individuals with SCI and arthritis personally make sense of their exercise experiences. Data were collected through semi-structured interviews with participants with SCI and 20 participants with arthritis. Following a thematic narrative analysis, three patterns were identified across the whole data set. These were: 1) exercise and restitution; 2) exercise and pain; and 3) exercise and pleasure. Taken together, these results provide new knowledge regarding the impact of exercise that both align with, and contrast, the dominant EiM discourse. When exercise is perceived as ‘medicine’, stories of exercise participation spoke of cure, and restitution, rather than health and well-being. Pain was an unwelcomed side effect of exercise participation for some, and had a detrimental impact upon motivation and engagement. Lastly, a focus upon the medicinal benefits of exercise did not reflect the multiple pleasures experienced through exercise participation. Thus, health professionals, academics and policy makers need to prescribe to more ethical forms of exercise promotion that may lead to more efficacious, person-sensitive interventions