Anthony Papathomas

The barriers, benefits and facilitators of leisure time physical activity among people with spinal cord injury: a meta- synthesis of qualitative findings

Physical activity (PA) can have a positive impact upon health and well-being for people with spinal cord injury (SCI). Despite these benefits, people with SCI are within the most physically inactive segment of society that comprises disabled people. This original meta-synthesis of qualitative research was undertaken to explore the barriers, benefits and facilitators of leisure time physical activity (LTPA) among people with SCI. Articles published since 2000 were identified through a rigorous search of electronic databases, supported with a hand search of relevant journals and papers. In total, 64 papers were read in full, and based on inclusion criteria, 18 were relevant for review. The key themes constructed from the data were summarised, compared and synthesised. Eight interrelated concepts were identified as barriers, benefits and/or facilitators of LTPA: (i) well-being (WB); (ii) environment; (iii) physical body; (iv) body–self relationship; (v) physically active identity; (vi) knowledge; (vii) restitution narrative; (viii) perceived absences. Based on the synthesised evidence, healthcare professionals need to appreciate the relationships between the barriers, benefits and facilitators of LTPA in order to successfully promote a physically active lifestyle. Equally, a more critical attitude to PA promotion is called for in terms of possible adverse consequences.

Athlete experiences of disordered eating in sport

To date, research into disordered eating in sport has focused on the prevalence and the identification of putative risk factors. Findings suggest that elite female athletes participating in sports with a focus on leanness or aesthetics are at greatest risk. A paucity of research remains as to the period after onset and how existing sufferers manage their illness over time. In line with the principles of interpretative phenomenological analysis (IPA), this study ‘gives voice’ to four athletes who have experienced disordered eating, documenting their personal accounts and interpreting these accounts from a psychological perspective. In‐depth, semi‐structured interviews were conducted and verbatim transcripts were analysed according to the procedures of IPA. Three superordinate themes emerged from the data: the struggle to disclose, social support needs and identity challenges. Athletes’ stories provided rich descriptions of their subjective disordered eating experiences. Their accounts give critical insight into the impact of eating disturbance on the lives of athletes. Future research should continue to identify athletes with existing eating problems in order to improve understanding as to how such individuals can best be helped.

A Life History Analysis of a Male Athlete with an Eating Disorder

ABSTRACT An exploratory investigation, employing the life history method, was conducted with a male athlete with an eating disorder. The focus of the life history is Mike (pseudonym), an individual with a strong athletic identity, who developed bulimia amidst aspirations to be an elite sports performer. Interviews were structured around the life course, beginning with early childhood memories and ultimately reaching the present day. His narrative suggests the achievement threats and weight-based performance pressures associated with competitive sport played a role in precipitating the onset of bulimia nervosa. When such performance pressures were removed the eating disorder remained and evolved, suggesting that disordered eating in sport can have deeper roots as opposed to being primarily situational. Recovery coincided with the cessation of sport participation and the opening up of a foreclosed identity.

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.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.

Narrative Constructions of Anorexia and Abuse: An Athlete's Search for Meaning in Trauma

Interpretive approaches to the study of eating disorders are scarce. Narrative analysis provides an attractive means to address this shortfall and is applied to the life story of Beth, a former elite athlete with experience of anorexia nervosa and, as she revealed, sexual abuse. Six unstructured life history interviews took place yielding more than 9 hours of interview data. Throughout our conversations, Beth constructed multiple, fragile, and sometimes contrasting narrative coherences indicative of a fragmented and uncertain understanding of her life. It is argued that how Beth makes sense of her trauma is consequential for her future experiences.

Understanding physical activity in spinal cord injury rehabilitation: translating and communicating research through stories

Abstract Purpose: The purpose of this article is to develop an evidence-based resource for knowing and communicating the complexities involved for both males and females in implementing and sustaining a physically active lifestyle shortly after spinal cord injury (SCI). Methods: Synthesizing a set of qualitative and quantitative studies with over 500 spinal cord injured people, the article represents research utilizing the genre of ethnographic creative non-fiction. This genre of representation holds enormous potential for researchers in terms of disseminating their findings to diverse audiences beyond the academy, and having real impact. Results: The ethnographic creative non-fictions show together for the first time the barriers, determinants, benefits, trajectories, emotions, fears, preferred methods and messengers for delivering important physical activity information to men and women with a SCI. Conclusion: The article contributes to knowledge by showing the embodied complexities involved when in rehabilitation for both males and females in implementing and sustaining a physically active lifestyle shortly after SCI. It also makes a contribution to practice by providing researchers, health care professionals and disability user-groups with a theory and evidence based resource to assist in informing, teaching and enabling people living with SCI to initiate and maintain a physically active lifestyle. Stories may be a highly effective tool to communicate with and to influence spinal cord injured people’s activity. Implications for Rehabilitation The findings of this research showed the many benefits and barriers to developing and sustaining a physically active lifestyle shortly after spinal cord injury. The preferred methods and messengers for delivering physical activity information as well as the activity types, intensities and durations of physical activity for men and women were also shown. Within rehabilitation, spinal cord injured people need to be offered accessible knowledge about how to implement and sustain a physically active lifestyle over the life course. Stories may serve as a unique and powerful means to achieve this.

Disability and the gym: experiences, barriers and facilitators of gym use for individuals with physical disabilities

Abstract Purpose: Individuals with physical disabilities are among the most inactive population in society, arguably due to the lack of suitable environments to exercise. The gym is a space dedicated to improving physical fitness in a controlled environment with specialized equipment and qualified instructors. The feasibility of using this space to promote health to this population, however, is yet to be established. Method: Over an 18-month period, 21 people with physical disabilities were interviewed regarding their experiences in the gym. Data were collected using semi-structured interviews, transcribed verbatim, and subject to thematic analysis. Results: Four broad themes were identified: (1) experiencing enhanced well-ness, (2) perceived conflict between gym values and disability, (3) influence of a previous gym identity, and (4) experiences of psycho-emotional disablism. Conclusions: Participants were perceived to experience a variety of health benefits; however, they also experienced many barriers such as not aligning to the cultural norms of the gym, limited interpretations of health, oppressive messages from the built environment, and negative relational interactions. While there is potential for the gym to be used as a place to promote health, more must be done to foster an inclusive atmosphere in this space. Implications for Research The gym may be a viable place to promote health enhancing behaviors to this population as participants perceived physical, social, and psychological improvements through exercising in this space. Barriers such as not aligning to cultural norms of the gym, psycho-emotional disablism, and a lack of representation in the gym were perceived to hinder exercise participation. Gyms should consider funding instructors to go on courses teaching them how to train an individual with a disability, and also consider employing instructors with a disability to mediate the socio-cultural barriers perceived to exist in the gym. Men and women’s past identity as gym users had different ramifications regarding their adoption of exercise after disability, therefore, professionals working in this field should be cognizant of this when designing and delivering exercise programs during and after rehabilitation.

Family experiences of living with an eating disorder: A narrative analysis

Families are considered important in the management and treatment of eating disorders. Yet, rarely has research focused on family experiences of living with an eating disorder. Addressing this gap, this study explores the experiences of an elite 21-year-old triathlete with an eating disorder in conjunction with the experiences of her parents. Family members attended interviews individually on three separate occasions over the course of a year. In line with the narrative approach adopted, whereby stories are considered the primary means to construct experience, interviews encouraged storytelling through an open-ended, participant-led structure. Narrative analysis involved repeated readings of the transcripts, sensitising towards issues of narrative content (key themes) and structure (overarching plot). Family difficulties arose when personal experiences strayed from culturally dominant narrative forms and when family members held contrasting narrative preferences. Suggestions are forwarded as to how an appreciation of eating disorder illness narratives might inform treatment and support.

Psychosocial factors associated with physical activity in ambulatory and manual wheelchair users with spinal cord injury: a mixed-methods study.

Abstract Purpose: To identify psychosocial factors which explain lower levels of leisure time physical activity (LTPA) in persons with spinal cord injury (SCI) who are ambulatory relative to those who use manual wheelchairs. Method: For the quantitative study component, 347 adults with SCI (78% male; M age = 47.7) completed baseline measures of LTPA attitudes, subjective norms, perceived behavioural control and intentions. Six months later, LTPA was assessed. The qualitative component involved semi-structured interviews with six ambulant adults with SCI (five male, M age = 52.8) addressing LTPA experiences with an emphasis on barriers and facilitators. Results: Ambulatory individuals had poorer attitudes towards LTPA than chair users (p = 0.004). Their attitudes had significant indirect effects on LTPA, through intentions. Perceived behavioural control was a significant negative predictor of LTPA. Qualitative analysis revealed three themes: an underestimated disability, low wheelchair skill self-efficacy and experiencing chronic pain. Conclusions: Poorer attitudes towards LTPA may partially explain why ambulatory individuals are less active. The qualitative and quantitative data suggest ambulators are an often-overlooked subgroup in need of targeted resources to enhance their attitudes, wheelchair skill self-efficacy and awareness of LTPA opportunities. Implications for Rehabilitation Rehabilitation practitioners must be sensitive to the unique needs of spinal cord injured individuals who are ambulatory, and tailor physical activity promotional strategies to suit the needs of this distinct group. Lack of wheelchair skills is a participation barrier for ambulators; ambulators should be introduced to activities that do not require wheelchair use, such as swimming, hand-cycling and adapted forms of circuit training. Strategies that encourage wheelchair skill development in non-wheelchair using ambulators, may increase physical activity opportunities for this segment of the spinal injured population.

Physical activity promotion for people with spinal cord injury: physiotherapists’ beliefs and actions

Abstract Purpose: It is vital that people with spinal cord injury (SCI) lead a physically active lifestyle to promote long term health and well-being. Yet within rehabilitation and upon discharge into the community, people with SCI are largely inactive. Physiotherapists are well placed to promote a physically active lifestyle and are valued and trusted messengers of physical activity (PA) by people with SCI. Therefore this study aimed to explore the perceptions of physiotherapists in SCI rehabilitation on PA for people with SCI, and what is done to promote PA. Method: Semi-structured interviews were completed with 18 neurological physiotherapists (2–22 years experience) from SCI centres in the United Kingdom and Ireland. Framed by interpretivism, an inductive thematic analysis was conducted. Results: Three themes were identified: (1) perceived importance of PA; (2) inconsistent PA promotion efforts; and (3) concern regarding community PA. Conclusions: This article makes a significant contribution to the literature by identifying that although physiotherapists value PA, active promotion of PA remains largely absent from their practice. To enable physiotherapists to promote and prescribe PA as a structured and integral component of their practice, effective knowledge strategies need designing and implementing at the macro, meso, and micro levels of healthcare. Implications for Rehabilitation Physiotherapists are well placed to promote a physically active lifestyle and are perceived as valued and trusted messengers of physical activity (PA). The importance of PA for patients with spinal cord injury (SCI) is valued by physiotherapists yet PA promotion is largely absent from their practice. Physiotherapists lack specific education and training on PA and SCI and hold certain beliefs which restrict their promotion of PA. Knowledge translation across the macro, meso, and micro levels of healthcare are essential to facilitate effective PA promotion.