Qualitative Analysis of the Reasons People with Spinal Cord Injury Opt to Enroll in an Exercise Program and their Barriers to Participation

Abstract

Objective: Understand why people with spinal cord injury (SCI) enrolled in an online exercise trial, what barriers to exercise they cited, and their plans to address these barriers. Design: Qualitative study of participant responses during a 16-week online exercise trial where they completed weekly online modules that included completing skill building activities. Participants/methods: Eligible individuals experienced a SCI [greater than] 6 months, required wheelchair use outside the home, and reported/week. Advertisements were disseminated through SCI-specific organizations across the U.S. Qualitative data from participant responses were analyzed by identifying themes that emerged from responses to online activities. Two researchers independently read and coded all responses. All disagreements were discussed and final coding decisions were unanimously achieved with the principal investigator. Results: Participants (n=111) average age was 49.6 years old and they lived average of 14.3 years post-injury. Health reasons emerged as the leading reasons participants enrolled in the exercise trial. Nearly two-thirds (64.9%) of participants stated they joined the program to improve their health while over half (56.8%) reported a desire to improve their function. Time was noted as the leading exercise barrier (53.8%) and a quarter (27.7%) reported accessibility issues. Participant-generated solutions to address time constraints included scheduling exercise (68.2%) or using friends or technology to support (15.9%) exercise efforts. Accessibility issue solutions included locating accessible facilities (30%) and obtaining equipment (25%) for home use. Conclusion: Health issues emerged as the primary reason people with SCI enrolled in the study. Health issues included those similar to the general population regarding improving cardiovascular health and longevity and SCI-specific issues, such as improving function related to activities of daily living. Exercise barriers followed a similar pattern, with the predominant concern being lack of time and the second most commonly cited barrier being accessibility problems. Accessibility issues included lack of accessible facilities, equipment, and need for self-advocacy. Intervention approaches to promote exercise for people with SCI should address issues faced by those in the general population as well as SCI-specific issues.