In order to tailor physical activity-enhancing interventions to the needs of individuals with SCI, it is necessary to understand the factors that facilitate and hinder their participation. Dozens of studies have been conducted to (a) test for predictors or correlates of physical activity participation and (b) generate lists of barriers and facilitators to physical activity experienced by people with SCI and other disabilities (Martin Ginis et al. 2016; Martin Ginis et al. 2021). The objective of this section is to summarize this literature.
In Table 2, we have synthesized the results of studies that have used quantitative methods and statistics to examine the strength of relationships (i.e., correlations) between factors that could be related to physical activity and a measure of physical activity participation. In Table 3, we have synthesized descriptive information from studies in which participants were explicitly asked about barriers and facilitators to physical activity, but there was not a statistical test of the relationship between these factors and physical activity participation.
Dozens of factors related to physical activity were identified in the studies synthesized in Tables 2 and 3. One way to organize these factors is to situate them within a social-ecological model. Social-ecological models are useful for showing the interplay between individual and broader levels of influence on health (McLeroy et al. 1988). While different social-ecological models may depict slightly different levels of factors that influence health, the levels typically included in social-ecological models of physical activity behaviour include:
- Intrapersonal factors: physical and psychological characteristics of the individual;
- Interpersonal processes and primary groups: formal and informal social networks and social support systems;
- Institutional/Organizational factors: social institutions with organizational characteristics and rules and regulations of operation;
- Community factors: relationships among organizations, institutions, and informal networks within defined boundaries; and
- Public policy: local, state, and national laws and policies.
Drawing on the studies conducted in samples of people living with SCI, here are the key categories of factors related to physical activity at each level:
- Psychological factors: Negative affect and emotion, attitudes/beliefs/perceived benefits, self-perceptions; use of behaviour change strategies, personality characteristics
- Body functions and structures (e.g., level of impairment, secondary health conditions, energy, strength, fitness)
- Employment status
- Social support: From family, friends, acquaintances, peers, colleagues, neighbours, and community members
- Societal attitudes toward people with SCI and the appropriateness of the physical activity
- Social processes (e.g., role modeling, social integration)
- Knowledge held by individuals working within institutions or organizations such as rehabilitation centers and fitness centers
- SCI-specific knowledge of people working in institutions or organizations such as how to exercise with SCI or the benefits of exercise for a person with an SCI
- Rehabilitation processes such as information or counseling from rehabilitation professionals to support a person with SCI to do physical activity
- Accessibility to sports, recreation, and fitness facilities
- Aspects of the physical activity programs being provided such as proximity/availability and the provision of fun, safe, enjoyable activities
- Information on how or where to be active with an SCI
- Availability of equipment, particularly adaptive/accessible equipment
- Access to transportation and transportation services
- Financial costs to the individual for programs or equipment
- Professional staff training for service providers
Looking across Table 2 and Table 3, it is evident that scientists have generated a considerable volume of information on factors associated with physical activity in people with SCI. There are several excellent reviews of these studies (Fekete & Rauch 2012; Williams et al. 2014) as well as meta-reviews of the reviews (Martin Ginis et al. 2016; Martin Ginis et al. 2021).
For the most part, this body of literature is comprised of studies conducted in high-income countries including several European countries, Canada, the United States, Australia, and the UK. It is encouraging to see some newer studies on barriers and facilitators emerging from middle-income countries such as Jamaica (Roopchand-Martin et al. 2018) and India (Amberkar et al. 2019). Currently, we know very little about factors related to physical activity participation among people with SCI living in middle-income countries and we have virtually no data from low-income countries. It is likely that the barriers to physical activity are different and more profound in these countries (for instance, because of a lack of infrastructure and social services) than in middle and high-income countries.
With regard to high-income countries, there has been a call to shift attention from conducting studies that merely list or describe barriers and facilitators in these countries to generating research and policies that intervene to alleviate the barriers or leverage the facilitators (Martin Ginis et al. 2016; Martin Ginis et al. 2021). With so much information already generated, it is difficult to see the benefit of conducting further studies of barriers or facilitators in high-income countries unless these studies will directly inform a planned intervention.