In this chapter, we are operationalizing the concept of (community/social) participation as involvement in life situations, in line with the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF) (WHO, 2001). These life situations are often tied to “activities”, another dimension of the ICF. Participation in these life situations and activities can then range between daily activities (e.g., preparing a meal) to leisure and social activities (e.g., meeting with friends). The evaluations/ratings of participation can be conceptualized as person-perceived participation (e.g., a person’s own judgement of their level of participation in an activity) or society-perceived participation (e.g., a person’s participation ability is judged against a social standard of “normal” participation) (Noreau et al., 2005). This section examines the evidence on the relationship between LTPA and participation in daily and social activities from studies that have assessed person-perceived or society-perceived participation. We do not explicitly separate the type of participation but rather provide an overview of the LTPA-participation relationship.
Description of studies. Compared to the other sub-sections within this chapter, fewer studies have examined the relationship between LTPA and participation-related outcomes. From these 9 studies, five were randomized controlled trials, one prospective controlled trial, two observational, and one pre-post study. The included studies were from different countries, including Canada (n = 3), USA (n=2), Netherlands (n=1), Australia (n=1), Italy (n=1), and India (n=1). The majority of studies have been conducted in high-income countries, limiting our knowledge of this relationship in low- or middle-income countries.
The LTPA and participation-related outcomes relationship. Across all studies, LTPA had a positive relationship with participation in daily and social activities, meaning that greater LTPA is related to greater participation. These promising results remain limited by the small number of studies, thus requiring further research. Another important limitation of this research is that most studies examine participation as a single, overall concept. Participation includes a number of independent activities that range from self-care to social activities. Currently, we have little knowledge on the relationship between LTPA and specific types of participation activities. For instance, McVeigh et al. (2009) demonstrated differences on home and social subscales among individuals who participated in sports or not. In another sample of individuals with physical disabilities, Sweet et al. (2021) found that individuals participating in a community-based LTPA program increased participation in family-based activities (e.g., preparing dinner) but not autonomous outdoor activities (e.g., moving outside the home). Future research could examine the relationship between types of LTPA and specific participation activities (or at least specific grouping of activities; e.g., self-care, social) to help optimize the design of LTPA interventions aimed to promote participation.
Moreover, the interventions reported varied from home-based, to person-centered, to supervised LTPA programs. This variability combined with the limited number of studies makes it impossible to conclude how to best intervene to improve participation. Further, these studies were primarily LTPA promotion studies where participation was not the primary outcome, but one of many secondary/tertiary outcomes. Effects could be stronger if the physical activities that are chosen are directly targeted or explicitly aimed to enhance specific participation activities. For example, Mulroy et al. (2011) and Kemp et al. (2011) provided a home-based program to optimize shoulder strength for shoulder-based activities (e.g., transfers, propulsion). Despite not finding effects on wheelchair propulsion speed and LTPA, Kemp et al. (2011) reported significant differences for participation in community activities and preparatory activities and, to a lesser extent, social activities. Interestingly, Kemp et al. (2011) noted that changes were mostly associated with community activities and preparatory subscale. These studies provide an initial example for future LTPA interventions aimed to specifically increase participation in daily and social activities.
Although it was beyond the scope of this section to compare and contrast measures and results of person-perceived or society-perceived participation, it may be an important next step in understanding the role of LTPA on participation. For example, do LTPA interventions (or types of interventions) differently impact person- vs society-perceived participation? Such an exploration could help identify which participation-related outcome measure may be most sensitive to (types of) LTPA.
In conclusion, there is a promising and positive association between LTPA and participation in daily and social activities. Excellent opportunities to investigate new avenues and conduct additional research to strengthen the current conclusions remain.
There is level 1a evidence from three RCTs – as well as support from two lower quality RCTs, one prospective control trial, one pre-post study – that physical activity-based interventions are effective for increasing participation in daily and social activities among persons with SCI.