For this chapter, psychological outcomes are defined as self-reported psychological health, specifically anxiety and depression, as well as QOL. Anxiety and depression are complicated and compounded in SCI as symptoms of anxiety and depression are to be expected, but one may also be at an increased risk for an anxiety or depression disorder (Le & Dorstyn, 2016; Williams & Murray, 2015)Depression is defined as persistent feelings of sadness, hopelessness, and a loss of interest in previously enjoyed activities (WHO, 2022). Clinical depression, or a major depressive disorder, is a medical diagnosis based on the presence of five or more symptoms of depression that are present for at least 2 weeks continuously (American Psychiatric Association, 2013). There are different types of anxiety disorders to which are characterized as excessive fear or unease that differs from expected situational feelings of nervousness or anxiousness (American Psychiatric Association, 2022). As there is a lack of physical activity research including individuals with SCI and a diagnosed anxiety or depressive disorder, we broaden our search to include symptoms of anxiety and depression for this chapter.
Regarding QOL, we approached the conceptualization of QOL from an objective and subjective standpoint (Dijkers, 2003). Objective QOL is defined as “what I have” and thus the congruency between one’s achievements and one’s expectations. Subjective QOL was operationalized as “what I think or feel about what I have”, involving one’s thoughts and feelings regarding whether one’s achievements meet one’s expectations (Dijkers, 2003).
Research examining LTPA and these psychological outcomes has grown in the past decade. In their review, Martin Ginis et al. (2010) found that, across 21 studies, LTPA had small-to-medium sized relationship with lower depression symptoms and higher life satisfaction (subjective QOL). They urged future research to examine the role of LTPA on other psychological outcomes and subjective evaluations of quality of life. To broaden the examination of the LTPA and QOL relationships, Tomasone et al. (2013) conducted a systematic review examining
LTPA and QOL and found that of the 110 analyses examined (from 33 studies), 84 found a positive relationship between LTPA and quality of life, 21 no relationship, and only 5 negative significant relationship. The majority of the studies were nonexperimental studies and only 5 of the 33 studies were randomized controlled trials. There continues to be a need to understand the relationship between LTPA and these psychological outcomes, including the impact of LTPA interventions on these outcomes.