This episode of the Disability Sport Info show considers the sport participation and physical activity experience of individuals with a physical impairment.
Dr Toni Williams, of Durham University, explains the sport participation experiences of physically impaired individuals. We consider some of the enablers and barriers physically impaired people face when accessing and participating in sport and physical activity. We also discuss how providers can promote sport and physical activity. Finally, we consider what can be done to increase the sport participation and physical activity of people with physical impairments.
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Speaker: CB: Dr Christopher Brown (Presenter – University of Hertfordshire, UK)
Speaker: TW: Dr Toni Williams (Participant – Durham University, UK)
Speaker: CB Time: 0:30
Hello Listener! Welcome to the Disability Sport Info Show!
Today's episode focuses on the sport participation experiences of individuals with a physical impairment. To get a better understanding of this area, I caught up with Dr. Toni Williams of Durham University.
Thank you, Toni, for joining me today. I really appreciate you spending your time and sharing your expertise on individuals with physical impairments and their physical activity and sport participation experiences.
So I think to begin and to help our listeners, are you able to please describe the research that has been carried out into the sport participation of individuals with physical impairments?
Speaker: TW Time: 1:06
Sure. And thank you very much, Chris, for having me. Well, there's actually been a lot of research into the sport and physical activity participation of individuals with physical impairments. Much of that research has really focused upon the barriers and facilitators to sport and physical activity. So we see at the individual level there are lots of factors about the individual that may prevent them or facilitate them from participating in sport. So, for example, that might include people not wanting to participate because they don't have the motivation to do so. Or they have a fear or embarrassment of taking part. It might be that taking part in sport and physical activity causes pain, because that might be another barrier that stops people. But also in terms of actual sport participation, some people actually just don't like sport. And so they would rather participate in other physical activities, more exercise or general meaning rather than sport participation itself.
And if you think as well about actual sports participation in terms of a team sport, or, for example, someone with a physical impairment who's in a wheelchair, to actually participate in sport costs a lot of money because you're talking about having a specialist sports wheelchair and other special equipment that doesn't come cheap. So that doesn't involve playing sport in your everyday wheelchair: you need that specialist equipment. And that's something that often people cannot afford. And then if we look at the individual as well, someone might be really motivated to take part in sport or physical activity, but that doesn't mean that they're able to because there's lots of other barriers that constrict participation. So, at a social level, if you think about social support, depending on the level of physical impairment, might mean that someone's reliant or dependent upon others to participate. So that could be friends or family ferrying people to or from sport and physical activity opportunities, providing emotional support, providing financial support. And then you see the role here of, like health care professionals and other sport and exercise practitioners, is quite important. So if you go to a health care professional who is knowledgeable about local sports opportunities or knows about accessible gyms etc., then that's really great. But it can be that the healthcare professionals or sport and exercise practitioners don't know about opportunities for disabled people. Or it might be that once you go to a gym or a sports club that’s supposedly accessible and inclusive, that you're faced with negative attitudes from others that can be quite hurtful and exclusionary. So at a social level we have quite a lot of barriers and facilitators as well.
And then we also have the environment, the physical environment and the built environment in which sports and physical activities take place. So within institutions, you know, is their disability specific knowledge? Are the buildings accessible? Do they have the equipment? Do you have the coaches who understand how to include disabled individuals? Do you have the healthcare professionals or exercise practitioners who know how to adapt exercises for people who are disabled? And then you have kind of, again at the environmental level, relationships between communities. So does schools and gyms and sports clubs talk to each other so that they can promote these opportunities? And, as well, we see at the environmental level, the weather, so the bad weather can often stop people. So if it's snowing outside, people are scared about slipping or tripping, or it’s really wet or it's cold, that can stop people participating.
I think we've seen a lot through COVID how important it is to have online support as well. So people don't, if they can't get out or we're not able to get out, you can still access those opportunities.
And then again, within this kind of barriers and facilitators research we have information about policy. So policies that may provide opportunities or hinder opportunities. So, for example, with our construction policy we now see that all new buildings must be accessible, they must have ramped access, etc. Whereas if you go to an opportunity that's in a dated building, those barriers to physically actually entering a facility or having the space in a changing room to transfer from a chair to from chair to chair or having the space to be able to manoeuvre around the changing room, would be restricted because of the building, the age and the size. So a lot of the research has really focused on those barriers and facilitators.
Speaker: CB Time: 5:56
Okay. And it's a very complex picture from what you've painted to me there. And when we’re looking at the kind of the population, more specifically, physical impairment is quite a broad category; it includes a number of different types of impairments. What has traditionally been focused on in terms of that particular impairment within the broader physical impairment category? So has it potentially been more about wheelchair users, looking at cerebral palsy, what kind of physical impairments have been focused on in the research?
Speaker: TW Time: 6:23
It's more common that the research focuses on one impairment than looks across. So that barriers and facilitators research I just mentioned was across.
There is quite a lot of research within spinal cord injury, which is where my focus has typically been. So those people who have acquired an impairment. And obviously when you think about having a significant illness or injury, which means an impairment has been acquired and then someone becomes disabled. That's huge. In terms of coming to grips with understanding that. And that can make some of the barriers and facilitators, you know, more specific to those populations. So if we think about people with spinal cord injury, first of all, if you've had a catastrophic injury which has changed your physical, motor, sensory capabilities, that's a lot to deal with, in and of itself. And then you're asking people now to become more physically active can be quite a challenge just in thinking about, well, you know, life has gone through major change. And not only have I got to think about, you know, the impact on relationships, on employment status, on being able to get round my house, for some people, actually then having to think about, ‘now I have to be physically active for my health’, it's another challenge that people have to deal with.
And so we see within the spinal cord injury literature, in terms of sport participation, a lot of the rehabilitation in the spinal units was typically aimed towards sport, and that's where we see the birth of the Paralympics. And, for some younger people, sports participation can be great. It can be a way of building confidence, gaining new skills, being part of that team, you know, some people really love being part of a team sport. But, on the other hand, it can also be quite difficult. People who, for example, played basketball before they were injured, don't necessarily want to go out and play wheelchair basketball because it's not the same. And you see within the spinal cord injury population as well, we have a higher incidence of older adults becoming spinal cord injured because the immediate care, Paramedic care, care in hospital has got so much better, people are surviving and they're living with a spinal cord injury in a much older age. So we're talking about trying to get an older generation active, sport might be something that they're not interested in.
So you kind of have those additional considerations that you need to make depending on the population you're dealing with. And again, if we think about spinal cord injured people as a population, and we look at the guidelines for being physically active and what level of sport or exercise participation people need to get for health benefits, we see that the generic guidelines, the level of intensity is quite high. So depending on the level of spinal cord injury and the level of impairment, it can be really difficult to hit the requirements for the number of minutes and the intensity in which people need to be active. So you do get this then development of we have some guidelines specifically for spinal cord injured people, which show that at a lesser intensity of exercise, you can still reach those health benefits.
And when we're thinking about promoting sport and physical activity, we need to move away from messages that are just focused solely on being active for health, and that kind of whole exercise as medicine narrative that individuals are responsible for their own health and well-being and they must be active to do that. And we need to think about the other reasons that people want to be active such as because it's fun, because it's pleasurable, and it's enjoyable. You can think about that enjoyment and pleasure in many different ways such as like the whole kind of doing activities to get tired, to get sweaty, to really feel like you've exerted yourself which, when we come back to people with spinal cord injury, for example, that can be quite difficult to achieve, again, depending on that level of impairment. And, yeah, being part of a team taking part in a meaningful activity rather than just taking part in physical activity for health, can be quite important if we want to motivate people to be active.
Speaker: CB Time: 10:37
So, lots of interesting content there. I just want to pull at a few of those threads that you've talked about. First of all, you mentioned about these guidelines and you were saying how those generic guidelines that are provided but also then specifically for spinal cord injuries. What level of involvement has been taken by individuals who are actually from that population group in creating the guidelines? I'm just curious whether it's been designed from the grassroots up or is being imposed from the top down?
Speaker: TW Time: 11:02
That’s a very good question! So, for example, with the spinal cord injury guidelines, that was an international effort of collaboration between researchers between people with spinal cord injury themselves, physiotherapists, sport and exercise practitioners; you had a lot of people coming together. And the actual guideline recommendation, which was what’s the amount of exercise that needs to be undertaken to achieve a health benefit, that information was based upon the scientific literature, which shows this level of exercise has given X outcome.
But when you look at how do we disseminate that information and what resources can be used to spread, that knowledge that research has been conducted with people with spinal cord injury themselves and the people who are promoting those messages such as the health care professionals, because it's important that the messages around physical activity are meaningful, and that they represent the experiences of the people who the message is trying to reach. So that's why it's really important that people with spinal cord injury were engaged in those messages and those resources, in terms of getting that information out there.
Speaker: CB Time: 12:13
So, what's the kind of current approach to promoting physical activity and sport from organisations? Have they actually been doing that approach of focusing on more the kind of softer elements rather than just focusing on health?
Speaker: TW Time: 12:27
Ooh, that’s a big question! If we're talking about organisations more broadly, the message is getting through that we need to focus beyond just health and look at the other benefits for sport. So the fact that it's about having fun, it's about engaging in activities that are meaningful. It's about bringing it bringing people together.
I don't know that I have examples off top my head that I can say an organisation has done X. You certainly see with the charities who have been involved in the broader physical activity and disability guidelines such as Sport England and Disability Rights UK, those charities for sure, are spreading the message around what else physical activity can do for us beyond our physical and mental health. And actually, you see a lot of campaigns at the moment focusing on mental health. We've certainly seen during the pandemic an increased rise in anxiety and depression etc. through isolation. And we saw that our disabled community were particularly isolated during this time and through the Sport England Active Life Survey, sport and physical activity participation in particular decreased more than the non-disabled population. So the messages about being active now are for sure, moving away from just the health benefits but obviously, the health benefits are still important. And we're looking now more at saying, ‘yes, you can be active to increase your strength, to increase your muscle mass. And that makes activities such as transferring from a wheelchair easier, but it also means that you might have more energy to play with your children when you come home from work at the end of the day’. So those kind of messages are important too, about what are the benefits outside of just our health? What impact can this have on our lives, in terms of employment, in terms of family, beyond just health?
Speaker: CB Time: 14:27
Yeah. Again, I think that's a really good point, that kind of transference of benefits that you can get from being physically active or participating in sport.
Okay, so we understand the potentially most efficient or effective way of promoting physical activity and sport, how do we do that? And what has the research been like in terms of understanding the channels of communication that we use to actually reach our audience?
Speaker: TW Time: 14:51
There’s quite a bit of research which talks about what are the preferred channels in terms of who are the messengers and what are the messages? So we kind of talked about the messages of being for exercise beyond health, how else it can impact us.
And then if you think about who is delivering those messages, we know that from the research, there's a few groups of people who are quite important for delivering the message. So you've got your healthcare professionals, GPs, physiotherapists, etc., who are seen as real credible messengers of this type of information about physical activity information. But what we also know from the research is that this group of people don't always know how to promote sport and physical activity and they don't know the specific information. So if I give you some examples. When we were doing our research with the physiotherapists in the spinal units, they absolutely knew the importance of being physically active, but that didn't always mean that they were actively promoting physical activity because, for example, they weren't aware of the guidelines of, you know, how much activity should be undertaken and for how long. They might not know about where in the local community that somebody lives, there are activities. They might not know about the disability sport organisations and charities who can provide support. And their job involves so much more than just promoting physical activity that again, it was seen as an addition to their role and so it wasn't always something that came up in conversation.
But you see there are policies in place such as, you know, make every contact count in the NHS, which is trying to get healthcare professionals to be promoting healthier lifestyles of which physical activity is one. But we also see the role of peers and our disability sports organisations who often include disabled people themselves running those organisations, promoting the sports. And peers are a really credible source of information. So, you know, those people who've been there, done that, who can tell stories. So we see in our research on narrative and, you know, the powerful capacity that stories have to shape our action, how important it can be for someone to tell a story about how they overcome the barriers that they face to be active, and the benefits that they got from being physically active.
So those stories from our peers are really important, and we've seen a lot with the new physical activity guidelines, the role of others, such as social workers. You know, the people who are interacting with disabled people on a more regular basis, and how they can be really credible messengers of physical activity information.
So you've got kind of the people, and then you've got the ways that information can be disseminated. So, you know, we've got our journal articles, but they're no good for people who are outside of academia for getting information. So we see how that knowledge is translated into infographics, which nicely break down key information. Again, an infographic, on its own, doesn't necessarily mean it's going to change behaviour. So that might need to be supported with some workshops to help people know how to promote physical activity, with some videos. So we’ve talked about the importance of stories. It's actually circulating videos of people talking about their experiences. And that can be done online through social media, through websites, etc. So you've got lots of channels, lots of ways to get to people, get the message out to people, disabled people themselves, and then to get other people promoting physical activity.
Speaker: CB Time: 18:31
So it's a big, big operation, it sounds like, to try and get that coordinated and working efficiently.
Speaker: TW Time: 18:39
Absolutely. I think a lot of the research has also shown that you can't just tackle one barrier at a time because people are not faced with just one barrier; they're faced with multiple barriers. And, you know, we know that we live in a very ableist society that favours able bodied individuals and discriminates against disabled people in terms of accessing opportunities to be physically active. And what we really need is kind of multi-sector approaches or systems approaches, if you like, to promote physical activity. And that's, you know, quite a big undertaking, which is why we're probably still not getting the levels of activity that we would like. So, in terms of addressing that, you kind of really need approaches to get more people physically active by engaging, trying to change environments and policy. You want to be fostering more inclusive and accessible environments and opportunities themselves. You need to be changing the knowledge and attitudes of healthcare professionals, sport and exercise practitioners, in terms of educating and motivating people.
So you need, really, partnerships between health and our community disabled organisations where we're facilitating information, so sharing knowledge about local programmes and facilities, sharing equipment. Being able to connect people together so that if you're a healthcare professional or you’re a sport and exercise practitioner, or you're a GP, and you see and interact with a disabled person, that you can have more positive and motivating conversations about sport and physical activity. And you're actually able to signpost people to accessible and inclusive opportunities. Because we see there are some really great initiatives that go on. So, for example, we had the inclusive fitness initiative, and, you know, you had these gyms that basically had an inclusive fitness initiative stamp. So this was a gym that were saying, ‘I’ve reached a certain standard of where disabled people could come and be physically active’ but, actually, it might be that the gym had a ramped access and the changing room was more spacious, but that didn't mean that there were positive attitudes of the non-disabled gym members in that space. You know, you're still faced with the same pictures of non-disabled people’s sporting bodies, those motivational messages that are very ablest.
So there does need to be this kind of systems approach to improve physical activity. And obviously we can try and address that one barrier at a time, but we need to be addressing those barriers together if we're going to be changing attitudes, improving access, and supporting disabled people to be physically active for life.
Speaker: CB Time: 21:29
You’ve hinted at this and this is probably an impossible question to answer here. So I've already kind of set you up for failure.
So apologies for that. What is the main thing that needs to be done to increase participation for people with physical impairments?
Speaker: TW Time: 21:44
Okay, so yeah! The main thing, as we said, there's not just one thing. But maybe what everybody could be doing is, if we're saying we need a systems level approach to tackling these barriers, that everybody should be taking the responsibility perhaps within the organisation that they're in, the sport and physical opportunities that they partake in to be more inclusive.
So if I give you an example. If we think about in our university institutions, we know the importance of positive physical activity messages, about being inclusive, etc. However, we also know that our sport and exercise science students, if we take them as a population, we think about in the curriculum, how much are we teaching them about disability sport? How much are we perpetuating ableist notions about, you know, the people who are physically active in sports in in our curriculum? And changing or improving the experiences that our students can have with disabled people as part of the curriculum. And if we have a look across sport and exercise science programmes as a whole, we see that disability and other inequalities doesn't often feature in our curriculum; we teach a lot of mainstream subjects such as physiology, nutrition, etc. But we focus a lot on our young, able bodied male athletes within that teaching. So if we think about in our universities, what can we do? We just did a small project which looked at the stories that our sport and exercise students tell about disability sport and physical activity. And we did that through a method of story completion. So that was where you provide a participant with the start of a story and you ask them to write the end of the story. So we provided some stems about physical activity, about an able bodied person interacting with a disabled instructor in the gym and asked the students to write what happened next. And what was really interesting is we saw that a lot of the stories that these students were writing, were underpinned by ablest notions about what disabled people can and can't do. And the premise is that a disabled person is incapable of doing a sport and physical activity to the same level as a non-disabled person because of their impairment. And so when we're thinking about what can we do? Well, within each of the organisations that we operate in, we need to think about changing the story and promoting positive messages. So, for example, within curriculums, such as our sport and exercise science degrees, where these are the next generation of sport, exercise and health practitioners who are potentially going to be supporting and fostering physical activity opportunities for disabled people. We need to make sure that we're raising issues of inequality and social justice, and also providing opportunities for people to understand how to tackle barriers and how individuals themselves can make important differences in the way they interact with disabled people and talk about disabled people in terms of the messages that they're promoting, the conversations they're having.
So, I think in terms of the main thing that can be done, it is a systems approach. We need from all areas; we need improvements in getting people more physically active. But on an individual level, we can each think about, ‘what's the environment I operate in? How can I take up a mission of social justice and try an improve the sporting activity participation for disabled people within the institution I'm in, within the gym I go to, within the sports club I run?’ You know, that goes as far as sport and exercise practitioners, gym instructors, coaches, our healthcare professionals, parents. You know, there’s a whole group of people that can be taking more positive action to be more inclusive. So I'm not sure if I've managed to sidestep your question!
Speaker: CB Time: 25:27
No, I think that was an excellent answer and I think you did admirably to tackle that, well, trap-laden question, I think! So, well done for doing that! And I think that's a really important point. So, you've got the macro level, the systems approach, and then you've got the micro level looking at the individual, and the fact that we can all be advocates in our day to day life. And that can obviously take different shapes and forms. But if we are advocates for being more inclusive and being more disability aware, hopefully, that will filter through into kind of small changes which aggregate into bigger changes, alongside the system's approach that you've highlighted.
Speaker: TW Time: 26:01
I hope so.
Speaker: CB Time: 26:03
Yeah. Indeed. A nice kind of positive empowering way to end, I think.
So thank you ever so much, Toni. It's been great chatting to you. And, well, I've learned a lot talking to you now and I hope the Listeners have also learned a lot by speaking about physical impairments and sport participation and physical activity opportunities.
So thank you ever so much. It'll be great to catch up with you soon.
Speaker: TW Time: 26:20
Okay. Thank you, Chris.
*** Discussion ends ***
Speaker: CB Time: 26:22
That’s it. That’s all we have time for. Thanks for listening to another episode of the Disability Sport Info show. Stay tuned for another episode. Until then. Goodbye.
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