Leisure-time physical activity motives and perceived gains for individuals with spinal cord injury

Individuals with spinal cord injury (SCI) often face a range of secondary health complications, including respiratory compromise, cardiovascular illness, bladder and bowel dysfunction, chronic pain, and mental health disorders. Leisure-time physical activity (LTPA), encompassing activities chosen in free time, offers numerous physiological, psychological, and functional benefits. Physiologically, LTPA improves cardiovascular and metabolic health, reduces secondary complications, enhances respiratory function, and decreases hospitalization rates. Psychologically, it decreases depressive symptoms, increases self-esteem, and improves life satisfaction. Socially, adapted sports and exercise bolster social inclusion and improve quality of life. However, the SCI population is relatively sedentary, with only a small percentage meeting SCI-specific PA guidelines. Understanding the motives and perceived gains of LTPA could improve participation. This study aimed to investigate motivational factors and perceived benefits of regular LTPA in individuals with SCI, comparing guideline adherers and non-adherers and examining relationships between motives, gains, and LTPA volume. The hypothesis was that motivation would be driven primarily by health improvement, with notable gains in avoiding ill health and improving fitness and appearance.

Existing research highlights the sedentary nature of the SCI population and the numerous barriers to LTPA participation. Only 10–20% of individuals with SCI meet recommended PA guidelines, which suggest at least two 20-minute sessions of moderate-to-vigorous intensity aerobic PA and three sessions of strength exercises twice weekly. The relationship between motivation and LTPA engagement is complex, with intrinsic motivation (engaging for inherent satisfaction) linked to longer-term adherence. Intrinsic motivators like improved physical and psychological well-being and social integration are crucial, while external rewards offer less sustainability. Previous studies indicate that individuals with SCI who are intrinsically motivated are more likely to be consistently active. However, extrinsic factors such as access to equipment, expert support, and social support also facilitate PA uptake and adherence. Both intrinsic and extrinsic factors appear to play a role in motivating LTPA in individuals with SCI.

This prospective cross-sectional study enrolled 105 participants with SCI from across Australia, recruited through SCI-specific organizations using social media, email, and snowball sampling. Data collection involved an online survey using REDCap software and semi-structured interviews. Participants completed demographic, motives, and gains surveys online, followed by interviews to gather LTPA volume data. Inclusion criteria included being 18 years or older, living in Australia, being at least 12 months post-injury, having a diagnosed SCI, and engaging in some LTPA in the previous seven days. Exclusion criteria included compromised cognitive abilities, unstable health conditions requiring intensive care, or recent spinal surgery. The Leisure Time Physical Activity Questionnaire for Individuals with Spinal Cord Injury (LTPAQ-SCI) assessed LTPA volume, while the Exercise Motives and Gains Inventory (EMGI) measured motives and perceived gains from PA. An exercise intensity infographic aided precise LTPA recall. Data analysis using SPSS version 28 included descriptive statistics, t-tests (comparing motives and gains between PA guideline adherers and non-adherers), and regression modeling (investigating relationships between motives/gains and LTPA volume).

One hundred and five participants (63% male, mean age 56 years, mean time since injury 13 years) completed the study. The most common motives for LTPA were improvements in health and fitness (positive health, strength and endurance, nimbleness), management of appearance and weight, and avoidance of illness. The most common gains included improved health, fitness, strength and endurance, increased nimbleness, and enjoyment and revitalization. Participants who adhered to PA guidelines reported higher scores on several motive and gain subscales (enjoyment, health improvement, strength and endurance, nimbleness) compared to non-adherers. Social engagement was the lowest motive, and weight management was the lowest reported gain. Gains scores were significantly higher than motive scores for social recognition, enjoyment, affiliation, and stress management, while gains in appearance and weight management were significantly lower than motives. Enjoyment/revitalisation and health and fitness were significantly associated with MV-LTPA and total LTPA. Perceived gains in appearance and weight management were associated with total and mild LTPA volume. Health and fitness benefits were positively associated with total LTPA volume. Regression analyses revealed that motives only slightly predicted LTPA volume (21% and 25% variance for MV-LTPA and total LTPA, respectively), and LTPA volume only slightly predicted gains (12% and 19% variance).

This study confirms that improving health and fitness is a primary motive for LTPA in individuals with SCI. While improvements in these areas were reported, gains were relatively low, with greater gains reported in affiliation and stress management. The higher gains scores compared to motive scores for enjoyment and revitalization suggest that participants experienced more pleasure and revitalization than anticipated. The lower gains scores compared to motives for appearance and weight management suggest that traditional approaches may be insufficient, highlighting the need for tailored dietary strategies alongside LTPA. The weak prediction of LTPA volume by motives and gains suggests the importance of behavioral strategies such as goal setting, progress monitoring, and positive feedback to enhance intrinsic motivation and self-efficacy. The significantly higher gains in social recognition, affiliation, and stress management underscore the importance of incorporating social connectedness into exercise programs.

Improving health and fitness and managing appearance were the main motives for LTPA in individuals with SCI. While benefits in these areas were reported, gains were relatively low, with greater reported gains in affiliation and stress management. PA guideline adherers reported more enjoyment, better overall health, and greater fitness. Regular LTPA should be encouraged for its health benefits, with emphasis on preventing illness, facilitating affiliation, and managing stress.

The study's limitations include the relatively small sample size (n=105), which might limit the generalizability of the findings. Future research should use a larger sample, expand the range of motive and gain constructs, and incorporate qualitative methodologies to explore influencing factors more deeply. Data extraction might have been influenced by interviewer variability, and self-reported LTPA data could be influenced by social desirability bias. The sample was solely from Australia, so the results might not generalize to other populations.