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

Individuals with spinal cord injury (SCI) experience significant secondary health complications, including respiratory and cardiovascular issues, bladder/bowel dysfunction, chronic pain, and mental health challenges. Leisure-time physical activity (LTPA) can confer physiological, psychological, and social benefits in SCI, yet participation is low and only about 10–20% meet SCI-specific physical activity (PA) guidelines. Motivation is a key determinant of LTPA adherence; intrinsic motivation supports long-term engagement, while extrinsic factors (e.g., access to equipment, provider support, social support) facilitate uptake and adherence. The primary aim of this study was to investigate motivational factors and perceived benefits (gains) of LTPA among individuals with SCI. Secondary aims were to compare motives and gains between SCI-specific PA guideline adherers and non-adherers and to examine relationships between motives/gains and LTPA volume. The authors hypothesised that health improvement would be the primary motivator and that perceived gains would center on ill-health avoidance, improved fitness, and appearance.

Prior work shows people with SCI are relatively sedentary, face multiple barriers to LTPA, and few meet SCI-specific PA guidelines recommending at least two sessions of moderate-to-vigorous aerobic activity and three sessions of strength exercise weekly for fitness, with higher doses for cardiometabolic health. Research in exercise psychology indicates intrinsic motivation (enjoyment, inherent satisfaction) predicts adherence, while external pressures may initiate but not sustain LTPA. In SCI, intrinsic motives (health, psychological well-being, social integration) and extrinsic facilitators (specialised equipment, experienced service providers, social support) both play roles. Previous studies using the Exercise Motivations Inventory (EMI-2) in SCI populations highlighted health/fitness motives; social connectedness and support are associated with better resilience, adaptability, and engagement in PA. These findings provide context for examining both motives and perceived gains via the EMGI in this study.

Design: Prospective cross-sectional study conducted in Australia. Recruitment was via SCI-specific consumer/support organisations using social media, emails, and snowball sampling (September 2022–July 2023). Data collection used REDCap with an online consent process; participants received an electronic gift card. Participants completed demographic and EMGI surveys online; semi-structured interviews (online/telephone) collected LTPA data using the LTPAQ-SCI. An infographic describing LTPA intensity (examples, heart rate, breathing rate, perceived exertion) aided recall. Participants: Inclusion criteria were age ≥18 years, resident in Australia, ≥12 months post-injury, diagnosed traumatic or non-traumatic SCI, and engagement in some LTPA in the prior 7 days (verified during interview). Exclusion criteria included compromised cognition, unstable health requiring intensive medical care, or spinal surgery within the last 30 days. Measures: Sociodemographic and SCI characteristics were obtained via a study-specific questionnaire modeled on prior population work. LTPA volume was assessed with the LTPAQ-SCI (mild, moderate, vigorous aerobic LTPA, and strength exercise minutes over the past 7 days). Motives and perceived gains were assessed using the Exercise Motives and Gains Inventory (EMGI), which contains 51 motive and 51 gain items on a 4-point scale, grouped into 14 motive and 14 gain subscales (social recognition, enjoyment, challenge, competition, affiliation, revitalisation, health pressures, ill-health avoidance, positive health, weight management, stress management, appearance, strength and endurance, nimbleness) and further into five categories (social engagement; adverse/negative health; health/fitness; appearance/weight management as motive; weight management as gain). SCI-specific PA guideline adherence was defined per Martin Ginis et al. guidelines. Analysis: SPSS v28 was used. Descriptive statistics summarized demographics, injury, and LTPA minutes (mild, moderate, vigorous, moderate-to-vigorous [MV-LTPA], total LTPA, and strength). Motives and gains were analyzed for all participants, guideline adherers, and non-adherers. Means (SD) were computed for EMGI categories and subscales. Dependent t-tests compared motive vs gain scores within categories/subscales; independent t-tests compared adherers vs non-adherers. Regression models (with 10,000 bootstrap resamples) examined associations between motive categories and LTPA volumes, and between LTPA volume and reported gains.

Sample: N=105 Australians with SCI (63% male), mean age 56 (SD 15) years; mean time since injury 13 (SD 14) years; 58% paraplegia; 73% incomplete; 81% traumatic injury. LTPA volumes (min/week, mean [SD], median): mild 107 [154], 70; moderate 96 [130], 60; vigorous 26 [57], 0; strength 96 [115], 60; MV-LTPA 123 [165], 80; total LTPA 301 [257], 210; range of total LTPA 23–1410. Guideline adherence: 49 (47%) adherent; 56 (53%) non-adherent. EMGI internal consistency: Cronbach’s alpha >0.95 for motives subscales and 0.98 for gains subscales. Top motives (subscales, mean out of 4): positive health 3.23; strength and endurance 3.03; nimbleness 2.93. Top perceived gains: strength and endurance 3.11; nimbleness 3.01; enjoyment 2.93. Across groups, non-adherers reported lower motive and gain subscale scores than adherers. Motives of enjoyment, health improvement, strength and endurance, and nimbleness were significantly higher in adherers than non-adherers (p<0.05). In category scores, social engagement was the lowest motive (1.29), and weight management was the lowest gain (1.09). Gains exceeded motives for social recognition, enjoyment, affiliation, and stress management (p≤0.05). Gains for appearance and weight management were significantly lower than motives (p≤0.05). Associations with LTPA volume: Enjoyment/revitalisation and health/fitness motives were the only motives significantly associated with MV-LTPA (p=0.005) and total LTPA (p=0.05). MV-LTPA multivariate model was significant [R2=0.21, F(5,63)=6.71, p=0.009] but had no significant individual predictors. Perceived gains in appearance and weight management were significantly associated with total LTPA (p=0.031) and mild LTPA (p=0.008) [model R2=0.12, F(4,74)=6.71, p=0.05]. Health and fitness gains were positively associated with total LTPA [R2=0.19, F(4,73)=6.71, p=0.004].

Findings confirm that health and fitness are primary motivators for LTPA among people with SCI, and perceived gains most commonly include improvements in strength, endurance, and nimbleness. Gains surpassing motives in enjoyment, affiliation, social recognition, and stress management suggest participants experienced psychosocial benefits beyond expectations, which may support engagement and adherence. Conversely, perceived gains in appearance and weight were lower than the corresponding motives, indicating LTPA alone may be insufficient for desired weight/appearance changes in SCI, likely due to post-injury metabolic and mobility constraints; complementary dietary strategies may be necessary. Adhering to SCI-specific PA guidelines was associated with higher motives and higher perceived gains in health, fitness, nimbleness, and ill-health avoidance compared with non-adherers, underscoring benefits of meeting guideline-recommended LTPA volumes. Although motive categories modestly predicted LTPA volume and LTPA volume modestly predicted perceived gains, the relationships were limited in strength, indicating that additional factors influence engagement and outcomes. The results support integrating behaviour-change strategies (goal setting, feedback, autonomy support) and fostering social connectedness in programs to enhance enjoyment, self-efficacy, and adherence.

Health/fitness improvement and appearance management were the primary motives for engaging in LTPA among people with SCI. Reported gains favored health, fitness, strength/endurance, nimbleness, and psychosocial benefits (affiliation, stress management, enjoyment), whereas gains in weight/appearance were comparatively low. Guideline-adherers reported greater enjoyment, overall health, fitness, and nimbleness gains than non-adherers. Programs should encourage regular LTPA for its health benefits and explicitly promote its roles in illness prevention, social affiliation, and stress management. Future research should include larger samples, expand motive/gain constructs, and incorporate qualitative methods to further explore determinants of LTPA motives and perceived gains in SCI.

Key limitations include: relatively small sample size (n=105), limiting statistical power; potential interviewer effects due to differing interview styles despite adherence to scripts; reliance on self-reported LTPA, which may be inflated by social desirability/approval; inclusion of Australian participants only, limiting generalisability to other socio-economic or cultural contexts; and a limited range of motive/gain constructs that could be expanded in future work.