Barriers and Facilitators Related to Participation in Aquafitness Programs for People with Multiple Sclerosis

Abstract

Exercise and leisure activities provide physical and psychosocial benefits to people with multiple sclerosis (MS) and can enhance their quality of life. In Winnipeg, Manitoba, Canada, people with MS have reported barriers to their participation in local MS-specific aquafitness (AF) programs. Therefore, a formal exploration of the accessibility of local AF programs for people with MS was undertaken. The purpose of this phenomenological study was to identify factors that facilitate or impede participation in AF programs by individuals with MS living in Winnipeg. Qualitative data were collected from a total of eight participants through one focus group (n = 7) and one in-depth interview (n = 1). The sample consisted of individuals with MS who were currently participating in AF programming as well as those who were not. Data were audio-recorded and transcribed verbatim, and thematic analysis was completed. Seven themes emerged regarding factors affecting participation in local AF programs. Barriers to participation included inadequate transportation, lack of one-on-one support, environmental inaccessibility, and fears associated with participation in the programs. Facilitators of participation included a knowledgeable instructor and experiencing physical and psychosocial benefits from the program. Information from this study was used locally to advocate for people with MS in order to increase participation in local AF programming. Int J MS Care. 2012;14:132-141.A quafitness (AF) programs provide a variety of physical and psychosocial benefits to people with multiple sclerosis (MS).1-3 Aquafitness programs consist of exercises performed in water, and are sometimes classified as aquatic therapy. 4 In Winnipeg, Manitoba, Canada, AF programs tailored to people with MS are offered through the City of Winnipeg. Although this specialized program has been offered regularly for over 10 years, class sizes have remained small, and anecdotal reports from people with MS have indicated difficulty attending the programs. In order to validate the reports of people with MS in this community and further understand the difficulties associated with participation in these programs, a formal exploration of the accessibility of local AF programs was undertaken. Benefits of AF Programs for People with MSMany advantages of water-based exercise have been identified for individuals with MS. Literature suggests that it can lead to reduced muscle stress, decreased pain, less guarded movement associated with the fear of falling, and improved performance in physical activity due to the properties of water. 5,6 The water supports the body through its density and buoyancy, allowing the individual with MS to move more easily.4,7 Aquatic exercise also limits exercise-induced increases in body temperature, a factor associated with worsening MS-related fatigue symptoms. 6,7 Many physical benefits are associated with AF programs for people with MS, including increased strength,

Barriers and Facilitators Related to Rehabilitation Stays in Multiple Sclerosis

“…This is in line with studies of participation in physical activities among people with MS and other chronic diseases. [30][31][32][33][34] Also, the need for improvement in infor-information about rehabilitation of people with MS. There also seems to be potential for better physician communication skills, particularly in the initial phase of the disease.…”

Physical activity and exercise training in multiple sclerosis: a review and content analysis of qualitative research identifying perceived determinants and consequences

“…Some of the consequences of physical activity and exercise perceived by those with MS mimic the quantitative evidence (e.g. improved aerobic capacity [23][24][25][26][27], balance [27][28][29], depression [26][27][28], muscular strength [26][27][28]30,31] and quality of life [25,26,28,[32][33][34][35]). Yet, qualitative inquiry provides an opportunity for extending our knowledge of the consequences of physical activity and exercise beyond the limitations of items on numerical scales and focal scientific outcomes by telling us, in the person's own words, about the range of perceived consequences.…”

“…Table 1 provides a summary of each study, participant information, any associated intervention, quality score and inclusion of perceived consequences (adverse or beneficial outcomes) and determinants (barriers or facilitators) to physical activity and exercise. Thirteen of these studies used only face-to-face interview methodology [24][25][26]28,[30][31][32][33][34]54,69,70,72], one used faceto-face and telephone interviews [27], one used only telephone interviews [23], and four used focus groups [29,35,68,71]. Interpretative phenomenological analysis [23,31,33,34,70] and more general inductive analytical approaches [24][25][26][27][28][29][30]32,54,68,69] were used in most studies.…”

“…Interpretative phenomenological analysis [23,31,33,34,70] and more general inductive analytical approaches [24][25][26][27][28][29][30]32,54,68,69] were used in most studies. The remaining three studies used deductive analytical approaches, specifically thematic content analysis [35,71] and phenomenology [72].…”

“…In particular, aspects of the built environment, social influences, one's health condition, and cognitive and behavioral areas have been associated with physical activity and exercise behavior in qualitative and quantitative inquiry [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. Yet, the uniqueness of qualitative inquiry is that much richer and more detailed accounts of these perceived determinants can be identified beyond that identified in quantitative methods.…”