All physiotherapists recognised the value of PA both in rehabilitation and the community. This included the importance of PA for well-being, physical health, the prevention of future illness and quality of life. For example, in terms of well-being, the physiotherapists highlighted factors that impacted upon a person’s subjective (SWB) and psychological well- being (PWB). SWB refers to an individual’s perceived happiness and satisfaction with life (Ryan & Deci, 2001; Keyes et al., 2002). In terms of this kind of well-being, the physiotherapists noted that participating in PA was beneficial in improving mood, self-esteem and self-confidence. PWB refers to psychological growth and development (Ryan & Deci, 2001; Keyes et al., 2002). This kind of well-being was perceived also to be promoted through PA by the physiotherapists in terms of their patients having more enthusiasm for life, a sense of purpose, increased social participation, engagement and integration. In addition, the physiotherapists valued PA for its benefit to physical health. This included improved balance, flexibility, strength and cardiovascular fitness. Furthermore they perceived that PA could help in the prevention of secondary health conditions such as weight gain, pressure sores, cardiovascular disease and diabetes in people with SCI. All of these factors were understood by the physiotherapists to positively impact upon a person’s ability to carry out activities of daily living, their independence, and ultimately their quality of life. The perceived
6 The term physical activity (PA) in referred to in this chapter over leisure time physical activity (LTPA) as the
81 importance of PA for health and well-being is encapsulated in the following comment from Andrew:
Physical activity just addresses so many areas of rehabilitation in life. You've got your cardiovascular element of physical activity, getting the heart rate up, as cardiovascular disease is the biggest killer of spinal cord injured people as well as able-bodied people nowadays. So you have to find ways to encourage and promote physical activity for cardiovascular fitness because patients are living longer, they're going to have these problems when they're older; they need to be educated about it now. Strength that you get from physical activity is insanely important. In inpatient rehabilitation there is a lot of functional and practical skills to learn, if you take transfers for example. And you can teach, and teach, and teach correct technique and patients will pick it up and they will know what the correct technique for transferring into a car is say. But they won't master it until they've got the strength in order to do that technique.
The physiotherapists in this study therefore recognised the value of PA beyond the medical model of disability which typically prioritises physical and functional restoration outcomes (see chapter two). Resounding with research on SCI rehabilitation and PA in other countries (Mulligan et al., 2011), the physiotherapist viewed PA through a social relational model of disability (see chapter two). This was evident as they recognised the importance of PA participation for promoting health and well-being including independence, social integration and quality of life.
The knowledge that PA can be important for health and well-being was predominately gained through the practical or experiential experience of caring for people with SCI over time. This type of practical and embodied knowledge is known as tacit knowledge (Ferlie et al., 2014). With the rare exception of four people who had chosen to take further education (MSc and PhD), the value of PA was learnt through seeing the perceived detrimental effects of physical inactivity. For example, all physiotherapists had witnessed people with SCI return to the rehabilitation centre months or years after leaving due to illness or secondary health conditions. They perceived that these could have been avoided, and thus readmission to the hospital prevented, by people with SCI being active in the community. Physiotherapists also perceived that many people who were readmitted to rehabilitation had poor SWB and PWB. Without claiming any causality or that PA is a panacea, they felt that poor well-being could have been prevented or helped through being regularly active. In addition to experiential knowledge, some physiotherapists also identified their own bodies as sources of knowledge
82 about PA. That is, for some people their practical knowledge of the importance of PA was reinforced by their own embodied experiences of being physically active.
Notwithstanding the value of experiential and embodied knowledge, participants revealed that they had a limited range of other sources of PA knowledge. For example, most said they did not access peer-reviewed academic papers, web-sites, or evidence based health policy documents promoting PA. Participants also stated that they were not educated on PA during their degree course or through any workshops. Therefore the participants did not gain any explicit knowledge through training (Ferlie et al., 2012). As Vicky commented:
The problem is physios are not trained to properly fitness train a patient. A sports therapist may have learnt to get someone fit, but I believe in SCI there are not many physios who can just take a patient to the gym and give them fitness training that would work for them. There are not many who could do something just like that; it is something they need to learn. It is not part of their obvious route. It is not yet in the culture that PA is something the physios should be doing.