Al interior de la escuela Francisco Neve

In the super-ordinate theme about the referral process, there is vast divergence of the experience at the point of referral with the health professional, with some choosing to self-refer and others told to induct themselves into the scheme which evoked reactions from each of the participants. Demonstrating there may be an impact for an individual when directive, guiding and following

communication styles are used to promote PA behaviour change. The driving motive behind referral to AOR for all participants was improvement in health (mental and physical) by becoming physically active; some participants openly accepted this motive, while others used sustained talk to explain why it was inappropriate for them to be physically active. The intention of the referral to AOR was clearly understood, i.e. that it was an opportunity to increase PA levels in order to improve the individual‟s health. The individual‟s perception of PA, current PA, and future intentions are explored in the next section.

3.5.6 PA.

3.5.6.1 Perception of PA.

Dav expressed the disturbing consequence of being physically active, painting the real picture of his physical limitation and the challenge of using his

wheelchair.

It‟ll hurt going to the shops. It means getting it out of there getting it out of that cupboard there and getting it out of the block, then getting in it, going down the shops and coming back and so I (small laugh) I just bite the bullet and go on my stick. Erm, but then just in pain. It gets you down, pain... Makes it a lot worse.

Although the thought of going to the gym was not acceptable to Heidi, she was able to express an alternative PA, signalling an inner awareness of what is inherently good for her. She came alive, when talking about dancing.

...like dancing and stuff like if you did that I‟d be like yeah ok, but going to the gym and running and stuff like I hate it that not my thing.... Don‟t need the gym. What‟s the gym going to do yeah ok makes you feel healthy, not everyone is like that.

When asking Heidi about the benefits of PA and her mental health, she gave a direct response.

“Nothing”.

Linda G shared her self-awareness and potential to fill her social void with PA. She felt it was something she could do with the time she had and an opportunity to feel better about herself, which she eagerly embraced.

...got back to my love of activity through this. Erm and er,

whenever I have been active in anything, like when I was skating, skating having blinkers on, only do skating, if you don‟t skate for a day you will forget it all. It‟s like here, if I don‟t come to the gym for the day or don‟t come to swim for a day I won‟t be able to swim, I will have lost my fitness and will have gained the weight, I am like that so I have to be very aware of that.

Linda G is delighted that she found PA again and is better able to cope with the depression when life events occur. It seems that PA is now Linda G‟s medicine.

I think, for me, it‟s been absolutely wonderful really. I can‟t say it has solved everything, like I haven‟t got a partner, my cat is on his last legs, that will be the next thing if anything happens to him. You know I am worried. That will be reactive depression it wouldn‟t be endogenous depression which is what I was experiencing then.

Max values the potential of PA and if she had better mobility, she would happily to go to the gym; she is aware of her own condition and her limitations,

expressing that she is fed up with the situation.

I used to go to the gym years ago, if it wasn‟t about mobility then I would have gone. ... But it is a gym to get you healthy, it‟s not something they can‟t help my knees, nothing that I can do to make me lose weight, cause you have to be active. Have to be on walking machines, bikes and the swimming and all that. Swimming is good but can‟t do it for hours. Cause my knees will seize up.

For Max, the consequential severe pain, despite the positive outcome of being physically active, is something to be avoided. Along with having to cope with day-to-day activities, the additional level of challenge would be too much.

Two days later my legs were hurting, I mean I have got crutches I don‟t go far, we parked right outside, getting up and getting in, then getting back up, normal things that everyone else takes for granted that I found really hard and so next two days I was in agony. That‟s why I don‟t do it. That‟s what that‟s what my

argument was with the doctor it‟s alright you saying this that and the other, I have got to sit at home like a cabbage...

However, Max can identify with benefits of being mobile; including returning to her previous quality of life and work. She felt stuck and not really herself.

Means everything. Number one priority. PA and to do it pain free is the top up on my first on my list, that is why I am going through all this pain. Can get you really depressed and sometimes you get arghh want to go. Don‟t know how able bodied, want to go back to work.

Pol articulated her understanding of the benefits of PA and her medical condition, so much so she self-referred and proactively looked for solutions and was

determined to improve her PA levels. Her confidence shone through.

“Because I have problems with joints and everything else, have got osteoarthritis and erm problems in my back, I said... I know

exercise is good...”

Pol‟s positive, determined attitude to the referral and line dancing was evident. Her end goal was to improve fitness so that she could feel better about herself whilst normalising her medical condition.

“I was thinking this is going to be really beneficial, I am going to get fitter be more active, be able to do more and actually feel healthier. With line dancing it‟s great fun and I am learning something”.

Mr T highly valued PA for both physical and mental benefits. He was self- determined to perform PA against the advice of health professionals and was determined to continue to self-heal.

I know it does. Cause what happened to me K. It affected my bowels and my er weeing. And er before I started swimming it was painful for toilet and stuff like that you know. And then once I started swimming I found it no problem then. So I know, I know my own head, I know my own body. So I knew that that was that this was the right thing to do for myself. And not only it was not just only for my illness, for my mental. You know because I was so depressed. That you know it‟s it‟s it was terrible. You know, I was you know I was going to take my own life to be honest.

It helped Mr T to feel better and he has noticed his own improvements.

...when you‟re sitting round, I know it‟s no good for me, so started swimming, and er lost a bit of weight, got back in trim er cause I lost weight it‟s easier for me to walk, less er painful when first happened. Terrible because had a bit more weight.

Patsy honestly reflected her dislike towards for the gym. She spoke with conviction, stating that others may also feel the same and it is just something you have got to do. No enjoyment was evident.

I suppose it‟s a means to an end. I‟d be lying if I said I enjoyed going to the gym because I don‟t enjoy going to the gym, not any aspect of it. Hate the music, hate the smell. Most of the people there are so self-obsessed they don‟t look or talk to anybody else. And erm, I think the whole experience is horrendous. I hate it. If I could afford to have a big house with my own gym and pool. It is a means to an end, not a pleasurable thing at all. ... I think it is boring. Erm so no, not a thing I would choose to do, if I could get away without doing it I would, if I could get the same effect by doing something else, I would because I think the gym is horrible.

3.5.6.2 Current PA.

Dav takes the time to develop arm strength for using his wheelchair. The frustration of not being able to do more was obvious and physical perspiration during the interview demonstrated the level of pain he constantly experienced. Life seemed hard for Dav.

“Build my arms up, barbells under there. Build my arms, have got to when I‟m out in the wheel chair. I am 15 st. It‟s very hard. It‟s a manual wheelchair not automatic one. Manual, self-propelling”.

Linda G uses PA to relieve her mental anxiety. This in itself can present new challenges of managing how much PA is enough; for example, her conscious awareness of potentially running away with herself. At current, she needs to work out daily to maintain mental stability. She articulated a worrying sense of uncertainty of being able to keep up the pace and used PA to fill the gap for loneliness and the gym to escape.

I can be in there sometimes 2 hours sometimes 3 hours. 20

minutes...then going for a resistance run so that is at least another 45 minutes, by the time you have done resistance exercises, come back in here and do cooling down, very often I don‟t cool down if I am really into it. You get addicted to treadmill. You can see

why...press the lever again and again you get on it and it‟s like you are somewhere else, you are just going, just going going going. Erm analogy of life really, said to ____ said that‟s really deep if you don‟t keep going fast enough you fall off the end.

Max is unable to perform PA because of the severity of pain, and even adjusting sitting movements was uncomfortable. She feels isolated and misunderstood by others. It was obvious whilst interviewing Max that she was physically suffering with her level of physical discomfort, reflecting that others in her situation may feel that way too.

Pain is horrendous. People look at you and think you are lazy, like come down, come down they wanted me to come down to their nans with them I don‟t want to, alright I don‟t have to walk far, I am sitting in the car, but you have got to get out of the car...then it‟s the sitting down and the getting up, cause what it is you can stand up and sit back down takes about 5 minutes to get going and then you get going and then you got to sit back down again stiffen up, not like a process, same process all the time throughout the day cause got to sit down because they are hurting you think awww stand up and really stiff, got to go through all that again. It‟s really tiring believe it or not, so by 6 o‟clock I get grumpy as well.

A niggling sense of “what if” persists in Pol‟s life. Although she was determined and externally positive, she was concerned about her health, as she feared health deterioration. She was externally coping well.

Pain, don‟t get that much pain in my back now, its slip discs you see well they are protruding. So I am always aware, bending down, leaning over bath to get to other side, just a simple action. Erm, always aware, but because of my back am left with some damage in my leg and in my foot numbness and stuff erm which isn‟t that troublesome, but it‟s there, always aware of it, constant reminder.

Mr T has a clear, structured PA routine. He is now self-regulating his progress which shows a dramatic difference to his previous life experiences. Being in control and a sense of stability is most welcome.

I don‟t go into the gym. Just use the pool. I swim a mile a day, urm come out of pool go into sauna sorry go into sauna first, then into pool and then er back into sauna and erm then into the jacuzzi, then when I come out of here and feel as if there is nothing wrong with me.

Mr T is able to self-manage his pain after a swimming session. He prefers being a regular swimmer and this has restored his self-pride.

The pains gone. It‟s gone it‟s gone. And er, until obviously, I get reminded once I get out. I get reminded. Hardest bit in here is the bit here the bit where I come from the swimming pool to shower and to the locker. Standing here for that little bit longer feel it kicking in. Bend over, let it breath a bit and then you know I deal with it do you know what I mean.

Patsy experiences a negative cycle involving inactivity and weight gain, so getting her knees repaired is her priority, so that she can get more active and subsequently improve her quality of life and feel less restricted.

Feel frustrated at the moment because it it does stop you erm exercising it does stop you doing what you like doing. I can‟t walk very far, longer time spent not exercising not walking the harder it is to get going again. When you can start walking, you are just not fit you get breathless the weight doesn‟t help, the weight is an enormous problem.

PA does not feature in Heidi‟s life, as just coping day-to-day is tough enough.

“That‟s how I feel. That you haven‟t got any energy...and have to have a sleep in the afternoon because I am up all night”.