Understanding factors that influence participation in physical activity among people with a neuromusculoskeletal condition: a review of qualitative studies

Purpose: This review aims to describe the factors that influence participation in physical activity (PA) in people with neuromusculoskeletal (NMS) conditions. Methods: A systematic search of six databases was conducted. Articles were included if the study qualitatively explored factors that influence participation in PA by individuals with a NMS condition. Fifteen peer-reviewed articles published between 2003 and 2013 were analysed for common themes and critically appraised. Results: Results were categorised using the International Classification of Functioning, Disability and Health framework. The most common demotivators reported for the three areas of functioning, body function and structures, activities and participation were lack of walking balance, muscle weakness, pain, stiffness, bladder and blower problems, depression, thermoregulation and fear of injury. Fluctuating symptoms and fatigue were mentioned as demotivators in all of the progressive conditions. Maintaining independence, function and weight, and the prevention of secondary conditions were the leading motivators reported in this domain. Most common environmental barriers include accessibility, costs, transport and insufficient information and knowledge from health professionals. Social support is a consistent determinate of PA and is reported as a facilitator in every study. The most common personal demotivators include lack of motivation, feelings of self-consciousness and embarrassment in public, anxiety, frustration and anger. Personal motivators include goal setting and achieving, enjoyment, feeling good, feeling “normal”, motivation and optimism, redefining self and escapism from everyday boundaries. Conclusions: Individuals with NMS conditions report complex common barriers, facilitators, demotivators and motivators to participation in PA. The way these factors influence participation in PA is unique to the individual; therefore, it is necessary to adopt an individually tailored approach when designing interventions.

• Implications for Rehabilitation

• Individuals with neuromusculoskeletal conditions report common factors that influence participation in physical activity.

• It is the characteristics, attitude and beliefs of an individual that determine the way in which these factors influence participation in physical activity.

• Health professionals should be guided by the International Classification of Functioning, Disability and Health framework when assessing individuals, as the model will ensure all major factors of interest with regard to disability and physical activity behaviour are considered.

• Interventions to promote participation in physical activity in people with neuromusculoskeletal conditions require an individual approach that facilitates the assessment and management of an individual’s barriers to physical activity.

• A multi-disciplinary approach may be required to address factors that influence participation in physical activity. Health professionals must be informed about other areas of expertise and draw on this when necessary.