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Attitudes of people with long-term conditions who decline support from community physical activity programmes

Abstract

The extensive health and wellbeing benefits of physical activity are widely acknowledged, including for people with long-term conditions. Despite this the proportion of New Zealanders that are physically inactive is increasing. Becoming more physically active can be challenging, especially for people with long term conditions, who are at the greatest risk of inactivity. Community physical activity programmes are one way to support individuals to become more active. However, due to a range of physical, psychological, cultural, social or environmental barriers not all those who have been referred to take part engage in these programmes.

This research aimed to gain an in-depth understanding of the perspectives of people with long-term conditions who declined to engage in the community physical activity programme, Green Prescription. Using qualitative methods and a social constructionist approach, I conducted in-depth interviews with participants who had declined support with physical activity from a Green Prescription.

Participants explained the challenges they faced living with long-term conditions, particularly how societal expectations and stigma affected their motivation to engage in lifestyle changes. Participants then illustrated the hard work they undertook, far exceeding just engaging in physical activity, trying to cope with and adapt to these challenges and to live up to social expectations, by carrying on as normal, and presenting an identity consistent with a healthy and coping moral citizen. At the same time as trying to live up to social expectations, participants valued making autonomous decisions about their engagement in physical activity and managing their long-term conditions and appreciated support that enabled them to do so.

The two main themes identified from thematic analysis of the interviews were the challenges of living with long-term conditions, and how participants responded to these challenges. Participants described unpleasant and uncontrollable symptoms that made engaging in physical activity, weight control and everyday life more difficult. In addition to the mental and physical challenges of living with long-term conditions, equally if not more demanding were the challenges of meeting social expectations. Participants’ lived experience of chronic illness often did not match the expectations they had of themselves or what they perceived society demanded. Some participants internalised their perceived failure to live up to societal expectations.

Despite these challenges, participants explained the hard work they undertook, far exceeding just engaging in physical activity, to try to cope and adapt. Participants described how they prioritised normalising life with a long-term condition and how they tried to present an identity consistent with a healthy and coping moral citizen. Lastly, participants explained how they valued making autonomous decisions about their engagement in physical activity and managing their long-term conditions and appreciated support that enabled them to do so.

Considering these findings, I suggest that fostering empowerment is key to improving engagement in community physical activity programmes for people with long-term conditions. Taking a collaborative approach, including shared decision making, should help achieve this. Listening and responding to participants, who know their own bodies and social needs, will help programme providers understand how chronic illness affects the participants’ lives, and what their strengths and limitations are. Additionally, programmes should support types of physical activity that people find meaningful and enjoyable, rather than focusing on weight loss, unrealistic exercise goals or societal expectations.