Increasing physical activity for people with physical disabilities: A mixed methods approach

People with physical disabilities who are physically active enjoy a range of benefits spanning physiological, emotional, cognitive, and social categories. Regular physical activity reduces the risk of noncommunicable diseases, including heart disease, diabetes, and dementia. However, due to various barriers, including those related to the individual (e.g., negative attitudes/beliefs, employment status) and/or environment (e.g., transportation, inaccessible facilities), most adults with physical disabilities fail to meet evidence-based physical activity guidelines. Therefore, there is a need to design and evaluate evidence-based interventions that are accessible and that could be implemented at scale to improve physical activity within this population. This thesis uses a mixed-methods approach to understand how physical activity can be increased in adults with physical disabilities. Following the Medical Research Council’s framework for developing and evaluating complex health interventions, a systematic review was first undertaken (Chapter 2), showing that interventions that aim to improve physical activity in manual wheelchair users with spinal cord injuries – one of the least physically active populations with a physical disability – appear to be effective. In Chapter 3, the behaviour change wheel was used to assess the theoretical underpinning of a novel smartphone application (or app), Accessercise, to increase physical activity in adults with spinal cord injuries. Overall, it was found that Accessercise showed high behaviour change potential; it could be used to support adults with spinal cord injuries to be physically and psychologically capable of undertaking physical activity, offers social and physical opportunities to reduce sedentary behaviour, and supports automatic and reflective motivation. In Chapter 4, the usability of Accessercise was assessed using Think Aloud methods, showing that despite several troubleshooting issues), it could be an effective intervention to overcome barriers to increasing physical activity in adults with physical disabilities. Finally, in Chapter 5, the feasibility of a randomised controlled trial assessing Accessercise was evaluated. Most participants reported satisfaction with the trial methods and intervention, suggesting a full-scale evaluation would be possible. Together, these findings reveal that digital behaviour change interventions could increase physical activity in people with physical disabilities.