Abstract
Context
Spinal cord injury or disease (SCI/D) can lead to health challenges that are exacerbated with aging. Adaptive sport is understood to provide health benefits for the SCI/D population. Prior literature investigating adaptive sport in this population pertains to adults with SCI/D who are <50 years of age. However, most Canadians with SCI/D are >50 years of age.
Objectives
This study aimed to: (1) Compare demographics of those who do and do not participate in adaptive sport; (2) Describe the characteristics of adaptive sport that adults aged ≥50 years with SCI/D participate in; and (3) Identify barriers and facilitators to adaptive sport participation in this age group.
Methods
This descriptive, cross-sectional survey was carried out using an online survey. Analytical statistics were used to address objective one, while descriptive statistics were employed for objectives two and three.
Participants
Responses from 72 adults aged ≥50 years, residing in Canada, living with a SCI/D for >6 months were included in the analysis.
Results
Findings revealed that adaptive sport participants aged ≥50 years with SCI/D were more likely to identify as men, be younger individuals (50–59 years), and report greater satisfaction with physical health (P < 0.05). Adaptive sport participants most commonly played individual sports at the recreational level. Common barriers pertained to physical capacity, travel, and COVID-19; common facilitators included social support, desire to improve health, and having friends/peers who also participate.
Conclusion
Future research should investigate strategies to enhance facilitators and mitigate barriers to adaptive sport participation in order to improve access.
Keywords: Aging, Exercise, Health, Spinal cord injuries, Sports for persons with disabilities
Introduction
The health challenges experienced by those living with spinal cord injury or disease (SCI/D) are exacerbated with aging. Older age is associated with an increased risk of geriatric pathologies, comorbidities, frailty, and physical and cognitive decline (1–3). Moreover, sedentary lifestyles, which are frequently observed in individuals with SCI/D, increase the challenges associated with aging (4,5). With age, complications to various body systems may occur (4). For instance, those with SCI/D experience faster age-related decline of lean tissue and an increased incidence of shoulder pain compared to age-matched individuals without SCI/D (4). Common age-related challenges associated with SCI/D include lack of weight bearing and muscle activity, changes in body composition, reductions in bone mineral density, fracture risk, cardiovascular disease risk, skin breakdown, bladder infection risk, and neurological deterioration (6). Many of these challenges can be mitigated through increased daily movement and activity (7–13).
Participation in adaptive sport may help mitigate some of the physical, psychological and social challenges associated with aging in those with SCI/D. ‘Sport’ is defined as physical activity involving exertion, skill, and/or hand-eye coordination, containing elements of competition, and formally existing through organizations (14). ‘Adaptive sport’ is defined as organized sport that has been modified to allow individuals living with physical and/or cognitive disabilities to participate (15,16). Evidence suggests that participation in adaptive sport can provide numerous benefits for individuals living with SCI/D (16–22). For instance, bone mineral density, exercise performance, community integration, life satisfaction, and quality of life have been shown to be enhanced in adaptive sport participants with SCI/D compared to those who do not participate in adaptive sport (16,18). Interestingly, a survey conducted among adults with SCI/D aged 16 years or older as well as other published literature have revealed that those who participate in adaptive sport are more likely to be male, younger in age, identify as white, use a manual wheelchair over a power wheelchair, and be employed, compared to those who do not participate (23–25). Among the aging population without SCI/D, sport participation helps older adults navigate the aging process, maintain health, develop relationships, and be part of a community (26–28).
Current literature has explored the factors that enable or limit adaptive sport participation for individuals with SCI/D. Facilitators to participation include having social support (i.e. from peers, friends, and mentors), being exposed to adaptive sport through rehabilitation facilities, having early or pre-SCI/D interest in sports, having the financial means to support adaptive sport participation (e.g. subsidized fitness memberships, employment), being connected to advocacy organizations (e.g. provincial SCI/D organizations), having accommodating environments (e.g. accessible parking), and being able to drive (17,24,25). Barriers to participation that have been cited in the literature include lack of the aforementioned facilitators to participation, negative or lack of information from healthcare professionals, difficulty with transportation, lack of time, lack of awareness of adaptive sport opportunities, and dealing with physical or psychological health challenges (17,24,25,29). This critical information has shed light on the context surrounding adaptive sport participation for adults with SCI/D.
Despite the extensive literature supporting adaptive sport participation for this population, two recent reviews have highlighted a critical gap in our understanding of adaptive sport participation after SCI/D (16,17). These reviews revealed that sport research has focused on individuals with SCI/D who are aged under 50 years (16,17). Only one qualitative study to date has focused on sport participation among adults aged 50 years or older living with SCI/D (30). This is an important gap to address, given that most people living with SCI/D in Canada are aged over 50 years (31,32).
This study aimed to increase our understanding of adaptive sport participation amongst individuals with SCI/D aged 50 years or older. First, we aimed to compare the demographic and injury-related characteristics of individuals aged 50 years or older with SCI/D who do participate and who do not participate in adaptive sport. Given the research findings for adults with SCI/D aged under 50 years outlined above (16,17,23–25,29), we hypothesized that in comparison to the group of participants who do not participate in adaptive sports, the group of individuals who do participate will have a greater proportion who identify as: man, male, white, younger in age, urban dweller, having a higher income, being employed full-time, having accessible/reliable mode of transportation, having paraplegia, having a motor incomplete SCI/D (i.e. American Spinal Injury Association Impairment Scale (AIS) C or D), and being satisfied with their physical, social and psychological health. Second, we aimed to describe the characteristics of adaptive sport that individuals aged 50 years or older with SCI/D currently participate in. Qualitative research with aging athletes with SCI/D revealed that there is high value placed on the social aspect of adaptive sport participation, as well as a reduction in competitive focus and intensity in the later years (30). Based on the literature, we hypothesized that team sports played at the recreational level at least once per week will be the most common form of adaptive sport engagement. Third, we aimed to identify the barriers and facilitators to participation in adaptive sport for individuals aged 50 years or older with SCI/D. Numerous barriers and facilitators to adaptive sport participation have been cited in the literature, with the most common factors pertaining to transportation, finances, social support, and athletic identity (17,24,25,29). We hypothesized that common barriers to participation will be financial constraints, COVID-19, and lack of geographic access to adaptive sport while common facilitators will be peer support, geographic access, and sport participation pre-SCI/D.
Materials and methods
A quantitative, descriptive cross-sectional survey was conducted. This study was approved by the Research Ethics Board (REB) at the University of Toronto (REB Protocol #43612). The Consensus-Based Checklist for Reporting of Survey Studies (CROSS) was followed (33).
Survey development
The survey questions were informed by the results of two knowledge syntheses investigating sport participation in adults with SCI/D (16,17) and by the findings of a qualitative study exploring sport participation among Canadians aged 50 years or older with SCI/D (30).
Survey questions included close-ended questions that used a variety of response formats, such as multiple-choice options for demographics, and Likert scales for the barriers and facilitators to sport participation. The survey consisted of two sections: (1) Participant demographics and injury-related characteristics, and (2) Information about participation in adaptive sport. The latter section consisted of three distinct streams with grouping-specific questions: (2A) Current participation in adaptive sport, (2B) Prior participation in adaptive sport, and (2C) No current or prior participation in adaptive sport. An initial draft of the English survey was developed by six physical therapy students and two researchers with physical therapy backgrounds. It was then reviewed by a team member living with SCI/D who was over 50 years of age and who participated in adaptive sport and revised according to his suggestions. Next, the final version of the English survey (Appendix) was translated to French by the research member fluent in French and English (JFL) and both versions were created in electronic format on LimeSurvey, version 3.28.64 (LimeSurvey GmbH, Hamburg, Germany) (34).
Participant recruitment
Participants were recruited through adaptive sport organizations and provincial SCI/D organizations across Canada. Provincial SCI/D organizations provide education, advocacy, peer support, and services to those living with SCI/D, such as information services, peer support programs, and opportunities for participating in research studies. Individuals were eligible to participate if they were: (1) aged 50 years or older, (2) residing in Canada, and (3) living with a SCI/D caused by a traumatic or non-traumatic mechanism for at least six months. Any etiology, neurological level, and severity of injury were included. If individuals did not meet these criteria (as confirmed by self-screen), they were not able to complete the survey. As stated at the beginning of the survey, consent to participate in the study was implied if participants proceeded with completing the survey. Upon completion of the survey, participants were provided with the option to enter a draw to win one of three gift card prizes. Survey data were collected from February to June 2023.
Analysis of survey data
Data were exported to Microsoft Excel for data cleaning. The REAL framework (35) was used to identify fraudulent survey activity (e.g. multiple responses from a single respondent, inaccurate responses). The REAL framework consisted of four key steps: Reflect, Expect, Analyze, and Label (35). Reflect identified ways the study was vulnerable to fraud and strategies built into the study to prevent fraud. Expect referred to identifying expected patterns in the survey data, based on previous knowledge of the survey population. During the Analyze step, expected patterns were compared with the data. To Label, researchers developed criteria for responses to be removed. For example, to address multiple responses submitted by a single respondent we (1) Inspected IP addresses and flagged responses from the same IP address, (2) Expected that the first response from such respondents would consist of the most accurate data, (3) Analyzed whether the first response from such respondents aligned with the study’s expectations, and (4) Labeled criteria to set consistent expectations for the remaining responses. Open-ended responses in French were translated by a French-speaking member of the research team (JFL). Respondents must have completed questions beyond section one (e.g. demographics) for data to be used. Data were first summarized with frequencies and percentages in tables. Data were then transferred to SPSS 26 (IBM, Armonk, NY, USA) for statistical analysis (36). An alpha value of 0.05 was used for all statistical tests.
To address objective 1, we used analytical statistics to compare the demographics, injury-related characteristics, and satisfaction with health between individuals aged 50 years or older with SCI/D who did and did not participate in adaptive sport. Categorical variables addressing this objective that had a natural order (i.e. age, household income, time since injury) were converted to an ordinal scale. These variables were compared between groups with Wilcoxon Rank Sum tests. Chi-squared tests or Fisher’s Exact tests (if cell count was less than 5) were used for all nominal variables. To satisfy objective 2 (i.e. describing the characteristics of adaptive sport that respondents currently participate in), descriptive statistics (i.e. frequencies, percentages) were used. Regarding objective 3 (i.e. identifying the barriers and facilitators to participation in adaptive sport), descriptive statistics were also used. The group of individuals who did not participate in adaptive sport were divided further into ‘Never participated’ and ‘Previously participated’ groups. It was expected that those who previously participated in adaptive sport had lived experiences of the facilitators, whereas the group who never participated in adaptive sport were unlikely to have these insights and therefore were not asked survey questions about facilitators.
Results
A total of 149 people clicked the survey link, of which 139 agreed to participate. Data from 67 respondents were removed during data cleaning due to incomplete responses, duplicates, and fraudulent responses (Fig. 1). Data from 72 participants were included in the analysis: 36 respondents currently participated in adaptive sports (50%) while 36 did not (50%).
Figure 1.
Data cleaning process.
Demographics
Most respondents were cis-gender males (69.4%), with significantly more individuals in the sport group identifying as male (P = 0.011) and as men (P = 0.009) compared to those in the non-sport group (Table 1). Sport participants were also significantly younger compared to non-sport participants, with 75% of the sport group aged 50–59 years compared to 50% of individuals in the non-sport group (P = 0.017). Respondents primarily identified as white (56.9%) and were living in suburban (40.3%) or urban (40.3%) areas. There was a trend of individuals in the sport group having a higher household income than participants in the non-sport group (P = 0.080). While participants responded from eight Canadian provinces, the majority of participants resided in Ontario (51.4%) or British Columbia (18.1%).
Table 1.
Demographic and injury-related characteristics.
| Variables | Total (N = 72)N (%) | Participated in sport(N = 36, 50%) N (%) | Did not participate in sport(N = 36, 50%) N (%) | P-value | Previously participatedin sport (N = 12) N (%)§ |
|---|---|---|---|---|---|
| Age (years) | 0.017* | ||||
| 50–54 | 20 (27.8) | 14 (38.9) | 6 (16.7) | 2 (16.7) | |
| 55–59 | 25 (34.7) | 13 (36.1) | 12 (33.3) | 4 (33.3) | |
| 60–64 | 16 (22.2) | 5 (13.9) | 11 (30.6) | 3 (25.0) | |
| 65–69 | 6 (8.3) | 2 (5.6) | 4 (11.1) | 3 (25.0) | |
| 70–74 | 3 (4.2) | 2 (5.6) | 1 (2.8) | 0 | |
| 75 or older | 2 (2.8) | 0 | 2 (5.6) | 0 | |
| Gender | 0.009* | ||||
| Man | 50 (69.4) | 30 (83.3) | 20 (55.6) | 7 (58.3) | |
| Woman | 21 (29.2) | 5 (13.9) | 16 (44.4) | 5 (41.7) | |
| Non-binary/third gender | 1 (1.4) | 1 (2.8) | 0 | 0 | |
| Prefer not to say | 0 | 0 | 0 | 0 | |
| Prefer to self-describe | 0 | 0 | 0 | 0 | |
| Sex | 0.011* | ||||
| Male | 50 (69.4) | 30 (83.3) | 20 (55.6) | 7 (58.3) | |
| Female | 22 (30.6) | 6 (16.7) | 16 (44.4) | 5 (41.7) | |
| Intersex | 0 | 0 | 0 | 0 | |
| Prefer not to say | 0 | 0 | 0 | 0 | |
| Other | 0 | 0 | 0 | 0 | |
| Race/Ethnicity | 0.265 | ||||
| Black | 4 (5.6) | 2 (5.6) | 2 (5.6) | 0 | |
| East/Southeast Asian | 0 | 0 | 0 | 0 | |
| Indigenous | 9 (12.5) | 5 (13.9) | 4 (11.1) | 2 (16.7) | |
| Latino | 4 (5.6) | 0 | 4 (11.1) | 0 | |
| Middle Eastern | 2 (2.8) | 1 (2.8) | 1 (2.8) | 0 | |
| South Asian | 3 (4.2) | 0 | 3 (8.3) | 1 (8.3) | |
| White | 41 (56.9) | 23 (63.9) | 18 (50.0) | 7 (58.3) | |
| Multi-race | 6 (8.3) | 4 (11.1) | 2 (5.6) | 1 (8.3) | |
| Prefer not to say | 3 (4.2) | 1 (2.8) | 2 (5.6) | 1 (8.3) | |
| Area of Residence | 0.837 | ||||
| Urban | 29 (40.3) | 15 (41.7) | 14 (38.9) | 3 (25.0) | |
| Suburban | 29 (40.3) | 15 (41.7) | 14 (38.9) | 7 (58.3) | |
| Rural | 14 (19.4) | 6 (16.7) | 8 (22.2) | 2 (16.7) | |
| Geographic Location | 0.621 | ||||
| Alberta | 7 (9.7) | 3 (8.3) | 4 (11.1) | 0 | |
| British Columbia | 13 (18.1) | 7 (19.4) | 6 (16.7) | 3 (25.0) | |
| Manitoba | 2 (2.8) | 0 | 2 (5.6) | 6 (50.0) | |
| Newfoundland and Labrador | 4 (5.6) | 3 (8.3) | 1 (2.8) | 2 (16.7) | |
| Ontario | 37 (51.4) | 17 (47.2) | 20 (55.6) | 0 | |
| Prince Edward Island | 2 (2.8) | 2 (5.6) | 0 | 0 | |
| Quebec | 6 (8.3) | 3 (8.3) | 3 (8.3) | 1 (8.3) | |
| Saskatchewan | 1 (1.39) | 1 (2.8) | 0 | 0 | |
| Injury Type | 0.546 | ||||
| AIS A | 23 (31.9) | 14 (38.9) | 9 (25.0) | 3 (25.0) | |
| AIS B | 8 (11.1) | 4 (11.1) | 4 (11.1) | 2 (16.7) | |
| AIS C | 7 (9.7) | 3 (8.3) | 4 (11.1) | 2 (16.7) | |
| AIS D | 6 (8.3) | 4 (11.1) | 2 (5.6) | 0 | |
| Not sure | 28 (38.9) | 11 (30.6) | 17 (47.2) | 5 (41.7) | |
| Non-traumatic SCI vs. Traumatic | 0.317 | ||||
| Non-Traumatic | 24 (33.3) | 10 (27.8) | 14 (38.9) | 4 (33.3) | |
| Traumatic | 48 (66.7) | 26 (72.2) | 22 (61.1) | 8 (66.7) | |
| Paraplegia vs Tetraplegia | 0.643 | ||||
| Paraplegia | 47 (65.3) | 25 (69.4) | 22 (61.1) | 8 (33.3) | |
| Tetraplegia | 13 (18.1) | 5 (13.9) | 8 (22.2) | 4 (66.7) | |
| Not sure | 12 (16.7) | 6 (16.7) | 6 (16.7) | 0 | |
| Employment Status | 0.715 | ||||
| Full time (30 + hours a week) | 9 (12.5) | 7 (19.4) | 2 (5.6) | 1 (8.3) | |
| Part time (Less than 30 h a week) | 12 (16.7) | 6 (16.7) | 6 (16.7) | 1 (8.3) | |
| Casual (Temporary or as needed) | 10 (13.9) | 5 (13.9) | 5 (13.9) | 2 (16.7) | |
| Unemployed | 8 (11.1) | 3 (8.3) | 5 (13.9) | 1 (8.3) | |
| Looking for work | 2 (2.8) | 1 (2.8) | 1 (2.8) | 0 | |
| Retired | 28 (38.9) | 13 (36.1) | 15 (41.7) | 6 (50.0) | |
| Other | 3 (4.2) | 1 (2.8) | 2 (5.6) | 1 (8.3) | |
| Household Income | 0.080 | ||||
| $0 to $19,999 | 15 (20.8) | 5 (13.9) | 10 (27.8) | 2 (16.7) | |
| $20,000 to $49,999 | 20 (27.8) | 11 (30.6) | 9 (25.0) | 1 (8.3) | |
| $50,000 to $99,999 | 17 (23.6) | 5 (13.9) | 12 (33.3) | 7 (58.3) | |
| $100,000 and over | 13 (18.1) | 11 (30.6) | 2 (5.6) | 1 (8.3) | |
| Prefer not to say | 7 (9.7) | 4 (11.1) | 3 (8.3) | 1 (8.3) | |
| Length of Time with SCI/D | 0.923 | ||||
| 6 months to under 1 year | 3 (4.2) | 2 (5.6) | 1 (2.8) | 0 | |
| 1–5 years | 22 (30.6) | 11 (30.6) | 11 (30.6) | 2 (16.7) | |
| 6–10 years | 15 (20.8) | 6 (16.7) | 9 (25.0) | 2 (16.7) | |
| More than 10 years | 32 (44.4) | 17 (47.2) | 15 (41.7) | 8 (66.7) | |
| Mode of Transportation | 0.090 | ||||
| Accessible Transport | 2 (2.8) | 0 | 2 (5.6) | 1 (8.3) | |
| Drives Own Car | 19 (26.4) | 13 (36.1) | 6 (16.7) | 1 (8.3) | |
| Public Transit | 2 (2.8) | 0 | 2 (5.6) | 0 | |
| Wheelchair/Walking | 11 (15.3) | 7 (19.4) | 4 (11.1) | 0 | |
| Relies on Others | 5 (6.9) | 1 (2.8) | 4 (11.1) | 1 (8.3) | |
| Multi-mode | 33 (45.8) | 15 (41.7) | 18 (50.0) | 10 (83.3) | |
| Sport Participation Prior to SCI/D | 0.429 | ||||
| Participated | 65 (90.3) | 34 (94.4) | 31 (86.1) | N/A | |
| Never | 7 (9.7) | 2 (5.6) | 5 (13.9) | N/A | |
| Physical Activity Prior to SCI/D | 0.083 | ||||
| 1–2 sessions per week | 20 (27.8) | 14 (38.9) | 6 (16.7) | N/A | |
| 3–4 sessions per week | 22 (30.6) | 12 (33.3) | 10 (27.8) | N/A | |
| 5–6 sessions per week | 10 (13.9) | 5 (13.9) | 5 (13.9) | N/A | |
| 7 + sessions per week | 8 (11.1) | 2 (5.6) | 6 (16.7) | N/A | |
| I did not engage in any physical activity | 12 (16.7) | 3 (8.3) | 9 (25.0) | N/A |
*Significant between-group difference (p ≤ 0.05). §Sub-group of ‘Did not participate in sport’ group.
SCI/D-Related characteristics
Most respondents were living with paraplegia (65.3%), experienced a traumatic mechanism of injury (66.7%), and had their SCI/D for more than 10 years (44.4%) (Table 1). Over a third of respondents identified as living with AIS A complete SCI/D (31.9%) or were not sure about their AIS rating (38.9%). Respondents mostly used multiple modes of transportation when traveling within the community (46%), such as using their wheelchair or walking, using accessible transport, and driving their own car. There was a trend of more sports participants using multiple modes of transportation compared to the non-sports participants (P = 0.090). The majority of respondents participated in sports prior to SCI/D (90.3%) and about a third participated in physical activity 3–4 sessions per week (30.6%). There was a trend for those in the sport group to have participated in more physical activity pre-injury compared to those in the non-sport group (P = 0.083).
Health satisfaction
Most participants, regardless of whether they participated in adaptive sport or not, were content with their physical, psychological, and social health, answering agree or strongly agree when prompted. Significantly more sport participants reported higher levels of satisfaction with their physical health (55.6%), compared to non-sport participants (25%, Table 2, P = 0.027). There were no significant differences observed between groups with respect to perceived contentment with psychological or social health.
Table 2.
Health satisfaction.
| Statement | Currently participatein sport N (%) | StronglyAgree N(%) | AgreeN(%) | Neither agreenor disagree N(%) | DisagreeN(%) | Strongly Disagree N(%) | P-value |
|---|---|---|---|---|---|---|---|
| 1. I am content with my physical health | 0.027* | ||||||
| Yes 36 (50) | 2 (5.6) | 18 (50.0) | 6 (16.7) | 8 (22.2) | 2 (5.6) | ||
| No 36 (50) | 2 (5.6) | 7 (19.4) | 6 (16.7) | 14 (38.9) | 7 (19.4) | ||
| 2. I am content with my social health | 0.124 | ||||||
| Yes 36 (50) | 4 (11.1) | 25 (69.4) | 5 (13.9) | 2 (5.6) | 0 | ||
| No 36 (50) | 4 (11.1) | 16 (44.4) | 9 (25.0) | 7 (19.4) | 0 | ||
| 3. I am content with my psychological health | 0.522 | ||||||
| Yes 36 (50) | 8 (22.2) | 20 (55.6) | 7 (19.4) | 1 (2.8) | 0 | ||
| No 36 (50) | 7 (19.4) | 15 (41.7) | 9 (25.0) | 4 (11.1) | 1 (2.8) |
*Significant between-group difference (p ≤ 0.05).
Characteristics of sport participation
Of the 36 adaptive sport participants, 18 participated in individual sports, seven in team sports, and 11 participated in both. Table 3 lists individual and team sports reported by current sport participants. Over half participated in adaptive sport for more than 5 years in duration (55.4%), with most respondents participating in sport either 1–2 sessions per week (44.4%) or 3–4 times per week (41.7%) for 1–2 h per session (69.5%). The majority participated in sport at a recreational level (86.1%, Table 3).
Table 3.
Characteristics of adaptive sport participation.
| Type of sport | Sport participants (N = 36, 50%) N (%) |
|---|---|
| Adaptive Team Sport | |
| Baseball | 2 (5.6) |
| Power Soccer | 1 (2.8) |
| Softball | 2 (5.6) |
| Sitting Volleyball | 5 (13.9) |
| Sledge Hockey | 6 (16.7) |
| Table Tennis | 6 (16.7) |
| Wheelchair Badminton | 3 (8.3) |
| Wheelchair Basketball | 6 (16.7) |
| Wheelchair Boccia | 2 (5.6) |
| Wheelchair Curling | 6 (16.7) |
| Wheelchair Handball | 5 (13.9) |
| Wheelchair Hockey | 3 (8.3) |
| Wheelchair Rugby | 3 (8.3) |
| Wheelchair Tennis | 8 (22.2) |
| Team Shooting | 1 (2.8) |
| Adaptive Individual Sport | |
| Archery | 6 (16.7) |
| Cross Country Sledding | 3 (8.3) |
| Golf | 4 (11.1) |
| Martial Arts | 3 (8.3) |
| Rowing | 3 (8.3) |
| Rock Climbing | 0 (0) |
| Sit Skiing/Snowboarding | 10 (27.8) |
| Surfing | 3 (8.3) |
| Swimming | 8 (22.2) |
| Table Tennis | 5 (13.9) |
| Track and Field | 1 (2.8) |
| Water Skiing | 4 (11.1) |
| Weightlifting/Powerlifting | 2 (5.6) |
| Wheelchair Fencing | 2 (5.6) |
| Wheelchair Racing | 16 (44.4) |
| Wheelchair Tennis | 10 (27.8) |
| Other | |
| Kayaking | 1 (2.8) |
| Mountain Biking | 1 (2.8) |
| Shooting | 1 (2.8) |
| Sledge Skating | |
| Number of years played | 1 (2.8) |
| Under 1 year | 4 (11.1) |
| 1–5 years | 12 (33.3) |
| 6–10 years | 8 (22.2) |
| 11–15 years | 5 (13.8) |
| 16–20 years | 4 (11.1) |
| Over 20 years | 3 (8.3) |
| Sessions per week | |
| 1–2 times per week | 16 (44.4) |
| 3–4 times per week | 15 (41.7) |
| 5–6 times per week | 1 (2.8) |
| Less than once per week | 4 (11.1) |
| Hours per session | |
| 1 h per session | 14 (38.9) |
| 2 h per session | 11 (30.6) |
| 3 h per session | 3 (8.3) |
| Less than 1 h per session | 7 (19.4) |
| More than 3 h per session | 1 (2.8) |
| Competition Level | |
| Recreational | 31 (86.1) |
| Regional | 9 (25.0) |
| Provincial | 8 (22.2) |
| National | 2 (5.6) |
| International | 1 (2.8) |
Barriers and facilitators
To identify the barriers and facilitators of adaptive sport participation, the non-sport group was further divided into two groups: ‘Previously participated in adaptive sport’ (n = 12, Table 1), and ‘Never participated in adaptive sport’ (n = 24). Figs. 2 and 3 summarize the barriers and facilitators of adaptive sport participation, as reported by current sport participants, previous sport participants, and non-sport participants. The following barriers were experienced by most participants, especially among those who did not currently participate in sport: not having the physical capacity to participate, challenging to travel to and from sports activity, and the COVID-19 pandemic. The most commonly experienced facilitators included having social support, a desire to improve physical and/or mental health, and friends/peers who also participate in adaptive sport.
Figure 2.
Barriers to adaptive sport participation.
Figure 3.
Facilitators to adaptive sport participation.
Discussion
This study was the first to investigate the current landscape of adaptive sport participation for Canadians aged 50 years or older living with SCI/D. The hypotheses pertaining to demographics of sport participants were partly met as the sport group was observed to have a greater number of individuals identifying as male and men, be younger in age, and report higher levels of satisfaction with their physical health when compared with the non-sport group. For those who were participating in adaptive sport, most participated in individual sports, or both individual and team sports, which was contrary to our hypothesis; however, we correctly hypothesized that most sport participants competed at the recreational level and participated at a frequency of 1–2 or 3–4 times a week for 1–2 h per session. The most significant barriers to participation in adaptive sport were challenges traveling to and from sports activity and the COVID-19 pandemic, as hypothesized, but not a lack of funds, which we had also hypothesized. We did not anticipate the perception of not having the physical capacity to play sports to be a frequently reported barrier. Common facilitators of adaptive sport participation included social supports and friends/peers who also participate in adaptive sport, as hypothesized, but not geographic access or pre-injury sport participation, which we also hypothesized. Yet, the most commonly reported facilitator was the desire to improve physical and mental health, which was not hypothesized.
The observations that more men and males with SCI/D aged 50 years or older participated in adaptive sport is consistent with the literature exploring sport participation in older adults (37). Increased sport participation in men compared to women has been postulated to be the result of cultural ideals and gender stereotypes instilled since childhood (38). This coincides with the concept of gender schema, in which individuals formulate beliefs and perceptions about their gender and choose to participate in activities or experiences (i.e. sport, adaptive sport) that conform to their gender identity (38). These concepts may also be relevant in the SCI/D population in the contexts of self-limiting beliefs as well as the facilitation of adaptive sport participation from peers, healthcare workers, and other social resources and supports.
This study demonstrated that a greater percentage of adults living with SCI/D aged 50–59 participated in adaptive sport compared to those aged 60 years or older. This finding is consistent with previous studies investigating sport participation in older adults without SCI/D (39). It is well understood that older adults experience an increased risk of developing chronic diseases and health complications, which can prevent participation in sport (40). This is similarly evident in the SCI/D population, in which those over the age of 65 have been found to have an increased risk for health challenges such as cardiovascular complications, arthritic joint pain, and have a lower overall mean health rating, when compared to those who were below the age of 65 (41). Jenkin et al. (40) determined that health consequences related to aging pose limitations for participating in sport in older adults (28), which may also apply to the aging SCI/D population.
Past studies have observed individuals with paraplegia to be more likely to participate in adaptive sport than those living with tetraplegia (23,42). This difference was proposed to be due to a reduced requirement for adaptive technologies to facilitate sport participation, higher thresholds before muscle and cardiorespiratory fatigue, and an overall higher level of function, allowing for more opportunities to participate (43). However, the results from this study, as well as those by McVeigh et al., (23) demonstrated that there were no significant differences between those who do and do not participate in sport with respect to neurological level of injury. Both McVeigh et al. (23) and this study had relatively small sample sizes that may have contributed to the inconsistencies with other literature. However, with advancements in adaptive technology, neurological level of injury is becoming less of a barrier to adaptive sport participation than ever before (23,25).
Individuals aged 50 years or older with SCI/D who participated in adaptive sport were significantly more satisfied with their physical health when compared to those who did not participate. This finding aligns with data from previous studies. Participation in sport and physical activity was found to improve subjective physical well-being through mechanisms such as increasing or maintaining functional capacity, strength, and cardiovascular health in older adults (44). Additionally, other studies have shown that participation in adaptive sport can have a positive impact on body composition, exercise performance, and subjective reports of pain in those living with SCI/D (16), which may also increase one’s contentment with their physical health.
Although adaptive sport has also been associated with greater satisfaction with social and psychological health in those living with SCI/D (16,23), there was no statistically significant difference between groups in our study. Individuals living with SCI/D experience depression, financial hardships, and lowered self-esteem (45), and participation in adaptive sport alone may not be sufficient to combat these challenges. Our survey corroborates these experiences, as about half of respondents who reported their household income (48.6%) earned less than the median after-tax income of Canadian households (46). Additionally, life satisfaction in those with SCI/D was shown to improve and stabilize after the first year post-SCI/D (47,48). Moreover, existing literature suggests that older adults in general often experience psychosocial difficulties, which may be compounded for older adults living with SCI/D (49).
Previous studies suggest that those with history of sport participation prior to the onset of SCI/D would be more likely to participate in sport post-injury or disease (39,50). In those with SCI/D as well as in older adults without SCI/D, those who participated in sport earlier in their life were more physically literate, had knowledge of how to participate in sport, were aware of the benefits of sport, and had higher rates of sport participation in older adulthood as a result (23,39). However, this study did not show a relationship between adaptive sport participation and involvement in sport prior to SCI/D, likely because almost all respondents (i.e. 90.3%) reported participating in sports pre-injury.
Limitations
This study was limited by its digital method of survey distribution. Participation may have been impacted by the ability to access and use a computer, especially considering our population of older adults with physical disabilities (48). Additionally, responses in this survey were self-reported, preventing the verification of demographic data, including injury characteristics. Finally, our survey was incentivized, and a large number of responses were suspected to be fraudulent. The impact of these responses was mitigated through the implementation of the REAL framework; however, future surveys may consider employing increased anti-fraudulent precautions such as the implementation of CAPTCHA questions, seriousness checks, as well as trick questions (35).
Clinical implications and future directions for research
It is important to address the inequality in adaptive sport participation seen with sex, gender, and age in order to enable a greater number of older adults living with SCI/D to experience the biopsychosocial benefits of adaptive sport and reach adequate levels of physical activity (16). This study provides further evidence for the need to address barriers and improve facilitators to adaptive sport participation in aging adults with SCI/D. Given that most participants expressed that ‘difficulty traveling to and from sports activity’ was a barrier to adaptive sport participation, current recreation therapists can consider the implementation of virtual sport programs, and physical therapists can explore their role in enabling safe participation across a virtual platform. Moreover, participants expressed that having ‘friends/peers who also participate in adaptive sports’ and ‘social support to participate in adaptive sports’ were facilitators to participation. This finding confirms the need for clinicians to implement group-based sport interventions and to involve families, friends, and caregivers whenever possible throughout the process. Additionally, sport programs targeting aging women with SCI/D should be considered. Given that women may be less likely to take risks and are more likely to experience caregiving burden, clinicians should implement a short, low commitment sport intervention to encourage participation (51). For instance, a sport program can span a short 4-week period, be only 30 min long in duration, and allow women to trial a session with no obligation to continue. To enhance engagement of older people (e.g. aged 60 years or older) within this subgroup of aging adults with SCI/D, it is worth considering a gentle sport intervention that is lower in intensity, duration, and/or frequency, and includes more monitoring by physical therapists and medical staff. Future studies should explore these options, and further investigate the barriers and facilitators to determine those that will be most impactful to effect change.
Conclusion
Individuals aged 50 years or older living with a SCI/D who participated in adaptive sport were more likely to be male, identify as a man, be younger, and report a greater satisfaction with overall physical health. Of those who participated in adaptive sport, most participated in individual sports, at the recreational level and 1–4 times per week for 1–5 years. A lack of physical capacity, challenges with travel, and COVID-19 were the most common barriers, whereas the desire to improve physical and mental health was the most common facilitator.
Acknowledgements
The authors would like to acknowledge Katherine Chan MSc for her assistance with data analysis.
Appendix: Survey English Version.
Survey for people with SCI/D
Thank you for participating in this survey. This survey will ask questions about your experiences with SCI/D and adaptive sport participation.
Adaptive sport refers to sport that has been modified to allow people living with physical and/or cognitive disabilities to participate, either recreationally or competitively. For the purposes of this survey, sport is defined as a physical activity that involves physical exertion, skill, hand-eye coordination, contains elements of competition, and formally exists through organizations. Examples of adaptive sport include individual or team sports such as wheelchair basketball, sledge hockey, adaptive track and field (this is a non-exhaustive list).
Please note: you do not need to have experience in adaptive sport to participate in this survey.
Demographic questions
1. What is your gender?
□ Man
□ Woman
□ Non-binary/third gender
□ Prefer not to say
□ Prefer to self-describe: _______
2. What is your sex?
□ Male
□ Female
□ Intersex
□ Prefer not to say
□ Other, please specify _______
3. We know that people of different races do not have significantly different genetics. But our race still has important consequences, including how we are treated by different individuals and institutions. Which race category best describes you? Select all that apply:
□ Black African, Afro-Caribbean, African Canadian descent
□ East/Southeast Asian Chinese, Korean, Japanese, Taiwanese descent or Filipino, Vietnamese, Cambodian, Thai, Indonesian, other Southeast Asian descent
□ Indigenous (First Nations, Métis, Inuk/Inuit) First Nations, Métis, Inuk/Inuit descent
□ Latino Latin American, Hispanic descent
□ Middle Eastern Arab, Persian, West Asian descent (e.g. Afghan, Egyptian, Iranian, Lebanese, Turkish, Kurdish)
□ South Asian South Asian descent (e.g. East Indian, Pakistani, Bangladeshi, Sri Lankan, Indo-Caribbean)
□ White European descent
□ Another race category Includes values not described above (please specify): _________________
□ Do not know
□ Prefer not to say
4. What is your age?
□ 50 to 54 years old
□ 55 to 59 years old
□ 60 to 64 years old
□ 65 to 69 years old
□ 70 to 74 years old
□ 75 years or older
5. What is the province/territory where you currently live?
□ Alberta
□ British Columbia
□ Manitoba
□ New Brunswick
□ Newfoundland and Labrador
□ Ontario
□ Prince Edward Island
□ Quebec
□ Saskatchewan
□ Northwest Territories
□ Nova Scotia
□ Nunavut
□ Yukon
6. What is your current employment status?
□ Full time (30+ hours per week)
□ Part time (Less than 30 h per week)
□ Casual (Temporary or as needed)
□ Unemployed
□ Retired
□ Looking for work
□ Other: _______
7. Please indicate your household income range:
□ $0 to $19,999
□ $20,000 to $49,999
□ $50,000 to $99,999
□ $100,000 and over
□ Prefer not to say
8. What is your primary mode of transportation? (select all that apply)
□ Public Transit
□ Car (drives own vehicle)
□ Wheelchair/Walking
□ Relies on others
□ Accessible transport (e.g. Wheeltrans or other accessible transport services in your area)
□ Other (please specify) _____
9. What is your area of residence?
□ Rural
□ Suburban
□ Urban
10. Please indicate the American Spinal Injury Association Impairment Scale (AIS) rating of your spinal cord injury, if you know it:
□ AIS A - Complete (No motor or sensory function is preserved)
□ AIS B - Sensory Incomplete (Sensory function preserved but no motor function is preserved below the neurological level)
□ AIS C - Motor Incomplete (Motor function is preserved below the neurological level, cannot raise legs or arms off bed)
□ AIS D - Motor Incomplete (Motor function is preserved below the neurological level, can raise legs or arms off bed)
□ Not sure
11. Do you have Paraplegia or Tetraplegia?
□ Paraplegia
□ Tetraplegia
□ Not sure
12. Was the mechanism of your spinal cord injury caused by a traumatic or non-traumatic event?
□ Traumatic (e.g. motor vehicle accident, fall)
□ Non-traumatic (e.g. tumor, infection, degenerative condition)
13. How long have you been living with spinal cord injury?
□ 6 months to under 1 year
□ 1 to 5 years
□ 6 to 10 years
□ More than 10 years
14. How often did you participate in physical activity prior to your injury or disease?
□ I did not engage in any physical activity
□ 1 to 2 sessions per week
□ 3 to 4 sessions per week
□ 5 to 6 sessions per week
□ 7+ sessions per week
15. Did you participate in sports prior to your injury or disease?
□ Yes
□ No
16. How strongly do you agree or disagree with the following statement?
| Strongly Disagree | Disagree | Neither agree nor Disagree | Agree | Strongly Agree | |
|---|---|---|---|---|---|
| Participation in sport was important to me prior to SCI/D. |
17. How strongly do you agree or disagree with the following statements?
| Strongly Disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree | |
|---|---|---|---|---|---|
| I am content with my physical health. (‘physical’ refers to the body or processes of the body) | |||||
| I am content with my psychological health. (‘psychological’ refers to the mind or processes of the mind) | |||||
| I am content with my social health. (‘social’ refers to the interactions or sense of interactions among individuals.) |
18. Do you currently participate in adaptive sports? (Adaptive sport refers to sport that has been modified to allow people living with physical and/or cognitive disabilities to participate, either recreationally or competitively).
□ Yes
□ No
<If ‘No’ is selected, skip ahead to question 33 (PART B)>
<If ‘Yes’ is selected, proceed to question 19 (PART A)>
PART A: Currently Participate in Sport
19. Do you participate in individual or team adaptive sports?
□ Individual
□ Team
□ Both
<If ‘Individual’ is selected, proceed to question 20>
<If ‘Team’ is selected, skip ahead to question 21>
<If ‘Both’ is selected, Proceed to question 20 and 21 >
20. Which adaptive individual sport(s) are you currently participating in? (select all that apply)
□ Archery
□ Cross country sledding
□ Golf
□ Martial arts
□ Para-triathlon
□ Rowing
□ Rock climbing
□ Sit skiing/snowboarding
□ Surfing
□ Swimming
□ Table tennis
□ Track and field
□ Water skiing
□ Weightlifting/powerlifting
□ Wheelchair fencing
□ Wheelchair racing/handcycling
□ Wheelchair tennis
□ Other (please specify): _________________
21. Which adaptive team sport(s) are you currently participating in? (select all that apply)
□ Baseball
□ Power soccer
□ Softball
□ Sitting volleyball
□ Sledge hockey
□ Table tennis
□ Wheelchair badminton
□ Wheelchair basketball
□ Wheelchair boccia
□ Wheelchair curling
□ Wheelchair handball
□ Wheelchair hockey
□ Wheelchair rugby
□ Wheelchair tennis
□ Other (please specify): _________________
22. What is the competitive level of the adaptive sports you are currently participating in? (select all that apply)
□ Recreational (i.e. leisure)
□ Regional (i.e. competing in local leagues, regional competition)
□ Provincial (i.e. competing against different cities across the province/territory)
□ National (i.e. competing against different provinces/territories across Canada)
□ International (e.g. competing at Paralympics, Commonwealth Games)
23. How long have you been participating in your adaptive sport?
□ Under 1 year
□ 1 to 5 years
□ 6 to 10 years
□ 11–15 years
□ 16–20 years
□ Over 20 years
24. How were you introduced to sport? (select all that apply)
□ Introduced by healthcare provider(s)
□ Introduced by family and/or friends (e.g. word of mouth)
□ Searching online
□ Introduced through organizations (e.g. Spinal Cord Injury Canada)
□ Other (please specify): _________________
25. On average, how many times per week do you participate in adaptive sports?
□ Less than once per week
□ 1 to 2 times per week
□ 3 to 4 times per week
□ 5 to 6 times per week
□ 7 or more times per week
26. On average, how long do your adaptive sport sessions last?
□ Less than 1 h per session
□ 1 h per session
□ 2 h per session
□ 3 h per session
□ More than 3 h per session
27. Regarding motivation for adaptive sport participation, please select all the statements that you agree with. (select all that apply)
□ I participate in adaptive sports to raise awareness/inspire others
□ I participate in adaptive sports to improve health (e.g. improving strength and function, mental health)
□ I participate in adaptive sports to develop and form relationships
□ I participate in adaptive sports to engage in competition or challenge
□ I participate in adaptive sports to have an outlet (e.g. relieving stress, negative emotions)
□ I participate in adaptive sports for leisure or enjoyment
□ Other (please specify): _________________
28. For the following options, please select the statement that best represents your perspective on potential barriers to sport participation. Please rate each on a scale from strongly disagree to strongly agree.
| Strongly Disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree | |
|---|---|---|---|---|---|
| I do not have enough time to participate in adaptive sports. | |||||
| I do not live somewhere close to where adaptive sports are accessible. | |||||
| I do not have access to funding to participate in adaptive sports (e.g. to purchase equipment or membership, to travel). | |||||
| I do not have access to equipment. | |||||
| I am not interested in participating in sports. | |||||
| It is too challenging to travel to and from the sports activity. | |||||
| I feel as if I do not have the physical capacity to do so. | |||||
| I feel as if I do not have the mental capacity to do so. | |||||
| The COVID-19 pandemic is a barrier to my participation in sport. | |||||
| I receive messages about sport from peers and/or society that deters my sport participation |
29. If a barrier was not listed above, please indicate it:
Barrier: __________
30. For the following options, please select the statement that best represents your perspective on potential facilitators for adaptive sport participation. Please rate each on a scale from strongly disagree to strongly agree.
| Strongly Disagree | Disagree | Neither Agree nor Disagree | Agree | Strongly Agree | |
|---|---|---|---|---|---|
| I am interested in adaptive sport participation. | |||||
| I have a desire to maintain/improve my physical and/or mental health. | |||||
| I have the social support to participate in adaptive sports (i.e. from family, friends, spouse, organization). | |||||
| I have friends/peers who also participate in adaptive sports. | |||||
| I have access to equipment (i.e. to purchase, maintenance, storage). | |||||
| I have access to transportation to and from the sports facility/course. | |||||
| The sports facilities/courses I go to are accessible. | |||||
| I have financial stability or support to participate in sport. | |||||
| My pre-injury sport participation motivates me to continue participating in sport. |
31. If a facilitator was not listed above, please indicate it:
Facilitator: __________
PART B: Used to participate in adaptive sports
32. Did you previously participate in adaptive sports?
□ Yes
□ No
<If ‘no’ is selected, skip ahead to question 45 (PART C)>
<If ‘Yes’ is selected, proceed to question 33>
33. Which adaptive individual sport(s) did you used to participate in? (select all that apply)
□ Archery
□ Cross country sledding
□ Golf
□ Martial arts
□ Para-triathlon
□ Rowing
□ Rock climbing
□ Sit skiing/snowboarding
□ Surfing
□ Swimming
□ Table tennis
□ Track and field
□ Water skiing
□ Weightlifting/powerlifting
□ Wheelchair fencing
□ Wheelchair racing/handcycling
□ Wheelchair tennis
□ Other (please specify): ________________
34. Which adaptive team sport(s)did you used to participate in? (select all that apply)
□ Baseball
□ Power soccer
□ Softball
□ Sitting volleyball
□ Sledge hockey
□ Table tennis
□ Wheelchair badminton
□ Wheelchair basketball
□ Wheelchair boccia
□ Wheelchair curling
□ Wheelchair handball
□ Wheelchair hockey
□ Wheelchair rugby
□ Wheelchair tennis
□ Other (please specify): _________________
35. What is the competitive level of the adaptive sports you participated in? (select all that apply)
□ Recreational (i.e. leisure)
□ Regional (i.e. competing in local leagues, regional competition)
□ Provincial (i.e. competing against different cities across the province/territory)
□ National (i.e. competing against different provinces/territories across Canada)
□ International (e.g. competing at the Paralympics, Commonwealth Games)
36. How long did you participate in adaptive sports before you stopped?
□ Under 1 year
□ 1 to 5 years
□ 6 to 10 years
□ 11–15 years
□ 16–20 years
□ Over 20 years
37. How were you introduced to adaptive sports? (select all that apply)
□ Introduced by healthcare provider(s)
□ Introduced by family and/or friends (e.g. word of mouth)
□ Searching online
□ Introduced through organisations (e.g. Spinal Cord Injury Canada)
□ Other (please specify): _________________
38. On average, how many times per week did you participate in adaptive sports?
□ Less than once per week
□ 1 to 2 times per week
□ 3 to 4 times per week
□ 5 to 6 times per week
□ 7 or more times per week
39. On average, how long did your adaptive sport sessions last?
□ Less than 1 h per session
□ 1 h per session
□ 2 h per session
□ 3 h per session
□ More than 3 h per session
40. Regarding motivation for adaptive sport participation, please select all the statements that you agree with. (select all that apply)
□ I participated in adaptive sports to raise awareness/inspire others
□ I participated in adaptive sports to improve health (e.g. improving strength and function, mental health)
□ I participated in adaptive sports to develop and form relationships
□ I participated in adaptive sports to engage in competition or challenge
□ I participated in adaptive sports to have an outlet (e.g. relieving stress, negative emotions)
□ I participated in adaptive sports for leisure or enjoyment
□ Other (please specify): _________________
41. For the following options, please select the statement that best represents your perspective on potential barriers to sport participation. Please rate each on a scale from strongly disagree to strongly agree.
| Strongly Disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree | |
|---|---|---|---|---|---|
| I did not have enough time to participate in adaptive sports. | |||||
| I did not live somewhere close to where adaptive sports is accessible. | |||||
| I did not have access to funding to participate in adaptive sports (e.g. to purchase equipment or membership, to travel). | |||||
| I did not have access to equipment. | |||||
| I was no longer interested in participating in sports. | |||||
| It was too challenging to travel to and from the sports activity. | |||||
| I felt as if I did not have the physical capacity to do so. | |||||
| I felt as if I did not have the mental capacity to do so. | |||||
| The COVID-19 pandemic was a barrier to my participation in sport. | |||||
| I received messages about sport from peers and/or society that deterred my sport participation. |
42. If a barrier was not listed above, please indicate it:
Barrier: __________
43. For the following options, please select the statement that best represents your perspective on potential facilitators to sport participation. Please rate each on a scale from strongly disagree to strongly agree.
| Strongly Disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree | |
|---|---|---|---|---|---|
| I was interested in adaptive sport participation. | |||||
| I had a desire to maintain/improve my physical and/or mental health. | |||||
| I had the social support to participate in adaptive sports (i.e. from family, friends, spouse, organization). | |||||
| I had friends/peers who also participate in adaptive sports. | |||||
| I had access to equipment (i.e. to purchase, maintenance, storage). | |||||
| I had access to transportation to and from the sports facility/course. | |||||
| The sports facilities/courses I went to were accessible. | |||||
| I had financial stability or support to participate in sport. | |||||
| My pre-injury sport participation motivated me to continue participating in sport. |
44. If a facilitator was not listed above, please indicate it
Facilitator: __________
PART C: Never participated in sports
45. For the following options, please select the statement that best represents your perspective on potential barriers to sport participation. Please rate each on a scale from strongly disagree to strongly agree.
| Strongly Disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree | |
|---|---|---|---|---|---|
| I do not have enough time to participate in adaptive sports. | |||||
| I do not live somewhere close to where adaptive sports is accessible. | |||||
| I do not have access to funding to participate in adaptive sports (e.g. to purchase equipment or membership, to travel). | |||||
| I do not have access to equipment. | |||||
| I am not interested in participating in sports. | |||||
| It is too challenging to travel to and from the sports activity. | |||||
| I feel as if I do not have the physical capacity to do so. | |||||
| I feel as if I do not have the mental capacity to do so. | |||||
| The COVID-19 pandemic was a barrier to my participation in sport. | |||||
| I receive messages about sport from peers and/or society that deters my sport participation |
46. If a barrier was not listed above, please indicate:
Barrier: __________
47. Do you have a desire to participate in adaptive sport?
□ Yes
□ No
<If ‘No’ is selected, skip ahead to end of survey >
<If ‘Yes’ is selected, proceed to question 48>
48. If you answered yes to the previous question, what type of individual sports are you interested in trying if you had the opportunity? (select all that apply)
□ Archery
□ Cross country sledding
□ Golf
□ Martial arts
□ Para-triathlon
□ Rowing
□ Rock climbing
□ Sit skiing/snowboarding
□ Surfing
□ Swimming
□ Table tennis
□ Track and field
□ Water skiing
□ Weightlifting/powerlifting
□ Wheelchair fencing
□ Wheelchair racing/handcycling
□ Wheelchair tennis
□ Other (please specify): _________________
49. If you answered yes to the previous question, what type of team sports are you interested in trying if you had the opportunity? (select all that apply)
□ Baseball
□ Power soccer
□ Softball
□ Sitting volleyball
□ Sledge hockey
□ Table tennis
□ Wheelchair badminton
□ Wheelchair basketball
□ Wheelchair boccia
□ Wheelchair curling
□ Wheelchair handball
□ Wheelchair hockey
□ Wheelchair rugby
□ Wheelchair tennis
□ Other:_______
Thank you very much for your participation! If you would like to be entered into the prize draw, please enter your email address here.
Email address: _______________________________
Funding Statement
This work was supported by the Canada Research Chairs program (KEM).
Disclaimer statements
Contributors None.
Conflicts of interest No potential conflict of interest was reported by the author(s).
References
- 1.De Luca d’Alessandro E, Bonacci S, Giraldi G.. Aging populations: the health and quality of life of the elderly. Clin Ter 2011;162(1):e13–e18. [PubMed] [Google Scholar]
- 2.MacNee W, Rabinovich RA, Choudhury G.. Ageing and the border between health and disease. Eur Respir J 2014 Nov;44(5):1332–1352. doi: 10.1183/09031936.00134014 [DOI] [PubMed] [Google Scholar]
- 3.Carman MB. The psychology of normal aging. Psychiatr Clin North Am 1997 Mar;20(1):15–24. doi: 10.1016/S0193-953X(05)70390-7 [DOI] [PubMed] [Google Scholar]
- 4.Hitzig SL, Eng JJ, Miller WC, Sakakibara BM, Research Team SCIRE.. An evidence-based review of aging of the body systems following spinal cord injury. Spinal Cord 2011 Jun;49(6):684–701. doi: 10.1038/sc.2010.178 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Park JH, Moon JH, Kim HJ, Kong MH, Oh YH.. Sedentary lifestyle: overview of updated evidence of potential health risks. Korean J Fam Med 2020 Nov 19;41(6):365–373. doi: 10.4082/kjfm.20.0165 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Groah SL, Charlifue S, Tate D, Jensen MP, Molton IR, Forchheimer M, et al. Spinal cord injury and aging: challenges and recommendations for future research. Am J Phys Med Rehabil 2012 Jan;91(1):80–93. doi: 10.1097/PHM.0b013e31821f70bc [DOI] [PubMed] [Google Scholar]
- 7.Cimino SR, Hitzig SL, Craven BC, Bassett-Gunter RL, Li J, Guilcher SJT.. An exploration of perceived social isolation among persons with spinal cord injury in Ontario, Canada: a qualitative study. Disabil Rehabil 2022 Jul;44(14):3400–3409. doi: 10.1080/09638288.2020.1861485 [DOI] [PubMed] [Google Scholar]
- 8.Newman SD, Li C, Krause JS.. Social isolation after spinal cord injury: indicators from the longitudinal aging study. Rehabil Psychol 2016 Nov;61(4):408–416. doi: 10.1037/rep0000112 [DOI] [PubMed] [Google Scholar]
- 9.Alve YA, Bontje P.. Factors influencing participation in daily activities by persons with spinal cord injury: lessons learned from an international scoping review. Top Spinal Cord Inj Rehabil 2019;25(1):41–61. doi: 10.1310/sci2501-41 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Noreau L, Fougeyrollas P, Post M, Asano M.. Participation after spinal cord injury: the evolution of conceptualization and measurement. J Neurol Phys Ther 2005 Sep;29(3):147–156. doi: 10.1097/01.NPT.0000282247.15911.dc [DOI] [PubMed] [Google Scholar]
- 11.Fann JR, Bombardier CH, Richards JS, Tate DG, Wilson CS, Temkin N, et al. Depression after spinal cord injury: comorbidities, mental health service use, and adequacy of treatment. Arch Phys Med Rehabil 2011 Mar;92(3):352–360. doi: 10.1016/j.apmr.2010.05.016 [DOI] [PubMed] [Google Scholar]
- 12.Chang F-H, Wang Y-H, Jang Y, Wang C-W.. Factors associated with quality of life among people with spinal cord injury: application of the international classification of functioning, disability and health model. Arch Phys Med Rehabil 2012 Dec;93(12):2264–2270. doi: 10.1016/j.apmr.2012.06.008 [DOI] [PubMed] [Google Scholar]
- 13.Elliott TR, Frank RG.. Depression following spinal cord injury. Arch Phys Med Rehabil 1996 Aug;77(8):816–823. doi: 10.1016/S0003-9993(96)90263-4 [DOI] [PubMed] [Google Scholar]
- 14.Pink B. Defining sport and physical activity: a conceptual model. Cambera: Australian Bureau of Statistics; 2018. [Google Scholar]
- 15.Herrmann KH, Kirchberger I, Biering-Sørensen F, Cieza A.. Differences in functioning of individuals with tetraplegia and paraplegia according to the international classification of functioning, disability and health (ICF). Spinal Cord 2011 Apr;49(4):534–543. doi: 10.1038/sc.2010.156 [DOI] [PubMed] [Google Scholar]
- 16.Cheung L, Chan K, Heffernan MG, Pakosh M, Hitzig SL, Marzolini S, et al. The impact of sport participation for individuals with spinal cord injury: A scoping review. NeuroRehabilitation 2022;51(3):353–395. doi: 10.3233/NRE-220037 [DOI] [PubMed] [Google Scholar]
- 17.Cheung L, McKay B, Chan K, Heffernan MG, Pakosh M, Musselman KE.. Exploring sport participation in individuals with spinal cord injury: a qualitative thematic synthesis. J Spinal Cord Med 2023 Jul;46(4):658–676. doi: 10.1080/10790268.2021.2009676 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Goktepe AS, Yilmaz B, Alaca R, Yazicioglu K, Mohur H, Gunduz S.. Bone density loss after spinal cord injury: elite paraplegic basketball players vs. paraplegic sedentary persons. Am J Phys Med Rehabil 2004 Apr;83(4):279–283. doi: 10.1097/01.PHM.0000118036.20170.6C [DOI] [PubMed] [Google Scholar]
- 19.Silva Md, Oliveira Rd, Conceição MIG.. Efeitos da natação sobre a independência funcional de pacientes com lesão medular. Rev Bras Med Esporte 2005 Aug;11(4):251–256. doi: 10.1590/S1517-86922005000400010 [DOI] [Google Scholar]
- 20.Furmaniuk L, Cywińska-Wasilewska G, Kaczmarek D.. Influence of long-term wheelchair rugby training on the functional abilities in persons with tetraplegia over a two-year post-spinal cord injury. J Rehabil Med 2010 Jul;42(7):688–690. doi: 10.2340/16501977-0580 [DOI] [PubMed] [Google Scholar]
- 21.Stephens C, Neil R, Smith P.. The perceived benefits and barriers of sport in spinal cord injured individuals: a qualitative study. Disabil Rehabil 2012 Apr 12;34(24):2061–2070. doi: 10.3109/09638288.2012.669020 [DOI] [PubMed] [Google Scholar]
- 22.Allan V, Smith B, Côté J, Martin Ginis KA, Latimer-Cheung AE.. Narratives of participation among individuals with physical disabilities: a life-course analysis of athletes’ experiences and development in parasport. Psychol Sport Exerc 2018 Jul;37:170–178. doi: 10.1016/j.psychsport.2017.10.004 [DOI] [Google Scholar]
- 23.McVeigh SA, Hitzig SL, Craven BC.. Influence of sport participation on community integration and quality of life: a comparison between sport participants and non-sport participants with spinal cord injury. J Spinal Cord Med 2009;32(2):115–124. doi: 10.1080/10790268.2009.11760762 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Ginis KA, Jörgensen S, Stapleton J.. Exercise and sport for persons with spinal cord injury. Pm&r 2012 Nov 1;4(11):894–900. doi: 10.1016/j.pmrj.2012.08.006 [DOI] [PubMed] [Google Scholar]
- 25.Rayes R, Ball C, Lee K, White C.. Adaptive sports in spinal cord injury: a systematic review. Curr Phys Med Rehabil Rep 2022 Jul 7;10(3):145–153. doi: 10.1007/s40141-022-00358-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Stenner BJ, Buckley JD, Mosewich AD.. Reasons why older adults play sport: a systematic review. J Sport Health Sci 2020 Dec;9(6):530–541. doi: 10.1016/j.jshs.2019.11.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Gayman AM, Fraser-Thomas J, Dionigi RA, Horton S, Baker J.. Is sport good for older adults? A systematic review of psychosocial outcomes of older adults’ sport participation. Int Rev Sport Exerc Psychol 2017 Jan;10(1):164–185. doi: 10.1080/1750984X.2016.1199046 [DOI] [Google Scholar]
- 28.Jenkin CR, Eime RM, Westerbeek H, O’Sullivan G, van Uffelen JGZ.. Sport and ageing: a systematic review of the determinants and trends of participation in sport for older adults. BMC Public Health 2017 Dec 22;17(1):976. doi: 10.1186/s12889-017-4970-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Slater D, Meade MA.. Participation in recreation and sports for persons with spinal cord injury: review and recommendations. NeuroRehabilitation 2004;19(2):121–129. doi: 10.3233/NRE-2004-19206 [DOI] [PubMed] [Google Scholar]
- 30.Cheung L, Chiang J, Kaiser A, Patterson KK, Musselman KE.. Exploring the experiences and perceptions of adults with spinal cord injury or disease aged 50 years or older on participation in sports. Topics in Spinal Cord Injury Rehabilitation. 2023;29(4):37–50. doi: 10.46292/sci23-00028 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Craven BC, Verrier M, Balioussis C, Wolfe D, Hsieh J, Noonan V.. Rehabilitation environmental scan atlas: capturing capacity in Canadian SCI rehabilitation. Rick Hansen Institute 2012. [Google Scholar]
- 32.Noonan VK, Fingas M, Farry A, Baxter D, Singh A, Fehlings MG, et al. Incidence and prevalence of spinal cord injury in Canada: a national perspective. Neuroepidemiology 2012 Apr 27;38(4):219–226. doi: 10.1159/000336014 [DOI] [PubMed] [Google Scholar]
- 33.Sharma A, Minh Duc NT, Luu Lam Thang T, Nam NH, Ng SJ, Abbas KS, et al. A consensus-based checklist for reporting of survey studies (CROSS). J Gen Intern Med 2021 Oct;36(10):3179–3187. doi: 10.1007/s11606-021-06737-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.LimeSurvey GmbH . Limesurvey: an open source survey tool. Hamburg, Germany: Limesurvey GmbH; 2020. [Google Scholar]
- 35.Lawlor J, Thomas C, Guhin AT, Kenyon K, Lerner MD, UCAS Consortium, et al. Suspicious and fraudulent online survey participation: introducing the REAL framework. Methodol Innov 2021 Sep;14(3):205979912110504. doi: 10.1177/20597991211050467 [DOI] [Google Scholar]
- 36.IBM Corporation . Statistical package for social sciences. Armonk: IBM Corporation; 2016. [Google Scholar]
- 37.Davison R. Sports participation and ageing- influence and impact. Observatory for Sport in Scotland 2020 May 12. [Google Scholar]
- 38.Chalabaev A, Sarrazin P, Fontayne P, Boiché J, Clément-Guillotin C.. The influence of sex stereotypes and gender roles on participation and performance in sport and exercise: review and future directions. Psychol Sport Exerc 2013 Mar;14(2):136–144. doi: 10.1016/j.psychsport.2012.10.005 [DOI] [Google Scholar]
- 39.Ward K, Pousette A, Pelletier CA.. ‘Not everybody’s an athlete, but they certainly can move’: facilitators of physical activity maintenance in older adults in a northern and rural setting. J Aging Phys Act 2020 Jun 4;28:1–10. [DOI] [PubMed] [Google Scholar]
- 40.Jenkin CR, Eime RM, Westerbeek H, van Uffelen JGZ.. Sport for adults aged 50+ years: participation benefits and barriers. J Aging Phys Act 2018 Jul 1;26(3):363–371. doi: 10.1123/japa.2017-0092 [DOI] [PubMed] [Google Scholar]
- 41.Hitzig SL, Tonack M, Campbell KA, McGillivray CF, Boschen KA, Richards K, et al. Secondary health complications in an aging Canadian spinal cord injury sample. Am J Phys Med Rehabil 2008 Jul;87(7):545–555. doi: 10.1097/PHM.0b013e31817c16d6 [DOI] [PubMed] [Google Scholar]
- 42.Muraki S, Tsunawake N, Hiramatsu S, Yamasaki M.. The effect of frequency and mode of sports activity on the psychological status in tetraplegics and paraplegics. Spinal Cord 2000 May;38(5):309–314. doi: 10.1038/sj.sc.3101002 [DOI] [PubMed] [Google Scholar]
- 43.Gaspar R, Padula N, Freitas TB, de Oliveira JPJ, Torriani-Pasin C.. Physical exercise for individuals with spinal cord injury: systematic review based on the international classification of functioning, disability, and health. J Sport Rehabil 2019 Jul 1;28(5):505–516. doi: 10.1123/jsr.2017-0185 [DOI] [PubMed] [Google Scholar]
- 44.An H-Y, Chen W, Wang C-W, Yang H-F, Huang W-T, Fan S-Y.. The relationships between physical activity and life satisfaction and happiness among young, middle-aged, and older adults. Int J Environ Res Public Health 2020 Jul 4;17(13). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 45.Khazaeipour Z, Norouzi-Javidan A, Kaveh M, Khanzadeh Mehrabani F, Kazazi E, Emami-Razavi S-H.. Psychosocial outcomes following spinal cord injury in Iran. J Spinal Cord Med 2014 May;37(3):338–345. doi: 10.1179/2045772313Y.0000000174 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 46.Statistics Canada . Focus on geography series, 2021 Census of Population Canada [Internet]. Statistics Canada. 2022 [cited 2023 Jul 15]. https://www12.statcan.gc.ca/census-recensement/2021/as-sa/fogs-spg/page.cfm?lang=E&topic=5&dguid=2021A000011124.
- 47.Post MWM, van Leeuwen CMC.. Psychosocial issues in spinal cord injury: a review. Spinal Cord 2012 May;50(5):382–389. doi: 10.1038/sc.2011.182 [DOI] [PubMed] [Google Scholar]
- 48.Post MWM, Leenders JMP, Tepper M, Snoek GJ, ALLRISC, van der Woude LHV, et al. Computer and internet use among people with long-standing spinal cord injury: a cross-sectional survey in The Netherlands. Spinal Cord 2019 May;57(5):396–403. doi: 10.1038/s41393-018-0237-1 [DOI] [PubMed] [Google Scholar]
- 49.Ross L, Jennings P, Williams B.. Psychosocial support issues affecting older patients: a cross-sectional paramedic perspective. Inquiry 2017 Jan 1;54:46958017731963. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 50.Zainudin MF, Ahmad Fauzi A.. Factors associated with sports participation amongst people with spinal cord injury in a Malaysian tertiary hospital. J Spinal Cord Med 2023 Jan;46(1):91–98. doi: 10.1080/10790268.2021.1950454 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 51.Nielsen MW, Stefanick ML, Peragine D, Neilands TB, Ioannidis JPA, Pilote L, et al. Gender-related variables for health research. Biol Sex Differ 2021 Feb 22;12(1):23. doi: 10.1186/s13293-021-00366-3 [DOI] [PMC free article] [PubMed] [Google Scholar]