Contradictory Roles of Exercise Participation: A Qualitative Synthesis

Background: Exercise is becoming increasingly medicalized among populations experiencing disability such as those with multiple sclerosis (MS). Medicalized exercise emphasizes rehabilitation and perpetuates compulsory able-bodiedness as a form of ableism which can impede the important process of disability identity navigation. This impacts psychosocial outcomes, especially anxiety, depression and quality of life. Objectives: To gain an understanding of the impact of medicalized exercise promotion on disability identity and exercise participation among persons with MS. Methods: Using the Social Relational Model of Disability as well as Mingus’ concepts of descriptive and political disability, an interpretative phenomenological analysis was conducted with 22 interviews spanning the two interview subsets. These two interview subsets focused on the experiences with exercise among adults with MS. Results: Results of this synthesis revealed several themes: vigilance over exercise and inactivity; exercise for self-care, social engagement and productivity; schisms in self; and ableism in exercise spaces. These themes demonstrate that an overemphasis on the medical benefits of exercise can reinforce feelings of direct responsibility over an individual’s disease course, contributes to both empowerment and disempowerment, can be beneficial for mental health and is detrimental to mental health outcomes, and serves a variety of other contradictory roles including roles related to self-concept. Furthermore, while guilt and shame were somewhat motivating to some participants, overall, these messages seemed to be very demotivating and did not result in long-term exercise participation as described by the participants. Conclusions: As practitioners and researchers move forward in exercise promotion, care must be taken to ensure this happens ethically, accessibly, and in ways that do not disrupt the important process of navigating a disability identity. Importantly, efforts to increase long-term exercise participation among those with MS should not undermine the psychological benefits of exercise through promotion that perpetuates ableism.

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