The experiences of inaccessibility and ableism related to physical activity: a photo elicitation study among individuals with multiple sclerosis

Purpose: Strong evidence supports the benefits of physical activity (PA) and exercise for adults with multiple sclerosis (MS) and multidisciplinary PA guidelines exist. Previous research indicates that healthcare professionals may not yet widely promote exercise to their patients with MS. Before active promotion of PA/exercise becomes widespread practice for healthcare professionals, it is essential to understand the disability and inaccessibility-related barriers to exercise for this population. We sought to understand the barriers to PA/exercise among individuals with MS across a spectrum of MS impairment. Methods: Participants were instructed to take pictures of people, places and things that make PA/exercise easier or more difficult in preparation for a semi-structured interview. This photo elicitation approach allowed individuals to explain the barriers they faced even if they would not attribute those barriers to ableism or inaccessibility themselves. Interviews were analyzed using Interpretative Phenomenological Analysis. Results: Twenty-three persons with MS participated. Three main themes were: inaccessibility limits PA/exercise participation, ableism happens in the PA space, and assistive devices both provide access to PA and are associated with disability stigma. Conclusion: This study adds nuance to current understandings of the barriers and facilitators of PA in this population by illustrating the disability-specific barriers and experiences with inaccessibility. With increasing efforts to promote PA, there must be an increased awareness of the structural inequalities and barriers that physically and psychologically affect decision-making around PA.IMPLICATIONS FOR REHABILITATION There are many barriers to exercise for individuals with multiple sclerosis which prevent this population from experiencing the benefits of exercise. Rehabilitation professionals may play a role in drawing attention to accessible resources when providing recommendations or discussing barriers with their patients/clients. Rehabilitation professionals should consider that people with MS make decisions about assistive technology based on their needs, the meanings they attribute to it, expectations and attitudes of people around them. People with MS experience disability stigma as they participate in exercise and physical activity and this may extend into the rehabilitation space in the form of perceived compulsory ablebodiedness.