Community-based exercise for adults with neurological physical disability

Abstract

Adults with Neurological Conditions causing Physical Disability (AwNPD) experience barriers to participation in community-based exercise. Within Northern Ireland, there is no exercise pathway available to support participation for this population. This PhD aimed to explore perspectives of stakeholders on community-based exercise for AwNPDs and to co-design a relevant pathway.

A mixed methods systematic review synthesised the perspectives of exercise and healthcare professionals on community-based exercise for AwNPDs. Thirteen studies were included and appraised using the Standard Quality Assessment Criteria for Evaluating Primary Research from a Variety of Fields (QualSyst). Data were integrated using a convergent integrated approach whereby quantitative data were qualitised and analysed alongside qualitative data using reflexive thematic analysis. Three themes were identified: Resourcing the environment, professional roles and responsibilities, and strategies for success. Key barriers included long waiting lists, limited time during healthcare appointments, uncertainty regarding professional responsibilities and limited awareness of available services. Facilitators included collaborative training, improved interprofessional communication and strategies which would support motivation of AwNPDs.

Findings informed a five-stage Experience Based Co-Design (EBCD) study, which involved AwNPDs and stakeholders responsible for delivering community-based exercise. Stage one interviews were analysed using the listening guide to identify emotionally resonant points to stimulate cross-stakeholder discussions at a joint stakeholder event where priorities for pathway development included flexibility, accessibility and sustainability. These priorities informed a series of co-design workshops, producing a community-based exercise pathway incorporating dual referral routes, a preliminary programme for AwNPDs with precautions to exercise and opportunities for both group and independent exercise.

Subsequent stakeholder feedback outlined strong acceptability of the pathway whilst highlighting implementation considerations including referral processes, motivation, stigma, accessibility and financial constraints. This thesis presents the first co-designed community-based exercise pathway for AwNPDs in Northern Ireland and also demonstrates how EBCD can support service development where no current pathway exists.

Date of Award	May 2026
Original language	English
Sponsors	Department for the Economy
Supervisor	Katy Pedlow (Supervisor), Lucia Ramsey (Supervisor) & Karen Mc Connell (Supervisor)