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Research Article

Perceptions and beliefs of community-based fitness professionals working with people with disability: a qualitative study

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Received 09 Feb 2024, Accepted 27 Jun 2024, Published online: 07 Jul 2024

Abstract

Purpose

There are many benefits of sport and exercise however people with disability experience barriers to participation including negative interactions with fitness professionals. To understand this barrier further, this study explored the perceptions of community-based fitness professionals working with people with disability.

Materials and methods

Thirteen fitness professionals took part in one semi-structured interview. Data were analysed inductively using an interpretive description approach.

Results

Theme 1, “Understanding your client’s individual needs” highlighted the requirement for fitness professionals to be flexible to the needs of their clients. Theme 2 “You have to have a little bit of the knack” discussed the importance of maintaining a mutually respectful relationship, and the skills required to achieve this. Theme 3 “It needs to be a team approach” called for greater interprofessional collaboration with health professionals. Theme 4 “The barriers of gym culture” explored the negative stigma placed on people with disability in relation to sport and exercise. Theme 5 “Change is needed” highlighted changes required within the fitness industry to better support people with disability.

Conclusion

To facilitate inclusive service delivery, changes are required within the supports and resources available to fitness professionals thereby allowing them to cater to their diversifying client population.

IMPLICATIONS FOR REHABILITATION

  • Physical activity is widely acknowledged as crucial to the health and wellbeing of people with disability, with focus being placed on creating inclusive community-based physical activity opportunities rather than disability specific programs alone.

  • Community-based fitness professionals could provide important support towards enhancing inclusive physical activity participation for people with disability.

  • Community-based fitness professionals experience many personal and professional benefits from working with people with disability, although, also experience challenges.

  • To continue to work towards inclusion, community-based fitness professionals require further educational and funding support facilitating them to deliver safe and effective services to people with disability.

Introduction

An estimated 16% of the world’s population − 1.3 billion people – live with disability [Citation1]. Research has consistently found that people with disability are more likely to experience poorer physical and mental health when compared to people without disability [Citation1]. There is clear evidence supporting the benefits of regular physical activity participation including reduced risk of chronic health conditions, improved cognitive ability, and improved physical and mental health and wellbeing [Citation2,Citation3]. For people with disability, physical activity has also been found to result in improved physical function and independence, reduction of pain, increased feelings of empowerment, and social inclusion [Citation4,Citation5]. Compared with the general population physical activity participation rates among people with disabilities are low [Citation2–5], therefore, policies and programs which increase participation are required.

Globally, sport and exercise are two popular types of physical activity [Citation6]. Recent years have seen a growing emphasis on the integration of disability and non-disability sporting and exercise organisations, enhancing people with disability’s ability to participate in the activities of their choosing rather than being restricted to disability specific programs alone [Citation7–9]. Inclusive practice within sport and exercise requires a holistic approach with a clear understanding of the person, as well as their physical and social environment [Citation10]. Within the literature for people without disability, community-based fitness professionals (e.g., grassroot coaches, personal trainers, yoga instructors) have been consistently identified as pivotal social agents responsible for driving inclusivity within sport and exercise settings [Citation10]. However, for people with disability, community-based fitness professionals have been described as both a facilitator and a barrier to participation [Citation5,Citation11]. For example, when working with people with disability, fitness professionals have often been said to lack the knowledge and skill required to tailor and adapt activities and exercises and have been suggested to display negative attitudes and stigma towards people with disability [Citation5,Citation12]. Conversely, other studies have highlighted the positive interactions experienced between fitness professionals and people with disability as a crucial component to the person’s successful participation in sport and exercise [Citation13–16]. Further, within a survey study by Hill et al. [Citation17], participants discussed the potential for community-based fitness professionals to provide a more cost-effective option to people with disability when compared to allied health professionals. This was suggested to be particularly so for people with disability whose goal is to improve health and wellbeing more generally rather than requiring a specific therapeutic intervention requiring the expertise of a physiotherapist or exercise physiologist.

Until recently, research regarding the interaction between people with disability and fitness professionals has largely been from the perspective of people with disability and their families [Citation5,Citation12–16]. However, due to the important role community-based fitness professionals can play in supporting the inclusive participation of people with disability within meaningful forms of sport and exercise, it is imperative that their experience is understood. Within the available literature, community-based fitness professionals have described the personal fulfilment they experience when working with people with disability, as they have reported enjoying the challenge of needing to tailor their programs or specific exercises to their clients [Citation4,Citation10,Citation17,Citation18]. Despite the positives, fitness professionals have also noted several challenges to their role, including managing the expectations of other gym users, lack of accessibility within the physical environment, as well as lack of disability specific training [Citation4,Citation10,Citation17–19].

Although providing valuable insights, these studies are limited in their generalisability due to largely focusing on specific client populations (physical disability or intellectual disability), and/or working within specific environments (sporting facilities or gyms) [Citation4,Citation10,Citation18,Citation19]. As inclusive practice requires the individual needs and motivations of the person be considered [Citation7] it is important that the perspectives of community-based fitness professionals working with a range of disabilities, across a range of social and physical environments, be understood. As such, this study aimed to explore the perceptions and beliefs of community-based fitness professionals working in Australia regarding working with people with disability.

Methods

A qualitative study was conducted to gain in-depth understanding of the perceptions and beliefs of community-based fitness professionals working with people with disability. This study was given ethics approval by The University of Queensland (2021/HE0002303). All participants provided written consent prior to their participation. This study was completed in accordance with the Standards for Reporting Qualitative Research [Citation20]

Participants

Participants were invited to take part in this study if they were over the age of 18 and working as a community-based fitness professional (e.g., grassroot coaches, instructors, personal trainers) in Australia. This excluded sport and exercise allied health professionals such as exercise physiologists or physiotherapists. Further, to understand why fitness professionals might choose not to work with people with disability, fitness professionals were invited to take part in an interview irrespective of their experience working with people with disability. An email database was created after an internet search identifying 169 relevant community-based sporting and exercise organisations in which an invitation to participate was emailed directly. Additionally, a flyer outlining the study was shared on relevant Facebook pages and groups. Snowball sampling was also used as participants were encouraged to share information regarding the study amongst their networks.

Data collection

Interviews were conducted through the online videoconference software Zoom [Version 5.11.1]. All interviews were conducted by author JH (an occupational therapist and certified personal trainer with 10-years’ experience supporting people with disability participate in sport and exercise) and followed a semi-structured interview schedule () allowing topics to be explored with consistency and compatibility between participants. Interviews ranged from 30 to 90 min. All interviews were recorded and transcribed verbatim by KG (pre-entry occupational therapy research student) and reviewed by JH for accuracy. All participants were provided with a pseudonym at the point of transcription and all personal information omitted to ensure anonymity.

Table 1. Interview schedule.

Analysis

As per the interpretive description procedure outlined by Thorne [Citation21], an inductive thematic analysis was used to manually code information arising from the transcripts. Author KG reviewed 100% of the transcripts and JH independently reviewed a 40% sample which was representative of a range of ideas and perspectives provided by participants. Authors KG and JH worked to establish a single coding system meeting with EB (Clinical Exercise Physiologist) on two occasions to discuss including exploring viewpoints and perspectives of participants that could potentially oppose the final codes until consensus was met. After general coding was complete, pattern coding was undertaken by KG and JH to refine and group the codes into themes. The final themes were then discussed by KG, JH, and EB in two separate meetings to ensure consensus between all three authors were achieved.

Results

Thirteen (N = 13) community-based fitness professionals agreed to take part in this study (). Most were female (n = 10) and resided in metropolitan locations (n = 11). Participants identified themselves as coming from a range of different professional backgrounds relevant to sport and exercise including instructors (n = 3), coaches (n = 3), trainers (n = 8), and an exercise scientist (n = 1) with multiple participants holding more than one qualification. Participants also identified a wide range of experience working within the health and fitness industry (between 18 months to 48 years), and with people with disability (between 18 months and 30 years).

Table 2. Participant demographic data.

Overwhelmingly, participants highlighted the personal and professional benefits they experienced working with people with disability, with over half describing it as the most rewarding part of their role. However, along with these benefits also came several challenges. The overall perceptions and beliefs of fitness professionals were captured within five themes: (1) Understanding your client’s individual needs, (2) You have to have a little bit of the knack, (3) It needs to be a team approach, (4) The barriers of gym culture, and (5) Change is needed.

Theme 1: Understanding your client’s individual needs

All participants discussed the ways they altered their practice to meet the individual needs of their clients with disability. This was said to begin from their initial interaction during the goal setting process. Participants explained that the goals of their clients with disability often differed to those of clients without disability. Instead of performance or body composition goals, participants identified that when working with clients with disability, they often addressed participation-based goals such as improving social engagement, independence, and function, as well as confidence and self-efficacy.

Then we talk about different areas of like the social side of things, because they are coming out into a community environment…There’s also then like, you know their personal goals of becoming independent. (Cindy)

When delivering services to their clients with disability, participants frequently discussed how they needed to be “flexible”, “adaptive”, and respond to things “on the fly”. They discussed the importance of “meeting people where they’re at,” and understanding that the needs of their client could change on any given day. Ways in which participants described adapting their practices included the scheduling of appointments, the location in which sessions were run, the delivery of specific exercises and programs, as well as strategies and techniques used to motivate their clients.

So, we’ll have a plan about where they might want to go and what things we might be doing. But some days we might not even get up into the air, we may just stay on the ground and stretch because they…their bodies, that’s where they need to be…There needs to be a lot more flexibility both in programming, but also in like actual scheduling of appointments and turning up and things like that too. (Cindy)

Few participants worked with their clients with disability within mainstream sport and fitness facilities due to the environmental barriers they faced. Instead, participants took advantage of outdoor spaces such as community parks and fields, as well as worked within their clients’ homes. Whilst all participants valued the “challenge” and ability to be “creative” and “think outside the box” when working with clients with disability, they also acknowledged the additional work that was involved. They emphasised that for people with disability to be appropriately supported, fitness professionals needed to have the motivation and willingness to invest the additional time and effort.

You have to be willing to make those modifications and know what the modifications are, so that you can, you know give three or four options for each exercise that you teach, and a lot of people may not want to do that because it’s extra work. (Natalie)

Theme 2: You have a little bit of the knack

When discussing the specific skills required of community-based fitness professionals to work with people with disability safely and effectively, participants described a more intuitive process, rather than specific learnt behaviours. Participants highlighted several innate qualities they believed were crucial for all community-based fitness professionals to possess if working with people with disability. Firstly, participants emphasised the importance of fitness professionals letting go of their ego, and respecting the fact that their client was the expert of their body and their experience.

Because one of the things we primarily come back to is that the individual knows what’s going on…If anyone’s the expert, it’s them. They’re the expert for their own bodies. So, trusting them and listening to them is actually the best thing that we can do. (Cindy)

Participants also highlighted the importance of being willing and able to support their client’s needs beyond exercise prescription. For example, many discussed times in which they were required to assist their clients with transfers, activities of daily living such as drinking and toileting, as well as provide support with executive function such as assisting with scheduling and time management.

It’s getting them in the car, to get to the facility. Like some of my, one of my clients can’t drink water out of a water bottle because they have a choking issue, so I have to make sure that they’ve got a straw, you know. (Amy)

Participants also acknowledged the mental and physical energy required of their clients during their session, and the impact this could have on the ability to perform other occupations within their life. As a result, having empathy was identified as crucial by participants, as they often had limited knowledge of what events and/or activities had occurred for their client prior to their training session, and the impact this could have on their performance.

No day is ever the same…I think that’s the case for every single person when they walk into a room that day. Don’t know what they’ve done, what stressors they’re bringing, what injuries have happened. Same for people with disabilities, but it can generally be a bigger change from day to day. (Cindy)

Each time you step into a group of people you don’t know what people are experiencing. Things aren’t always visible. There’s a lot of hidden barriers. (Nikki)

Participants discussed the importance of rapport and taking the time to build “mutual trust” and “respect,” developing a pathway for “open communication”. Further, participants emphasised the importance of being “honest” and “transparent” when communicating with their clients, particularly if they were unsure about a particular strategy or technique they wanted to recommend.

So, you’re like, “Hey, we’re going to try this. We don’t know if it’s going to like one hundred percent work for you, but we’re gonna keep an eye on it. We’re gonna test and retest and see how you respond to it. If you’re not enjoying it, let me know.” So, the relationship has to be there. (Mitchel)

Finally, the importance of passion and tenacity were noted by several participants. Many believed that, to provide a safe and effective service to people with disability, fitness professionals needed to enter the sector if their primary motivator was to assist people with disability to live better and healthier lives, rather than as a method of increasing revenue. Participants acknowledged the additional time and work required to educate themselves on disability, develop and tailor their services, as well as the additional cost that was involved in making these changes.

You know it can be a little tricker to get it organised and get it up and running. So, there’s a period there where you might not always be earning a lot of money because you’ve got to get it up and running…So it does take, I think a certain kind of passion to be able to do those kind of things. (Natalie)

Theme 3: It needs to be a team approach

Participants also discussed the importance of a team approach. When working with clients with disability, this team was said to consist of the individual themselves, their support people, and their allied health professionals. When discussing the role of the support workers participants identified that without their assistance, many of their clients would not be able to access their service. Support workers often assisted with transport, as well as many of their clients’ activities of daily living. However, participants also cautioned about the importance of their clients having access to well-trained support workers who were equally as invested in the needs and wellbeing of their client.

The [support worker’s] there to make sure he’s safe and sound. She’s not allowed to sit there on her phone. The first day she came in and sat on her phone, and I said, “yeah, you’re not doing that anymore.” (Max)

When discussing collaboration with allied health professionals, participants acknowledged the different roles of each profession, and the ways in which they could work together to provide more effective care to their client.

We would sit down, and we would go off and say, “Okay, well this is what [the client] would like to do. We can do this in the pool,” but then refer them to our occupational therapist (OT). We had a big set of OTs and Physiotherapists, and say, “This is what [the client] wants.” (Max)

However, despite recognising the potential benefits of interprofessional collaboration, most participants believed that current practice required improvements. Many described a perceived hesitance from allied health professionals making referrals to or communicating with community-based fitness professionals in relation to clients with disability. This was perceived by participants to stem from the education discrepancies specific to disability resulting in negative stigma from the allied health professionals towards the community-based fitness professionals.

Personally, I think part of it, is the fact that I’m “just” a personal trainer. I’m not an exercise physiologist…I do think the biggest part of it is if I had that degree after my name then maybe [the allied health professional] would have responded.” (Sarah)

All participants advocated for changes in the way in which community-based fitness professionals and allied health professionals currently collaborate to ensure the best quality care for their clients.

At the end of the day, we want a good outcome. We both want a good outcome for our clients. (Sarah)

Theme 4: The barriers of gym culture

All participants discussed the barriers created by the current gym culture and the lack of societal understanding of the benefits sport and exercise could have for people with disability. Specifically, participants discussed how the lack of inclusion within community-based sport and exercise facilities is negatively influenced by both the physical and social environments. When discussing the physical environment, all participants described the barrier of most community-based facilities not being designed from the beginning to support people with disability. This was thought by participants to put their clients off from the outset as people with disability reported feeling excluded before even entering the building.

Things like disability toilets, even just the access to the front door, parking, all those kinds of things. But there’s the actual space, like the physical environment can be a barrier. (Cindy)

Further, participants discussed that barriers to environment extended to the sensory environment, as the bright lights and loud music were also not inclusive for many disability populations.

It didn’t work for my autistic clients at all because it was very overwhelming. It was too loud; it was too busy. They got sensory overload. (Andy)

Whilst recognising the physical environment as a major barrier for many of their clients, participants also acknowledged that as most community facilities were not initially designed to be inclusive, there would be a substantial financial cost to the business if they were to invest in making the necessary changes.

Of wanting to be more inclusive. But if I was to put the studio owner hat on that the place where I started that was not necessarily a goal of theirs. You know, their business was structured to be doing something different, therefore, having the capacity to run a program like this is much lower priority. (Cindy)

When addressing the social environment, participants also highlighted the common assumptions made by many fitness professionals regarding client goals. They discussed that the performance and body composition goals typically addressed within the fitness industry often did not align with the goals of people with disability.

I know the fitness industry, the training and fitness industry, does focus much more on the able-bodied person, and it focuses on smashing people. Not everyone wants to be smashed…Anybody can smash people. It takes a talented personal trainer to train someone to be better, not just tired. (Sarah)

These assumptions were thought by participants to fuel a negative stigma within the fitness industry about the specific “type” of person suitable for sport or exercise. This was said to act as an additional barrier to participation as many people with disability did not fit this stereotype.

I started off teaching general classes and I noticed then that there were people who didn’t necessarily fit into the regular classes. The pace, the postures, the studio vibes, the gym environment…It’s really off putting anyway people of all shapes, sizes, and abilities don’t feel like they’re welcome. (Nikki)

It was these attitudes projected by the fitness industry that were thought by participants to result in many people with disability not believing they could participate in sport or exercise. Many explained they had worked with several clients who had previously perceived sport and exercise to be beyond their capabilities, preventing them from taking the “first step”.

Like they don’t even take the first step of just turning up and having a conversation, and they just see it as like “that’s out of my reach, that’s not possible.” (Mitchel)

So, a lot of people when they find me say, “I never knew I could do yoga.” I thought that, you know, you had to be in a certain kind of body to be able to do it. (Nikki)

Theme 5: Change is needed

Participants highlighted the change that was needed for community-based fitness professionals to provide inclusive services more effectively. These changes fell under two subthemes, (1) Improvements in the training provided to community-based fitness professionals, and (2) Greater access to funding.

Subtheme 1: Improvements in the training provided to community-based fitness professionals

Firstly, all participants identified the need for better disability specific training and education for community-based fitness professionals working within Australia.

Well first of all, where do you go for education? How do you gain that experience? You really have to search it out. There’s not a TAFE of something that you can do, Uni courses or anything like that so that is the first barrier. (Andy)

Several participants described the training they received within their Certificate or Diploma level training to include information regarding specific muscle groups and energy systems, as well as exercise prescription for the general population. However, participants believed that there were no opportunities either within their initial qualification or as continuing professional development to learn the additional skills required to work with people with disability safely and effectively, such as communication and how to adapt specific exercises.

It’s not something that is often taught. So, people don’t really know about making yoga accessible, working with people with different abilities and disabilities. (Nikki)

Participants discussed that had they not been able to source their own education and experience, this may have resulted in unintended risk on both them and their clients.

Like, had I done my Cert and then gone, “you know what” I wanna work with people with disability. I’ve never met one, I’ve never had anything to do with it, but it sounds fun, I would have probably crashed and burned. (Connie)

Ways in which participants described gaining their own knowledge and experience working with people with disability included learning on the job through “trial and error”, “social media”, seeking “mentorship” from more experienced professionals, “learning from the clients with disability”, and by seeking their own independent learning through “reading” and “research”.

A lot of what I do outside my job, I’m always reading literature or following people who specifically work on those things. (Mitchel)

Several participants highlighted that, due to the lack of resources specific to working with people with disability, only the fitness professionals with an interest and passion to work with this population would be motivated to seek it out. This was thought to reduce the number of community-based fitness professionals with the skills to support people with disability, thus further increasing the barrier to entry for these individuals.

You kind of need to be really interested, and I guess have the time to go and do your own research and read up on it. (Samantha)

Participants discussed the specific changes required in the current training of fitness professionals, allowing them to appropriately support people with disability. Examples of these changes included the introduction of disability specific content in the foundation training of all community-based fitness professionals, and the increased availability of recognised continuing professional development courses, and mentors.

So, I think some, some short courses would be really, really, really good, or even a module in the actual cert would be really, really good as well as because there’s such a huge need for it, such a huge need for it. So you may not necessarily be interested in doing it, like, as a lifestyle, when you’re studying to do Cert IV but I think it’s still really, really important to do, because you’re always going to be coming across people in your life that do have disability so understanding it, a lot more would be just a massive step in the right direction. (Sally)

Subtheme 2: Greater access to funding

In addition to the education gaps experienced by community-based fitness professionals, participants also discussed the difficulty accessing funding to support their clients with disability. Several participants discussed the importance of their clients being able to access government funding due to the increased time, and subsequent cost, that was required within a session. Several participants explained that to ensure their client’s needs were met, session duration could often double the time required for a client without disability (e.g., a 30-min session delivered to a client without disability could take 60 min for a client with disability).

You have mobility issues, you have accessibility would be another issue, and everything takes time. (Amy)

Participants frequently discussed the difficulty they had experienced navigating the National Disability Insurance Scheme (NDIS – an Australian specific government funded initiative to provide funding to people with disability to support their overall health and wellbeing). Most described this funding system as “confusing”, “time-consuming”, and, overall, not worth their time due to the small amount of funding provided. Many participants believed that the lack of financial support available for sport and exercise services was a major barrier for many community-based fitness professionals agreeing to work with people with disability.

They pay much less than what I’m currently getting…A lot of my clients they don’t work, they don’t have a lot of funding available to them beyond their NDIS and a lot of personal trainers say, “Well, I can’t work for $30 an hour if I usually charge $90 an hour…It is confusing.” I heard from a lot of personal trainers the go, “I want to work with people with disabilities, but the NDIS is just too much paperwork it’s too much application.” How to navigate that. (Andy)

Discussion

Sport and exercise participation has been found to provide several benefits for people with disability, and recent times have seen a growing focus on supporting inclusive participation within community-based programs [Citation10]. However, for inclusive practice to be implemented effectively, the appropriate supports must be put in place to ensure the needs of the individual are met [Citation20]. Due to their important role in supporting inclusion within sport and exercise, this study aimed to understand the perceptions and beliefs of community-based fitness professionals regarding working with people with disability. Five themes emerged which encompassed the participants’ experiences. Like previous literature [Citation4,Citation10,Citation17], these themes highlighted the personal and professional gains fitness professionals experienced from working with people with disability, as well as the many complexities.

Within the first theme, participants described the need for community-based fitness professionals to be flexible, adapting their services to the unique needs of each client. They discussed the importance of shifting their focus from performance and body composition goals to participation-based goals such as optimising daily function and social engagement. This shift in the way in which fitness professionals approach goal setting with their clients was also noted by Sakalindis et al. [Citation10], who compared the practices of coaches working with athletes with intellectual disability to those working with athletes without intellectual disability. Within their study, coaches discussed the ways in which they supported a “participation environment” rather than a “performance environment” within their teams, working towards improving the athletes’ social skills and independence. Participants within the present study also provided examples of how they adapted their practices when working with people with disability, including changing the physical location in which they delivered their services, as well as how they modified specific exercises. To ensure community-based fitness professionals have the appropriate knowledge and skills to deliver services to people with disability safely and effectively it would be beneficial for future research to understand what specific adaptations are required for each disability group.

In theme two, participants described the skills and qualities they perceived to be important for fitness professionals to possess if they were going to successfully work with people with disability. Specifically, participants discussed the importance of demonstrating empathy, and ensuring they took the time to develop a working relationship with their client built on mutual trust and respect. These findings echoed that of Sakalindis et al. [Citation10] whose participants highlighted the importance of coaches working to connect and build a meaningful relationship with their athletes with intellectual disability. These coaches emphasised the importance of creating an environment that was not only physically safe but also emotionally safe [Citation10]. Due to the conflicting literature citing fitness professionals as both facilitators and barriers to sport and exercise participation for people with disability [Citation5,Citation13–16], it is crucial that further research is done to understand the specific personal and professional skills that are supportive of inclusive practice.

In theme three participants discussed the potential benefits interprofessional collaboration with allied health professionals could provide when working to deliver client-centred care with shared clients. Similarly, researchers Cunningham et al. [Citation4] and Hill et al. [Citation17] also found that community-based fitness professionals had experienced positive interactions with allied health professionals such as physiotherapists, exercise physiologists and occupational therapists. Like participants within the Hill et al. [Citation17] study, participants within this study noted that the respectful sharing of knowledge and expertise between each profession could assist to ensure that all the client’s needs were appropriately met. Also consistent with past literature [Citation4,Citation17], fitness professionals within this study highlighted past challenges they had experienced when attempting to communicate with allied health professionals. Participants within the present study believed that this resistance to collaboration was due to the negative stigma held by some tertiary trained allied health professionals regarding the qualifications attained by the community-community based fitness professionals. As these were the belief of the participants and no similar studies exist exploring allied health professionals experience working with community-fitness professionals, further research is required to understand this perception. Further, due to the potential for community-based fitness professionals to provide a more cost-effective service [Citation17] when compared to allied health professionals, work is required to create a culture in which allied health professionals see community-based fitness professionals as a genuine part of the client’s interprofessional team. Participants within this study reported that for these changes to occur guidance relating to how best to collaborate with allied health professionals was needed.

Theme four described the negative stigmas created by the current gym culture and the barriers these presented to people with disability participating in sport and exercise. In addition to physical and sensory environments of community facilities being perceived as unwelcoming and not supportive of inclusion, participants described the specific “type” of person gym culture appeared to define as suitable for sport and exercise. This meant that many of their clients with disability had never even considered themselves to be suitable for sport or exercise believing they did not fit this “mould.” These findings are consistent with past research [Citation4,Citation11,Citation16] which has highlighted the stigma created by gym culture as a major barrier to people with disability participating in sport and exercise. Like past literature [Citation4,Citation11,Citation16], participants within this study recognised the need for further societal education regarding the benefits of sport and exercise participation for all people for there to be a positive change towards inclusion.

Within theme five participants discussed the support community-based fitness professionals required to better improve service delivery to people with disability. In line with past literature [Citation4,Citation17,Citation18], participants highlighted the significant gaps in the disability specific education provided to community-based fitness professionals. For fitness professionals working in Australia specifically, disability specific information appeared to be missing from both their foundation training, as well as post gaining their qualifications. These findings echoed those of an Australian survey study which found that community-based fitness professionals wanting to work with people with disability were required to source their own training which often included on-the job experience and workshops [Citation17]. Accessible and detailed education is essential for community-based fitness professionals to deliver evidence-based practice when working with people with disability [Citation17]. Initially conceptualised within the field of health sciences, evidence-based practice involves the integration of the best available research evidence, clinical expertise, and client values and circumstances enabling clinicians to provide holistic, client-centred care [Citation22]. Although evidence-based practice is still emerging for fitness professionals, literature suggests that to ensure people with disability are provided with the best quality services, similar practices should be followed [Citation17,Citation23]. As such, further research and collaboration with consumers and relevant stakeholders (e.g., fitness and health professionals, as well as support people of people with disability) is required to understand what specific practices are evidence-based for fitness professionals working with people with disability. Once these practices have been established it should then be decided how best to educate community-based fitness professionals ensuring they have the knowledge, confidence and skills to effectively work with people with disability.

Finally, within theme five, participants also discussed the barriers their clients had experienced accessing funding to support their participation in sport and exercise. These findings are in line with the sport and exercise literature from the experience of people with disabilities themselves [Citation12]. Further, participants within Hill et al.’s. [Citation17] study also acknowledged the difficulty they had experienced accessing funding. This was perceived as a barrier for many Australian fitness professionals to being able to work with people with disability due to the additional time and cost involved. Given the plethora of research highlighting the benefits of sport and exercise to the health and wellbeing of people with disability, government funding bodies might benefit from looking for opportunities to fund and evaluate the economic impact of health promoting interventions such as sport and exercise with the aim of reducing the economic cost of reactive medicalised interventions. However, further trials are required to explore this hypothesis.

Limitations

These findings provide important insights regarding the experience of community-based fitness professionals working with people with disability. Although this study provided many new insights into this topic, limitations remained. Firstly, most participants were female, which is incongruent with the current Australian fitness professional workforce (approximately 50% female). However, these numbers are more in line with the disability sector which consistently averages a higher number of female staff (approximately 70% female). This may suggest that female fitness professionals are more inclined to work with clients with disability potentially resulting in a sampling bias. Additionally, despite attempts to recruit participants across Australia, most participants identified residing within metropolitan locations within four of the eight states or territories of Australia, therefore, they may not be representative of this population.

Implications for practice and future research

Consistent with past research, this study highlighted the benefits community-based fitness professionals can experience when working with people with disability. However, change is required to better support the shift towards inclusive practice. Firstly, improvements in the disability specific training and education are required to ensure that these fitness professionals are equipped with the knowledge and skills required to meet the potential growing diversity of client populations accessing their services. It is recommended that these learning activities involve a practical component to support the development of the skills that cannot be learnt through direct teaching. Improving the level of disability training received by community-based fitness professionals may also assist to reduce some of the negative stigma received from the tertiary trained allied health professionals, thus supporting more effective interprofessional collaboration.

Secondly, for people with disability to feel included within community-based sport and exercise activities, changes are required within the current gym culture and societal understanding about the importance of sport and exercise for people with disability. This should be achieved through not only the education provided to fitness professionals, but also people with disability themselves, assisting them to understand their own capabilities and options available. Finally, changes are required in the current funding models supporting people with disability to participate in sport and exercise. It was acknowledged by all participants that ensuring that their clients with disability received the appropriate support took additional time and, as such, cost. Considering the many health and wellbeing benefits that can result from improved physical activity participation for people with disability including increased independence and function, government funding should consider placing higher importance, and funds, to support participation within these meaningful occupations.

Authors’ contributions

JH conceptualised the project and developed the interview schedule. JH conducted all interviews. KG transcribed all interviews. KG, JH, and EB completed analysis. JH drafted the initial manuscript and KG, EB, SG, ST, and HG reviewed the final draft.

Acknowledgements

The authors would like to thank the participants for volunteering their time and experiences by participating in the interviews.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

SG is partly funded by the Health and Wellbeing Centre for Research Innovation (HWCRI), which is co-funded by The University of Queensland and Health and Wellbeing Queensland. No additional funding was received in the completion of this project.

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