Background & Aims
Canadian military Veterans are almost twice as likely to experience chronic pain compared to the rest of the Canadian population.1 Pain is a complex, biopsychosocial phenomenon that is highly comorbid with mental health problems among Veterans.2 Clinical practice guidelines suggest physical activity interventions as first-line treatment for people with musculoskeletal pain,3,6 and previous work has aimed to understand the barriers and facilitators of engaging in physical activity for various populations.4-6 Exercise and training are often core values for military members, and the unique needs and complex health concerns of Veterans may make it more challenging to engage in physical activity. Further, changing exercise-related expectations and behaviors when transitioning from military service to civilian life can be difficult. This study aimed to understand the barriers, facilitators, and preferences for physical activity and exercise for Canadian Veterans living with pain.
Methods
A qualitative interpretive description was used in this study to capture the experiences of Canadian military Veterans living with pain to inform recommendations based on the barriers, facilitators, preferences, and unique needs of Veterans related to physical activity and exercise. A purposeful sample of Canadian military Veterans was recruited through email invitations and a social media campaign with the support of the Chronic Pain Centre of Excellence for Canadian Veterans network. The inclusion criteria for research participants were: 1) 18 years or older, 2) can read, understand, and speak English or French, and 3) Canadian Armed Forces Veterans living with chronic pain (persistent or recurring pain lasting 3 or more months). Twenty-one semi-structured interviews were completed (17 English and 4 French) through Zoom. Eight women and thirteen men participated. The interviews were audio-recorded and transcribed. Transcripts were coded using thematic analysis.
Results
We found that the intersection between mental health issues and chronic pain that arose as a result of their military service is a significant barrier to engagement in physical activity or exercise for Canadian Veterans. Navigating the physical activity and exercise environment outside of the military was particularly challenging due to the lack of awareness of military experiences by exercise professionals, lack of resources specific to Veterans, and lack of tailoring and adaptation specific to their chronic pain and mental health needs. Most spoke about the need to tailor programs specific to their pain and how their preferences for participation in physical activity or exercise changed frequently relating to pain and mental health fluctuations. Social factors, particularly family, were a key facilitator for engaging in physical activity. Most wanted to participate in physical activity and believed that exercise is beneficial to health; but that it made their pain worse, not better. There was a desire to find ways to engage in physical activity in ways that reduced their pain and helped with mental health issues.
Conclusions
The findings from this study bring forward new information and knowledge on the needs, preferences, experiences, barriers, and facilitators for physical activity and exercise among Canadian Veterans living with pain. Despite positive attitudes and beliefs in exercise as a health behaviour, Veterans were challenged to enact their exercise goals due to experiencing increases in symptoms. A clear need for tailoring exercise to fluctuating pain and co-existing mental health symptoms was expressed and suggests that decision support tools, monitoring systems, and better clinicians’ awareness of the unique needs of Veterans are needed. The results of this study also reveal the impact of mental health issues on physical activity engagement for Veterans with chronic pain. This information will assist in developing a decision aid to support Veterans living with pain to develop personalized plans to optimize their physical activity by addressing their unique needs.
References
1. VanDenKerkhof EG, VanTil L, Thompson JM, Sweet J, Hopman WM, Carley, ME, Sudom, K. (2015). Pain in Canadian veterans: Analysis of data from the survey on transition to civilian life. Pain Research and Management, 20(2), 89-95.
2. Irwin KC, Konnert C, Wong M, O’Neill TA. (2014). PTSD symptoms and pain in Canadian military veterans: The mediating roles of anxiety, depression, and alcohol use. J Trauma Stress, 27(2):175-81.
3. Bannuru RR, Osani MC, Vaysbrot EE, Arden NK., Bennell K, Bierma-Zeinstra SMA,…McAlindon TE. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and cartilage, 27(11), 1578-1589
4. Clifford BK, Mizrahi D, Sandler CX, Barry BK, Simar D, Wakefield CE, Goldstein D. (2018). Barriers and facilitators of exercise experienced by cancer survivors: A mixed methods systematic review. Supportive Care in Cancer, 26(3), 685-700.
5. Glowacki K, Duncan MJ, Gainforth H, Faulkner G. (2017). Barriers and facilitators to physical activity and exercise among adults with depression: A scoping review. Mental Health and Physical Activity, 13, 108-119.
6. Kanavaki AM, Rushton A, Efstathiou N, Alrushud A, Klocke R, Abhishek A, Duda JL. (2017). Barriers and facilitators of physical activity in knee and hip osteoarthritis: A systematic review of qualitative evidence. BMJ Open, 7(12).
Presenting Author
Joy MacDermid
Poster Authors
Joy MacDermid
BSc, BScPT, MSc, PhD
Western University
Lead Author
Robin Campbell Bromhead
BRM
Western University
Lead Author
Shannon Killip
MSc
Western University
Lead Author
Nicholas Held
PhD
McMaster University
Lead Author
Jordan Miller
BSc
Queen’s University
Lead Author
Heidi Cramm
PhD
Queen’s University
Lead Author
Topics
- Treatment/Management: Interventional Therapies – Other