#COT2017 S31 – On your bike

As someone who prefers life on two wheels, and whose husband is verging on MAMIL status (if you’re not sure, I’ll leave you to Google), I could not help but be drawn to this session. OT + cycling = a dream combo for me.

Michael Feignton of Devon Partnership NHS Trust opened the session by presenting his research on the value of cycling, and was rightly pleased to point out that he’d recently met the call to action from Diane Cox’s Casson lecture: to ‘publish, publish, publish’!

Michael’s opening message was that, despite being within the domain of occupation, physical activities have often been overlooked as a concern of occupational therapy. In fact, one audience member noted how a fellow professional had described this as a concern for physios alone.

Michael’s literature review had found much research into exercise, but little about sustaining engagement. Michael reported a lack of exploration into the meaning of physical activity, and identified a need for more evidence around adherence. Sustaining engagement is a universal theme in OT, and is particularly pertinent to physical activity, where it is common to sign up then give up: Michael referenced the tendency to sign up to a January gym membership, only to never attend.

Michael referred to five themes in the occupational science literature relating to the meaning of occupations: connecting with others; enjoyment; developing physical and mental wellbeing; achieving goals; providing structure and routines.

Seven people, all keen and regular cyclists, were recruited to Michael’s qualitative study, with the requirement that they were reflective in nature: people who could access and verbalise their thoughts, and tolerate being with him throughout the interview (Michael’s words!).

From semi-structured interviews, Michael identified three key findings on the value of cycling to these individuals. These focused on the feelings and thoughts surrounding cycling (sheer joy, enjoyment, sensory, freedom and release, and getting healthy); the experiences of belonging and community; and the occupational identity of being a cyclist.

One of the male interviewees expressed that cycling with a friend provided a space to talk about deep and meaningful issues – which may not have otherwise surfaced.

Michael noted that even talking about their occupation had people buzzing – this had me wondering whether this is something unique to cycling, to physical activity, or whether this reflects passion for an occupation?

A key factor in the analysis was that sustained participation relied on participants having a repository of meanings for their chosen occupation. It must be about more than just fitness – and beyond ‘prescribing’ exercise – this is not enough to keep people engaged. Other aspects must be present, whether it is the sense of community and belonging an occupation brings, or its contribution to occupational identity. A valuable insight that paves the way for further research and exploration.

Next up were two facilitated posters. Janet Paske, a student at Sheffield Hallam University, presented: The occupation of cycling: an intervention for patients in rehabilitation and recovery? Janet highlighted how cycling can help to mitigate impairment, citing a person with facial disfigurement who was ‘freed’ by this form of transport, rather than being stared at by other passengers on the bus.

Janet highlighted how cycling can be socially inclusive, and discussed the range of bicycle options out there, such as hand cycle attachments for wheelchairs, trikes and electric bikes. Janet relayed her own experiences working with service users on one to one lessons, group rides, map reading and road sign identification, and referenced cycling charities and support.

Finally came Laura Dickson of NHS Lothian and her poster Promoting cycling and walking in the psychiatric rehabilitation setting, which charted the creation of a cycling programme with mental health inpatients. Laura cited the generally reduced physical health and life expectancy of people with mental health issues.

Laura called in a local organisation to support service users with fixing up bikes that had been left abandoned in the grounds of the Royal Edinburgh Hospital, where she is based. This gave participants a stake in the activity – being able to use what they had fixed – which, in turn, encouraged participation.

Laura referenced her insight into the risk assessment involved in a cycling programme: not only considering road safety, but also safe use of tools. But challenges aside, cycling sessions within the confines of the hospital grounds led to increased physical activity, confidence and skills, and provided a gentle form of exercise that did not mimic symptoms of anxiety, as a gym session might.

Written by Bev Goodman
1st year pre-reg MSc student at the University of Essex

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