Medicalization of Exercise Through Vigilance, Productivity, and Self-Care: A Secondary Data Analysis of Qualitative Interviews Among Those With Multiple Sclerosis

in Adapted Physical Activity Quarterly

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Brynn Adamson Department of Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA

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Matthew Adamson Department of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA

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Dominique Kinnett-Hopkins School of Kinesiology, University of Michigan, Ann Arbor, MI, USA

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Robert Motl Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA

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DOI:
https://doi.org/10.1123/apaq.2021-0200
Keywords:
critical disability studies; compulsory able-bodiedness; health promotion; qualitative inquiry
First Published Online:
26 Apr 2022
In Print:
Volume 39: Issue 4
Page Range:
399–423
Restricted access

Exercise is becoming more integrated into the management of multiple sclerosis (MS) and is promoted to manage impairments and symptoms. Whereas extensive research outlines factors impacting participation, less is known regarding how medicalized exercise promotion might impact views of exercise and self. We conducted a secondary data analysis to understand how medicalized exercise-promotion paradigms impact the meaning and roles of exercise among those with MS. Twenty-two interviews were selected for reanalysis with an interpretative phenomenological analysis methodology and a critical disability studies lens. Three themes were identified: Constant Vigilance (worry about exercise), Productivity and Social Engagement (exercise to feel productive, engage socially, and enhance self-worth), and Exercise as Medicine/Self-Care (exercise to manage MS, relax, improve mental well-being, prevent/reverse disability, and stay healthy). This research underscores that exercise occupies many contradictory roles reflecting a medicalized exercise-promotion paradigm for those with MS, and this should inform exercise promotion practices.

B. Adamson (badamso2@uccs.edu) corresponding author, https://orcid.org/0000-0002-1796-4047

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  • Adamson, B., Kinnett-Hopkins, D., Athari Anaraki, N., & Sebastião, E. (2020). The experiences of inaccessibility and ableism related to physical activity: A photo elicitation study among individuals with multiple sclerosis. Disability and Rehabilitation. Advance online publication. https://doi.org/10.1080/09638288.2020.1844315

    • Search Google Scholar
    • Export Citation

  • Adamson, B.C. (2018). The role of exercise in negotiating an identity as disabled: A qualitative exploration of the experiences of individuals with multiple sclerosis. http://hdl.handle.net/2142/101502

    • Search Google Scholar
    • Export Citation

  • Adamson, B.C., Adamson, M.D., Littlefield, M.M., & Motl, R.W. (2018). ‘Move it or lose it’: Perceptions of the impact of physical activity on multiple sclerosis symptoms, relapse and disability identity. Qualitative Research in Sport, Exercise and Health, 10(4), 457–475. https://doi.org/10.1080/2159676X.2017.1415221

    • Crossref
    • Search Google Scholar
    • Export Citation

  • American College of Sports Medicine. (2017). Exercise is Medicine: Your prescription for health. http://exerciseismedicine.org/

  • Benito-León, J. (2011). Physical activity in multiple sclerosis: The missing prescription. Neuroepidemiology, 36(3), 192–193. https://doi.org/10.1159/000328276

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Bennett, E.V., Hurd Clarke, L., Kowalski, K.C., & Crocker, P.R.E. (2017). From pleasure and pride to the fear of decline: Exploring the emotions in older women’s physical activity narratives. Psychology of Sport and Exercise, 33, 113–122. https://doi.org/10.1016/J.PSYCHSPORT.2017.08.012

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Borkoles, E., Nicholls, A.R., Bell, K., Butterly, R., & Polman, R.C.J. (2008). The lived experiences of people diagnosed with multiple sclerosis in relation to exercise. Psychology & Health, 23(4), 427–441. http://www.tandfonline.com/doi/abs/10.1080/14768320701205309

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Brittain, I., Biscaia, R., & Gérard, S. (2020). Ableism as a regulator of social practice and disabled peoples’ self-determination to participate in sport and physical activity. Leisure Studies, 39(2), 209–224. https://doi.org/10.1080/02614367.2019.1694569

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Brocki, J.M., & Wearden, A.J. (2006). A critical evaluation of the use of interpretative phenomenological analysis (IPA) in health psychology. Psychology & Health, 21(1), 87–108. https://doi.org/10.1080/14768320500230185

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Cairney, J., McGannon, K.R., & Atkinson, M. (2018). Exercise is medicine: Critical considerations in the qualitative research landscape. Qualitative Research in Sport, Exercise and Health, 10(4), 391–399. https://doi.org/10.1080/2159676X.2018.1476010

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Canadian Society for Exercise Physiology. (2012). Canadian Physical Activity Guidelines for adults with multiple sclerosis.

  • Chatfield, S. (2020). Recommendations for secondary analysis of qualitative data. The Qualitative Report, 25(3), 833–842. https://doi.org/10.46743/2160-3715/2020.4092

    • Search Google Scholar
    • Export Citation

  • Clare, E. (2017). Brilliant Imperfection: Grappling with Cure (1st ed.). Duke University Press.

  • Clarke, A.E., Shim, J.K., Mamo, L., Fosket, J.R., & Fishman, J.R. (2003). Biomedicalization: Technoscientific transformations of health, illness, and U.S. biomedicine. American Sociological Review, 6, 161–194.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Clarke, C.V., & Adamson, B.C. (2021). A syndemics approach to exercise is medicine. Health. Advance online publication. https://doi.org/10.1177/13634593211021481

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Compston, A., & Coles, A. (2008). Multiple sclerosis. Lancet, 372(9648), 1502–1517. https://doi.org/10.1016/S0140-6736(08)61620-7

  • Conrad, P. (1992). Medicalization and social control. Annual Review of Sociology, 18, 209–232.

  • Crawford, R. (1977). You are dangerous to your health: The ideology and politics of victim blaming. International Journal of Health Services, 7(4), 663–680. https://doi.org/10.2190/YU77-T7B1-EN9X-G0PN

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Crawford, R. (1980). Healthism and the medicalization of everyday life. International Journal of Health Services, 10(3), 365–389.

  • Crawford, R. (2006). Health as a meaningful social practice. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 10(4), 401–420. https://doi.org/10.1177/1363459306067310

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Dalgas, U., Langeskov-Christensen, M., Stenager, E., Riemenschneider, M., & Hvid, L.G. (2019). Exercise as medicine in multiple sclerosis—time for a paradigm shift: Preventive, symptomatic, and disease-modifying aspects and perspectives. Current Neurology and Neuroscience Reports, 19(11), 88. https://doi.org/10.1007/s11910-019-1002-3

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Dufour, I.F., & Richard, M.C. (2019). Theorizing from secondary qualitative data: A comparison of two data analysis methods, Cogent Education, 6(1), Article 1690265. https://doi.org/10.1080/2331186X.2019.1690265

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Foucault, M. (1963). The birth of the clinic: An archaeology of medical perception. Routledge. https://doi.org/10.1016/0037-7856(76)90065-2

    • Search Google Scholar
    • Export Citation

  • Garland-Thomson, R. (2019). Critical disability studies. In K. Ellis, R. Garland-Thomson, M. Kent, & R. Robertson (Eds.), Manifestos for the future of critical disability studies (1st ed., pp. 11–19). https://doi.org/10.4324/9781351053341-2

    • Search Google Scholar
    • Export Citation

  • Garry, A. (2001). Medicine and medicalization: A response to Purdy. Bioethics, 15(3), 262–269. https://doi.org/10.1111/1467-8519.00236

  • Godin, G. (2011). The Godin-Shephard leisure-time physical activity questionnaire. The Health & Fitness Journal of Canada, 4(1), 18–22. http://healthandfitnessjournalofcanada.com/index.php/html/article/view/82

    • Search Google Scholar
    • Export Citation

  • Heaton, J. (2004). Reworking qualitative data. SAGE Publications Ltd. https://doi.org/10.4135/9781849209878

  • Heyes, C.J. (2006). Foucault goes to Weight Watchers. Hypatia, 21(2), 126–149. https://doi.org/10.1353/hyp.2006.0009

  • Hughes, B. (2005). What can a Foucauldian analysis contribute to disability theory? In S.L. Tremain (Ed.), Foucault and the government of disability (pp. 78–92). University of Michigan Press.

    • Search Google Scholar
    • Export Citation

  • Hutchinson, K., Roberts, C., & Daly, M. (2018). Identity, impairment and disablement: Exploring the social processes impacting identity change in adults living with acquired neurological impairments. Disability and Society, 33(2), 175–196. https://doi.org/10.1080/09687599.2017.1392931

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Jones, E., Pike, J., Marshall, T., & Ye, X. (2016). Quantifying the relationship between increased disability and health care resource utilization, quality of life, work productivity, health care costs in patients with multiple sclerosis in the US. BMC Health Services Research, 16(1), 294. https://doi.org/10.1186/s12913-016-1532-1

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Kafer, A. (2013). Feminist, queer, crip (1st ed.). Indiana University Press.

  • Kim, E. (2017). Curative violence: Rehabilitating disability, gender, and sexuality in modern Korea (1st ed.). Duke University Press.

  • Kurtzke, J.F. (1983). Rating neurologic impairment in multiple sclerosis an expanded disability status scale (EDSS). Neurology, 33(11), 1444–1452. http://www.neurology.org/content/33/11/1444.short

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Lai, B., Young, H.J., Bickel, C.S., Motl, R.W., & Rimmer, J.H. (2017). Current trends in exercise intervention research, technology, and behavioral change strategies for people with disabilities. American Journal of Physical Medicine & Rehabilitation, 96(10), 748–761. https://doi.org/10.1097/PHM.0000000000000743

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Learmonth, Y.C., Adamson, B.C., Balto, J.M., Chiu, C.Y., Molina-Guzman, I.M., Finlayson, M., Barstow, E.A., & Motl, R.W. (2018). Investigating the needs and wants of healthcare providers for promoting exercise in persons with multiple sclerosis: A qualitative study. Disability and Rehabilitation. 40(18), 2172–2180. https://doi.org/10.1080/09638288.2017.1327989

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Learmonth, Y.C., Adamson, B.C., Balto, J.M., Chiu, C.Y., Molina-Guzman, I., Finlayson, M., Riskin, B.J., & Motl, R.W. (2017a). Multiple sclerosis patients need and want information on exercise promotion from healthcare providers: A qualitative study. Health Expectations, 20(4), 574–583. https://doi.org/10.1111/hex.12482

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Learmonth, Y.C., Adamson, B.C., Balto, J.M., Chiu, C.Y., Molina-Guzman, I.M., Finlayson, M., Riskin, B.J., & Motl, R.W. (2017b). Identifying preferred format and source of exercise information in persons with multiple sclerosis that can be delivered by health-care providers. Health Expectations, 20(5), 1001–1010. https://doi.org/10.1111/hex.12541

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Learmonth, Y.C., & Motl, R.W. (2016). Physical activity and exercise training in multiple sclerosis: A review and content analysis of qualitative research identifying perceived determinants and consequences. Disability & Rehabilitation, 38(13), 1227–1242. https://doi.org/10.3109/09638288.2015.1077397

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Markula, P. (2003). The technologies of the self: Sport, feminism, and Foucault. Sociology of Sport Journal, 20(2), 87–107. https://doi.org/10.1123/ssj.20.2.87

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Markula, P. (2014). Embodied subjectivities: Intersections of discursive and critical psychology with socio-cultural exercise research. Sociology of Sport Journal, 31, 139–161. https://doi.org/10.1123/ssj.2013-0049

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Markula, P., & Pringle, R. (2006). Foucault, sport and exercise: Power, knowledge, and transforming the self (1st ed.). Routledge.

  • Markula, P., & Silk, M. (2011). Qualitative research for physical culture (1st ed.). Palgrave Macmillan.

  • Mayes, C. (2016). The biopolitics of lifestyle: Foucault, ethics and healthy choices (1st ed.). Routledge.

  • McRuer, R. (2006). Crip theory: Cultural signs of queerness and disability. NYU University Press.

  • McRuer, R., & Johnson, M. (2014). Proliferating cripistemologies. Journal of Literary & Cultural Disability Studies, 8(2), 149–170. https://doi.org/10.3828/jlcds.2014.13

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Motl, R.W. (2014). Benefits, safety, and prescription of exercise in persons with multiple sclerosis. Expert Review of Neurotherapeutics, 14(12), 1429–1436. https://doi.org/10.1586/14737175.2014.983904

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Motl, R.W., Barstow, E.A., Blaylock, S., Richardson, E., Learmonth, Y.C., & Fifolt, M. (2018). Promotion of exercise in multiple sclerosis through health care providers. Exercise and Sport Sciences Reviews, 46(2), 105–111. https://doi.org/10.1249/JES.0000000000000140

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Mozo Dutton, L., Simpson, J., & Boot, J. (2012). MS and me: Exploring the impact of multiple sclerosis on perceptions of the self. Disability and Rehabilitation, 34, 1208–1217. https://doi.org/10.3109/09638288.2011.638032

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Papathomas, A., Williams, T.L., & Smith, B. (2015). Understanding physical activity participation in spinal cord injured populations: Three narrative types for consideration. International Journal of Qualitative Studies on Health and Well-being, 10, 27295. https://doi.org/10.3402/QHW.V10.27295

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Patsavas, A. (2014). Recovering a cripistemology of pain: Leaky bodies, connective tissue, and feeling discourse. Journal of Literary & Cultural Disability Studies, 8(2), 203–218. https://doi.org/10.3828/jlcds.2014.16

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Peers, D. (2012a). Interrogating disability: The (de)composition of a recovering Paralympian. Qualitative Research in Sport, Exercise and Health, 4(2), 175–188. https://doi.org/10.1080/2159676X.2012.685101

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Peers, D. (2012b). Patients, athletes, freaks: Paralympism and the reproduction of disability. Journal of Sport & Social Issues, 36(3), 295–316. https://doi.org/10.1177/0193723512442201

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Polkinghorne, D.E. (1989). Phenomenological research methods. In R.S. Valle, M. King, & S. Halling (Eds.), Existential-phenomenological perspectives in psychology (pp. 41–60). Plenum Press. https://doi.org/10.4135/9781412995658

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Pond, R., Stephens, C., & Alpass, F. (2010). Virtuously watching one’s health: Older adults’ regulation of self in the pursuit of health. Journal of Health Psychology, 15(5), 734–743. https://doi.org/10.1177/1359105310368068

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Pullen, E., & Malcolm, D. (2018). Assessing the side effects of the ‘exercise pill’: The paradox of physical activity health promotion. Qualitative Research in Sport, Exercise and Health, 10(4), 493–504. https://doi.org/10.1080/2159676X.2017.1388833

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Purdy, L. (2001). Medicalization, medical necessity, and feminist medicine. Bioethics, 15(3), 248–261. https://doi.org/10.1111/1467-8519.00235

  • Reeve, D. (2002). Negotiating psycho-emotional dimensions of disability and their influence on identity constructions. Disability & Society, 17(5), 493–508. https://doi.org/10.1080/09687590220148487

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Reeve, D. (2006). Towards a psychology of disability: The emotional effects of living in a disabling society. In D. Goodley& R. Lawthom (Eds.), Disability and psychology (1st ed., pp. 94–110). Palgrave Macmilllan.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Richardson, E.V., Barstow, E.A., & Motl, R.W. (2018). A narrative exploration of the evolving perception of exercise among people with multiple sclerosis. Qualitative Research in Sport, Exercise and Health, 11(1), 119–137. https://doi.org/10.1080/2159676X.2018.1509369

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Richardson, E.V., & Motl, R.W. (2020). The experience and meaning of aging with multiple sclerosis: An existential phenomenological approach. Journal of Aging Studies, 54. 100872 https://doi.org/10.1016/j.jaging.2020.100872

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Richie, C.S. (2019). Not sick: Liberal, trans, and crip feminist critiques of medicalization. Journal of Bioethical Inquiry, 16(3), 375–387. https://doi.org/10.1007/S11673-019-09922-4

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Rimmer, J., & Lai, B. (2017). Framing new pathways in transformative exercise for individuals with existing and newly acquired disability. Disability and Rehabilitation, 39(2), 173–180. https://doi.org/10.3109/09638288.2015.1047967

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Rimmer, J.H. (1999). Health promotion for people with disabilities: The emerging paradigm shift from disability prevention to prevention of secondary conditions. Physical Therapy, 79(5), 495–502. http://ptjournal.apta.org/content/79/5/495

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Ruggiano, N., & Perry, T.E. (2017). Conducting secondary analysis of qualitative data: Should we, can we, and how?: Qualitative Social Work, 18(1), 81–97. https://doi.org/10.1177/1473325017700701

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Sherry, M. (2016). A sociology of impairment. Disability & Society, 7599, 1–16. https://doi.org/10.1080/09687599.2016.1203290

  • Siebers, T. (2008). Disability theory (1st ed.). The University of Michigan Press.

  • Sinclair, L.B., Fox, M.H., Jonas, B.S., Berry, H.G., Quatrano, L.A., McGowan, A.K., & Peacock, G. (2018). Considering disability and health: Reflections on the Healthy People 2020 Midcourse Review. Disability and Health Journal, 11(3), 333–338. https://doi.org/10.1016/j.dhjo.2018.04.001

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Smith, J., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological analysis: Theory, method and research (1st ed.). SAGE.

  • Smith, J., & Osborn, M. (2003). Interpretative phenomenological analysis. In J. Smith (Ed.), Qualitative psychology: A practical guide (pp. 229–254). Sage. http://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=17525616&AN=53920709&h=R7OnANKucW65EOVyhhF1Zav4N0um3RkCeqOfCl6%2FUF633ChHXk5H4gOQ7FqCI9eSfrputN2DJE4I6llZksL7Rg%3D%3D&crl=c

    • Search Google Scholar
    • Export Citation

  • Snook, E.M., & Motl, R.W. (2008). Physical activity behaviors in individuals with multiple sclerosis: Roles of overall and specific symptoms, and self-efficacy. Journal of Pain and Symptom Management, 36(1), 46–53. https://doi.org/10.1016/j.jpainsymman.2007.09.007

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Stuij, M., Elling, A., & Abma, T. (2021). Negotiating exercise as medicine: Narratives from people with type 2 diabetes. Health (United Kingdom), 25(1), 86–102. https://doi.org/10.1177/1363459319851545

    • Search Google Scholar
    • Export Citation

  • Thomas, C. (2012). Theorising disability and chronic illness: Where next for perspectives in medical sociology? Social Theory & Health, 10(3), 209–228. https://doi.org/10.1057/sth.2012.7

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Thomas, C. (2014). Disability and Impairment. In J. Swain, S. French, C. Barnes, & C. Thomas (Eds.), Disabling barriers—Enabling environments (3rd ed., pp. 9–15). SAGE.

    • Search Google Scholar
    • Export Citation

  • Verweij, M. (1999). Medicalization as a moral problem for preventative medicine. Bioethics, 13(2), 89–113. https://doi.org/10.1111/1467-8519.00135

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Wardrope, A. (2015). Medicalization and epistemic injustice. Medicine, Health Care and Philosophy, 18(3), 341–352. https://doi.org/10.1007/s11019-014-9608-3

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Wheatley, E.E. (2005). Disciplining bodies at risk: Cardiac rehabilitation and the medicalization of fitness. Journal of Sport and Social Issues, 29(2), 198–221. https://doi.org/10.1177/0193723504270870

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Williams, O., & Gibson, K. (2018). Exercise as a poisoned elixir: Inactivity, inequality and intervention. Qualitative Research in Sport, Exercise and Health, 10(4), 412–428. https://doi.org/10.1080/2159676X.2017.1346698

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Williams, T.L., Hunt, E.R., Papathomas, A., & Smith, B. (2018). Exercise is medicine? Most of the time for most; but not always for all. Qualitative Research in Sport, Exercise and Health, 10(4), 441–456. https://doi.org/10.1080/2159676X.2017.1405363

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Zola, I.K. (1972). Medicine as an institution of social control. The Sociological Review, 20(4), 487–504. http://www.jstor.org/stable/j.ctt14bt7nw.13

    • Crossref
    • Search Google Scholar
    • Export Citation
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