Perceived Benefits of Adapted Fitness Participation Among Adults with Physical Impairments

Abstract

Background/Objectives: Regular physical activity is recommended to maintain a healthy lifestyle. Individuals with physical impairments have barriers that limit their participation in traditional exercise. Understanding their perceptions of adapted fitness programming can aid in the large-scale development and implementation of such programs. The aim of this study was to identify perceived benefits of adults with physical impairments participating in an adapted fitness program. Methods: Eight adapted fitness program participants (7 males and 1 female) with various neurologic diagnoses or bilateral lower extremity amputation completed the study. A consensual qualitative research (CQR) design with a semi-structured interview guide with evidence of content validity was used. The interview guide explicitly prompted physical, functional, emotional, and social benefits. Interviews were conducted via Zoom. Data were analyzed through three phases of consensus coding by three researchers. Trustworthiness measures included member-checking, multi-analyst triangulation, and an external auditor. Results: Three themes with associated categories were developed through the broader CQR analysis. The present study focuses on the intrinsic benefits theme, which included four categories: (1) general physical benefits, (2) functional movement/activities of daily living benefits, (3) mental/emotional benefits, and (4) social benefits. Participants described perceived improvements in physical capacity and daily function, as well as benefits related to mood, identity, and social connection. These benefits coexisted with continued functional deficits and variation in participants’ experiences of social connection. Conclusions: Participants reported physical, functional, mental/emotional, and social benefits that they associated with adapted fitness participation. These findings describe the perceived value of participation among eight participants in an adapted fitness program. The findings may inform discussions of participants’ goals and experiences but do not establish program effectiveness. Rather, they provide insight into how participants perceived the adapted fitness program and its relevance to their physical function and well-being.

1. Introduction

According to the Centers for Disease Control and Prevention (CDC), one in four adults in the United States lives with a disability [1]. Of this population, 12% experience mobility-related impairments, and approximately 32.9% report frequent mental distress [2,3]. Additionally, adults with physical impairments are at increased risk for secondary impairments, which are impairments that arise indirectly as a consequence of their primary disability [3,4].

The importance and benefits of regular physical activity are well-established and widely promoted for all individuals [5,6,7]. However, for adults with physical impairments, engaging in physical activity presents distinct challenges that may deter participation [7,8,9,10]. Consequently, these individuals often report fewer days of sufficient physical activity, despite recommendations being equivalent for the general population [11]. The disparity in activity levels between those with and without disabilities underscores the need to eliminate barriers to participation. These barriers include economic constraints, insufficient professional education and training, negative societal perceptions, and non-inclusive practices within recreational and fitness settings [8,12,13,14]. Furthermore, prevailing societal misconceptions often underestimate the capabilities of individuals with physical impairments, overlooking their potential to maintain active, fulfilling lifestyles [3,15]. Those who support health and wellness, including healthcare providers, hold a critical responsibility to address obstacles and support health promotion across broader society, including those with disabilities [15,16,17].

The benefits of physical activity for individuals with physical impairments are extensive. Participation can enhance physical functioning, independence in activities of daily living (ADLs), cognitive and emotional well-being, and overall quality of life and reduce further functional decline [2,15,18]. Despite widespread awareness of these benefits, efforts to research and promote inclusive health and wellness have remained insufficient [7,19,20,21].

While this issue resonates across all health and wellness practitioners, one particular entry point is within the physical therapy community. As such, several strategies have recently been proposed within neurologic physical therapy, emphasizing advocacy, community engagement, and continuity of care [16,17]. Among these strategies, a key recommendation encourages physical therapists to support lifelong engagement in physical activity by connecting clients with local adapted fitness professionals and evidence-based community programs [16,17]. This suggestion helps bridge the gap in the clinic-to-community transition, which has been shown to have long-term benefits beyond the clinical episode of care.

Previous research has examined participant-perceived outcomes of adapted fitness and adapted sports participation [15,22,23]. The present study contributes a contextualized account of perceived benefits within one community-based adapted fitness program, with attention to how participants related these benefits to everyday function, emotional experiences, and interactions with peers. Thus, the purpose of this study was to explore the perceived benefits of adults with physical impairments participating in a local adapted fitness program. Our goal was to characterize the benefits participants associated with their adapted fitness participation.

2. Materials and Methods

2.1. Design

We used a convenience sample and a consensual qualitative research (CQR) design to examine the participants’ perceptions of benefits associated with participation in an adapted fitness program. CQR is rooted in the traditions of grounded theory and phenomenology and is commonly used to characterize participant experiences in associated phenomena via descriptive analysis. CQR requires a rigorous analysis process with multiple researchers to ensure the trustworthiness of the findings [24,25]. The Old Dominion University Human Subjects Review Committee determined this project to be exempt (1915564).

2.2. Participants

We recruited participants from a local adapted fitness program offered for individuals with long-term physical or traumatic impairments. We obtained consent from the owner/operator of the program to recruit from the clientele. To be eligible to participate in the study, interested persons were required to be 18–89 years old, have a physical impairment, be current program participants who had attended at least one session, and be able to provide informed consent and independently answer interview questions. Individuals without a physical impairment, those not participating in the program, and those with cognitive deficits preventing independent responses were excluded. A total of 8 (mean age = 45.1 ± 12.2 years; 7 men, 1 woman) adapted fitness program participants enrolled in the study. Reported physical impairments included spinal cord injury alone (n = 3), cerebrovascular accident (n = 2), bilateral lower extremity amputation (n = 1), spinal cord injury with traumatic brain injury (n = 1), and spinal cord injury with amyotrophic lateral sclerosis (n = 1). Onset of physical impairments was recorded as acute (<1 year, n = 3) and chronic (>1 year, n = 5). The recruitment target was 20 participants within a three-month time period. During that window, eight individuals expressed interest. All eight were screened, met eligibility criteria, provided consent, and completed interviews. No interested individuals were excluded or declined participation, and no enrolled participants withdrew. Recruitment ended at the conclusion of the recruitment period. Preliminary analysis was not conducted during recruitment, and saturation was not used to determine when recruitment ended. Participant pseudonyms and demographics can be found in

Table 1. Participant pseudonyms and demographics.

Pseudonym	Sex	Age	Diagnosis	Impairment Onset
Alex	M	40	Bilateral LE amputation	Chronic
Aaron	M	41	CVA	Chronic
Phillip	M	26	SCI	Acute
Angelica	M	56	SCI and ALS	Chronic
James	M	51	SCI and TBI	Chronic
George	M	58	CVA	Chronic
Thomas	M	32	SCI	Acute
Eliza	F	57	SCI	Acute

M = male, F = female, LE = lower extremity, TBI = traumatic brain injury, SCI = spinal cord injury, CVA = cerebrovascular accident, ALS = amyotrophic lateral sclerosis.

.

2.3. Program Context

The adapted fitness program consisted of a coach-led, hour-long, functional fitness class. Sessions were offered daily, with no more than eight participants at a time. Sessions focused on strength and conditioning and were mixed modal, combining use of cardiovascular, strength and flexibility training. Activities were modified to individual abilities, and equipment to accommodate impairments was provided (i.e., larger or modified grip handles for participants with compromised grip strength). The coach’s training included CPR and first aid, American Council on Exercise group fitness instruction, and additional formal training or certification in adaptive and inclusive exercise, functional training, and movement and mobility. Individual duration of program participation and usual attendance frequency were not systematically recorded.

2.4. Instrumentation

Three members of the research team (LRP, BEJ, JMC) created a semi-structured interview guide intended to meet the purpose of the study and answer the research questions. The interview guide was then reviewed for content validity by a team of three expert clinicians separate from the research team. The three reviewers were asked to evaluate the relevance and clarity of interview guide questions on a scale of 1–4 (1 = not at all relevant/clear, 4 = extremely relevant and clear) using a content validity index scoring instrument. Any score below a 3 on this rating scale required the reviewer to provide feedback as to what would make the question a 3 or 4 [26]. The research team met to review all provided feedback and made minor wording and order edits to improve upon the clarity and flow of the instrument. The final Scale Content Validity Index (S-CVI) score of the instrument was 0.94, indicating excellent content validity of the interview guide [26]. The final semi-structured interview guide consisted of 11 standard questions with pre-scripted follow-up inquiries to any non-open-ended questions (

Table 2. Semi-structured interview guides.

Question
1. Describe why you chose to participate in the adaptive fitness program.
2. Have you noticed any physical improvements from participation in the adaptive fitness program?  a. [If yes] Describe the physical improvements you’ve had.  b. [If no] Explain why, in your opinion, there have been no physical improvements from participation in the adaptive fitness program.
3. Have you noticed any emotional improvements from participation in the adaptive fitness program?  a. [If yes] Describe the emotional improvements you’ve had.  b. [If no] Explain why, in your opinion, there have been no emotional improvements from participation in the adaptive fitness program.
4. Have you noticed any improvements in your activities of daily living, such as bathing, toileting, transferring or dressing, from participation in the adaptive fitness program?  a. [If yes] Describe the improvements you’ve had.  b. [If no] Explain why, in your opinion, there have been no improvements from participation in the adaptive fitness program.
5. Have you noticed any social benefits, such as increased social activity or increased interaction with others, from participation in the adaptive fitness program?  a. [If yes] Describe the social benefits you’ve had.  b. [If no] Explain why, in your opinion, there have been no social benefits from participation in the adaptive fitness program.
6. Can you describe any other additional benefits you have seen from your participation in the adaptive fitness program?
7. Have you achieved your anticipated goals by participating in the adaptive fitness program?  a. [If yes] Describe the goals you have been able to achieve. Explain how you determined that all of your goals were achieved.  b. [If no] Describe the goals you have been unable to achieve.
8. Describe any factors that have influenced your outcomes with your participation in the adaptive fitness program.
9. Describe how your outcomes with the adaptive fitness program differ from previous therapies or other adapted sports/activities.
10. Is there anything else you would like us to know about your adaptive fitness program experience?
11. Have your outcomes affected your interest in participating in other adapted sports/activities?  a. (If yes) Explain which activities you are interested in and why.  b. (If no) Explain why you are not interested in participating in other adapted sports/activities.

). The interview guide included questions explicitly addressing physical, emotional, functional, and social improvements or benefits. Follow-up prompts allowed participants to describe an absence of improvement or benefit. Consistent with the CQR approach, the semi-structured format permitted additional follow-up questions as needed, while all participants were asked the same 11 base questions [24,25].

2.5. Procedures

Participants were recruited by posting recruitment flyers within the adapted fitness facility to ascertain interest and eligibility in participating in our study and provided a phone number and email for interested persons to contact the research team to participate. Interested and eligible persons completed a brief demographic survey after consenting to participate and confirming that they met the inclusion criteria. After demographic information was recorded, individual interviews were scheduled and conducted by the principal investigator (LRP) using the Zoom videoconferencing platform. Each participant completed one interview lasting no more than 30 min, with no subsequent follow-up interviews. Interviews were audio-recorded, transcribed using Zoom’s automated transcription feature, and conducted over a 3-month period. Each transcript was then de-identified and copy-edited by a member of the research team. Prior to data analysis, transcripts were sent to each associated participant for participant transcript verification to confirm the accuracy of their responses.

All interviews were conducted by the principal investigator (LRP), a physical therapist with neurologic specialty certification. She had not previously known or treated any participant. No member of the research team had a professional, referral, consulting, or financial relationship with the program, and the principal investigator was the only member of the research team who interacted with the participants. Before the study, she had observed the program as a community member and was familiar with its activities. Her clinical background and familiarity with the program informed an expectation that physical activity could provide benefits for participants. Participants were informed that their interview responses would remain confidential from the coach. Individual interview findings were not shared with the coach.

2.6. Data Analysis

The primary analysis team consisted of three primary researchers (LRP, BEJ, JMC): two who are both physical therapists and were novices to CQR and one who is an athletic trainer and had extensive CQR experience. Before data analysis, the two researchers with less CQR experience were trained on the CQR processes and data analysis approaches, as encouraged by Hill et al. [24,25].

Data analysis occurred in three phases. Final theme and category labels were developed during transcript analysis. The codebook developed through successive rounds of coding and team review (Supplementary File S1). Participants’ accounts were elicited within a partially structured set of physical, functional, emotional, and social benefit domains. Coding and category refinement occurred through the CQR process described below; the interview structure may have influenced the organization of participants’ accounts and the resulting categories. First, each researcher independently reviewed three transcripts that were randomly selected. Transcripts were open coded to identify repeated concepts throughout, and the research team met to discuss their findings and develop a preliminary codebook. Next, one transcript from the first round of coding and two additional randomly selected transcripts were reviewed independently in an axial coding approach to refine overarching themes and categories. The team met once again to discuss findings and finalize the codebook. Lastly, all transcripts were independently coded using the codebook, and all team members met to finalize the consensus codes for all data. The final codebook, transcripts, and coded data were reviewed by the external auditor, an athletic trainer with expertise in CQR who was not a member of the primary analysis team, to confirm the accuracy of the codebook and thematic representation of the data. The auditor recommended collapsing two separate themes—formally named physical benefits (i.e., general physical benefits and impacts to functional activities/ADLs) and non-physical benefits (i.e., mental/emotional benefits and social benefits)—into one theme named intrinsic benefits to more holistically characterize the totality of the effects that participants experienced. This data analysis process ensured trustworthiness of the data using member-checking, multi-analyst triangulation, and an external auditor [24,25].

Frequency counts were applied to coded data to determine the relative occurrence of each theme/category within the dataset (

Table 3. Theme and category frequencies.

Theme	Category	Frequency of Code Use	No. of Participant Cases	Category Description
Intrinsic benefits	General physical benefits	18	7	General
	Functional/ADLs	21	6	Typical
	Mental/Emotional	18	6	Typical
	Social	18	8	General

). Categories were labeled as general if they were noted in all or all but one participant case (n = 7 or 8), typical if they applied to half or more participants (n = 4–6), variant if they contained two or three participant cases, and rare if only one participant case was represented in the category [24,25]. These labels describe how widely categories were represented across participant cases. They do not indicate effect size, magnitude of benefit, or prevalence in the broader population.

3. Results

CQR analysis of participants’ accounts elicited using the semi-structured interview guide resulted in three themes with associated categories. Participants described the (1) intrinsic benefits of the program when detailing the physical, emotional, and social changes that they associated with participation, (2) contextual factors of the program that made it ideal for their participation, and (3) what motivated them to participate in adapted fitness programming. The decision to report the intrinsic benefits theme separately was made during manuscript preparation to allow focused presentation of participants’ perceived benefits and their meaning in everyday life. The other themes address program characteristics and motivations for participation and are planned for separate reports. The present report includes both perceived benefits and accounts that qualify or complicate those perceived benefits. Categorical labels with associated frequency counts are provided in Table 3. This theme encompassed four categories: general physical benefits, improvements specific to their functional movement or activities of daily living, mental/emotional benefits, and social benefits. Table 3 distinguishes frequency of code use from the number of participant cases represented, and these quantities should not be interpreted interchangeably. The four categories correspond to benefit domains explicitly prompted by the interview guide and were refined through the CQR process. Participant quotes by category are presented in Supplementary File S2. The following sections describe each category using illustrative quotations, including accounts of ongoing difficulties and variation in experience.

3.1. General Physical Benefits

Participants generally described changes to their strength, mobility or endurance that were noted after participating in this type of program. Eliza stated,

“I’m at a point where I’m stronger and I think it supplements my physical therapy by helping me get stronger and hopefully it will further my progress.”

• Participants noted that the physical benefits aided them in other aspects of their lives. Phillip stated,

“Just everything in general is just easier because I am getting so much strength from going to the gym.” I think it really helped with a lot of physical therapy stuff too. Like we’re working on, like standing recently and I feel like just having all the additional strength to my abdomen and arms, and shoulders has really made it a lot easier.”

• In these accounts, perceived strength gains were associated with easier activity performance and progress toward rehabilitation goals. Eliza described adapted fitness as supplementing physical therapy, while Phillip connected perceived gains in trunk and upper extremity strength with the standing activities he had been practicing in therapy. These accounts situate perceived physical benefits alongside ongoing rehabilitation.

3.2. Functional Movement/Activities of Daily Living

Our participants typically identified that the physical changes they experienced were specific to daily activities they perform. James elaborated,

“I am feeling that I know I can get myself back up when I fall. Now I know I can do that. Allows me to…I wouldn’t leave my house because I was afraid of falling, not getting back up and me sprawled on the street somewhere. So it’s helped me with some of my independence that I can get a little, a little more quality of life, so I can feel almost like the man I used to be.”

• For James, the significance of being able to recover from a fall extended beyond performing the movement itself. His account connected confidence in getting up with reduced fear of being unable to recover outside the home, greater independence, and a sense of continuity with his previous identity. However, James did not describe complete resolution of difficulties with daily activities. When asked about bathing, toileting, transferring, and dressing, he stated:

“It’s gotten a little easier. I still have a hard time with a lot of it, but it’s gotten a little easier to keep up with it.”

• His account details how a perceived improvement can coexist with persistent difficulty. Confidence related to fall recovery therefore did not imply independence across all activities of daily living. Thomas stated,

“I would say definitely bathing and dressing. I’m able to help, like wash and I could definitely put my shirt on and take it off where I couldn’t do that before.”

These accounts illustrate different meanings of perceived functional improvement. James emphasized confidence and independence in relation to fall recovery, whereas Thomas described greater involvement in bathing and dressing. The value of these perceived changes was therefore expressed through their relevance to everyday activities.

3.3. Mental/Emotional Benefits

Participants in this adapted fitness program typically detailed the mental and emotional benefits of having the opportunity to engage in this type of activity. Angelica stated,

“The mindset, it gets in your mind, it gets in your heart and you just want more, and makes the workout fun, which is important.”

• Angelica also emphasized the gradual nature of perceived progress:

“So you really have to have that mindset to know that it’s a slow process and enjoy the little progresses that you’ve made.”

• This statement places enjoyment alongside recognition of incremental change. For Angelica, the emotional meaning of participation included valuing small gains while acknowledging that progress was slow. Aaron succinctly summed up his experience by saying,

“I have noticed an improvement in my mood.”

• The quotations presented here describe both a perceived change in mood and enjoyment of the exercise experience. Aaron identified improved mood, whereas Angelica emphasized the mindset and enjoyment associated with working out. These descriptions distinguish perceived improvement in mood from enjoyment of participation and appreciation of gradual progress. They do not suggest that emotional benefits required rapid or complete physical recovery.

3.4. Social Benefits

Participants described social interaction and shared understanding within the group, although their experiences of connection varied. Eliza described,

“It’s a place where I can go for an hour and not worry about my own situation. We’re all in the same situation.”

• Additionally, our participants identified that they were able to form new friendships through an experience with others who are facing similar circumstances. George stated,

“It’s good being with other challenged individuals and see how they deal with their issues. We can talk to one another on the same language if that makes sense. We just kind of intuitively understand one another.”

• For Eliza and George, the value of the social environment involved being with people who understood experiences related to impairment. Eliza described temporary relief from focusing on her own situation, while George emphasized a sense of mutual understanding. Their explanations suggest that the perceived benefit involved the quality of connection with peers, beyond the opportunity for social interaction alone. James’ description contrasted with George’s or Eliza’s, explaining that he had felt more comfortable in a previous group that included more veterans:

“There was a time there was a… group of us. It was mostly more vets and it was more comfortable going than the group they have now and there’s nothing against the group now. It’s just they’re not, they’re not combat vets. And you get used, you want to be around people that understand you. So emotionally, I’m on a roller coaster ride.”

• For James, a shared experience of physical impairment did not fully substitute for the understanding he associated with a shared military background, although his experience demonstrated that social participation in the program could coexist with ongoing emotional difficulty. James further distinguished interaction during sessions from social participation outside the program:

“I get along with the guys there. I mean, I don’t have a social interaction. I don’t go out.”

• He later stated:

“But as far as outside, no, I don’t have a social life anymore. But that’s not her [course instructor], that’s just I…have a hard time with that now still.”

• Participants could value social interaction during the program while still having difficulty connecting with others in the group or engaging socially outside of the program.

3.5. Summary of Benefits

Participants associated adapted fitness participation with perceived physical, functional, mental/emotional, and social benefits. The meaning of these experiences included progress toward rehabilitation activities, greater involvement in daily tasks, confidence related to fall recovery, enjoyment, and shared understanding with peers. These benefits were not uniformly experienced. Participants also described continuing functional difficulty, gradual progress, and differences in social connection within and beyond the program.

4. Discussion

The goal of this study was to characterize the benefits participants associated with adapted fitness participation. The findings focus specifically on the intrinsic benefits identified within the broader qualitative study. Within this theme, participants described four categories of perceived benefits: general physical benefits, functional movement/activities of daily living (ADLs), mental/emotional benefits, and social benefits. These findings describe participants’ interpretations of their experiences and do not establish that the program caused the reported changes.

Physical benefits were a perceived outcome discussed by participants. Participants noted general physical improvements, such as increased upper and lower extremity strength, endurance, and stability. Additionally, participants described functional improvements, such as improved mobility and performance in ADLs, which they associated with greater functional independence. James’s account also shows that perceived improvement could coexist with substantial ongoing difficulty. The significance of a functional gain should therefore be understood in relation to the activity and the individual’s remaining challenges. Gains in perceived function are relevant, as there is an association between functional independence and mental health [27]. This relationship is also reflected in the mental and emotional benefits described by participants. Given that enhancing functional independence, autonomy, and social engagement are primary goals for people with physical impairments to engage in therapy and/or physical activity [28], our data show that the perceived outcomes from participating in an adapted fitness program align with these goals. For rehabilitation providers, these findings highlight the importance of considering both changes in physical capacity and whether those changes translate into activities that are meaningful to the individual. Providers may consider asking whether gains in strength, endurance, or stability carry over to mobility, transfers, fall recovery, self-care, or other daily activities and incorporating these patient-perceived changes when discussing longer-term physical activity or fitness goals. Considering community fitness resources alongside rehabilitation goals is consistent with recommendations to strengthen community partnerships and health promotion across the continuum of neurologic physical therapy care [16].

Participants described mental and emotional benefits, including perceived improvements in mood and enjoyment in exercise. Similar experiences have been reported in community-based adapted sports, where participants described benefits related to mood regulation and changes in how they viewed themselves [22]. Research involving wheelchair users participating in adapted sports has also identified perceived benefits related to self-esteem, self-efficacy, and managing emotions [23]. Although adapted sports and adapted fitness represent different participation contexts, these findings illustrate the personal and emotional significance individuals may attach to physical activity. In the present study, participants’ descriptions of improved mood and enjoyable exercise suggest that the perceived value of adapted fitness extended beyond changes in physical capacity. Angelica’s emphasis on appreciating small gains adds that perceived emotional value could involve acknowledging gradual progress rather than expecting rapid recovery. These accounts do not establish changes in clinical mental health outcomes or demonstrate the mechanisms responsible for perceived benefits. Nevertheless, they highlight aspects of participation that may be meaningful when discussing individuals’ community fitness experiences and goals. For rehabilitation, providers asking about enjoyment and perceived emotional benefits alongside physical and functional goals may provide a more complete understanding of what individuals value about participation.

Participants emphasized social benefits such as social interaction, peer understanding, and connection as valued aspects of their experience. Participants’ accounts discussed the value of interacting with peers who understood experiences related to impairment. Across existing literature, adapted physical activity and sport appear to support social participation when they create conditions for belonging, meaningful engagement, interpersonal connection, and the development of self-efficacy within a physically accessible and socially affirming environment [22,23]. In the present study, participants’ descriptions suggest that the adapted fitness environment provided opportunities for shared understanding and connection with peers. This finding is important because social benefits are not guaranteed by physical activity participation alone. Prior work suggests that poorly structured or inadequately adapted environments can reinforce social isolation, questioned competence, and restricted participation, whereas supportive environments can foster belonging, skillful participation, and shared benefit [29,30]. The quotations presented support an interpretation of valued peer understanding and a sense of belonging, although they do not establish that these connections extended beyond the program or reduced social isolation more broadly. These findings are consistent with the broader literature indicating that group-based fitness and adapted sport may reduce isolation, strengthen social connectedness, and contribute to improved quality of life through mechanisms that extend beyond the physiological effects of exercise [31,32]. Social support and social connection have been shown to contribute to the mental health benefits of physical activity, suggesting that the quality of the social environment may be particularly important in adapted fitness settings. Previous research on sports has described participant-perceived benefits involving peer connection and belonging [22,23]. In the present study, participants’ accounts similarly emphasized shared understanding among peers. For rehabilitation providers and program staff, these findings suggest the value of asking participants whether they feel understood and connected within the program. Such questions may help clarify the social aspects of participation that individuals value, without assuming that all participants experience the group environment similarly.

Collectively, this theme describes physical and psychosocial benefits that participants associated with adapted fitness participation. The findings suggest the value of considering participants’ perceived physical, functional, emotional, and social experiences when discussing community fitness participation. Whether these experiences contribute to sustained engagement requires further investigation.

4.1. Study Strengths

This study centers on the perspectives of adults with physical impairments participating in a community-based adapted fitness program. Individual interviews provided accounts of perceived benefits across physical, functional, mental/emotional, and social aspects of participation. The analysis incorporated independent coding by multiple researchers followed by consensus discussions. Transcripts were returned to participants for review, and an external auditor reviewed the codebook, transcripts, and coded data. Together, these procedures provided complementary opportunities to examine the accuracy and interpretation of the data.

4.2. Study Limitations

This study used a convenience sample of eight participants from one adapted fitness program, limiting transferability to other programs and populations. Seven participants were men, limiting representation of women’s experiences. Participants also differed in diagnosis and time since impairment onset. This heterogeneity provided varied perspectives but limits interpretation for specific clinical populations and stages of recovery. The sample size was determined by recruitment feasibility during a three-month period. Analysis did not occur concurrently with recruitment, and saturation was not established as a recruitment stopping criterion. The dataset may therefore not capture the full range of experiences within the program. Eligibility required attendance at only one session, and individual participation duration and usual attendance frequency were not systematically recorded, limiting interpretation in relation to program exposure.

Recruitment through the program may have preferentially reached individuals who were engaged with or satisfied with participation. These findings therefore should not be assumed to represent individuals who declined or discontinued participation or perceived little benefit. Several interview questions explicitly asked about improvements or benefits. Although follow-up prompts permitted descriptions of no improvement, this positive framing may have influenced the experiences participants emphasized. The correspondence between the four reported categories and the benefit domains prompted by the interview guide should therefore be considered when interpreting the findings. Expert review supported the relevance and clarity of the questions but did not eliminate the potential influence of their framing. Social desirability may also have influenced participants’ accounts. The interviewer’s professional expectation that physical activity could be beneficial may also have influenced interviewing and interpretation. Independent coding, team review, and external auditing provided opportunities to examine interpretations but do not establish an absence of researcher influence.

The findings reflect retrospective self-report and were not corroborated by objective assessments of physical performance, daily function, or mental health. Some participants explicitly described concurrent physical therapy. Concurrent rehabilitation was not systematically assessed, so the extent of such participation across the sample is unknown. Their accounts therefore cannot establish whether perceived changes were attributable to adapted fitness, rehabilitation, or other influences. The findings should be interpreted as participants’ perceptions of benefits associated with participation rather than effects attributable solely to the adapted fitness program.

5. Conclusions

Program participants reported physical, functional, mental and emotional, and social benefits that they associated with participation in the program. Perceived benefits coexisted with ongoing functional difficulty and variation in emotional and social experiences. These accounts describe the perceived value of participation among the individuals interviewed and provide insight into how they perceived adapted fitness as relevant to their physical function and well-being. For rehabilitation providers, the findings suggest the value of discussing individuals’ perceived physical, functional, emotional, and social experiences when considering community fitness goals. The study does not establish program effectiveness, reductions in participation barriers, or increases in physical activity. Future studies should further investigate the long-term impact of adapted fitness programs, evaluate outcomes across different types of adapted wellness initiatives, and explore how these programs can be tailored to meet the needs of specific patient populations with physical impairments.