Investigating the Relationship Between Quality and Quantity of Participation in an Online Community-Based Exercise Program: A Mixed-Methods Study

Abstract

The Quality Participation Framework proposes that repeated quality experiences foster continued quality participation (i.e., participation quantity over time). This study explored the relationship between the quality and quantity of participation in an exercise setting. Individuals (n = 17) with a physical disability engaged in Revved Up @ Home, a 10-week online community-based exercise program designed to foster quality participation. Using a mixed-methods sequential explanatory design situated in critical realism, participants completed quality experience global questionnaires at baseline and 10 weeks, and acute questionnaires following each exercise session. Participant attendance was retrieved from program records. In semi-structured interviews at 10 weeks, participants were shown graphs of results derived from the acute questionnaires and asked about their quality and quantity of participation during the program. Correlations quantified the relationship between quality and quantity of participation, and thematic analysis facilitated an exploration of the contextual relationship. Qualitative and quantitative findings were integrated, highlighting important relationships between belongingness and quantity, meaning and quantity, as well as between challenge and mastery. Findings provide preliminary evidence that repeated quality experiences foster quality participation, and detail relationships between the aspects of quality participation and between quantity and quality participation. Findings can be used to enhance quality participation and attendance among individuals with physical disabilities who attend community-based exercise programs.

1. Introduction

Individuals with physical disabilities who are physically inactive are more likely to experience secondary health conditions and require increased medical intervention to enable a positive quality of life [1,2]. Physical activity participation rates among individuals with disabilities can be up to 62% lower than the general population [3]. Implementing structured interventions can increase the quantity of exercise individuals complete, which increases overall physical activity and its many benefits [4,5]. While individuals with physical disabilities may participate in exercise through rehabilitation programs, these programs are often only available in the short term and do not address the health promotion and leisure needs for continued exercise participation [4]. Community-based exercise programs (CBEPs) fill this gap and serve as an option to provide leisure-focused physical activity opportunities for individuals with disabilities, helping participants to improve and retain mobility, functional capacity, and balance [6,7]. CBEPs offer disability-specific, affordable exercise opportunities [4] and are recommended by the World Health Organization [8] to increase physical activity and exercise participation among individuals with disabilities. To further mitigate barriers to exercise participation, CBEPs can also be offered online, reducing accessibility, socioeconomic and intrapersonal barriers to exercise programs [9]. Adam and Morgan [6] note that important aspects of a CBEP include knowledge of adaptive exercise, and the means to provide adaptive equipment. Program providers have experimented with the delivery of exercise through online platforms, demonstrating that online exercise programs can be tailored to the participants’ goals while providing adequate knowledge of adaptive exercise and appropriate adaptive equipment [10,11].

While CBEPs help to increase the overall amount of physical activity individuals with physical disabilities perform [12], simply measuring quantity of participation does not account for the complexities in participation among individuals with physical disabilities [13]. Imms and Granlund [14] suggested that the perception of participation include one’s subjective experience (i.e., quality), in addition to assessing the frequency of participation (i.e., quantity). In response, Martin Ginis and colleagues [15] proposed six aspects that comprise a quality experience: autonomy (i.e., independence, choice, control), belongingness (i.e., a sense of belonging), challenge (i.e., feeling appropriately challenged), engagement (i.e., motivated, focused), mastery (i.e., experiencing achievement), and meaning (i.e., obtaining a meaningful goal). Evans and colleagues [16] expanded this conceptualization by proposing the Quality Parasport Participation Framework, which proposes that repeated quality experiences (i.e., quantity of participation) fosters overall quality participation (i.e., the broader subjective evaluations of participation). Three conditions (i.e., social environment, physical environment, and activity environment) are foundational for an experience to be considered quality. Evans et al. [16] further postulated that the six aspects of quality experience are interrelated (i.e., more than one aspect may be experienced simultaneously), have varied value (i.e., individuals will value different aspects), vary over time (i.e., the experience of an aspect can change from one session to the next), and have varied means of achievement (i.e., several strategies can be used to achieve a given aspect).

Despite its conception in the disability sport domain [16], the Quality Participation Framework [15] has demonstrated resonance and applicability for persons with physical disabilities participating in CBEPs. Specifically, studies have highlighted that the six aspects of a quality experience are evident in participants’ CBEP experiences [17] and that the experience of each aspect is individualized and dependent on participants’ context outside of the CBEP [18]. Koch et al. [19] assessed the relationship between quality and quantity of participation in CBEPs, hypothesizing that the level of quality participation individuals with disabilities experience within their CBEP could predict their quantity of weekly moderate-vigorous leisure-time physical activity. The results of the cross-sectional study indicated that quality of participation did not significantly predict quantity of participation when measured as moderate-vigorous physical activity (MVPA) [19]. However, the authors measured quality of participation within the program, while assessing MVPA within and outside of the program. Therefore, the authors suggested that CBEP attendance might serve as a better measure of quantity of participation when assessing the relationship between quantity and quality of participation within the exercise setting.

While it is currently accepted that quality and quantity of participation are important factors for exercise behaviours among individuals with disabilities, the relationship between these factors remains unclear. Additionally, while the relationship between quality and quantity of participation in a cross-sectional nature has been investigated, the relationship between these variables over time is unknown. Accordingly, this project sought to explore how the six aspects of quality participation [15] interact with the quantity of participation (i.e., attendance) in Revved Up @ Home, an online CBEP for individuals with physical disabilities. Specifically, this study aimed to: (1) to quantitatively assess the relationship between quality and quantity of participation, and (2) to qualitatively explore this relationship by inquiring about participants’ perceptions of the aspects of quality participation, and their potential relation to fostering overall quality and/or quantity of participation.

2. Materials and Methods

2.1. Study Design

To further elucidate the relationship between quality and quantity of participation in the exercise setting, there is a need for a mixed-methods inquiry. Quantitative analysis of the relationship between quality and quantity of participation can provide insight as to how specific aspects may relate to program attendance, while the collection of qualitative data would enable a deeper contextual exploration of any potential relationships between aspects of quality and quantity. Previous analysis [19] has facilitated a numerical assessment of quality participation; however, to truly understand what encompasses a quality experience, participants must be allowed to expand on their personalized experience and provide nuanced context to their ratings of the aspects of quality participation. A sequential explanatory design was employed, in which quantitative data is collected and analyzed, then subsequently used to guide qualitative data collection and analysis [20]. The design was deemed to be mixed methods as the quantitative data was used to initiate conversations about participant experiences. Semi-structured interviews are commonly used in mixed-methods inquiry [21] and enable researchers to employ data-prompted graphic elicitation, an innovative methodological approach that prompts shared understanding of a topic through data-derived diagrams [22,23]. Contributions about the broader topic are ultimately made possible because the diagrams provide a common foundation that is easily understood by both the interviewer and interviewee. Given the complex nature of the Quality Participation Framework (i.e., six aspects, three conditions, interrelated nature), collecting both quantitative and qualitative data enables the researcher and participant to communicate descriptive findings [20]. Member checking was not conducted in this study to minimize the cognitive and emotional burden on participants during the already stressful time of COVID-19 lockdowns. A schematic depiction of the sequential explanatory mixed-methods design for data collection and subsequent analysis is included in Appendix A, Figure A1.

2.2. Philosophical Assumptions

This study is situated within critical realism. Critical realism assumes a realist ontology, contending that the truth can be measured to some degree and lending the potential of using quantitative methods to infer causality, as well as a constructivist epistemology, meaning that the knowledge is error-prone and constructed based upon past experiences and social structures [24]. Taken together, critical realism proposes that causality may be assessed, but that any potential relationship exists within “open systems” [24] (p. 11), as it is difficult for reality to be measured independently of social structures or context. Critical realism proposes that participants of a study are members of society, and the external influence of participants’ daily lives is reflected in their exercise participation.

The first research question relied on assessing the relationship between quality and quantity of participation, both of which can be assessed quantitatively. The ontological position of critical realism (i.e., realist) allowed for a quantitative assessment of the relationship between these two variables. The second research question, which sought to understand how participants experience quality participation and how this may relate to their quantity of participation, relied on a deeper contextual understanding of each participant’s experience in Revved Up @ Home. Exploring each participant’s own experience is especially important when assessing quality exercise participation among individuals with disabilities, as quality participation is highly individualized and subject to factors external to any form of exercise intervention [16,25]. The epistemological position of critical realism (i.e., constructivism) suggests that an understanding of social structures and context is important to gain when assessing a quantitative relationship (i.e., the relationship between quality and quantity of participation).

2.3. Participants and Context

Revved Up @ Home is an online exercise program based in Canada for persons with a physical disability that was launched in response to the COVID-19 pandemic. The program involves tailored exercise programs with trained undergraduate student interns via Zoom (an online videoconference software, Version 5.4X). Each undergraduate student intern was a third or fourth-year Kinesiology or Health Studies student. Each student had taken undergraduate courses in exercise prescription and in development and delivery of adapted exercise programs, and received practical skills training for online exercise coaching for persons with disabilities by the program coordinator (a Registered Kinesiologist). The 10-week program during the study period (September to December 2020) offered participants the opportunity to engage in two different types of exercise sessions. First, they could engage in two “online 1:1 exercise” sessions each week, during which student interns guided the participant in completing their 40-min home-based program, which was developed by a Registered Kinesiologist (i.e., human movement specialists who promote health and well-being through exercise and physical activity) with participant input. Second, participants could engage in “online group exercise” classes, during which interns would deliver a 30-min themed exercise session over Zoom (i.e., core, muscle strengthening, aerobic fitness) alongside other participants. The primary focus of this study was to investigate members’ experience of the 1:1 exercise session on their perceptions of quality participation. For the purposes of this study, experiences in the online group exercises were not investigated, and data were not explicitly collected to explore these group-based sessions.

Potential participants included the 24 individuals enrolled in Revved Up @ Home during the study period. Individuals who participated in Revved Up in-person programming prior to the COVID-19 pandemic were invited to participate in the Revved Up @ Home program. Individuals could also be referred to the program by their primary care provider or by a rehabilitation specialist, for consideration of long-term physical activity involvement. Program members were eligible for the current study if they had a physical disability (congenital or acquired), did not display signs of cognitive impairment, and could read and write in English. All 24 individuals enrolled in the program indicated their interest in participating on their program enrolment package. All participants expressing interest were contacted by phone by the student investigator. From this group, 21 participants volunteered to partake in the study. One participant did not complete the baseline questionnaire, two participants engaged in exercise sessions together (which may have influenced their quality of participation relative to all other participants who exercised independently), and one participant was unable to answer most questions during the interview due to signs of cognitive impairment. Therefore, complete data from 17 participants were included in the final analysis.

2.4. Quantitative Measures: Questionnaires and Attendance Data

2.4.1. Questionnaires

All participants completed two different sets of questionnaires. First, participants completed a questionnaire assessing quality participation at two separate time points (i.e., global questionnaire)—baseline (prior to beginning Revved Up @ Home) and following 10 weeks of the program. The global questionnaire included questions about demographic information (baseline only), quantity of leisure-time physical activity (LTPA) participation, and global perceptions of quality exercise participation. Second, participants completed a questionnaire assessing the aspects of quality participation following each exercise session.

The quantity of participation on the global questionnaire was assessed using the Leisure-Time Physical Activity Questionnaire for people with Spinal Cord Injury (LTPAQ-SCI) [26]. The LTPAQ-SCI is a self-report measure that assesses minutes of mild, moderate, and heavy intensity LTPA over the past seven days and is validated for use in populations with physical disabilities [27]. For both aerobic and strength-based activities, participants were first provided with a definition of the type of intensity and subsequently asked to recall the number of days (i.e., from 0 to 7) over the past seven days they performed the given LTPA at each intensity. Participants were also asked to recall the number of minutes they spent performing aerobic-based and strength-based LTPA at a given intensity. Total strength-based or aerobic-based LTPA performed at a given intensity (for aerobic or strength) is calculated by multiplying the number of days by the number of minutes of activity per day reported. To calculate the total quantity of LTPA performed for a given intensity, aerobic-based and strength-based LTPA at a specific intensity are added together. For the purposes of this investigation, total MVPA and total LTPA were calculated.

Quality of participation on the global questionnaire was assessed using the MeEAP, a parsimonious measure that aligns with the six experiential aspects of quality participation [28], and has been used to assess quality participation in an exercise setting [19,25]. The scale consists of 12 items, two items for each aspect of quality participation [28]. Participants were asked to respond to each item using a scale from 1 (strongly disagree) to 7 (strongly agree). On the global questionnaire, the items were phrased relative to one’s overall perceptions of quality participation while exercising (e.g., When engaging in exercise activities, I feel…). For the acute questionnaire, a modified version of the MeEAP was used to reflect the exercise session that was just completed (e.g., In my Revved Up @ Home session today, when I engaged in exercise activities, I felt…) [25,28]. Additionally, each acute questionnaire contained one final question to be used during the semi-structured interviews (i.e., “What do you think is the most meaningful experience [positive or negative] that you had in your Revved Up @ Home session today, and why?”).

2.4.2. Attendance Data

Attendance percentages were included as a second measure of the quantity of participation as per the suggestion of Koch et al. [19]. Attendance data, collected from program records, were reported as percentages, dividing the number of sessions attended by the total number of sessions offered (i.e., 20).

2.5. Qualitative Data: Interviews

All participants engaged in a semi-structured one-on-one interview following 10 weeks in Revved Up @ Home. The interviews were conducted online using Zoom. Interviews lasted an average of 64.41 min (SD = 11.57; range 52–88 min). All participants provided consent prior to the interview and agreed to be audio recorded. Cameras were turned on to establish rapport and increase the comfort level of the participant. Visual cues also facilitated understanding of a participant’s responses [29].

The overall purpose of the interview was to explore each participant’s perceptions of their quality and quantity of participation. There were two sections of the interview. During the first part of the interview, participants were asked to reflect on different types or sources of motivation for engaging in Revved Up @ Home, as well as any goals they hoped to achieve when initially starting the program. The second part of the interview utilized graphic elicitation to explore how participants experienced quality participation in Revved Up @ Home, and how this contributed to their continued attendance in the program. The process of graphic elicitation involved showing participants numerical graphs of each aspect of their quality participation in alphabetical order (i.e., autonomy, belongingness…) over time in Revved Up @ Home. Participants were probed to explain any variation or stability in each aspect of quality participation. This conversation was aided by reminding participants of their answer to the final question of the acute survey (i.e., “What do you think is the most meaningful experience (positive or negative) that you had in your Revved Up @ Home session today, and why?”). Additionally, participant motivations and goals, as addressed in part one of the interview, were referenced to help participants share which aspects of quality participation contributed to continued attendance in Revved Up @ Home.

2.6. Analysis

2.6.1. Descriptive Statistics

Descriptive statistics were first calculated for the demographic variables as well as the aspects of quality participation and measures of quantity of participation. The two questions for each aspect of quality participation [28] were averaged to provide an overall score for an aspect of quality participation at baseline and 10 weeks. Scores for each aspect of quality participation were averaged across all 17 participants at baseline and 10 weeks. Total quality participation scores at baseline and 10 weeks were calculated by averaging scores for all six aspects of quality participation. Paired samples t-tests were performed to determine the difference over time in MeEAP scores for each aspect of quality participation and total quality participation. Paired sample t-tests were also performed to determine differences in MVPA and total LTPA between baseline and 10 weeks. The level of significance was set at p < 0.05. Effect size was calculated using Cohen’s d, whereby 0.2, 0.5, and 0.8 represent small, medium, and large effects, respectively [30].

2.6.2. Correlations Between Quality and Quantity of Participation

To assess the relationship between quality and quantity of participation over the 10-week program, residualized change scores were calculated [31,32] for all six aspects of quality participation, as well as MVPA and total LTPA. A potential quantitative relationship between quality and quantity of participation was assessed by performing the following bivariate correlations: (1) the relationship between the change in quality of participation and the change in quantity of participation assessed as MVPA, (2) the change in quality of participation and the change in quantity of participation assessed as total LTPA (i.e., mild, moderate and vigorous intensity) and (3) the change in quality of participation and attendance to Revved Up @ Home. Pearson correlation values were interpreted based on the following conventions: r < 0.10 as negligible, 0.10–0.29 as small, 0.30–0.49 as moderate, and r > 0.50 as large [33].

2.6.3. Thematic Analysis

All interviews were transcribed verbatim. A reflexive process was used to guide the process of a primarily deductive thematic analysis [34]. A ‘critical friend’ (B.T.) encouraged reflection on interpretations of the data, with the goal of ensuring the participants’ voices were maintained throughout the analysis [35]. Theme development assumed a recursive approach, during which the transcripts were revisited to ensure the final created themes accurately reflected participants’ experiences [34]. Throughout the analysis, both the researcher and critical friend considered what may be influencing links between aspects of quality participation and continued attendance in Revved Up @ Home. When developing initial codes, extensive thought went into whether to comment on a specific response from a participant, and how the response might contribute to the overall analysis. Codes that were prompted by many aspects of quality participation signaled potential interrelations between aspects of quality participation, while codes that were only prompted by one aspect of quality participation would indicate potential links between quality and quantity of participation. Themes were extensively discussed and named over multiple meetings with the critical friend (B.T.) and other authors. The connections between the developed themes were drawn to visually map the links between quality and quantity of participation, as well as between aspects of quality participation.

2.6.4. Integration of Quantitative and Qualitative Results

Findings from the quantitative and qualitative analyses were integrated. Integrating mixed-methods data is an important task as the two forms of data can construct a broader story [36,37]. It is difficult to place equal weight on both qualitative and quantitative methods, as the research question often leans towards one of the two methods [37]. As such, authors have noted that an important consideration of data integration is whether quantitative or qualitative data is prioritized [20,38]. While the quantitative analysis provides a numeric representation of any relationship, the potential contextual relationships uncovered by the qualitative analysis were also of value. Given that this study sought to contextualize the relationship between quality and quantity of participation, emphasizing the participants’ lived experiences was a primary objective. Additionally, in line with this investigation’s philosophical assumptions, critical realism often seeks to theorize underlying causes for empirical observations (i.e., previous postulations [16] and data that suggest a relationship exists between quality and quantity of participation [18,19]) through the process of retroduction [39]. Retroduction involves seeking the cause of an observable phenomenon, which involves curating a deeper understanding through qualitative inquiry. As such, if there was a discrepancy between quantitative findings from a correlation and qualitative interview data, priority was allocated to the interview data when making interpretations.

3. Results

3.1. Demographics

Participants included in the analysis had a mean age of 64.35 + 12.25 years. More than half (53%) of participants were male, and 100% were Caucasian. The majority of participants (77%) were living with an acquired disability, and the average time since diagnosis was 12.87 + 9.66 years. Full demographic data is in

Table 1. Participant demographics.

Characteristics	Totals Mean ± SD or n (%)
Participants	n = 17
Age (years)	64.35 ± 12.25
Sex
Male	9 (53)
Female	8 (47)
Marital Status
Married	11 (65)
Common Law	2 (12)
Divorced	3 (17)
Widowed	1 (6)
Ethnicity
Caucasian	17 (100)
Education
High School or less	2 (12)
College	9 (53)
University	6 (29)
Postgraduate Degree	1 (6)
Years since injury or diagnosis a	12.87 ± 9.66
Cause of disability
Acquired	13 (77)
Congenital	4 (23)

^a Two participants did not answer this question.

.

3.2. Descriptive Statistics

Average baseline and 10-week scores for each of the six experiential aspects of quality participation, including the average of all six experiential aspects (i.e., total quality participation), are in

Table 2. Baseline and 10-week scores for the aspects of quality participation and quantity of participation.

	Baseline Score		10-Week Score
	Mean ± SD	Range	Mean ± SD	Range	t (df)	Cohen’s d
Aspects of Quality Participation
Autonomy	5.16 ± 1.60	2.5–7	5.75 ± 1.82	1–7	1.15 (15)	0.35
Belongingness	5.33 ± 0.73	4–6.5	6.53 ± 0.72	4.5–7	6.19 (14) **	1.69
Challenge	5.53 ± 0.65	4–6.5	6.38 ± 0.80	4.5–7	4.17 (16) *	1.17
Engagement	5.79 ± 0.73	4.5–7	6.44 ± 0.85	4–7	3.16 (16) *	0.82
Mastery	5.26 ± 1.13	3–7	6.26 ± 0.71	5–7	5.09 (16) **	1.06
Meaning	5.53 ± 0.98	3.5–7	6.41 ± 0.69	4.5–7	6.06 (16) **	1.05
Total Quality Participation	5.40 ± 0.75	3.8–6.7	6.30 ± 0.69	5–7	7.21 (16) **	1.25
Measure of Quantity of Participation
MVPA	50.29 ± 70.59	0–225	104.29 ± 120.94	0–400	1.62 (16)	0.55
Total LTPA	170.00 ± 184.37	0–530	258.47 ± 193.36	40–655	1.60 (16)	0.47
Attendance			91 ± 10	60–100

Note. The aspects of quality participation and total quality participation are scored out of 7. MVPA and total LTPA are reported as minutes/week. Attendance scores were represented as a percentage of the sessions attended. At 10 weeks, one participant selected “prefer not to answer” on the two questions targeting autonomy, and two participants selected “prefer not to answer” on the questions targeting belongingness; hence, n = 16 for autonomy and n = 15 for belongingness at this time point. * p < 0.01, ** p < 0.001.

. There was a statistically significant difference in MeEAP scores between baseline and 10 weeks for belongingness, challenge, engagement, mastery, meaning, and total quality participation (Table 2).

3.3. Correlations Between Quality and Quantity of Participation

The correlation matrix of the changes in aspects of quality participation, total quality participation, and the three measures of quantity of participation is presented in

Table 3. Pearson Correlations Between Quality and Quantity of Participation.

Aspect of Quality Participation (RCS)	Quantity of Participation
	MVPA (RCS)	Total LTPA (RCS)	Attendance
Autonomy a	0.12	0.08	−0.14
Belongingness b	0.19	0.35	0.12
Challenge	−0.09	−0.02	0.14
Engagement	−0.14	−0.04	0.04
Mastery	0.17	−0.08	0.18
Meaning	0.16	−0.08	0.35
Total Quality Participation	0.13	0.06	0.34

Note. RCS, Residualized Change Score. MVPA, moderate-vigorous physical activity. LTPA, leisure-time physical activity. ^a n = 16 for autonomy. ^b n = 15 for belongingness.

. None of these results were statistically significant. Attendance was moderately positively related to change in total quality participation (r = 0.34), MVPA demonstrated a small positive relationship (r = 0.13), and Total LTPA was not related to change in total quality participation (r = 0.06).

3.4. Thematic Analysis

Within the qualitative data, four main themes provide context to a potential relationship between the quality and quantity of participation. These themes include: (1) meaning is cyclically related to quantity of participation, (2) belongingness is cyclically related to meaning, autonomy, and quantity of participation, (3) challenge and mastery are cyclically related and both aspects link to quantity of participation, (4) engagement does not relate to quality or quantity of participation. Findings are described below with quotes from participants.

3.4.1. Meaning Is Cyclically Related to Quantity of Participation

Participants experienced meaning in the program as they felt that participating in Revved Up @ Home prompted a feeling of responsibility towards themselves and their commitment to the student interns.

Many participants described meaning as a sense of responsibility towards their own participation. One participant mentioned the following: “I’m the one that’s willing to get the exercise done. For me, I know that I have to, I have to be doing some kind of physical activity or I’m gonna be in trouble.” (P3). Participants were motivated by, and found meaning in, different personal goals. Some participants were motivated by the promotion of their own health or mobility: “The exercise is definitely good for you to keep in good shape.” (P14). Other participants exercised for the pure enjoyment of the activity: “It’s fun! I enjoy it. It’s a lift for me to—to uh, to do it.” (P17). Despite differing motivations, almost all participants’ responses were centered around their own desire to complete the exercise. Participants who had individual goals or motivations to participate in the program were likely to cite those factors as contributing to continued attendance in Revved Up @ Home.

Participants also felt a responsibility to the student interns, which manifested in two ways. First, participants felt obligated to attend because the interns had dedicated time and energy to complete the session, as one participant stated: “People have gone out of their way to help me and—, and there is a feeling of responsibility to you know, make sure that time is not wasted.” (P7). This obligation provided meaning to the participants through the responsibility they felt to others in the program: “I think it holds me accountable having someone to—that is giving their time to me. It’s like I would never cancel, that’s something that’s pretty important to me. […] Other people’s time is valuable.” (P6). Participants also felt responsibility to the interns when they recognized that they were contributing to the interns’ education: “They might be going into a career like physio or um maybe occupational therapy or even medicine or something. So, um they’re benefitting from me.” (P11). Contributing to students’ training fostered a sense of meaning to the participants, as the program provided participants with a way to enhance the students’ training for possible future employment in healthcare.

As participants continued to attend Revved Up @ Home, they reported an increased sense of meaning from their experience as they saw their function and/or health improve: “These exercises over a period of time are meaningful to me because I was improving my muscle tone, my outlooks on life, and enjoying myself at the same time.” (P4). The meaning some individuals associated with their participation in Revved Up @ Home was often influenced by their relationship with others in the program, which, due to the online format of Revved Up @ Home, was with their intern: “[The intern] said that she was really going to miss me. I said yeah right. And she just came back with ‘no, I’m going to miss you’. And that was very emotional.” (P17).

3.4.2. Belongingness Is Cyclically Related to Meaning, Autonomy and Quantity of Participation

The second major theme was the existence of a cyclical relationship between autonomy, belongingness, and meaning. Additionally, belongingness seemed to be mutually related to the quantity of participation. A participant’s feeling of meaning in Revved Up @ Home was somewhat shaped by the connections they developed with the student interns of the program. Similarly, many participants’ feelings of autonomy were influenced by the relationships developed in the program.

Meaning and Belongingness

The responsibility that participants felt towards the intern was dependent on their relationship: “Them being there each day was important. That’s probably the biggest cue to keep me engaged. […] And they were all very social, always chatting away, showing interests, we always kept each other going with some good stories.” (P6). Some participants liked to conceptualize Revved Up @ Home as a “team effort”, where the student intern and the participant would both benefit from the exercise session, which was contingent upon a strong relationship with their interns: “It was like a responsibility. This is important for their education. I’m helping them. They’re helping me. So it’s a team effort and responsibility.” (P13). P2 realized how meaningful the connections she developed with the interns were when she experienced a change from one intern to another:

The number of exercises I got done [after switching interns] during a session were fewer but we got to know each other a lot more […] we developed a program that was more to my needs, which never would’ve happened had we not stopped to talk about things going on in my life.

(P2)

Participants characterized meaning and belongingness interacting in a cyclical manner, where a sense of belonging would often prompt a meaningful experience, which in turn facilitated an increased sense of belonging.

Relationship Between Belongingness and Quantity of Participation

The level of belongingness that participants felt in the program also influenced their desire to continue attending their dedicated session each week. Due to the online nature of Revved Up @ Home, the primary point of contact for participants were the student interns. As such, the more connected a participant felt to their intern, the more likely they were to continue attending the program: “I created a bond with my interns, and like it just encouraged me to continue with the program because if the people didn’t make me feel welcome, then I’d be like dreading going to my workouts.” (P13). Indeed, P13 spoke about the close relationship she developed with her interns, to the point of her referring to the interns as her “friends”. The close relationship that some participants developed with their interns led to a continued desire to attend Revved Up @ Home.

Belongingness and Autonomy

Participants who had developed a close relationship with their interns (i.e., experienced belongingness) were more likely to suggest beneficial changes to their own exercise program (i.e., autonomy over Revved Up @ Home): “I was getting used to the students, perhaps, the more comfortable I felt probably the more comfortable I was of expressing what I needed, how I was feeling about the exercise.” (P17). There was an initial adaptation period, during which the participants would become acclimatized to the intern’s coaching style, prompting participants to feel a sense of control over their exercise program. If an exercise was too difficult or too easy, participants wanted to change the program to fit their abilities or goals: “I more or less just felt more comfortable with the program and as I felt more comfortable, I think I was able to convey what I was expecting and how I was feeling during it.” (P11). As belongingness increased, participants perceived interns as more comfortable asking about participant goals and needs, which further facilitated autonomy for the participant. Participants appreciated when the interns would inquire about what exercises met participant expectations of physical improvement:

I was telling them I have lots of difficulty with cramps in my hamstrings. And so they showed me a very specific stretch for my hamstrings […] It made me feel like they’re listening to what I’m saying and they’re trying to do something that’s going to help out.

(P16)

Participants reported that a close relationship with their intern encouraged conversations about their exercise program (i.e., autonomy), which consequently led to a more enjoyable relationship with their intern (i.e., belongingness).

Autonomy Was Not Important to Some Participants

Of note, a few participants did not desire to change or to take control of their exercise program. Many participants attended Revved Up @ Home in hopes of following a workout plan that would achieve their set goals. Thus, some participants felt as though they should just follow the workout plan as it was created: “I felt very strongly that I would get the most benefit out of this interaction with the students if I followed the program that was laid out.” (P4). This feeling was, however, often linked to a belief that the interns were knowledgeable about the program and knew what was best for the participant: “I’ve never felt in control because I’m always taking the assumption that the trainers know more than I do about physical activity.” (P2). Participants felt a sense of security when engaging with Revved Up @ Home, administered by the interns. Many participants felt assured that the interns would always work to maintain their safety:

They realized that I’m an [older] person and they never dwelt on it, but they made my safety and well-being, were always paramount and they would do a great deal of trouble to make sure the exercises were always to be done at my pace.

(P4)

Taken together, competent interns who constantly ensured safety provided assurance to participants, and while some participants experienced autonomy in Revved Up @ Home, others did not. As a whole, individuals who did not experience autonomy felt as though it was an insignificant aspect of their participation.

3.4.3. Challenge and Mastery Demonstrate a Cyclical Relationship and Both Aspects Link to Quantity of Participation

Challenge and Quantity of Participation

Participants who continuously felt challenged by their specific exercises continued to attend the program: “That’s one thing with Revved Up @ Home, it was always a good challenge. So it kept me motivated.” (P15). How participants perceived challenge was often linked to whether their engagement with various exercises in the program were oriented by personal goals. Having specific set goals enabled participants to recognize the importance of feeling challenged and motivated continued attendance to Revved Up @ Home. Potential barriers caused by a physical disability often contributed to an increased desire to participate, so that participants could improve their functional fitness and limit the impact of their disability on their daily life. The desire to continue participating in the program was specific to each individual: “I have nerve damage in my hands. […] I drop things on a regular basis. And actually the exercises have helped me because it’s easier to pick things up now, than when I wasn’t doing Revved Up @ Home.” (P17). Taken together, while some participants were driven by the challenge of the exercises alone, others desired to overcome the challenges they experienced outside or within Revved Up @ Home related to their disability. Challenging exercises tended to lead to personal improvement, achievement of goals and drove overall desire to continue participating.

Mastery and Quantity of Participation

Participants’ reflected that when mastering a movement or exercise, they were more likely to continue attending Revved Up @ Home. Consequently, when participants attended the program more frequently, they would master more exercises and reach their goals. The goals that participants formed were often observable milestones, which were a direct consequence of participating in Revved Up @ Home: “We tried to move my right arm in order to be able to swing at the ball. I’m still about—about three-quarters there. […] That’s why I look forward to the exercise. Because I can see some improvement. “ (P14).

When participants noticed they had improved an exercise or their overall function, they would feel an increased sense of confidence, which promoted continued participation in Revved Up @ Home:

I was getting more confident as time wore on. That’s what I was after, to feel more confident, to feel as if I was accomplishing what I wanted to be accomplishing in terms of doing better with the exercises, getting stronger, being able to perform them better.

(P8)

Consequentially, as participants continued to attend, they engaged more with their exercises, which led to further mastery: “Suddenly it just seemed to click and my ability to do them was improving. […] It was just that it was just easier to do the exercises, and I was getting the right cues.” (P17).

Cyclical Nature of Challenge and Mastery

Participants who were provided with challenging exercises reported experiencing mastery: “I was getting more used to them, not that they were getting any easier, they were just beginning to be things that I could do…more easily.” (P8). There was a shared sentiment that challenging exercises served as a precursor for improvement:

People who were waiting for the next class would remark that my appearance looked as though I had a good workout and that’s what I needed, that’s what I wanted, and you only get that if you put into it the maximum effort […] cause if you don’t push yourself, you don’t improve.

(P4)

Once participants reported a sense of mastery with an exercise to their intern, they recognized that the interns would provide more challenging exercises: “They asked ‘would you mind if we challenged you a little bit?’ And I said ‘sure go ahead.’ […] I felt fine with the challenges and I think that I was quite successful.” (P11). Over time, participants would receive challenging exercises, which they would eventually master, leading to the inclusion of more challenging exercises: “This is hard stuff [but you] get the job done right, that’s it. And then you master it. But there’s always one higher level to go to.” (P1). Findings suggests that participants’ perceptions of challenge and mastery led to increased quantity of participation.

3.4.4. Engagement Demonstrates Limited Relation to Quality or Quantity of Participation

Due to the online format of Revved Up @ Home, participants commended the intern’s focus and reported some feelings of engagement as a result: “They’re not just sitting there like texting or looking at their Facebook [...] they’re focused on me.” (P13). Another participant spoke to the attention he received from the interns as a mechanism to improve his form: “You might be slouching a little bit […] They’re like, okay, well, just remember, you’ve got to keep that elbow straight or try not to move your head when you’re doing your exercise.” (P15). Participants such as P13 and P15 felt as though their interns were engaged and this prompted an increased sense of motivation to engage with the program.

Appreciation with the intern’s focus was contrasted by frustration with a lack of interaction with other Revved Up @ Home members. Participants had the opportunity to engage in group exercise sessions but were often less inclined to participate due to busy schedules, personal insecurities, or lack of interest in group exercise. Since some participants had little desire to engage with the online group sessions, and there were limited alternative opportunities for socialization among program participants, some participants cited less engagement in their one-on-one sessions with the interns. While participants enjoyed Revved Up @ Home for what it provided, the missing camaraderie among other participants was noted: “I miss the socialization of seeing other people exercising, you know. The benefit of people getting together, enthusiasm.” (P10).

3.5. Integrated Findings

A representation of quantitative findings is provided as the first pane of Figure 1A. A moderate r value was selected as a cut-off because the quantitative relationship between the total quality participation and quantity of participation is represented by r = 0.34 (i.e., moderate). A representation of qualitative findings is demonstrated in Figure 1B. Quantitative and qualitative findings were integrated for the final representation in Figure 1C. The overall relationship between quality and quantity of participation (i.e., as depicted at the top of the figure) was shared between qualitative and quantitative findings. The two relationships that demonstrated coherence between qualitative and quantitative findings are: (1) meaning and quantity of participation (i.e., attendance) and (2) mastery and challenge. As illustrated in Figure 1C the quantitative data highlights relationships that may exist between different aspects of quality participation, while the qualitative data features the links between the aspects of quality participation and quantity of participation.

4. Discussion

This investigation achieved its objective of exploring the relationship between the quality and quantity of participation in an exercise setting. Findings indicate that there is a relationship between quality and quantity of participation (i.e., repeated quality experiences over time are related to quality participation); however, the relationship is nuanced in nature.

Findings provide preliminary mixed-methods evidence that there is a relationship between quality and quantity of participation. In agreement with Koch et al. [19], this study found that quality and quantity of participation demonstrated a negligible relationship (r = 0.13) when MVPA data was used as the measure quantity of participation. This investigation provides empirical evidence to suggest that there is a moderately sized relationship between quality and quantity of participation (r = 0.34) when attendance is used as the measure for quantity of participation; however, the quantitative results were not statistically significant. Following the integration of the quantitative finding of a moderate-sized relationship between quality and quantity of participation, with the qualitative findings that multiple aspects of quality participation prompt continued attendance in an exercise program, the current investigation supports the proposition by Evans et al. [16] that repeated quality experiences facilitate continued quality participation. Additionally, integrating quantitative and qualitative data provides new insight regarding how specific aspects of quality participation may interact with one another and with quantity of participation. Findings suggest the importance of establishing a preliminary quality experience for individuals with disabilities in an online CBEP, as this is likely to lead to repeated quality experiences and continued quantity of participation.

Qualitative findings from this investigation provided context for how a given aspect of quality experience may relate to participants’ continued attendance in the program. Participants derived a sense of belongingness by spending quality time and developing a close relationship with their intern, which led to the participant feeling a continued desire to attend the exercise program. This is not a novel finding, as close relationships between interns and participants have previously been demonstrated to be an integral component of extended participation in exercise programs [40]. Therefore, it is imperative that interns of a CBEP should be trained to foster quality participation strategies within the program. For example, one strategy for fostering quality participation in CBEPs is to “Create opportunities to get to know the participants beyond their identity in the program as an exerciser” [41]. This strategy specifically targets participant perceptions of belongingness and interns could be trained to adhere to this strategy by asking the participants about their lifestyle and interests or hosting social sessions after weekly exercise sessions to get to know participants [41]. In relation to autonomy, some participants may not have cited this aspect as important to their experience because their intern did not make it clear that collaboration is an integral aspect of (the exercise program). As such, interns should be trained to help their participant understand early in the program that the exercise session is a collaborative environment. Subsequently, interns should constantly ask for participant feedback and inquire what they are looking for in the program.

Participants in the current study spoke to a cyclical relationship between challenge and mastery. When participants received challenging exercises, they worked hard to master the exercises, and subsequently receive a more challenging exercise. Experiencing both mastery and challenge made the participants feel like the program was meeting an appropriate level of difficulty and helping to reach their goals, ultimately encouraging future attendance. Revved Up @ Home is designed with an initial ‘intake session’ where the participants communicate their goals of the exercise program with the individuals designing their program. Other CBEPs should adopt this strategy [41], as it was integral to participants feeling a sense of control over their exercise program at the early stages of their participation (i.e., autonomy; [15]. Subsequent sessions should focus on participants’ small achievements throughout the program; in fact, the exercise program should be designed for the participant to achieve a small victory every few sessions. A continuous focus on achieving mastery in the exercise program, with an emphasis on increasing the challenge of the exercise program over time, is integral to ensuring that the program fosters repeated quality experiences and keeps the participant returning.

Data integration highlighted the relationship between meaning and quantity of participation. Participants continued to attend the exercise program because they felt as though they were achieving personally or socially meaningful goals. Personally, many viewed attendance as a commitment to themselves and their own well-being, aligning with intrinsic motivation, a sense of achievement and personal growth [42]. Additionally, participants felt that attending the program achieved a socially meaningful goal as they were contributing to their interns’ education, reflecting extrinsic motivation, where the expectation of being present for the interns became a driving force for participation [42]. As participants continued to attend the exercise sessions, they further achieved the personally meaningful goal of commitment to attendance and the socially meaningful goal of contributing to the interns’ learning. Koch et al. [43] suggest that meaning is the aspect of quality participation that is highly related to other aspects of quality participation. In this study, meaning seemed to impact one’s continued attendance over time in an exercise program; however, the reason meaning led to continued attendance over time was seemingly related to the commitment the participants made to their intern, manifested through the close relationships that interns and participants developed from the exercise program taking place online.

Engagement did not demonstrate a clear qualitative relationship with the quantity of participation. Some participants perceived that the one-on-one format offered direct intern attention, which enhanced feelings of engagement. However, the lack of peer-to-peer interaction previously experienced in the in-person version of the program led to diminished perceptions of engagement. Peer-to-peer interaction can be a core aspect of CBEPs, supporting feelings of community, mutual encouragement, and shared motivation [44]. The individualized format of Revved Up @ Home limited these social dynamics. This discrepancy suggests that engagement, as conceptualized by the participants, extends beyond focused attention or individualized support; it requires social connections and shared experiences with peers.

4.1. Strengths and Limitations

This study adopted a mixed methods design to assess and explore the relationship between quality and quantity of participation. Building on previous explorations of this relationship (e.g., Koch et al. [43]), the addition and prioritization of qualitative inquiry enabled this investigation to explore data beyond simple quantitative relationships. In addition to the robust study design, multiple researchers were included in the analysis process to encourage reflexivity when analysing the qualitative data analysis [34]. Methodologically, the use of graphic elicitation addressed a major barrier to engagement in research: the inability of participants to understand complex theories [45,46]. The use of data-prompted interviews enabled this investigation to ask participants specific questions about their quality participation as they progressed through the program. However, the method displayed some limitations, as participants may have sought to agree with the information presented by the interviewer, leading to confirmation bias. Finally, caution should be exercised when generalizing these findings to larger CBEPs. The first reason being that this study reports findings from an online CBEP, necessitated by the COVID-19 pandemic, which may not generalize to an in-person CBEP. The second reason being that the entire sample size of this study identified as white (n = 17), and 15 of the 17 total participants received some form of post-secondary education. While access to CBEPs may vary based upon ethnicity [9,47], CBEPs must offer programming that meets the needs of diverse groups of participants. Future investigations could seek to evaluate the quality participant among participants in different exercise programs across Canada, enabling a more diverse population.

4.2. Future Directions

The online exercise program was an interesting and intuitive solution to public health countermeasures imposed by the COVID-19 pandemic. To enhance future online programming and increase the quantity of participation, future investigation should seek to understand how the relationship between quantity and quality of participation is fostered in other online settings and among alternative, more diverse samples of participants. Further, studies should seek to determine if the current findings regarding the nuanced relationship between quality and quantity of participation translate to in-person CBEPs. Both online and in-person CBEPs can refer to the recently published list of strategies to design and implement quality exercise experiences for individuals with disabilities [41]. Strategies that are used frequently to foster repeated quality experiences should be compared to the findings of the current study, and a tailored strategy matrix for online exercise programs can be developed.

Future investigations would benefit from employing mixed-methods research to study quality participation. Quality participation is highly nuanced in that there is inter-individual variability, variation over time, and interrelations between aspects [16,25,43], so developing a contextual understanding of the framework through qualitative inquiry is highly encouraged. However, quantitative data enables researchers to quantify and generalize relationships within the framework. As theoretical relationships within the framework are uncovered, future investigation can probe further into practical implications of the framework, helping to achieve the goal of offering optimal CBEPs for individuals with physical disabilities.

Researchers in sport and exercise psychology are encouraged to use graphic elicitation (or data-prompted interviews) to understand participants’ experiences and their impact on behaviour. Experts in the field of physical activity promotion cite the importance of basing research in theoretical constructs [48,49], and these constructs (e.g., aspects of quality participation) may be difficult for research participants to grasp. Graphic elicitation and data-prompted interviews offer an intriguing alternative to alleviate the complexity of theories that guide exercise psychology research.

Lastly, this study demonstrates that mixed-methods research can stay true to an ontological and epistemological philosophical assumption. The adoption of ontological realism and epistemological constructionism, both central to critical realism, enabled for the generation of data through mixed-methods which draw contextual-specific conclusions. Collection and analysis of quantitative data provided a starting point to build an understanding of the relationship between quality and quantity of participation, while qualitative data provided ‘real world’ evidence that supported these relationships and contributed to contextual ideals that surround the framework.

5. Conclusions

This investigation advances our knowledge of the Quality Participation Framework in the exercise setting. Previous studies had proposed a link between repeated quality experiences (i.e., quantity of participation) and quality participation. Investigation of the link between quality and quantity of participation in an online CBEP illustrates that fostering the aspects of the Quality Participation Framework leads to continued quality experiences, which results in continued quality participation in the exercise setting. Within this relationship, the aspects of quality participation are highly interrelated, which also leads to continued quality experiences. Continued investigation into various strategies that may enhance the relationships between the aspects of quality participation, as well as between quality and quantity of participation, will lead to the goal of full and effective participation among individuals with physical disabilities in online and in-person CBEPs.