Providing Optimal Help for the Heroes: Military Veterans' Experiences of a Sports Recovery Programme.

Abstract

Wounded, injured, and sick (WIS) military veterans are regularly encouraged to adopt sport and physical activity as part of their recovery journey. The military, and military charities alike, have developed and encouraged adoption of sports and physical activity programmes designed specifically for WIS military veterans. Nevertheless, what remains unknown is whether participation in such programmes leads to the perceived benefits associated with them. To address the identified gap in the literature, the purpose of this thesis was to assess and examine the use of, benefit of, and potential stress of and barriers to using sport and physical activity as part of WIS military veterans’ recovery journeys. Specifically, the thesis aims to: (a) determine the role of sport and/or physical activity in WIS veterans’ recovery journey, (b) explore the prevalence of WIS veterans use of sport and physical activity recovery programmes, (c) to track and explore WIS veterans experiences of international competitive sport, and (d) to propose a theory and evidence-based physical activity psychosocial intervention.

Following an introduction to the thesis, Chapter Two provides a review of the main models of disability, as well as the transactional theory of stress and self-determination theory, upon which the thesis is based. Furthermore, Chapter Two seeks to develop an understanding of current knowledge on the experience of sport and physical activity rehabilitation and the use of these experiences in WIS military veterans’ recovery. Chapter Three (Study One) reports a cross-sectional questionnaire-based study that explores whether a series of psychosocial variables are associated with engagement in a national programme of military veteran recovery (Help for Heroes), and whether level of engagement mediates the relationship with health and well-being. The findings offer support to, as well as further previous literature, whilst also demonstrating that engagement in recovery pathways alone does not have a significant effect on military veteran health and well-being. Chapter Three (Study One) looked to build up a picture of the overall UK military veteran, sport, and physical activity landscape as it currently stands, and is therefore a fundamental foundation block in this thesis. Chapter Three influenced the direction and focus of Chapters Four and Five, as the studies focus narrowed and took an in-depth look at a specific sub-population of WIS military veterans who engaged with an international sporting event as part of their recovery journeys. Specifically, in Chapter Four, Study Two reports the longitudinal exploration of patterns of change in stress variables (i.e., stressors, appraisals, emotions) experienced in military veterans in the build up to, during, and following an international sporting competition (e.g., the Invictus Games). In addition, Study Two also examined interactions between psychosocial variables and salivary biomarkers of stress (i.e., cortisol and salivary immunoglobulin A) and how these relate to veterans’ health, well-being, illness, and performance. In line with the theoretical underpinnings of the thesis, this study found a number of stress-related variables (e.g., organizational stressors, appraisals, and coping) could predict performance, well-being, and mental health. Furthermore, intensity of organizational stressors were positively related to salivary cortisol exposure at competition. Study Two offered novel, longitudinal, and interdisciplinary insight into psychological and biological markers of the stress response as it related to military veteran athletes, whilst also contributing to theoretical understanding of the transactional nature of stress. Exploring these findings further, Chapter Five (Study Three) is a qualitative study which explores, in depth, a further sub-set of military veteran athletes’ experiences of preparing for, competing at, and returning from the Invictus Games. In doing so, this chapter identifies how individuals were motivated to compete, the organizational demands encountered prior to and at the Games, as well as the impact the Games had upon them. The findings and development of Chapters Three through Five led to the return to a broad focus on military veterans. To be precise, having developed a deeper understanding of military veterans and their use of sport and physical activity, Chapter Six (Study Four) looked to use the findings of the previous studies to aid in the design of a theory and evidence-based psychosocial physical activity intervention. Specifically, the intervention is designed to increase physical activity in WIS military veterans. Study Four used the six-step, systematic approach of Intervention Mapping, which culminated in the design of an eight-session intervention that could be delivered over six-weeks, focusing on a number of psychosocial aspects to increase physical activity.

Following the final study, Chapter Seven provides a summary of the studies presented in the thesis. Chapter Seven includes a discussion of the theoretical and empirical contributions, practical implications, strengths and limitations, and future research directions, as well as a conclusion. Overall, this programme of research provides a greater understanding of the UK military veteran population and their use of sport and physical activity in their recovery journeys. Furthermore, it enhances theoretical and scientific knowledge by expanding extant theories and scientific techniques to an understudied population. Practically, the findings offered can be incorporated into interventions to utilise sport and physical activity, which can better aid and support WIS military veterans in their recovery journeys.

Date of Award	2019
Original language	English
Awarding Institution	University of Bath
Supervisor	Rachel Arnold (Supervisor), James Bilzon (Supervisor), Fiona Gillison (Supervisor) & Martin Colclough (Supervisor)