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Is leisure a luxury?

Alison Johnson, MS Specialist Occupational Therapist
The Walton Centre for Neurology and Neurosurgery, Liverpool

Way Ahead 2009;13(3):9-11

Introduction

an artist drawing at an easel'

There are a great number of complex factors that can affect how an individual copes with a long-term neurological condition such as multiple sclerosis (MS). Anecdotal evidence suggests that people with MS who maintain leisure interests or activities often appear to have better coping mechanisms and manage their condition more effectively. In spite of this, health professionals frequently overlook the therapeutic potential of engagement in leisure. Alison Johnson, an MS specialist occupational therapist, explores the correlation between participation in leisure and better health outcomes for people with MS.


Defining leisure

The task of defining leisure is complex. What is leisure for one person may be seen as work, or a means of keeping healthy, by others[1]. In the abstract sense of the word, leisure has been defined as 'occupations which produce intrinsic rewards and provide life-enhancing meaning and a sense of pleasure'[2]; while within the context of occupational therapy, one researcher proposed, 'participating in leisure neither cures nor removes the effects of chronic health problems, but it does have the potential to change quality of life for many individuals'[3].

In the last 30 years, there has been a recognisable shift away from the idea of leisure as a discrete activity, to a focus on the 'leisure experience' which is more closely related to a state of mind. Characteristics of leisure explored through research have included: freedom of choice, pleasurable feelings, timelessness or flow, perceived competence, spontaneity, intrinsic satisfaction and fun[3].


Leisure and occupational therapy

Within occupational therapy, occupations are generally classified as one of the following: self-care, productivity or leisure[4]. Critics of this system of classification suggest that rather than being a linear classification system, it is a hierarchy that reflects the values and priorities of physically independent, employed theorists.

Despite the recognition of leisure as a key concept in occupational therapy, in practice, leisure assessment is often perceived as a luxury. As a result, more emphasis is given to self-care and productivity activities and the therapeutic potential of leisure remains largely unrecognised and unexplored.

A team of researchers explored the practices of occupational therapists in a variety of settings and deduced that the frequency with which therapists assessed leisure closely correlated with how much value they placed on leisure in the practice of occupational therapy. Interestingly, therapists practicing in psychosocial areas valued leisure significantly more than those practicing in physical areas[5].


MS and leisure

While there is a wealth of literature supporting physical activity to improve quality of life for people with MS, an extensive literature search confirmed that there is presently very limited research that focuses specifically on leisure and MS. It is important to make the distinction between physical activity and leisure; physical activity is not an enjoyable pursuit for everyone and it can become increasingly difficult as the condition progresses. Furthermore, pleasure is the main outcome of leisure, and improvement in the overall management of the condition is usually a less conscious, but however welcome, outcome.

In spite of the apparent lack of research focus on leisure, a wider search of the literature revealed that several studies on MS and quality of life have indicated leisure as a contributing factor to health and wellbeing[6-13]. Particularly interesting is one qualitative study on women who participated in artistic occupation with chronic illness; three of whom had MS. The study suggested that this occupation may provide a source of positive identity, even when the individuals had not engaged regularly in art earlier in their lives[14].


Many factors influence the participation in leisure

Participation in leisure is influenced by many factors including age, parenthood, culture, education, environmental factors and lifestyle[15]. As an individual changes so too do their leisure activities and preferences. Yorkston proposed a useful model hypothesizing factors related to participation for people with MS and has more recently identified self efficacy as a particularly distinguishable variable[16, 17].


Health and leisure

Leisure is frequently recognised as a potential coping mechanism after the onset of illness or disability and is thought to exert its influence in a variety of ways such as: providing distraction; generating optimism; restoring aspects of self; giving meaningful goals and promoting personal growth[8,18-22].

Furthermore, researchers have acknowledged the role of leisure in facilitating the rehabilitation of people with neurological conditions. One proposed a theoretical framework that synthesizes three main forms of leisure, nominally: serious; casual; and project-based leisure; and pointed to its usefulness as a tool for professionals working in neurorehabilitation. Serious leisure is differentiated from casual leisure, the latter being seen as essential to life but unlikely to enhance personal development. Serious leisure contains many characteristics that can also be derived through work. Serious leisure requires perseverance and training and is driven by self-actualisation[23].

Hutchinson and Kleiber examined the ways in which casual leisure may contribute to health and well being, particularly in response to stressful life circumstances[24]; "Going for a meandering stroll through the forest. Watching a 'mindless' movie on a Friday night after a busy week of family and work demands. Doing a jigsaw puzzle. Playing a casual game of pool with friends."

They propose that casual leisure is not emotionally, cognitively, or physically demanding but is most valued for its ability to give people a temporary break from stressors. Casual leisure is often a positive distraction. Furthermore, having these relatively ordinary activities provides something to look forward to, which could help a person get through a difficult time. The benefits of brief experiences of enjoyment may extend beyond the moment, by enhancing beliefs that they can manage the ongoing stressors in their lives[24].


Other conditions and leisure

The role of leisure for people with other conditions has also been investigated. For people with mental illnesses the main enabling factor of participation in leisure was often found to be the network of people to provide support through these activities. The main hindering factors were identified as physical limitations, lack of finances and lack of transport. In the absence of paid employment leisure was particularly important and individuals reported that engagement in leisure activities increased their sense of wellbeing[25]. Some parallels can be drawn between people with multiple sclerosis and those with mental illnesses regarding participation in leisure, besides which, evidence suggests that people with multiple sclerosis have a higher prevalence of mental health problems than the general population[26].

Parallels can also been drawn in the work of Drummond[27] who investigated how the leisure activities of people changed following a stroke. The most common reasons for change in activity were reduced ability to walk, reduced manual dexterity, poor concentration, problems with continence, lack of transport, embarrassment, finance and the need for physical assistance. It was suggested that most of the findings could also be true for people with multiple sclerosis[27].


Conclusion

All the available literature on leisure and health supports the view that leisure can be a tool for coping with, adjusting to, and at times growing personally, despite chronic illness. However, in order to be recognised for its full therapeutic potential, there needs to be a shift away from the idea of leisure as mere indulgence. It is hoped that the research that has highlighted leisure as a key variable in an individual's quality of life, will encourage a shift in mindset and help to place it higher up the agenda for commissioners, funding bodies, and busy members of the multidisciplinary health care team.


References

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