Exploring physical activity as a potential intervention to address the health consequences associated with gender-based violence.

One-third of women globally will experience Gender Based Violence (GBV) in their lifetime. GBV is a risk factor for noncommunicable diseases including post-traumatic stress disorder, depression, anxiety, chronic pain and cardiovascular disease. Noncommunicable diseases are associated with physical inactivity, which can further exacerbate mental health symptoms and cardiometabolic risk. Physical activity may therefore be an important target for intervention to improve health outcomes among people who experience GBV. Health professionals, including exercise professionals, are likely to encounter people who experience GBV as part of routine practice, yet their readiness to respond appropriately is unknown. This thesis aimed to i) determine whether individuals who have experienced GBV engage in different levels of physical activity and/or sedentary behaviour compared to individuals who have not been exposed to GBV; and ii) determine preparedness of exercise physiologists, physiotherapists and other allied health professionals (AHPs) to respond to and support a person who has experienced GBV. Chapter Two was a systematic review to explore aim (i). Electronic databases were searched from inception until May 2023. Eligible studies were original research publications that reported a quantitative measure on physical activity and/or sedentary behaviour in a group of people who have experienced any form of GBV as well as a comparator group with people who had not experienced GBV. A total of 856 studies were identified in database searches of PubMed, Embase, PSYCinfo, SPORTDiscus and CINAHL. From screening, 11 eligible studies were identified. Most studies were conducted in the United States (n=9, 82%) and most participant groups were exclusively female (n=9, 82%). The most common form of GBV measured in studies was Intimate Partner violence (n=5, 45%). Five studies reported that individuals who had experienced GBV engaged in lower levels of physical activity compared to those without a history of GBV. However, results were mixed, and the overall evidence did not support our hypothesis, that people who have experienced GBV engage in less physical activity compared to people who have not been exposed to GBV. No studies examined levels of sedentary behaviour. The overall quality of studies was poor, indicated by risk of bias and study quality scores, with 55% (n=6) of studies rated as fair and 45% (n=5) rated as poor quality based on the Newcastle Ottawa Scale. No studies used validated tools to measure levels of physical activity and inconsistent across studies precluding pooling and statistical analysis. Chapter Three was a mixed-methods study to explore aim (ii). Study advertisement was posted to social media with a link to an online survey, as well as researchers’ contact details for participants to volunteer to participate in an interview. The modified Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) survey was used to assess AHPs perceived preparation, knowledge, opinions and practice issues. Qualitative interviews with AHPs were also conducted to explore understanding of participants’ readiness to identify and respond to GBV. In total, n=105 participants completed the modified PREMIS. Most participants were female (n=78, 74%), from Australia (n=95, 90%) and exercise physiologists (n=43, 41%). Most (80%) of the sample had received one hour or less of GBV training. Mean preparedness scores were low among respondents for perceived preparation (2.79 out of 7) and perceived knowledge (2.68 out of 7). Qualitative interviews were subsequently conducted with n=10 AHPs. Thematic analysis identified four themes: knowledge, lack of confidence, seeking GBV training and clarification of AHPs role. Individuals who experience GBV may have lower physical activity levels compared to individuals not exposed to GBV, however more research with validated tools to accurately determine physical activity and sedentary behaviour levels of people who have experienced GBV is needed. Despite recognition of the importance and agreement of the relevance to AHPs practice, this workforce felt underprepared, had low perceived knowledge and lacked confidence to respond to and support people who have experienced GBV. More research is needed to understand the complex bidirectional relationship between experiencing GBV and physical activity and to further clarify the role of exercise and other allied health professionals’ in supporting people who experience GBV.

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