Understanding occupation and it’s significant role in either enabling or disabling health and well-being is rooted in the paradigm of occupational therapy’s founders (Cole 2017). Occupational therapy was originally developed and established on humanistic values and scholars viewed occupation as the positive engagement between the person and the environment to influence overall well-being (Wong & Fisher 2015). This is further explored in Keilhofner’s Model of Human Occupation, which was the first contemporary model to implement occupation-focused practice (Keilhofner 2008). While MOHO is the most commonly referenced occupation-focused model, others include, Canadian Model of Occupational Performance and Engagement and Person-Environment-Occupation-Performance Model (Wong & Fisher 2015). According to Keilhofner (2008), occupation refers to doing work, play, or activities of daily living within a temporal, physical, and sociocultural context at characterizes much of human life. CMOP-E and PEOP categorize occupation as self-care, leisure, and productivity or work (Wong & Fisher 2015). All three models ultimately describe occupation as the “doing," essentially the activities an individual engages in routinely. However, the “ doing” will appear differently in each individual. It is believed that Individuals are occupational beings, with unique desires, habits, and needs drawn from their specific circumstances and capacities (Durocher, Gibson & Rappolt, 2013).
Occupational therapists have thoroughly explored the relationship between health and occupation. Mary Reiler, an influential occupational therapist in the 1960’s, developed the theory of occupational behavior, which was founded on the belief that the through engagement in activity or occupation health is produced and maintained ( Cole 2017). Ann Wilcock, an Australian Occupational therapist argues that occupations are innate human behavior that encompass all the things people do, serving both a social and biological function (Creek & Lougher 2008). Creek & Lougher (2008) explains “occupational nature” as a person’s desires to be occupied and the chosen occupations role in fulfilling the individual, ultimately promoting survival and health. The difficulty is when an individual is denied or restricted from desired occupation, which could be caused by individual or social factors (Creek & Lougher 2008).
Consider exercise as the occupation to illustrate these core concepts further. Wether it is high or low intensity, many individuals incorporate exercise into their daily routine. The reason exercise is a meaningful occupation is subjective to each individual (Backman 2013). It may be for health benefits, the companionship, or pure enjoyment. The motives for participation in an occupation, such as exercise, may change across a life span. For example, a young person may exercise because they enjoy the physical activity and results. An adult may exercise as a release from the daily responsibilities of work and family. An elderly person may exercise to feel a sense of community by participating in fitness classes designed to accommodate an older age group. The motives for exercise may vary, yet each person exercises to meet an occupational desire or need. Individualistic motives reinforce the idea of volition, which is a discussed in Keilhofner’s Model of Human Occupation. MOHO is divided into subsystems to understand human occupation: volition, habituation, performance, and environment. Keilhofner puts significance on volition, describing it as a person’s innate and acquired urges to act a certain way (Kielhofner & Burke 1980). Each person holds individual values, interests, and personal causation for their actions. Therefore, one person may hold exercise as a meaningful occupation, while another person may not. Even those who routinely exercise, may have different motives for their participation in the same occupation (
Backman 2013).
The choices from the volition subsystem can then be integrated into roles and routines in the habituation subsystem (Kielhofner & Burke 1980). Once identified as an interest, exercising becomes apart of routine living, when interrupted, can lead to a decline in health and well-being. Many intrinsic and extrinsic factors can disrupt participation in exercise. To understand what might disrupt exercise, the skills and capacities to enable exercise must be identified first. To participate in exercise, there is a level of performance skills required. Performance subsystem includes motor and processing skills (Kielhifner & Burke 1980). Consider the process of exercising and the skills that it may be require. Whether it is walking the block, running a marathon, or lifting weights there are cognitive and physical abilities required to complete these activities, some more demanding than others. For example, an elderly woman values remaining active, and has developed a habit of walking her neighborhood every morning. In order for her to complete this activity she must be independent and mobile to get out of bed, get dressed, leave her house, and reach the sidewalk before she even begins her routine walk. She must have the strength and stamina to complete her walk, which means her musculoskeletal and neurological systems are functioning sufficiently for her to coordinate movements required to walk.
Consider the disruption of exercise and the effect in may play in this woman’s daily living. A disruption from her walk could manifest itself in numerous ways, such as an illness, relocation, or unemployment (Creek & Lougher 2008). Imagine the woman was completing her daily walk and experiences a fall. She fractures her hip and undergoes a hemiarthoplasty, which will lead to a temporarily restriction in her normal movement patterns because of the recovery time after an invasive surgical procedure. This is an example of a short term condition, where injury will prevent participation in normal occupation during her recovery. Since this is a valued occupation in her life, the inability to participate may lead to a feelings of frustration, anxiety, and hopelessness. This is just one example of physical impairment that illustrates disruption in occupation. There are several individual, social, and environmental factors that also influence engagement in exercise (Creek & Lougher 2008).
Through a disruption in desired occupation, an individual may experience occupational imbalance, occupational deprivation, or occupational alienation, which can cause a breakdown of health (Creek & Lougher 2008). These concepts are drawn from the idea of occupational injustice, which is when participation in occupation is disrupted. Occupational justice as defined by Christiansen & Townsend (2004, quoted in Creek & Lougher 2008 pg. 48) refers to “ justice related to opportunities and resources required for occupational participation sufficient to satisfy personal needs and full citizenship.” Occupational therapist view engagement in occupation as a right for all individuals and when occupation is met in a satisfying and meaningful way for an individual, justice is also met (Creek & Lougher, 2008). While occupational therapist strive to maintain occupational justice, there are many cases of occupational injustice. Occupational alienation and deprivation are viewed as issues of occupational injustice. To illustrate this further, if a teenager exercises because they are being forced to by their parents, but it is not a valued occupation, the outcome is occupation alienation (Creek & Lougher, 2008). On the other hand, if a child values exercise, but does not have the resources available or access to the desired tools, the outcome is occupational deprivation (Creek & Lougher 2008). Occupational alienation and deprivation can lead to occupational imbalance. Durocher, Gibson & Rappolt (2013) define occupational imbalance as an excessive time spent occupied in one area of life at the expense of other areas. Creek and Lougher (2008) reinforce this balance by emphasizing that engagement in a valued occupation is healthy, but people need engagement in a range of occupations. Therefore, exercise is not the only occupation in an individual’s life, but rather one of many valued, obligatory, and discretionary occupations that join together to serve different purposes that create health and well-being (Backman 2013). This concept of occupational harmony, fulfillment, and compatibility with one’s values is known as occupational balance (Backman 2013).It is believed that occupational balance and occupational imbalance is a spectrum and throughout our life it is a constant shift as we change, develop, and grow over a lifespan (Backman 2013). Contemporary occupational therapist view the sufficient balance as occupations performed in the areas of self-care, productivity, and leisure (Backman 2013). Depending on the individual, exercise could fall into one or all three of these categories. Keeping your body in shape and gaining the physical health benefits from exercise can be viewed as self-care. Exercise that stimulate feelings of accomplishments could be viewed as productivity. When exercise brings a sense of relaxation, it can be seen as leisure. Whether it is self-care, productivity, or leisure exercise should be integrated with other meaningful occupation to create a well balanced life.
The last subsystem discussed by Kielhofner & Burke (1980) is the environment, which includes objects, events, and people. These environmental factors influence in either enabling or disabling engagement in occupation (Kielhofner 2002). For instance, the gym can be viewed as an environment that enables individuals to engage in exercise. Objects provide individual’s with opportunities for doing (Kielhofner 2002). Without the objects in the gym, such as workout equipment, an individual could not physically engage in a workout. Culture also influences occupation and environment (Kielhofner 2002). Individuals participation in occupation is often shaped by the cultural values and norms of the societies in which people live (Whitford 2013). Occupation often takes place in specific built spaces, which are established and understood by members of society to meet a designated purpose (Kielhofner 2002). Society creates, acknowledges, and promotes the space, labeled as a gym, to carry out physical activity. Without the established building and space, exercise could not take place there. Events held at the gym, such as workout classes, can effect whether an individual engages in exercise. A person may choose to exercise because of the camaraderie and companionship that is felt in participating in classes with other people. Therefore, the people at the gym may play a significant factor in engagement with exercise. If a person feels a connection with other members, the gym may be seen as a social environment, where they are able to meet social and physical desires. Environment often creates opportunities for individuals to engage in occupation, such as the objects, events, and people in gym influencing exercise.
The environment is not limited to the tangibly felt and seen, but also cultural, social, and political factors. Outside sources, such as public announcements, media , and government can also influence engagement in exercise. In 2014, Lord Coe, a formal Olympian urged families, schools, and businesses to live a more active style. Coe reported that today’s children are the 'the least active generation in history’ and could be the first to have a shorter lifespan than their parents. His messaged driven by a report from the All Party Commission on Physical Activity, which showed that only 22 percent of British adults exercise for 30 minutes a week and that on average are now 24 percent less active than in 1961. The commission warns that the lack of activity is strongly linked to a rise in type 2 diabetes, heart disease and cancer (Donnelly 2014). Statements and warnings of disease and death, can affect people’s awareness and be a contributing factor in prioritizing exercise. The media promotes exercise with promises of higher self-esteem, confidence, and beauty. A study by researchers at the University of Arizona and Texas State University showed that exercise-related posts on social media make people more concerned about their own weight. They reported the benefits of media posts for some is the increased interest in exercise, while for others it brings feelings of insecurity in their bodies. (Does Viewing Exercise-Related Social Media Influence Your Health? , 2018). Influenced by others results or own insecurities, social media has the ability to engage people in exercise. Studies show that physical environment has a strong impact on physical activity (U.S. Health Policy Gateway, year). Local governments can play a role in promoting physical activity through their influence on built environment. They have the ability to create or restrict opportunities for physical activity for communities by the layout and maintenance of neighborhood parks, recreational facilities, sidewalks and roads, bike and walking trails, as well as investing public money in enhancing existing areas (Institute of Medicine (US) and National Research Council (US) Committee on Childhood Obesity Prevention Actions for Local Governments, 2009). Local governments can dictate participation in exercise through resources and accommodations made available to the public. These are just a few examples of how culture, society and political matters can influence engagement in exercise.
Occupation plays a central role in health and well-being. Most literature, including occupation-focused models such as MOHO, CMOP-E, and PEO agree that occupation comprises play/leisure, activities of daily living, and productivity (Kielhofner 2009).
Through participation in several of occupations, individuals are able fulfill different roles in life, ultimately finding meaning in the world. (Kielhofner 2009, Backman 2013). For many people, exercise creates a part of their identity. When interrupted, denied, restricted, or prohibited, it has the potential to create short-term or long-term emotional and physical difficulties. Personal factors combined with environment circumstance creates or restricts engagement in exercise.