Quality of Life and Body Image in Para-Athletes: A Perception of Swimmers Who are Members of Paraprolim

1. Introduction

Regular physical exercise is crucial for physical, social, and psychological health. However, it highlights that people with disabilities (PWD) and the general population often become more sedentary, leading to health issues like insulin resistance, hypertension, and atherosclerosis [1]; this is particularly concerning for PWD, who face additional challenges in sports due to congenital or acquired disabilities [2]. Consequently, many PWD experience social displacement and lack awareness of the benefits of structured physical training.

Adapted sports have significantly advanced in rehabilitation since World War II. In Brazil, sports for PWD began in 1958 with the founding of “Clube do Optimismo.” The Navy Paralympic Project (Paraprolim), a collaboration between the Brazilian Navy, Caixa Econômica Federal, and Associação Desportiva Almirante Adalberto Nunes (ADAAN), supports Para-athletes in Swimming, Athletics, Shooting, and Weightlifting.

Sports provide Para-athletes with a platform to showcase their resilience and compete against their disabilities [3]. Quality of life, which encompasses health, satisfaction, and social relationships [4,5], is a testament to their determination. Body image reflects their self-esteem and attitudes towards themselves [6].

This study aims to understand how Para-athletes from the Paraprolim program perceive sports’ influence on their quality of life and body image. Previous research indicates that exercise benefits PWD, although excessive training can have negative effects [7,8]. Exercise enhances self-efficacy, self-image, and self-esteem [9]. By evaluating Para-athletes’ perceptions, we can potentially improve their quality of life and performance, offering hope for professionals working with this population. Understanding the physical and psychological impacts of sports on Para-athletes can enhance multidisciplinary support and improve their quality of life and competitive performance.

This study aims to identify the perception of quality of life and body image in Para-athletes participating in the Paraprolim program.

2. Materials and Methods

This study uses a qualitative and descriptive approach. Seven para-athletes, representing Paraprolim of both genders, with physical and intellectual disabilities and swimming abilities, were evaluated.

We interviewed the athletes at the Almirante Adalberto Nunes Physical Education Center (CEFAN), where they train to avoid interfering with their intense routine. The interview utilized the focus group technique, considered as the meeting of people selected to discuss and comment on a specific topic (focus on the subject), aiming at a faithful analysis of the athletes’ speech without capturing images (video) of the athletes. Themselves, thus providing participants with peace of mind when discussing the proposed topics through the coordination of a central researcher who; in turn, assumes the role of facilitator of the discussion process in which the psychosocial aspects that emerge are prioritized, emphasizing influences of opinions on a given topic.

The focus group strategy is a qualitative technique that can be used alone or in conjunction with other qualitative or quantitative methods. It seeks to deepen knowledge of the interviewees’ needs. The advantages of working with the focus group are the relaxed atmosphere of the discussions, the confidence of participants in expressing their opinions, active participation, obtaining information that is not limited to the evaluators’ previous conception, and the high quality of the information obtained.

On the other hand, it has disadvantages, such as difficulties in obtaining participants who must meet particular criteria and invalidating the findings due to the interference of some of the participants. This technique allows for diverse opinions and the participants’ confidence in expressing their ideas and concepts. The speech expressed by the participants is not just descriptive or exploratory; it is a speech with a sense of debate, a discussion where it is possible to observe each participant’s points of view and concepts.

The research participants used numerical codes to guarantee the confidentiality of their identities and the ethical principles of research. This research studied the quality of life, self-esteem, and motivation of Paralympic athletes based on a semi-structured interview script consisting of 12 questions: 04 about the athlete’s trajectory, 04 about motivation, 01 about self-esteem, and 03 about quality of life in sport.

2.1. Participant Inclusion Criteria

• Being an athlete with a disability;
• Both sexes;
• Be part of the Paraprolim project in swimming and training at CEFAN.

2.2. Participant Exclusion Criteria

• Missing the collection day;
• Para-swimming athlete who is not a member of the Paraprolim project;
• Para-swimming athlete who is part of the Paraprolim project but does not train at CEFAN.

2.3. Research Ethics

The study was submitted to the ethics and research committee of the Salgado de Oliveira University and in compliance with the standards on research involving human beings, as set out in resolution 466/2012 and 510/2016 of the National Health Council, and, before the study, all the participants agreed and signed the free and informed consent form (TCLE), containing the objective of the research, evaluation procedures and voluntary nature.

2.4. Theoretical, Methodological Framework for Data Analysis

We used ethnomethodology and content analysis to analyze the interviews. When deciding to investigate the quality of life and self-esteem in Paralympic athletes, the researcher needs to know the daily lives of these athletes and the way they perceive and give meaning to their life experiences built daily; to do this is necessary to understand how athletes perceive themselves, the form of their actions, the strategy they develop to train at high performance, face their adversities in their routine, or even the everyday situations that life presents to them.

When investigating a phenomenon, the researcher starts from the experiences lived by the research subjects, obtains descriptions from these subjects regarding their knowledge, and holds in their hands significant speeches that can be understood and revealed in their essence.

Within the context proposed for analysis and discussion of the results, it is essential to highlight ethnomethodology, current sociology that emerged in California in the 1960s that goes beyond the singular conception of the social construction in which data are collected and processed. For ethnomethodology, the quantitative approach that is only concerned with the input and output of data without observing the process in which they are constructed needs to reflect how reality is built adequately. Therefore, it represents a rupture, both in the research perspective and in the intellectual stance of the researcher. The hypothesis assumes that we are all sociologists in a practical state so that ordinary people understand and describe reality and that each social group can understand, comment on, and analyze itself. Ethnomethodology privileges micro social approaches to phenomena, giving greater importance to understanding than explanation. Social actors’ descriptions of the facts surrounding them are valued, and these descriptions become the essential object of ethnomethodological research [10,11].

The language that interests ethnomethodologists differs from the educated language of erudite linguists or that of structured discourses but that of everyday life, used by ordinary citizens in their practical everyday actions. Ethnomethodologists use the same linguistic resources as ordinary men, standard language in their research, and descriptions and interpretations of social reality [10]. One of the bases for the study of practical reasoning consists of how members of a society use words and everyday narratives to determine the position of their experiences and activities. Therefore, the ethnomethodologist is interested in how actors use elocution or speech to construct a set of coordinated and intelligible actions.

Another characteristic from this perspective derives from indexicality, which always suggests a local and contextual meaning unique to each interactional act. Therefore, sociology can never hope to obtain generalizations through its analyses that can explain the social facts dispersed in different historical and cultural contexts. In this way, the researcher must uphold the indexical expressions of his analyses. Still, on the contrary, he must pay attention to them to absorb the most excellent possible explanatory content through their meanings.

As we have seen, ethnomethodology is based on the study of everyday practical reasoning, seeking from this set of evidence to reconstruct a simple explanation of the observed reality, that is, with the connotation of partiality and relative scientific humility, admitting that explanations they serve to account for the interactional meanings of a given group, in a given historical and cultural context.

Therefore, this technique produces a large amount of data, and one way of working with such a quantity is to use transcriptions with raw data. It aims to show how participants managed the interaction in an orderly way. For this approach, the analyst seeks to interpret a turn (one person’s speech from beginning to end), examining the response of another participant in the following turn, as the key to spatial organization lies in the relationships between adjacent turns.

This article highlights five key terms regarding the operationalization of field research, considering them the most important for research in Information Science. Recognizing that ethnomethodology does not allude to the method but to the field of investigation, the key terms that focus on and explain the highlighted concepts are practice or achievement, indexicality, reflexivity, notion of member, and reportability [10].

Practice or achievement is the subject’s ability to produce and signify actions. It starts from the assumption that social reality is seen as a practice constructed in the daily lives of social actors.

Indexicality refers to the circumstances surrounding a word or a situation. It starts from the premise that social life is constituted through language. In everyday relationships, people talk, ask questions, and respond; this means that, like language, social actions need to be indexed. In the specific case of research on reading, indexicality guides us towards understanding the research context since the statements collected in the interviews are insufficient and can only be considered with the researcher understanding the social context in which they are uttered.

Indexicality in the researched group occurs when readers share memories of time lived in the family, at school, on the street, through names and expressions that awaken affective memory, imagination, and creativity, when they talk about a time not experienced by the researcher. The natural, ordinary language through which people express themselves in their daily lives is profoundly indicative; it gives clues because, for each social actor, the meaning of their everyday language depends on the context in which they live. It manifests itself [10].

Reflexivity designates practices that simultaneously describe and constitute the social framework and cannot be confused with reflection. Reflexivity shows the construction of social action as we talk, the meaning, order, and rationality of what we are doing now. Through this line of reasoning, we understood that the speeches of the research subjects present characteristics that describe their social world, which is why they need to be explored in interviews. We can also see that when they talk about reading, they describe it and, at the same time, construct reality, make their paths, and also remade by them due to the action-reflection process, in which the subject’s marks on the and with the world they reveal themselves.

The notion of member established by ethnomethodology concerns a person who, having incorporated the ethnomethods, the methods that people uses to understand and construct the reality that surrounds them of a considered social group, ‘naturally’ exhibits the social competence that adds you to this group and allows you to be recognized and accepted. It conceives that a person is a group member not because he belongs to a group in a face-to-face relationship but because he dominates the language of this group. The notion of member refers to a person endowed with know-how, a set of methods and procedures, which make them capable of inventing adaptation mechanisms to make sense of the world around them.

Accountability is the characteristic that allows communication to flow between social subjects, making rational, practical activities shareable, aiming at intersubjectivity and the constitution of the social action of knowledge. Its basic premises are: the way an individual interprets facts and acts towards other individuals or things depends on the meaning (or meanings) he attributes to these different individuals and things and; meaning, however, is the result of (or is constructed from) the processes of social interaction. When reading stories and experiences, the first approach to the principle of accountability occurs through descriptions and reports of their stories and experiences, which reveal specific realities of their lives. The world provided by accountability represents a local universe centered mainly around a limited group of people, where the objectification of the social world takes place as a product of the practical activities of these interacting actors. Given the above, the ethnomethodological points complement each other.

The five key concepts that guide Garfinkel’s [10] thinking are a reference for ethnomethodological thinking. The set of these concepts enables the practice of Garfinkel’s ‘profane sociology’, which emphasizes understanding the construction of everyday life and valuing the naturalistic organization of a social group through its practices.

The focus group is an instrument for data collection in which the researcher can listen to several subjects simultaneously and observe the interactions characteristic of the group process. It aims to obtain various information, feelings, experiences, and representations from small groups about a given topic.

According to Bardin [12], the theme is the unity of meaning that naturally emerges from an analyzed text, respecting the criteria for the theory that guides this reading. Therefore, the content analysis of the theme consists of discovering the cores of meaning that comprise a communication whose presence or frequency means something for the intended analytical objective.

We transcribed the interview speeches to a computer, where the speeches were skimmed. First, impressions were taken, maintaining the participants’ original speech and subsequently analyzed, observed in the content analysis. According to Bardin’s [12] proposal that determines it as a set of techniques for studying the communications carried out, aiming to obtain, through systematic procedures. These indicators allow the inference of knowledge regarding the production of the messages received, which organizes them into three phases: 1) pre-analysis, 2) exploration of the material, and 3) treatment of results, inference, and interpretation.

a) The pre-analysis, the organization phase, aims to operationalize and systematize the initial ideas to lead to a precise research development scheme. The hypotheses and initial objectives of the research are revisited and reformulated in light of the material collected, and indicators are created that guide the final interpretation. This phase consists of three tasks: skimming reading, the constitution of the corpus, and reformulation of hypotheses and objectives. Floating reading takes exhaustive contact with the material to learn its content. The floating term appears as an analogy to the psychoanalyst’s attitude, as little by little, the reading becomes more precise, depending on hypotheses and theories that support the material. Organization of the material so that it can meet some validity standards: exhaustiveness, representativeness (that reliably represents the universe studied), homogeneity (it must precisely comply with the themes), and relevance (the contents must be appropriate to the objectives of the work). Reformulation of hypotheses and objectives: the recording unit (word or phrase), the context unit (the delimitation of the context of understanding of the recording unit), the clippings, the form of categorization, and the most theoretical concepts are determined by general guidelines that will guide the analysis. At this stage, the interview data was collected to provide transparent and objective questions in search of simple answers; considering that the current study aims to evaluate some athletes who have intellectual difficulties in understanding the dialogue, we selected the critical points for the conversation were selected, then subdivided into athlete’s trajectory, quality of life, motivation, self-esteem, and quality of life.

b) Dealing with exploring the material and systematically analyzing the text according to the previously formed categories. They were: The meeting with the project consists of participants’ reports on how they became aware of the sport and the opportunity; the difficulty of being a para-athlete daily; the prejudice they may have suffered: the Paraprolim project and everything it represents for each of them; the motivation and demotivation involved in the routine; self-esteem and body perception before and after swimming. Moreover, a relationship exists between the positive and negative pressures of being a Para-athlete.

c) In the treatment of results, inference, and interpretation, the raw results, that is, the categories that were used as units of analysis are subjected to simple or complex statistical analyses depending on the case, highlighting the information obtained so that it can be inferred and predicted. Some benefits were then identified regarding the objective of this study, with the use of the focus group and content analysis as a clinical-qualitative methodological strategy that can significantly contribute to other studies.

3. Results and Discussion

Initially, we present the description of the participants, and then the categorizations are made based on the analysis of the participant’s statements collected in the focus group. We omitted the names of the participants to preserve anonymity. We named as P1, P2…

3.1. Description of Participants

Below is a description of the participants and their respective data regarding disability, age, gender, swimming practice, and profession.

Table 1. Characterization of participants about disability, age, sex, and class in Paralympic swimming.

DISABILITY	AGE	GENDER	CLASS
P1	19	MAS	S14
P2	24	MAS	S7
P3	26	MAS	S7
P4	20	FEM	S14
P5	18	MAS	S8
P6	30	MAS	S14
P7	18	FEM	S8

Source: Authors.

Table 1. Characterization of participants about disability, age, sex, and class in Paralympic swimming.

DISABILITY	AGE	GENDER	CLASS
P1	19	MAS	S14
P2	24	MAS	S7
P3	26	MAS	S7
P4	20	FEM	S14
P5	18	MAS	S8
P6	30	MAS	S14
P7	18	FEM	S8

Source: Authors.

The International Convention on the Rights of Persons with Disabilities, 2007, approved by Legislative Decree no. 186 of 2008 and incorporated into Brazilian law by Decree no. 6,949 of 2009, considers people with disabilities to be those who have long-term impairments of a physical, mental, intellectual or sensory nature, which, in interaction with various barriers, can obstruct their full and effective participation in society on equal terms with those other people [13].

3.2. Category 1 - Meeting the Project

Participants initially brought information about how they found out about the project:

• P1 - My mother signed me up for a club, and I took a swimming test there. I passed the test, and then I met the coach, and he asked me to swim on his team. Paraprolim came about after the pandemic
• P2 - I had a spinal cord injury when I was 16 years old, and as a form of rehabilitation, I started paralympic swimming with the coach here. As the journey progressed, I had to stop swimming and the sport, in general, to work when he said he had Paraprolim here at the Navy would take me, and that is how I managed to return to the sport.
• P3 - In 2020, after suffering an accident, an acquaintance posted about the project, and I became interested in swimming; after the accident, I did not see much opportunity, so I looked for ways to communicate until I was heard, so I managed to speak to the project representative, and they gave me the notice, I filled it out. I did not pass it; I kept running after it, and the professor gave me attention and support. I went through the hiring processes and managed to fit into the project and come train here.
• P4 - I have been swimming since I was little. I fell in love with it, and they taught me everything. I did not swim during the pandemic and missed it. The teacher recommended it to me when everything came back, and I joined. I was delighted and very excited. It changed my life a lot.
• P5 - Well, I started swimming at thirteen years old as a form of physiotherapy because I was crooked. I continued until I was ten, twelve, and thirteen when Patrick found me. From then on, I started training seriously with a focus on competitions. Through Patrick, after the pandemic, I stopped for a long time until this opportunity arose, and I could be here training in the Navy.
• P6 - I was nominated by Sarah Kubitschek, where I come from. I was in an accident and had a head injury. I am discovering everything, and I know that sport is outstanding.

They said that swimming is very good in life, which gives more stability when it comes to walking, dealing with people and discovering everything again. I just started swimming here in the project; I already done another sport; I used to do judo, I won many medals too, but when I was young, I am already thirty years old, here I am going to see if I can get more medals.

• P7 - I started participating in the Navy project here after the pandemic and love participating in this excellent project. Every day here, I dedicate myself more and feel thrilled to be part of this project. I have been swimming since I was four years old, starting as a little girl, recommended by physiotherapy.

3.3. Category 2 - Difficulty Being a Para-Athlete

Regarding the most significant difficulty in becoming a Para-athlete, the athletes mentioned demands, discipline, and difficulty in accessibility. However, the mention of overcoming and the desire not to give up are present in the participants’ statements:

• P1 - It is difficult because there is much pressure, and you have to have discipline and listen to what the coaches tell you; that is what is difficult.
• P2 - When you start, the most significant barrier for people with disabilities is this issue of lack of accessibility, and this makes everything much more tiring; if I have to come to training very early, I have to wake up much earlier to avoid running the risk of missing the bus, because, unlike a person without a disability, I cannot run after that bus, increasing my physical and mental exhaustion, this is the most significant difficulty, the lack of accessibility makes everything heavier. Still, as an athlete, I develop tranquility despite my limitations; this is nothing your body cannot adapt to achieve.
• P3 - I have experienced many difficult moments in life, and through it all, I have learned to be strong and not get discouraged by any barrier or obstacle. Thank God, I do not see this as a difficulty; I try to overcome my limits.

However, it is essential to highlight the willpower of Para-athletes, each person with their story, their fears, and their way of dealing with their challenges. Paralympic athletes have also been studied as essential characteristics for the rehabilitation process, considering that more resilient athletes have attitudes and behaviors favorable to the rehabilitation process. These cognitive aspects can facilitate responses that promote the best sporting performance.

3.4. Category 3 - Prejudice

Regarding prejudice along the way, they had reports about never having gone through anything that shook them:

• P7 - I have never been in a situation of prejudice. I always try to be on good terms with people, and those who pass by me are kind.

However, in most of the situations they experience, the quest to not get discouraged is what matters most:

• P2 - There are these archetypes created by society, or about what we do, which are like “Wow, you do things alone” or “no, calm down, let’s be careful.” this is because I have a disability because I am in a chair as if that limited me, but, in truth, what limits us is our head, what is inside our mind, but there is prejudice every day, every time, a look, a way of speaking, a way of trying to resolve a situation, it exists directly.
• P3 -There is always prejudice, but I try not to get discouraged. Sadly, it is part of society, but it means lifting your head, looking ahead, and letting go.

Stating that prejudice is part of athletes’ reality, a survey carried out by the DataSenado Institute, in partnership with Senator Romário’s office and support from the Brazilian Paralympic Committee, carried out with Para-athletes, where 12% participated in the Rio Paralympics in 2016, pointed out that more than 70% of Paralympic athletes in Brazil have already suffered social prejudice.

In this report, it is essential to highlight the athlete’s emotional shock caused by a person who commented on her future:

• P4 - Some people doubted it. They told me I did not have to go swimming, which was not for me, but that is what P3 said. We have to hold our heads up and be strong because it is our plan and our future. I liked this and started crying a lot because people do not know about our future; we do.

In this speech, it is essential to highlight how this Para-athlete decided to react to some prejudice situations he experienced:

• P6 - I have been through this a lot, but today, I deal with it well; that is just me. When someone joked with me and made fun of me like that, I smiled, and that was a very, very direct answer: that the best thing is to give a smile because we are there, we are enjoying ourselves, and if you want, we still wish to. They beat you, you look much prettier than them, and they even get jealous.

3.5. Category 4 - The Project and Its Benefits

Participants described how the project interferes with their routines:

• P2 - Financially, it does not help me yet because I joined recently and did not get many results to get the scholarship, but there is an expectation of getting there; I come early, I have coffee, I have access to accommodation, so it is something I achieved here, go and rest and have a good performance the next day because I do not need to wake up very early, I have not yet had access to physiotherapy and nutrition like other Para-athletes because I have just started, but I have already requested it. I will be able to access that, too.
• P3 - I still do not have financial help, but I am dedicating myself to chasing the index and getting visibility to earn income. However, the structure helps me a lot with my accident problem. Swimming is essential for my recovery from the motorcycle accident. Before I only lived on a motorcycle, running here and there and now I can dedicate myself to the sport and do my best. We have access to food, coffee, lunch, and training.
• P4 - I am trying hard and changing a lot because everything we have here dramatically helps me with my legs and respiratory problems.
• P5 - Wow, there are many positive points: the location, the people here are very friendly, I like it here, good teachers, and with the athletes, and I was able to socialize more; I liked it here because of that; and it is an opportunity. Being in the Navy and being able to be an athlete here is a great opportunity. Here you have lunch and breakfast, it is perfect because I do not have much time or financial means sometimes to have lunch out to come here, so having access to all of this I think it is perfect because here it gives you that possibility Since you do not have to rush anywhere to get back here, it makes this a lot easier, having food and transport to take us too.
• P6—It is perfect because I do not need to worry about these issues of food, transport, and training issues. The service here is excellent, and there is a perfect structure for me to come here and do my best without worrying about these things. The treatment is ideal, excellent. I still do not have access to physiotherapy either because I am new, but soon, I will be on my way.
• P7—It is very, very good. So, the project here, in terms of swimming, has been great for me. It has been perfect, and we have lunch there. It is cool. I use transport sometimes, but we have a card, making it much easier.

One of the aspects observed was the possibility of socialization, identified with coexistence in the heterogeneous age group and disabilities; in addition to the relaxed atmosphere, the training environment represents leisure, well-being, tranquility, and friendship. We noted personal fulfillment and self-esteem, and they were represented in the appreciation of the achievement of being part of the project.

The ParaProlim project’s objectives include developing Paralympic sport and social inclusion, even though we believe this population is still excluded. According to the Brazilian Paralympic Committee (CPB), the entity that governs Paralympic sports, there are 25 official sports today, and swimming is the second sport that brought the most medals to Brazil in the Paralympics.

3.6. Category 5 - Objective, Motivation, and Demotivation of Para-Athletes

During the interview, we observed that the discipline that these athletes acquire through sport provides young people with positive attitudes, good thoughts, and a strong desire to win. Regarding the objectives of sport, the participants reported their desire to win a place in the Paralympics and international competitions:

• P1 - My dream in swimming, I told my mother, is to go to the international Paralympics, because my mother was a swimmer and she understands a lot about this part of swimming and life as an athlete, so I am training hard to achieve it.
• P4 - My dream is to go abroad; I like traveling abroad; I already went once and won third place; I like going to represent my country.
• P7 - My goal is to reach the world championships; I dream a lot about reaching the world championships and leveraging my career.

They also raised questions about being a reference for younger Para-athletes:

• P2 - This issue is that physically, everything improves. Good conditioning allows you to prolong your life without depending on people. Also, I want to be a reference for younger people. I was already 18. Today, I am 26, and tomorrow, I will be 30. I want to be part of Paralympic sport so that it can be a reference in the sport beyond the physical. Regardless of anything, if we want it, we will achieve it.

They experienced some of them commented on encouraging motivation in situations:

• P3 - What motivates me is to look around and see that not everything is lost. If we think it is a lost cause, we see that there are worse cases that did not give up or get discouraged, so we have to look forward and walk.
• P5 - What gives me the most encouragement is the competition. When I see that there is someone better than me at something, when I see that there is someone up front, I try to know that person and try to get closer and closer to them. However, one goal I have is to be able to compete in the Paralympics one day. It is to be the best in my category.
• P6 - I see that we cannot give up. I see many people achieving things, and then I see I can do it. Nothing is easy, but we have to have a lot of strength and motivation so we do not stop. We always have to keep looking ahead, walk, walk, but never stop.

The athletes’ statements confirm that motivation is an essential element in achieving good results in athletes’ performance and that it is seen as fuel for the athlete. When asked about something in their routine that demotivated them, some of the participants talked about comparison and tiredness from training, but P1 shows the importance of receiving external motivation through the support of his mother, emphasizes that this motivates him to continue, and P6 highlights motivation already present in you and in your life.

Regarding the types of motivation in the Para-athlete’s speech, Silva [6] says that motivation can be intrinsic and extrinsic. When intrinsic, it has to do with internal aspects, such as the person’s feelings, which will generate motivation, as we can see in P6 speech. External factors create this motivation when irrelevant, such as a compliment given by another person or a reward for something they do or have done, as we can see in P1’s speech.

• P1—Sometimes, I feel sad comparing myself to others. I think I will not achieve things, and I feel sad; my mother always motivates me to reach my goals and strengthens me.
• P6—Nothing is easy in life, but it is difficult for me to feel unmotivated. The tiredness of the routine does not demotivate me today, stopping when I am dead.

Most participants brought up the idea that focusing on motivation is better in everything in life; they reported that regardless of a bad day of training or difficulty encountered along the way, there is no reason to let yourself become demotivated:

• P2—We try to focus on motivation rather than demotivation. This issue of access is complex and tiring, but looking at the excellent path in life is better.
• P5 - Until today, nothing has affected me; nothing has affected me much. Because I have always had a much disciplined mind, I say: Look, it is all up to me; I will not let anyone tell me otherwise, understand? I always had that thought, so none of it ever shook me.
• P7 - I have almost no demotivation because swimming is my life. So, every training day, I focus on my goal; when I get discouraged, it is only when the training is not exactly what I expected, right? When my income drops, I do not get discouraged. Because even then, in everyday life, we know things do not go as planned. We woke up the next day, which is the only reason I say this: I am discouraged; my training was not what I expected. I expected it, but I will go there and try again the next day. I try to be better.

According to the results obtained in the research, moral values correlate positively with prosocial (socially positive) attitudes, and the mental (focus) of these Para-athletes needs to be strengthened within the entire training scenario, overcoming experiences. Athletes must focus on the future and achievements and not defeat to overcome the moment. Even when down, it is essential to believe that victories will come in the future, as this becomes decisive for athletes to continue their careers. He also talks about the importance of learning to deal with difficulties so they do not give up immediately when faced with such situations.

3.7. Category 6 - Self-Esteem and Body Perception before and after Swimming

Adapted swimming with the properties of water, influences the behavior of people with disabilities, whether physiologically or psychologically. It develops motor skills that will contribute to activities of daily living, eliminates the shame of their own body, raises self-image, and encourages independence, autonomy, and socialization with other groups [14].

Adapted swimming is an essential tool in rehabilitation and social inclusion, highlighting that athletes with physical disabilities who practice swimming can experience increased muscle strength and flexibility, reduced fat percentage, increased self-esteem and confidence, enabling more effective participation in classes/training.

In the athletes’ self-esteem category, we found results on the context units, body perception, and athletes’ feelings of inferiority. We will discuss the importance of sports in modifying feelings of inferiority and the influence of self-esteem on sporting results.

The participants reported the improvement in self-esteem caused by swimming, and they compare the change in physical and psychological valences before and after as Para-athletes of the sport:

• P1—Swimming strengthens my muscles, and I feel stronger when I swim butterfly.
• P2—Sports as a whole increase self-esteem by providing much better conditioning. You gain strength and stability, making your body visibly more potent and more beautiful; this increases your desire to go out, wear nice clothes, and show off, bringing back the desire to live and show off.
• P3 - Swimming has changed this physical aspect and strength a lot.
• P4- Swimming brings me physical well-being and my desire to live.

Athletes generally show good acceptance of their bodies and feel good about their image regardless of disability. This perception changes significantly with the beginning of sports practice.

• P5 - I feel more beautiful, more robust, and even taller. Swimming also helped a lot with my self-esteem. Before, I was not very good with my body, and now I have greater confidence. In general, my quality of life has improved, not only in terms of my body but also in terms of socializing with people.
• P6 - I am feeling thrilled, I am getting strong, and I am cute. Moreover, it is excellent. Swimming gives us good motivation, and we look good and are more potent when walking.

It mentioned a report on the impact of the COVID-19 pandemic. There was a perception of decline and low self-esteem.

• P7 - I feel stronger. It was not as challenging, but I am achieving it. The pandemic period was difficult. I had to stop, which impacted me when I returned to training or felt that my performance dropped. However, I recovered in three months, and I am firm. I am evolving, and I feel happier with my work every day.

The athletes’ high self-esteem and good self-acceptance may be related to their sporting careers. In a study in which the researchers interviewed ten Paralympic athletes, they found an increase in self-esteem and self-concept, among other factors, such as acceptance of themselves, as benefits of sport in their lives [15].

3.8. Category 7 - Positive or Negative Pressure

Regarding Paraprolim motivating more or generating a hostile atmosphere about the pressure that the sport provides, varied reports have emerged, and despite having to show good results, the coach’s figure seems to help the Para-athletes to be calmer:

• P2—This varies from person to person because before ParaProlim charged me, I charged myself, but obviously, the coach always says it comes to your health first. You are here; remember that it is for results and for you to be well. For you to be well, we are happy and calm, and then you understand that demanding the result is normal for any club.
• P7 - Well, it is both; it is a small quantity of both. Because like I said, I try my best to do my best, but I sometimes feel pressured; this is very good because it exists and always exists in an athlete’s life, right? That charge. However, I have to give good results and my coach demands more during competition periods, especially. I am apprehensive, but I also have moments when I am more relaxed, and he helps me, and I try to do my best in the tests.

In the sporting environment, when the coach offers continuous support and respect and is accessible to the athlete when needed, both for sporting and personal issues, he favors preventing the adverse effects of stressful events. These findings demonstrate that the more athletes spend time with their coaches, the more these relationships transcend the sporting dimension to a more personal relationship [16]. The influence of highlighted encouraging the project was when asked about their feelings about how they deal with it.

• P3—For me, it is not a chore. I like the project, and being present is encouraging. We are training, we are looking, and we are focusing on the index medal.
• P4 - It is calmer here on the project; it motivates me more.
• P5—So, when I learned I would train here at the Navy, it greatly motivated me. There is pressure to get the index, but the motivation is much greater.
• P6 - I deal with this very well. I see it in a way that it is good to be pressured, that you know you are not alone, and that you have to improve, improve, and never stop because when you are stopped, I always say that it is the one who is dead! I am breathing, so we always have to improve, and if it stops, it gets rusty, right? If you cannot stop, then it is terrible.

Dealing with the pressure of competition is a challenge faced daily by these athletes; in the report below, we can highlight the importance that the coach has in this pre-race moment:

• P1 - I do not need to stay calm. I get nervous, worried, and tense because it is not easy. Being an athlete takes work. That is why the athlete has to be very strong and work psychologically. Then there is much pressure, but I know that the coach says it is for my good. He wants me to improve and achieve results, but there is much pressure for my good. My coach wants my good.

The relationship that the athlete has with the facts that involve their routine and the importance that the coach’s support can offer, according to P1’s speech, can give meaning to the athletes’ lives, making them gain independence and self-confidence, in addition, to have improvements in their self-concept and self-esteem, to seek better results, that is, their best marks, dealing more calmly with the pressure naturally experienced by them, it understood that psychological work is essential, not only for the technician but for an entire set.

4. Conclusions

This study sought to identify the perception of quality of life and body image in Para-athletes participating in the Paraprolim program. Through the participants’ reports, carried out based on the focus group, the Para-athletes’ self-esteem and quality of life demonstrate that they have been positively affected by the project.

The perception of the evaluated Para-athletes showed that the physical and psychological impacts were positive on the body image associated with professional practice and improved their quality of life. This consequently promoted better performance in training, spending time with friends, and competing in competitions with full support from the coach, especially who was mentioned a lot by the participants during the interview.

Furthermore, understanding this entire context revealed that most started swimming as an alternative for post-injury rehabilitation and have now become professionals; this corroborates the idea that multidisciplinary work between physiotherapists and physical education professionals who work with Para-athletes is essential for the professional training of Para-athletes and has changed their lives.

The results of the analysis suggest that motivation and self-esteem are fundamental to the sporting results of Paralympic athletes. The study identified that external or internal motivation was essential for them to continue their athletic careers, from the difficulties in their sporting initiation to when they needed to overcome moments of failure in the sport.

Self-esteem also remained present in the participants’ speeches, so they were confident in their potential and ability to overcome themselves throughout their careers, including after going through harmful situations and not achieving a goal. Despite the findings presented in this study, it is essential to highlight some limitations. First, more studies on Paralympic athletes are needed, making comparing findings and establishing parameters impossible. The sample size and the recruitment of only one individual sport prevent the generalization of the results to the entire Paralympic context.

However, the sample is relevant because the athletes compete in the main competitions of the sport in Brazil and are part of a new incentive program that began after the COVID-19 pandemic and improved, according to the findings, the quality of life and self-esteem of these athletes.

Furthermore, future research should involve athletes from other sports to compare groups (collective versus individual), involve other psychological variables, and use a longitudinal design to verify possible changes in motivation and individual and group resilience throughout a competitive season.