Disability And Exercise

Appropriate  physical  activity  engagement  promotes a host of psychosocial benefits. These benefits  are  especially  valuable  for  individuals  with disabilities  because  they  have  high  rates  of  overweight  and  obesity.  Additionally,  because  people with  disabilities  often  have  associated  secondary conditions  (e.g.,  pressure  sores,  diabetes)  physical  activity  is  particularly  important  as  a  mechanism to prevent or attenuate secondary conditions. Unfortunately,  most  individuals  with  disabilities are sedentary or get limited physical activity. Low levels of physical activity among people with disabilities have been documented in North America, Europe, Asia, and Africa. Minimal physical activity is evident irrespective of age, gender, the setting (physical education vs. leisure), disability type (spinal  cord  injury  vs.  visual  impairment),  or  assessment  method  (pedometers  vs.  self-report).  Older females with severe disabilities from low socioeconomic-status groups are most at risk for low physical activity engagement. In this entry, the various psychosocial benefits of physical activity are highlighted, followed by a discussion of the barriers to physical activity.

Benefits

Increases in strength and endurance typically contribute  to  enhanced  perceptions  of  competence. Mastery  experiences  and  social  influences  both serve  to  contribute  to  enhanced  competence  perceptions.  Competence  benefits  have  been  derived from  activities  as  varied  as  lifestyle  leisure  activity, martial arts, youth sport, fitness training, and horseback  riding.  Most  people  also  derive  social benefits  such  as  self-esteem  enhancement  stemming  from  being  physically  active  with  friends. Children  in  adapted  sport  programs  find  that they  can  more  easily  be  themselves.  Participation in  physical  activity  also  leads  to  increased  social integration  and  reduces  feelings  of  loneliness  and isolation.

However, being physically active does not automatically confer social benefits upon participants. For  example,  it  is  not  unusual  for  children  to  be excluded from physical education classes, ignored when sport teams are selected, and teased at recess, for looking different. Adults with disabilities (e.g., spina  bifida)  participating  in  inclusive  recreation programs  report  both  positive  and  negative  reactions  and  experiences.  In  one  study,  participants with  disabilities  reported  having  difficulty  ascertaining  whether  able-bodied  participants  disliked them  or  were  simply  ambivalent  toward  them. Other  times,  adult  participants  perceived  that able-bodied  exercisers  treated  them  like  children. Despite  these  reports,  physical  activity  involvement  helps  minimize  the  negative  influence  of  a disability  on  self-perceptions.  A  participant  in one  study  reported  that  she  felt  “normal”  when being  physically  active.  Other  individuals  with disabilities  have  experienced  less  stigmatization which  they  attributed  to  their  physical  activity involvement.  Researchers  have  also  found  that able-bodied  people  tend  to  evaluate  people  with physical  disabilities  more  positively  if  they  perceive  them  as  being  physically  active.  Two  other benefits  expressed  by  people  with  disabilities  are greater feelings of independence from being physically active, and more opportunities to travel away from home on a sport team.

In  addition  to  competence  and  social  benefits, engaging  in  physical  activity  is  simply  enjoyable, and  such  experiences  are  valuable  for  quality-of life  reasons.  In  addition  to  the  momentary  value of  increased  positive  affect,  physical  activity  can also  help  in  mood  management  when  individuals do  not  have  good  days.  For  example,  individuals with  spinal  cord  injury  (SCI)  reported  increased positive  affect  and  decreased  negative  affect  after exercising irrespective of whether participants had positive  or  negative  life  events  that  day.  There  is also  preliminary  evidence  that  individuals  with neurotic  tendencies  benefit  the  most  from  the mood enhancing benefits of physical activity. In a recent  study,  virtually  half  the  respondents  noted enhanced emotional functioning that they viewed as  stemming  from  their  physical  activity  involvement. Many male adults with SCI have also experienced reduced stress, depression, pain, increased life  satisfaction,  and  subjective  well-being  as  a result of exercise. In brief, much research has supported physical activity as an important vehicle for quality-of-life  enhancement  by  reducing  negative emotional  states  and  increasing  positive  affective states.

A  growing  body  of  research  has  also  documented  the  relational  benefits  experienced  by families  who  are  physically  active.  Researchers examining  family  recreation  and  leisure  experiences show that such involvement enhances family quality of life. A small body of research pertained to the family as a unit and to how physical activity experiences impact children, siblings, and parents. Adolescent  participants  were  asked  to  describe how  their  adaptive  skiing  or  horseback  riding experiences  influenced  the  quality  of  their  family life. Virtually 70% agreed or strongly agreed that their  experiences  in  these  two  activities  enhanced their family life. Additionally, almost 80% of the  participants  agreed,  or  strongly  agreed,  that  skiing or riding with family members contributed to the  meaning  of  the  activity.  This  finding  has  also been supported by scientists who have found that parents, particularly mothers, in families that have children  with  disabilities  often  engaged  in  activities like bike riding with their children in order to enhance family relationships.

Unique experiences, such as outdoor skill training programs and outdoor adventure trips including both parents and children with disabilities, are promising.  Parents,  for  instance,  have  reported that  their  experience  helped  them  overcome  or eliminate  constraints  to  being  physically  active. Both qualitative and quantitative results indicated that  parents  believed  the  experience  enhanced family  interactions,  and  promoted  greater  cohesion.  Swedish  families  involved  in  orienteering, golf, and archery found that their children believed their  participation  helped  the  family  experience “a  feeling  of  togetherness.”  In  brief,  physical activity–oriented  experiences  are  vehicles  that enhance the psychosocial functioning of families.

Parents   also   benefit   from   their   children’s involvement in physical activities. Fifteen families with  children  with  disabilities,  who  participated in adapted baseball, found parents derived mutual support from each. In particular, the shared social reality  nature  of  the  support  was  particularly meaningful. In summary, physical activity engagement results in a plethora of benefits to participants although  sometimes  participants  report  negative experiences. Individuals participating with or supporting the physical activity experiences of people with  disabilities  can  detract  from  or  enhance  the physical activity experience.

Barriers

The  benefits  of  being  physically  active  are  often difficult  to  obtain  because  of  a  multitude  of  barriers to physical activity. Individual based barriers include  disability  type.  For  instance,  leg  amputees cannot of course run or walk, although they can  use  crutches  and  wheels.  Pain  or  discomfort is  also  a  major  barrier  to  being  physically  active. People with cerebral palsy (CP) and SCI list pain as frequently interrupting and preventing physical activity  engagement.  The  physical  discomfort  of exercise is also viewed as a barrier by some individuals. In addition to pain, people with disabilities also note that fatigue, a lack of energy, disease, injury,  and  poor  health  prevent  them  from  being physically active.

Not   knowing   where   exercise   facilities   are located  or  how  to  start  and  develop  an  exercise program  also  inhibits  physical  activity.  A  lack of  time  for  physical  activity  is  also  reported  by adults because of work and family responsibilities. Limited financial resources reduce or prevent travelling to exercise clubs, buying exercise equipment for the home, or purchasing exercise club memberships. A fear of developing tight muscles and joints from  exercising  has  also  been  reported.  Finally, inner city residents are often afraid to leave their homes for fear of crime or fear of falling.

Barriers  that  are  more  social  in  nature  are also  common.  For  instance,  most  children  need their  parents  to  transport,  pay  for,  and  facilitate their  physical  activity  involvement.  At  the  same time,  parents  are  often  fearful  that  their  children might get teased by their peers for looking different.  Parents  also  fear  for  their  children’s  physical health  if  they  engage  in  sports  viewed  as  dangerous  by  their  parents  (e.g.,  basketball  for  a  blind child).  Parents,  in  turn,  criticize  community  recreation  personnel  for  not  knowing  enough  about adapted sport programming principles and various disability  conditions.  Physical  education  teachers are  also  seen  as  lacking  appropriate  training  in disability  conditions  and  adapted  physical  education.  Physical  education  teachers  themselves  confirm  this  view  by  indicating  that  they  often  lack adequate professional preparation in their teacher education programs. It is not unusual for physical education  to  be  replaced  by  therapy  or  mobility training  or  canceled  because  of  blanket  medical excuses  from  doctors.  Caregivers  of  adults  with CP  have  asserted  that  they  did  not  believe  an exercise program was of value for their residents, and about a third of them believed exercise would not  help  their  client’s  CP.  Some  caregivers  even believed, contrary to research, that exercise would worsen CP.

In  addition  to  individual  and  social  barriers, the environment can also hamper physical activity engagement.  For  instance,  children  with  disabilities often note that there are very few places to be active and rarely are facilities conveniently located. As children get older, their limited physical activity opportunities tend to diminish. Opportunities can also be illusionary, as wheelchair basketball league officials sometimes ban motorized wheelchairs and swimming  pools  are  viewed  as  too  cold  by  some swimmers  with  disabilities.  Built  environmental barriers, such as a lack of a curb cut or crosswalks without  auditory  signals,  can  prevent  individuals with  disabilities  from  crossing  the  street.  Ramps that are ostensibly designed to facilitate access are often built too steep and cannot be used.

Barriers are also subtle. For example, although wheelchairs help people with disabilities to move, many  individuals  with  SCI  view  their  wheelchair as  the  number  one  barrier  to  physical  activity.  In one  study,  participants  rated  their  wheelchairs  as bigger  barriers  to  physical  activity  than  their  disability. Most medical personnel and clinicians have only  limited  training  in  prescribing  wheelchairs, which  might  explain  why  some  individuals  with SCI  find  manual  wheelchairs  uncomfortable,  too wide and heavy, and therefore hard to move.

Researchers   such   as   James   Rimmer,   Barth Riley, Edward Wang, Amy Rauworth, and Janine Jurkowski  have  examined  the  accessibility  of health  clubs  and  found  that  many  (over  50%) clubs do not have curb cuts for easy access or clear paths to lockers. Most weight rooms do not have enough  room  for  exercisers  to  move  their  wheelchairs  around  the  exercise  floor.  Inadequately lighted  biking  and  running  paths  and  wooded walking trails with exposed tree roots can be barriers to individuals with vision loss.

In  summary,  physical  activities  ranging  from formal  exercise  and  sport  opportunities  to  recreation and leisure lifestyle activities can all provide a  wide  ranging  set  of  psychosocial  benefits  to participants. However, many physical activity barriers organized across individual, social, and environmental  categories  limit  how  physically  active people with disabilities are, and thus, the benefits they accrue.

References:

  1. Goodwin, D. L., & Compton, S. G. (2004). Physical activity experiences of women aging with disabilities. Adapted Physical Activity Quarterly, 21, 122–138.
  2. Henderson, K. A., & Bedini, L. A. (1995). “I have a soul that dances like Tina Turner but my body can’t”: Physical activity and women with mobility impairments. Research Quarterly for Exercise and Sport, 66(2), 151–161.
  3. Martin, J. J. (2006). The self in disability sport and physical activity. In A. P. Prescott (Ed.), The concept of self in education, family and sports (pp. 75–90). London: Nova Science.
  4. Martin, J. J. (2007). Physical activity and physical self-concept of individuals with disabilities: An exploratory study. Journal of Human Movement Studies, 52, 37–48.
  5. Martin, J. J. (2012). Exercise psychology for people with disabilities. In E. O. Acevedo (Ed.), Oxford handbook of exercise psychology. New York: Oxford University Press.
  6. Rimmer, J. H., Riley, B., Wang, E., Rauworth, A., & Jurkowski, J. (2004). Physical activity participation among persons with disabilities. American Journal of Preventive Medicine, 26(5), 419–425.

See also: