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Houston, Texas

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Health Behaviors--Physical Activity

Women with disabilities have very low rates of physical activity, which may be an important contributor to overweight in this population.

According to the U.S. Department of Health and Human Services, people with disabilities and chronic illness are less likely than those without disabilities to report regular moderate physical activity (27.2 percent vs. 34.4 percent) or regular vigorous activity (9.6 percent vs. 14.2 percent). The few studies that have been conducted on the physical activity patterns of women with disabilities also suggest that they are not engaging in physically active lifestyles.

In one study, researchers reported that out of a sample of 50 African-American women with mobility impairments:

  • 92 percent indicated that they did not participate in any type of leisure-time physical activity;
  • 10 percent indicated they exercised regularly three or more times weekly;
  • 2 percent stated that they participated in outdoor unstructured physical activity, such as gardening;
  • almost 82 percent of the women said that they would like to start an exercise program.

In another study of 165 women with physical disabilities:

  • 72 percent reported decreasing levels of participation in physical activity over the past 10 years;
  • almost 60 percent reported that they "never or rarely" participated in leisure-time physical activity that increased their breathing and heart rate;
  • over half of the women reported never participating in physically active household activities (71 percent) or in physical activities like standing (58 percent), walking (55 percent), lifting (91 percent), or exercise (55 percent).
  • Other researchers have reported lower scores on physical activity participation in a cohort of women with multiple sclerosis compared to a normative sample of women without disabilities.

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Barriers to participation in physical activity include knowledge, skills, attitudes, values, beliefs, social support for participation, time, money, and accessibility issues.

In general, barriers to participation in physical activity can be conceptualized as being intrapersonal, interpersonal, or structural. Existing research on barriers or constraints to physical activity for women with disabilities suggest that all three categories of constraints impede the ability of these women to routinely engage in physical activity.

  1. Intrapersonal constraints include attitudes, values, or beliefs which a person holds that hinder involvement in physical activities. Examples include negative attitudes or beliefs about the value of physical activity, low expectations about one's ability to participate, or lack of interest or knowledge. Intrapersonal constraints identified by women with disabilities that limit their involvement in physical activities include fatigue and pain, the disability itself, lack of knowledge about where to find a program, and limited access to knowledge about their capabilities for activity. Researchers conducting a study of women with multiple sclerosis reported that these women generally lacked the knowledge and skills needed to exercise safely. Lack of behavioral capability and knowledge about how to exercise may be a particular concern for certain subgroups of women with disabilities. For example, some women with severe mobility impairments may not know how to exercise in their wheelchairs, and women with conditions such as multiple sclerosis may exacerbate their symptoms if they do not know how to exercise properly.
  2. Interpersonal constraints can be categorized as those that arise from interactions with others (e.g., family, friends, co-workers). An example of an interpersonal constraint is lack of social support for participation in physical activity. Data from qualitative interviews with women with mobility impairments identified social support as a factor that influenced the values and attitudes women with physical disabilities have about physical activities. Likewise, women with physical disabilities surveyed in another study identified social support, specifically lack of companionship, as a major barrier to being physically active.
  3. Structural constraints consist of barriers that arise as a result of external conditions in the environment (e.g., lack of opportunities). Examples of structural constraints include lack of time, money, or accessibility issues. Women with physical disabilities in one survey identified structural constraints that inhibited their involvement in physical activity. These included lack of money and concern about crime. Additionally, 50 women with physical disabilities in another study identified structural barriers related to transportation and costs. A sample of 215 women with various disabilities in another investigation reported similar structural barriers, including problems with architectural access, access to available and affordable transportation, access to knowledgeable professionals regarding equipment and programs, and feeling safe in their community activity.

Despite these barriers, women with disabilities report interest in participating in physical activity. In a sample of African-American women with mobility impairments, almost 82% said that they would like to start an exercise program. In another survey of 165 women with physical disabilities, many of the participants also indicated that they would like to make lifestyle changes regarding their exercise (42%) and leisure and recreation (48 percent) activities.

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Studies have not yet investigated whether the long-term benefits of physical activity, such as reduced risk for cardiovascular disease, osteoporosis, and obesity, can be obtained by women with disabilities.

While research has recently begun to investigate the health benefits of physical activity among people with disabilities, few studies have specifically focused on women with disabilities. No studies have yet investigated whether the long-term benefits of physical activity, such as reduced risk for cardiovascular disease, osteoporosis, and obesity that occur among persons without disabilities, also apply to persons with disabilities. However, the available data do suggest these benefits would extend to people with disabilities.

Additionally, numerous studies have established that people with disabilities have the same physiological response to physical activity as the general population. In a review of the published physical activity research conducted with people with disabilities, researchers reported that the data clearly demonstrated physical activity generated significant physiological changes among people with arthritis, neuromuscular diseases, spinal cord injury, respiratory diseases, and stroke. These and more recent studies reveal that the health benefits of physical activity include improved muscle strength of the exercised extremities, improved aerobic capacity, decreased walking times, extended time to fatigue onset, reduced joint swelling, pain, and stiffness, decreased serum cholesterol levels, improved pulmonary function among those with respiratory diseases, and decreases in levels of depression.

The benefits of physical activity may be even greater for people with disabilities than for the general population due to increases in endurance and strength that may improve function. Additionally, people with disabilities who participate in physical activity may reduce their risk for developing additional health conditions.

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Since women with disabilities have low rates of physical activity, it is important to identify determinants, or factors, that predict exercise maintenance for this population. To date, only one study has investigated determinants of physical activity among people with disabilities (Kinne, Patrick, & Maher, 1999).

Determinants of physical activity are factors that distinguish individuals who are more physically active. Three general categories of determinants have been identified as relevant for the adoption and maintenance of physical activity. These determinant categories encompass the physical and social environment, personal attributes, and aspects of the physical activity itself, such as exercise intensity and enjoyment of activity.

To date, only one study has investigated determinants of physical activity among people with disabilities. This study examined whether various factors (i.e., demographic, disability, barriers to exercise, motivation, or self-efficacy) discriminated between individuals with long-term disabilities who reported being physically active versus those who reported being inactive. The only factors that predicted exercise maintenance were reporting lower motivational barriers and higher exercise self-efficacy. These results should be interpreted with caution due to the study's reliance on retrospective, self-report of activity which increases the possibility of self-report bias. Thus, it is possible that those reporting activity were not as physically active and may not have differed much from the inactive group.

Due to the current lack of evidence regarding determinants of physical activity among people with disabilities in general, and women with disabilities in particular, it is important to identify factors that predict exercise maintenance in these subgroups.

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Much more research is needed to investigate methods to promote physical activity effectively among women with disabilities.

While numerous studies have demonstrated that people with disabilities show significant physiological improvements due to physical activity, little research has investigated how to promote physical activity effectively among this population. Even fewer studies have targeted women with disabilities.

Two studies have focused on home-based exercise programs for people with disabilities, while other researchers have investigated center-based studies of physical activity for people with disabilities using community centers or other locations where accessible fitness equipment is available. These studies include interventions to promote walking programs among women with fibromyalgia, home-based strength training for people with various disabilities, exercise classes for people with arthritis and other disabilities, and walking and water aerobics for people with arthritis. While the results of these studies are promising, there have been mixed results in participant retention and adherence to fitness programs.

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While the usefulness of alternate forms of moderate physical activity, such as T'ai Chi, has not been explored specifically for women with disabilities, some preliminary evidence of their usefulness for person with disabilities has been documented in mixed gender research.

In terms of physical activity, T'ai Chi, a traditional Chinese martial art that emphasizes body relaxation, mental concentration, and movement coordination, and yoga would be classified as moderate physical activities. A review of 31 controlled experimental studies and clinical trials indicates that T'ai Chi Ch'uan is effective in improving cardiorespiratory and musculoskeletal function, posture control capacity, and the reduction of falls in the elderly.

Some preliminary evidence of T'ai Chi's usefulness for person with disabilities has been documented in mixed gender research. The use of T'ai Chi has been investigated with hip replacement patients, individuals with rheumatoid arthritis, older adults with osteoarthritis, people with multiple sclerosis, and as part of a rehabilitation program for clients with severe head injury. Collectively, these studies provide preliminary support for further research examining the usefulness of T'ai Chi as a form of moderate physical activity in persons with disabilities.

Less research exists regarding the use of yoga as a form of physical activity for persons with disabilities. Most of the research done in this area has focused on the use of yoga in individuals with back pain, chronic pain, osteoarthritis, or rheumatoid arthritis. These studies primarily focused on yoga's utility in decreasing the experience of pain in these populations, although researchers have reported increases in hand grip for persons with rheumatoid arthritis and increases in finger range of motion following yoga training.

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