Physical Activity and Disability: The Challenge Ahead
It is clear that habitual physical activity is a missing component in the lives of most persons who have a physical or mental disability. In two studies involving adults with intellectual disabilities, for example, investigators reported a low functional capacity and high incidence of obesity among persons with this condition. Studies on persons with physical disabilities have reported similar findings. In one study, investigators found that a sedentary lifestyle makes ambulation in a wheelchair a more stressful event when fitness levels are low. In another study, physical inactivity was found to be a major contributing factor in the deteriorating physical health of persons with disabilities.
There are several reasons for the inactive lifestyle often found in persons with disabilities. These include lack of knowledge concerning the importance of exercise to healthy living, limited access to transportation to and from the exercise site, inaccessible facilities and equipment, and a perception by some individuals that they are not able to exercise as a result of their disability. Compounding the problem is the medical profession's lack of enthusiasm of can enhance functional capacity and lower the rate of enthusiasm in prescribing exercise to their patients. This was brought to light in an article by Young, a physician and professor who noted: "It is important for all doctors to know more about when and why to promote or prescribe exercise, and to know how to ensure that all may exercise safely and enjoyably. These matters receive scant attention in conventional medical teaching, which perpetuates a 'static' concept of the patient" (p. 532). If physicians are not apt to prescribe exercise for "healthy" patients, it is highly unlikely that they are encouraging persons with disabilities to become more active.
Given the interest in physical activity and fitness over the past two decades, it is surprising that there is only a small volume of literature on the level of physical activity among persons with physical and mental disabilities. This was evident in a recent position paper entitled, "Physical Activity and Public Health," which was published in 1995 in the Journal of the American Medical Association and sponsored by the Centers for Disease Control and Prevention and the American College of Sports Medicine. Although the report mentioned persons with disabilities, they were obscured by being grouped with "older adults, the socioeconomically disadvantaged, and the less educated."
The part of the report that cited data on the proportion of adults who did not engage in leisure-time physical activity, categorized by gender, race, annual income, and education, did not include persons with disabilities. The report did note that "There is clear evidence demonstrating that physiological and performance capacities can be improved by regular physical activity in older adults and in persons with disabilities and/or chronic disease" (p. 406). However, the scientific reference that was used to support this statement was published over 20 yr ago and was a study that included only eight persons with a physical disability. Clearly, more research is needed before researchers and clinicians can draw valid conclusions and make meaningful recommendations pertaining to physical activity and health promotion among persons with disabilities.