Prescribing Physical Activity for People with Disabilities Requires More than General Guidelines
|James H. Rimmer, Ph.D., Director|
But what we're seeing in much of the literature regarding exercise guidelines for people with various types of disabilities are composite programs for specific disabilities. While it is important to develop guidelines for specific groups of individuals with similar conditions such as stroke, spinal cord injury, or diabetes, the extensive heterogeneity between individuals with the same disability makes it extremely difficult to pinpoint and isolate an exercise program that will achieve the highest measure of adherence with the greatest benefit in health. It is rare to find two people with multiple sclerosis or Down syndrome who are exactly alike and who could benefit from a 'canned' program for someone with this condition. The multitude of factors that must be considered besides knowing the person has one of these disabilities can be an exhaustive list. Take, for example, someone with multiple sclerosis. Variations in the condition can extend from using a wheelchair with limited or no use of the upper or lower extremities, to someone able to carry out most activities with minimal interruption. Similarly, some individuals with multiple sclerosis have optic neuritis, which involves some level of difficulty with their vision, while others may not have any difficulty with vision. When you read most of the literature on exercise for people with multiple sclerosis, however, you find general assumptions that may or may not be relevant or achievable to a subset of people with the same disability. And most exercise guidelines seldom discuss how to arrange an exercise facility to accommodate the individual user with a disability, or how to develop various balance routines for someone with multiple sclerosis who also has a visual impairment.
Variations within a specific disability hold true for almost all disabilities. Some people with osteoarthritis manage well without an assistive aid; others are at extreme risk of falling with an assistive aid. A person with a high-level spinal cord injury will have a different set of physiological responses to exercise compared to a person with a lower-level spinal cord injury. Some individuals with spina bifida are obese, while others are within a safe weight range. What this all means is that exercise guidelines for specific disabilities will, in the future, need to have a higher level of precision for not only the individual's specific disability, but also regarding the variation in secondary conditions that are associated with the disability and the general personal and environmental barriers that may facilitate or impede participation.
In the future, exercise prescriptions will have to be tailored to the individual's disability along with the type and number of physical, psychological, and social secondary conditions they have, their medication usage, past history of exercise, their access to various exercise facilities and equipment, and their motivational level. Since many progressive conditions (i.e., multiple sclerosis, rheumatoid arthritis) may alter these factors over time, it is important to constantly monitor and revise the program to accommodate the person's needs in real time.
Tailored programs for people with disabilities that consider a multitude of factors at one time and achieve a greater adherence rate and health outcome must be the next frontier of exercise science. There is a clear and present need for tailoring physical activity programs for people with disabilities that address all factors and conditions in one composite. Consider the following statement from a person describing her condition in a chatroom for persons with lupus: "I've spent the last several years deteriorating to the point of no longer being able to work - chronic fatigue, chronic infections, a tonsillectomy, a cervical cyst removed, cold especially when sleeping, shooting pains in my extremities, pain in neck, back, joints, hands. I am only 33 and I don't have any children and haven't worked in over a year and a half." Developing an effective exercise program for this person would require more than just knowledge of her disability. Lupus can vary quite dramatically from person to person and when you consider that we haven't even started a discussion on where the person would like to exercise (i.e., home, outdoors, or fitness center), what their psychological profile might be (i.e., motivated/not motivated, socially isolated, possible depression), and what types of activities they would like to engage in, it is clear that exercise guidelines must become more specific to the individual subscriber.