Commentaries on Physical Activity and Health
Physical Activity’s Benefits Aren’t Just for the Able Bodied
by Dianne V. Jewell, PT, DPT, PhD, FAACVPR
I started my career as a physical therapist in early 1989. In August of that year, DeVivo and colleagues published data regarding the leading causes of death among individuals who sustained a spinal cord injury (SCI) between 1973 and 1980.1 Pneumonia, septicemia and pulmonary embolism were the prevailing threatening conditions at the time. Four years later, non-ischemic and ischemic heart disease had crept onto the list.2 Today, lethal cancers in their many forms are in 3rd place3 – a perverse unintended consequence of the success of “model systems” of SCI management. We can save the most profoundly impaired individuals after the initial crisis (remember Christopher Reeve?), but we cannot spare them from the chronic diseases that have afflicted the able bodied population in progressively greater numbers.
When the lens is widened to include people living with other physical and/or cognitive disabilities, a more concerning picture comes into focus. Data from the National Health Interview Survey suggest that individuals who acquired disabilities as young children had increased odds of developing coronary heart disease, diabetes, hypertension, obesity and cancer compared to individuals who lived into adulthood without limitations.4 The underlying causes of this higher risk are likely multi-factorial and require further study. However, there is one potential contributor that is common to both the disabled and able-bodied alike: insufficient physical activity.
Physical activity’s benefits are extensively documented in the scientific literature, a fact reflected by the expansive lists of citations that accompany public policies, clinical practice guidelines and grassroots initiatives devoted to this topic. We are still debating the “how much is enough” question, but we all agree that lack of regular physical activity results in avoidable insults to our health and wellbeing. It’s logical to imagine, then, that difficulty moving due to physical or cognitive disability could magnify our susceptibility to development of these costly chronic conditions.
It may be tempting to think of this conundrum as a health care issue to resolve, but that would be short sighted. National survey data from 2014 indicate that 53 million adults have a functional, sensory and/or cognitive disability.5 These individuals live, work and play in all socioeconomic and geographic dimensions of our communities. Rehabilitation professionals like me direct our efforts to engage them in meaningful, productive activities that transcend their need for health care services. As such, a comprehensive, purposeful effort must be made across all sectors to apply physical activity initiatives to disabled people.
Undertaking this call to action is not as easy as one might imagine when looking at the words on the page. For example, the U.S. Surgeon General’s “Step it Up” campaign focuses on increasing physical activity through walking and access to walkable communities. The word “disability” appears only once in the Partners Guide. There is a brief mention of “walking with assistive devices” and “wheelchair rolling” in the executive summary, but these references are insufficient to reflect the physical demands on individuals who depend on mobility aids to be active. The revised National Physical Activity Plan is more direct in its acknowledgement of individuals with differing “physical, cognitive and sensory abilities” in the document’s introduction. However, the strategies and tactics tend to include more abstract terms like “diversity”, “disparity” and “underserved”. The word “disability” appears only 3 times and is limited to the Sport Sector of the Plan. Both of these initiatives are population level efforts, so it makes sense that any one segment of society isn’t highlighted more than another. That said, in the absence of language that more explicitly outlines how to facilitate increased physical activity for individuals with disabilities, a mix of imagination and evidence is needed.
For example, walkable communities and environments are more than just accessible pedestrian throughways. They include development and maintenance plans that factor in transit width and grade, uneven surfaces and trip hazards, lighting, guide rails, frequent rest areas, and wheelchair accessible water sources and restrooms. Something as simple as the basic ability for a person with reduced gait speed to cross a street before the traffic lights change can be transformative! Similarly, signage must be well lit, set at readable heights, printed in font that doesn’t require a magnifying glass to read and paired with alternative communication modes for those with profound vision and/or hearing loss. These environmental characteristics may seem self-evident in the context of statutes like the Americans with Disabilities Act, but they must be designed and implemented in ways that encourage participation, not just make it possible.
Social and attitudinal barriers are more challenging to address. Unfortunately, it is still too easy for many, including health care providers, to believe that physical activity is unsafe or too difficult to modify for individuals with disabilities. Strategies and tactics in every sector that emphasize increased awareness, education and understanding of what is needed to make physical activity accessible for individuals of all abilities would help to overcome impediments to participation. Ultimately, inclusiveness is a team sport. The objectives, strategies and tactics described by both “Step It Up” and the National Physical Activity Plan are organized by individual sectors. However, it is cross-sector collaboration that will leverage the knowledge and expertise required to apply these efforts to the unique needs of individuals with disabilities. Partnerships with advocacy groups that represent the disabled are also necessary to ensure that those affected have opportunities to influence design and allocation of resources, and to engage in implementation activities. I am one health care provider who has had the privilege of witnessing the resilience of individuals facing disability. It takes all of us to ensure that these same people can access physical activity’s benefits.
Dianne Jewell is a physical therapist with 28 years of experience in clinical practice, education and practice management roles. Her clinical expertise is managing individuals with heart and/or lung disease with an eye toward keeping them active and engaged in all aspects of the lives. She has written and spoken about the application of fitness principles across the continuum of health care settings from the ICU to community-based programs. Jewell currently focuses her energies on helping her physical rehabilitation colleagues navigate contemporary health care policy through documentation, outcomes analysis and value demonstration via her company The Rehab Intel Network. She currently represents the American Physical Therapy Association (Alexandria, VA) on the National Physical Activity Plan Alliance board of directors.
1 DeVivo MJ, Kartus PL, Stover SL, Rutt RD, Fine PR. Cause of death for patients with spinal cord injuries. Arch Intern Med. 1989;149(8):1761-6.
2DeVivo MJ, Black KJ, Stover SL. Causes of death during the first 12 years after spinal cord injury. Arch Phys Med Rehabil. 1993 ;74(3):248-54.
3 National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham, 2015 Annual Statistical Report – Complete Public Version. Available at: https://www.nscisc.uab.edu/PublicDocuments/reports/pdf/2015%20NSCISC%20Annual%20Statistical%20Report%20Complete%20Public%20Version.pdf.
4Dixon-Ibarra A, Horner-Johnson W. Disability status as an antecedent to chronic conditions: National Health Interview Survey, 2006–2012. Prev Chronic Dis. 2014;11:130251. 1993 ;74(3):248-54.
5Centers for Disease Control and Prevention. http://www.cdc.gov/media/releases/2015/p0730-us-disability.html.
Suggested Citation: Jewell, D. V. (2016). Physical Activity’s Benefits Aren’t Just for the Able Bodied. Physical Activity Plan Alliance Commentaries on Physical Activity and Health, 2(5).