# Exercise as it relates to Disease/The effect of disability on physical activity
## What is the background?

It is well known that participating in regular physical activity improves health however disabled people don’t get the same opportunities as non-disabled people. In the U.S. around 20% of the population has some type of disability and those that don’t meet the recommendations stated in the physical activity guidelines have a 20-30% increased risk of all-cause mortality$^{[4]}$. This paper identifies some barriers faced by disabled people that prevents them from participating in regular physical activity and solutions to these problems.

## Where is the research from?$^{[6]}$

The research conducted by the University of Illinois took place in the U.S. between 2001-2002 and was published in the American Journal of Preventative Medicine in 2004. Collection of results were supported by a few organizations such as the National Centre on Birth Defects and Developmental Disabilities and the National Institute on Disability and Rehabilitation Research The authors have high credibility as each has published many papers relating to disability and physical activity while having thousands of citations between them while lead researcher James Rimmer has received multiple awards for his work.

## What kind of research is this?

This was an observational study where researchers travelled to 10 cities across the U.S. to collect data from different groups of people that have occupations related to physical activity$^{[7]}$.

## What did the research involve? $^{[6]}$

The first method of gathering information was to separate participants into four focus groups. People with disabilities, Architects, Fitness professionals and City planners. They were asked to comment on the accessibility of fitness centres, swimming pools, parks, trails and give ideas on what could be done to solve the issues. The information was gathered during recorded meeting sessions to be analysed. The second method was the researches going to the different cities to have a look at the facilities, brochures and signage provided, and advertisements of the facilities.
Strength of Study:
* Addressed issues faced by disabled people regarding physical activity participation and provided some ideas on how they can be reduced
* Taken opinions from professionals who work in the fitness industry and people than plan towns/cities
Weakness of Study:
* Only takes into account people who have physical disabilities and not those with intellectual disabilities
* Only 42 disabled people were interviewed

## What were the basic results?

The results show that there are many barriers that prevent disabled people from participating in physical activity. The main barriers and solutions to increase physical activity are presented in the table below $^{[6]}$:
| Barriers | Issues | Facilitators |
| Environment | Lack of curb cuts Doorway too small Service desk height No elevators or handrails Slippery floors | Non-slip surface Disabled parking spaces Automatic doors Ramps Specific changing rooms (for those who need assistance) |
| Cost | Focus is on profits more than accessibility Spending money maintaining equipment is more of a priority Membership cost too high Disabled people have more financial difficulty | Building disabled-friendly places from the start reduces fees facilities get sponsorships to upgrade |
| Equipment | No space between equipment Not user friendly | Adaptive equipment Upper body aerobic equipment |
| Psychological | Perception that these places are unfriendly environments Non-disabled people are not friendly towards disabled people Self-conscious Lack of support | Friendlier environment Allow trial period Family and friends support Show more encouragement towards disabled people |
| Attitude | Non-disabled people tend to look past or ignore disability Fear of liability if anything happens to them Less of a Priority | Change the way people perceive disabled people Added benefits to the business as disabled people are usually accompanied by family or friends |

## What conclusions can we take from this research?

Many barriers prevent disabled people from participating in physical activity. Most of these barriers are created by non-disabled people overlooking the needs of disabled people that give off a negative attitude towards them as they are seen as unimportant$^{[1]}$. Also, there are not many studies exploring factors that affect disabled people. This shows that there is a lack of understanding towards disabled people.

## Practical advice

* Suggestions were made to develop a reliable way of measuring physical activity levels in disabled people
* It was suggested that researches should find more specific issues within the barriers that affect participation and that an ecological model is made to gain a better understanding
* Deeper research into factors that affect participation in physical activity can help to reshape the way people think about disabled people and increase participation

## Further information/resources

Overview of Physical Activity in Australia: Participation in physical activity
Barriers:
Factors affecting Children with Disabilities
Environmental factors
Organization:
Increasing physical activity among adults with disabilities

## References

1. Centres for Disease Control and prevention. Impairments, Activity Limitations, and Participation Restrictions. U.S. Department of Health & Human Services; 2020. https://www.cdc.gov/ncbddd/disabilityandhealth/disability.html
2. Hutzter Y, Bar-Eli M. Psychological benefits of sports for disabled people; a review. Scand J Med Sci Spor. 1993; 3(4): 217-228. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0838.1993.tb00386.x
3. Jaarsma EA, Smith B. Promoting physical activity for disabled people who are ready to become physically active: a systematic review. Psychol Sport Exerc. 2018; 37: 205-223. https://www.sciencedirect.com/science/article/pii/S1469029217302790
4. National centre of Health, Physical Activity and Disability. Physical Activity Guidelines for Adults with Disabilities. 2020. [Date accessed 10 September 2020] https://www.nchpad.org/618/2576/Physical~Activity~Guidelines~for~~Adults~with~Disabilities
5. Physiopedia. Physical Activity in Individuals with Disabilities. UK: Physiopedia; 2020. https://www.physio-pedia.com/Physical_Activity_in_Individuals_with_Disabilities
6. Rimmer JH, Riley B, Wang E, Rauworth A, Jurkowski J. Physical activity participation among persons with disabilities: Barriers and facilitators. AM J Prev Med. 2004; 24(5): 419-425. https://www.sciencedirect.com/science/article/pii/S0749379704000297
7. Thiese MS. Observational and interventional study design types; an overview. Biochemia Medica. 2014; 24(2): 199-210. https://hrcak.srce.hr/125364?lang=en