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Motivating individuals with disabilities to be physically active

Increasing the number of individuals with disabilities who are physically active is a public health priority [United States Department of Health and Human Services (USDHHS), 2001]. The purpose of this presentation is to report motivational strategies aimed toward physical activity participation. The benefits of exercise/physical activity for certain disability types will be presented as a reminder of the importance of an active lifestyle. Physical activity concerns will also be reported in order to introduce certain considerations when trying to identify ways to increase motivation. 

General benefits of physical activity

• Both physiological and psychological benefits can be obtained from regular physical activity involvement.

• Regular exercise (i.e., 3 or more days per week for 20 or more minutes) can increase health-related physical fitness such as cardiovascular endurance (CVE), muscle strength and endurance, and flexibility.

• Weight control, prevention of obesity and other health-related conditions such as cardiovascular diseases, diabetes, colon cancer, hypertension, osteoporosis, and arthritis can all be reduced by physical activity.

• Psychological benefits such as decreased anxiety and depression may also be realized with positive improvements in emotions, self-esteem, and self-confidence.

Physical activity benefits for people with physical disabilities

• Physical activity can contribute to self-control, psychological empowerment, physical strength, and personal freedom for women with several disabilities such as spinal cord injury, post-polio, spina bifida, dwarfism, type I diabetes, breast cancer, AIDS, and heart disease (Guthrie, 1999).

• Within the same populace, physical activity has been utilized to optimize body-mind functioning and reconstruct self-identity based on personal rather than societal standards. 

• Subgroups of women based on ethnic backgrounds with the aforementioned disabilities participated in organized sports and adopted a political perspective through exercise. Specifically, their purpose was to challenge gender role, sexual, racial, and disabilities stereotypes indicating that successful sport participation is not only the province of high functioning heterosexual European-Americans. The group of minority populations emphasized self-enhancement and fulfillment through participation in organized sports.

• Adolescent swimmers with physical disabilities can experience high self-esteem (self-worth) and strong athletic identity. On the contrary, social physique anxiety (perceived negative evaluations of one's body from others) has been shown to be low to moderate and highly related to self-esteem and athletic identity (Martin, 1999). 

• Perceived competence within and outside sport settings to attain specific tasks and goals, social integration (social skill development), goal setting behaviors, and persistence in sports have been identified to increase among male, college students with physical and sensory disabilities (Blinde & Taub, 1999). 

Physical activity benefits for people with developmental disorders

• Regular physical activity can improve cardiovascular and respiratory functioning among individuals with intellectual disabilities (ID). It can also increase muscle strength and endurance, energy levels, vocational functioning, and decrease anxiety (Chanias, Reid, & Hoover, 1992; Eichstaedt & Lavay, 1992).

• Participation in exercise programs of moderate intensity has revealed increased time on-task and attention to task relevant information leading to successful responses for adolescents with autism (Rosenthal-Malek & Mitchell, 1997). 

• Physical activity can also diminish and control inappropriate behaviors related to autism and intellectual disabilities such as stereotypic behaviors (Elliot, Dobbin, Rose, & Soper, 1994). 

Physical activity benefits for people with depression

• An 8-week running program with intensity varied between 70% and 85% of maximal heart rate was found to decrease depression and increase psychological well-being among individuals who experienced a major depressive episode (Bosscher, 1993). 

• Objective changes in physical measures (e.g., improvement of flexibility and body composition) after an ongoing exercise program can increase self-perceptions such as physical self-efficacy, physical competence, physical acceptance, and eventually self-esteem. Increased self-esteem in turn can elevate mood (Sonstroem & Morgan, 1989; Van De Vliet, Van Coppenolle, & Knapen, 1999). 

Physical activity concerns

Beyond the positive gains of physical activity, scholars and practitioners in the field of adapted physical activity/education have taken into consideration the potential negative implications of physical activity for certain populations. 

• In the western European-American society, media advertisements, Hollywood movies, fashion shows and magazines relate fitness to thinness for women. Thinness in turn is linked to sexual and physical attractiveness, success, power, and status (Kilbourne, 1994). Such messages may render vulnerable individuals to eating disorders such as anorexia nervosa (Sherwood & Nenmark-Sztainer, 2001). For individuals with anorexia or bulimia nervosa, excessive exercise may be a way to remain slender, but not necessarily healthy (Kilbourne, 1994). 

• Excessive exercise to restore a distorted body image can result in very negative complications (e.g., injuries, dehydration). Vigorous exercise, which lasts for many hours, may not contribute to enjoyment and fun. On the contrary, motivation and joy can, in fact, decrease. In addition, aerobic exercise may not result in well-sculpted muscles of certain body parts. Therefore, increases in body weight and lack of well-sculpted muscles on certain body parts may lead to dissatisfaction and frustration given that the role of exercise is viewed superficially (e.g., lose weight and look thinner). Dissatisfaction may, in turn, lead to withdrawal from exercise and sports (Polivy & McFarlane, 1998). 

• The negative consequences of the western culture messages may have affected individuals from different ethnic groups. Eating disorders are not a "province" of only heterosexual European-Americans. Acculturation of different ethnic and religious groups such as African-Americans and Jewish may evoke the negative implications of the thinness over idealization of the western society. For example, an African-American, a white Jewish, or a homosexual woman may adopt a slender body ideal and engage in maladaptive behaviors such as dieting and excessive exercise in order to better fit into the western society and avoid further discrimination (Thompson, 1994). 

• An analogous phenomenon has evolved recently among individuals with muscle dysmorphia (Goodale, Watkins, & Cardinal, 2001). Muscle dysmorphia is the reverse phenomenon of anorexia nervosa. There is a perceived dissatisfaction with body shape and size as in anorexia nervosa. However, those with muscle dysmorphia think that they are too thin and frail; although their body shape and size may be "normal" or even "super-normal". This person is preoccupied with their muscularity and engages in unhealthy behaviors such as excessive weight training and misuse of anabolic steroids in order to increase their muscle size (Pope, Gruber, Choi, Olivardia, & Phillips, 1997). Preoccupation with exercise can lead to social alienation and isolation (Lantz, Rhea, & Mayhew, 2001).

• Muscle dysmorphia has been identified among European (Austrian and French) and American college students who can exhibit obsession with exercising at the gym (Pope et al., 2000). 

• Goodale, Watkins, and Cardinal (2001) did not find significant differences in muscle dysmorphia symptomatology between men and women. This suggests that women also can be preoccupied with their muscle development.

• According to the above statements, scholars and practitioners who work with people with disabilities should emphasize the importance of physical activity for health and not for body size (Goodale et al., 2001). Distorted body sizes and shapes based on unrealistic societal standards should be challenged. Media campaigns should encourage healthy lifestyles rather than maladaptive and potentially dangerous behaviors (Goodale et al., 2001). 

• Accordingly, policy makers should reinforce proper health and physical activity education starting in kindergarten; exclusion or objection to advertisements and products that promote unhealthy images should be emphasized as well (Kilbourne, 1994). The United Kingdom government has already taken action to boycott unrealistic body ideals that may be adopted by individuals vulnerable to anorexia nervosa.

Motivational programs

Although the importance of exercise/physical activity as well as healthy exercise behaviors are very well documented, only 23% of individuals with disabilities engage in regular physical activity, which is characterized by at least 20 minutes of exercise on 3 or more days per week (USDHHS, 2000). One reason for that might be low motivation to participate in regular physical activity. Low motivation may not be a personal choice, but rather an undesirable outcome of negative affect and self-perceptions due to societal and cultural constraints and discrimination. In order to increase motivation toward physical activity participation certain strategies will be proposed:

• Encouragement to participate in leisure-type activities that promote successful experiences to increase self-confidence and motivation to further participation. 

• Encouragement to set individual and specific goals to accomplish in certain time limits (Cole, Leonard, Hammond, & Fridinger, 1998).

• Information about benefits and risks of physical activity, stress management techniques, goals setting, problem solving strategies, reevaluation of benefits and costs of physical activity, social support, self-talk, and relapse prevention can be very beneficial in enhancing motivation (Sallis, et al., 1999).

• Barriers, preferences, and constraints identification toward physical activity should be communicated with physical activity promoters in order to organize activities that cover individual needs. 

• Another important area is the plan of local events in order to promote health-related behaviors. Such activities may include a walking event to the local zoo or aquarium encouraging family members to take action. Hosting weekend events in the community (e.g., basketball or volleyball games), outdoor dancing lessons or power-walking seminars, as well as indoor or worksite events can increase opportunities for and motivation toward physical activity participation. Through these events, physical activity can become more enjoyable and available to everyone.

• In a similar vein, the increasing percentages of young people who are overweight led to the development of certain recommendations for the promotion of age-appropriate, meaningful, and enjoyable physical activities among youth (Cardinal, Engels, & Zhu, 1998; CDC, 2001). Certain strategies have been identified such as barriers identification, education of parents and guardians as physical activity promoters for their children, and quality physical education incorporating both extracurricular and recreational exercise programs have been recommended (Cardinal, Engels, & Smouter, 2001). 

• In addition, accessibility and equal opportunities to recreational and organized athletic programs, well trained coaches and recreation program staff, design considerations such as the development and use of close-to-home bicycle and walking paths, sidewalks, and community facilities may encourage and promote physical activity participation (Wright, Paterson, & Cardinal, 2000). 

• Challenging tasks that reinforce active involvement and equal opportunities should be offered. Participants in physical activity programs should have some control in decision making. Individual effort should be recognized encouraging self-evaluation and allowing time for improvement (Epstein, 1988).

• Positive attitudes toward teaching individuals with disabilities can increase motivation toward physical activity participation. Such positive attitudes can be derived from appropriate training of the adapted physical activity specialists (Conatser, et al. 2000; Folsom-Meek et al. 1999). Appropriate training in the area of adapted physical education should not only be the responsibility of adapted physical educators but also of all physical educators.

• Physical activity experiences should offer fun, enjoyment, and excitement, by diminishing anxiety, embarrassment, and discrimination. 

In conclusion, the importance of health-related lifestyles should be fostered by specialists in the adapted physical education/activity field. Strategies to heighten awareness about the health benefits of physical activity by increasing choices and thus motivation toward physical activity participation should be of priority. Equal opportunities and discrimination elimination should be fostered in order to understand and recognize the needs and culture of individuals with disabilities increasing their quality of life.
 

Support for this Web cast is provided by the National Institute for Disability and Rehabilitation Research (NIDRR) as part of its initiative to promote greater use of disability research findings by consumers, their families, service providers, and other non-researcher stakeholders.  Specific NIDRR project support comes from RIIL (Research Information for Independent Living), RRTC on Managed Health Care & Disability, and RTC on Health & Wellness. NIDRR is part of the U.S. Department of Education, and no endorsement of the opinions expressed as part of this Web cast by the Department should be inferred.