Chapter 15 Physical Activity and Special Populations “PURE ENJOYMENT COMES FROM ACTIVITY OF THE MIND AND EXERCISE OF THE BODY.” -- ALEXANDER VON HUMBOLDT

 This chapter is about the pattern of physical activity and inactivity among persons who represent diverse racial ethnic groups, those of lower socioeconomic status and persons with disabilities.  What about the physical activity of majority groups (white, mid-to higher income, no disabilities) compared to special pops—the discrepancy of disease occurrence and health status.  The risk and burden of early mortality and morbidity from chronic disease in the US is higher among diverse racial and ethnic groups than among non-Hispanic whites.  The public health burden imposed by low levels of activity is very high among diverse race- ethnic and lower SES communities.  Minorities have lower levels of PA and higher levels of inactiveness than do Caucasians.

P-446  Many studies show no apparent racial-ethnic differences when looking at the effects of PA on all-cause mortality.  Cancer-PA appears to be protective against breast cancer across race-ethnic groups.  Overweight & Obesity:  Metabolic Syndrome: Regular PA is associated with reduced risk of metabolic syndrome for men and women across all major race-ethnic groups.  NIDDM-P-448  Summary: PA is associated with a protective effect and disease—no minimum threshold of effect exists—especially among low-active and inactive people—in other words: Some activity is better than none.

Physical Activity & Disability  P-448  Disability refers to limitations in ability to perform life activities due to impairment of ADL’s.  Physical Activity and Disabling Conditions: orthopedic impairments, arthritis, heart disease, hypertension, visual impairments, diabetes, mental disorders, asthma, intervertebral disc disorders and nervous disorders. The proportion of people reporting a disability due to chronic health conditions and impairments appears to have been rising since the early 1980’s.  Those with disabilities are usually less active and have a lower work capacity than those without.  Inactivity (as you know) then causes more problems such as increased risk of CVD, high BP, thrombosis, osteoporosis, obesity, & type-2 diabetes.  P-454. People with disabilities expend more energy with ADL’s—because of reduced muscle mass, inefficient locomotion, abnormal posture due to paralysis, difficulty breathing due to respiratory impairment.

 Inactivity & Aging: Older adults are more likely to experience a disability than younger adults.— They may already have an existing condition or disease which limits their activity. This results in a reduced capacity beyond that imposed by the condition or disease which leads to a spiral of deterioration.  Long term activity reduces the risk of degenerative noninflammatory joint disease common in the elderly. Joints do degenerate with age and this results in an increasing inability to perform ADL’s.  Elderly people (with exercise) improve stamina and work capacity which leads to greater functional strength (muscle, neural recruitment).  Physical Activity and Long-Term Health Among People With Disabilities (P-456). Prolonged physical inactivity is associated with long-term risks of disease in persons with and without disability. Exercise may improve the life expectancy of those even with the most severe disabilities.

 CVD—Lipid Metabolism—Hypertension—DVT—Metabolic Health—Musculoskeletal Health (muscular strength)…  Activity in the Prevention of Secondary Complications: Individuals with disabilities are likely to be at increased risk for a number of preventable health problems referred to as secondary conditions. These are “physical, medical, cognitive, emotional or psychological consequences to which persons with disabilities are more susceptible by virtue of an underlying impairment, including adverse outcomes in health, wellness, participation and quality of life.”  This includes pain and fatigue.  Quality of life. Exercise also benefits self-image—we live in a society that can devalue individuals for having a disability and they may devalue themselves.  Functional Health for Daily Living: For people with disabilities who are not interested in sport or exercise, a physical activity plan may be based on customary activities. Even brief bed rest may cause deterioration.

 P-460  Physical Work Capacity: Low physical work capacity is reversible. They do not depend on enormous physical effort—rather, they depend on a physical effort greater than that to which the individual is accustomed.  Regular physical activity, sport participation, and active recreation are essential behaviors for the prevention of disease, promotion of health, maintenance of functional independence, and reduction in health disparities in special populations. This health behavior is essential for persons with and without disabilities.  The lack of participation in recommended amounts of physical activity is a serious public health concern for all, but it is even more important for persons with disabilities, who are demonstrably at much greater risk of developing the types of serious health problems associated with a sedentary lifestyle.