Sunday, January 19, 2014

A Cliche That Kills

Read any news article on fitness and two types of commenters almost inevitably appear. One is the person who feels compelled to give WAY too much information about their personal regimen. The other is the commenter who writes, "But I'm disabled and I can't exercise".

The first of these is merely annoying. The second is promoting a cliche that kills people.

While doing some random Googling over the weekend, I came across two studies that should grab the attention of everyone who has a disability or is in any way associated with the fitness world. Both have to do with cerebral palsy (sorry, but that's what I have, so it grabs my interest), but the conclusions should apply to many physical disabilities.

The first of these is a study from 1999 that looks at the causes of death of people with CP. While some of these are unsurprising to those familiar with the condition (many deaths are due to pneumonia), one finding in particular should be shocking. In the California population these researchers studied, people with cerebral palsy were approximately twice as likely to die from coronary artery disease as people in the general population. They were also 2-5 times more likely to die from stroke. And these numbers are actually conservative, as I'm leaving out the ambiguous 0-34 age group.

These deaths are not just happening among the old. They apply to the 35-54 and 55+ age classes.

To drive this point home, we can look at a French study that just came out and got similar results. This article conveniently included graphs showing at what ages deaths from various causes occurred among people with CP contrasted with the general French population. Here is the graph for circulatory disease.
What this graph shows is that the vast majority of deaths from circulatory disease in the general population happen at ages 75 and older. But among people with CP, they happen at almost all ages. People in their 30s are dying of cardiovascular disease!

This is the kind of graph that ought to make us furious. Because, despite all the caveats that could be put in (maybe preterm birth has an effect, maybe stress has an effect, probably not all these deaths are from atherosclerosis), we do know something about preventing heart disease and stroke. We know that food and fitness are both major players.

I will say little about diet, except to note that, strictly speaking, it's body fat percentage that matters, not weight. You can have the stereotypically skinny CP body and still be metabolically obese because many of us have little muscle mass and can carry a fair amount of fat without showing it or appearing as overweight by BMI standards. Skin fold measurements, which should be done by a professional, and measures related to waist circumference, which can be done at home, are both more informative and potentially more wheelchair accessible than scales. And it's hard to be too disabled to eat better.

I will say more about exercise, because this is where the cliche does its damage. At the risk of sounding like those TMI commenters, I will first say a little about myself. I have a form of cerebral palsy that affects my balance and upper body control. I can walk with assistance but use a powerchair to get around. Also, I currently climb at a rock wall at least once a week and do weight training twice a week and cardio (exercise bike or rowing machine) 2-3 times a week.

Working at a university with a good gym and having a mini-gym in my apartment building helps me to be this active. Not everybody has this access, but everybody should be looking for something. Set up something at home or check out a few gyms and pick one that's accessible and suits your style and budget. The National Council on Health, Physical Activity, and Disability website has tons of resources.

"But I can't exercise!" Unless you're completely paralyzed, that's probably not true. (If you've been told by a doctor not to exercise, seek a more detailed explanation of why and consider a second opinion.) Start where you are and work up little by little. When I began using the rowing machine as a college freshman, after more than two years of inactivity, I started off with five minutes and went up by a minute a week. When I got to ten minutes, I started going up by two minutes a week. With these barely noticeable increments, I was soon doing a solid 20 minutes.

Strength training is also very beneficial and can be more accessible than aerobic exercise because you can choose from many exercises at various levels of difficulty. And it carries many of the same health benefits! Actually, you should do it either way, for the reasons laid out at this Mayo Clinic website. Ignore the sometimes macho culture and start where you are, moving up in small increments. (Consider hiring a trainer for a few sessions if you need help designing a program.) But do move up! If you need to start an exercise with five pounds -- or even one pound -- that's fine. Just don't stay there. Speaking from experience, being able to handle more weight than a non-disabled person is fun!

Weight machines can help overcome some disability-related limitations. I was never able to do sit-ups until I started using an ab machine with weights and gradually brought the weight up. Now, they're not a problem. And, as counterintuitive as this is, strength training doesn't exacerbate spasticity.

 "But people will be looking at me!" Yes, but not in the way you fear. They'll be admiring you. A person with an obvious disability who works out, at whatever level, commands respect. And your presence can make others with and without disabilities more comfortable. The overweight or inexperienced person who just started going to the gym might see you there and think, "If they can do this, I can do this". That's a powerful thing.

Those of you working in fitness-related fields should consider what you can do to improve accessibility. (The NCHPAD website has ideas for doing this.) When I started doing strength training as a University of Georgia grad student, the weight room staff was easily able to provide help because of their room setup. At UCLA, getting the logistics worked out took a bit of time, but we made it work. Think of what kind of support people might need and what your facility can provide.

Ultimately, all of us, with and without disabilities, should start treating access to fitness as a civil rights issue. Because staying alive is as fundamental a right as they come.


cushiemonster said...

I very much appreciate what you have written. But, believe me I'm not making excuses, I suffer from chronic pain in addition to my disabilities. And chronic pain coupled with adrenal insufficiency (amongst other things) is a crappy combo. The pain is so great, and when i try low impact things, such as hydrotherapy, the pain is two-fold when i get out of the water. To be honest, it is a kind of defeat that is extremely hard to describe. I want so badly to have the energy and tolerance to move about physically, but have literally found it impossible. And when I do find something that might work, I end up injuring my back bc of my obesity. I think there are cases where it just seems hopeless.

Jane Shevtsov said...

OK, that officially sucks. While I'm not an expert or a trainer or anything like that, I'd like to ask you a question or two and see if we can come up with some ideas. First, where is your chronic pain? Are there movements or activities you can do (just think everyday life) that don't exacerbate the pain?

Also, I know that this isn't easy advice to follow, but the main factor in obesity is food, not exercise. Exercise is important for overall health, but it's hard (almost impossible for most people) to burn enough calories with exercise alone. That's good news because your disabilities shouldn't stop you from taking a look at what (and how much) you're eating and making some tweaks. (To make sure any changes you make are safe and effective given your endocrine issues, you might ask for a referral to a dietician.) And, going by your own comment, losing weight should make exercise easier. Just take it one step at a time.