Is Exercise a Medical Necessity for People with Disabilities?

It seems, almost everyday we hear about new health benefit from routine exercise for the general public, but what does this mean for the disabled community? The opportunities for exercise are often overlooked by therapists in discharge planning, by doctors that are overwhelmed with the other medical issues, and from insurance companies that do not view exercise as a medical necessity for people in wheelchairs. The truth is, the general health of the disabled is significantly poorer than the able body population. The disabled have slightly higher rates of smoking and alcohol consumption but the main reason for poor health is because of metabolic syndrome.

Cardiovascular exercise and a good diet will help reduce obesity and health problems for people with disabilities.

Metabolic syndrome is a multitude of medical problems such as high blood pressure, dyslipidemia, coronary heart disease, stroke, type two diabetes, early onset damansia, gallbladder disease, some cancers (endometrial, breast, colon), and sleep apnea. This disease can have a genetic predisposition but is often resulting from obesity. The prevalence of metabolic syndrome is significantly higher in the disabled population because some neurological deficits result in muscle cell loss and fat cells replacement. But the greatest contributing factor is the lack of opportunities for good cardio vascular exercise. Also, many people with disabilities are not identified for this risk, because they look to be thin but are actually, what is termed, normal weight obese. Also, some people that have had a spinal cord injury, especially people with triplegia, often look thin except for extensive belly fat. This is concerning, because of the added risk of pressure sores, from the force on the pelvic, but also from recent studies indicating that an increase in visceral (belly fat) can lead to an increase in death by heart disease. It was found that men that have a waist size over 40″ and women over 35″ have double the risk from premature death due to heart disease and diabetes. But, a recent study indicates that people that are technically obese, such as ex-football players, are healthier, than their size would indicate. The players had less prevalence of diabetes and other metabolic problems, if they stayed fit, than men the same age and size from the general population. Another problem resulting from the vascular risk factors from obesity is early onset of Alzheimer’s disease and dementia. The good news is studies also indicate that the best prevention is a good diet and regular exercise.

Obesity is becoming a large health care problem for the general population, but it has graver implications for the disabled, especially as this population ages. For example; a sixty year old, C6, SCI male that developed metabolic syndrome- what are the implications for pressure sores, if he has diabetes? How will his care be affected if he develops dementia? Or will dementia not be a problem, because heart disease will shorten his life before the onset? What impact will these problems have on his family/caregivers?

Cardio vascular exercise and good diet are the most proven ways to combat obesity and the affects of metabolic syndrome. If someone uses a manual wheelchair many people think that they are getting plenty of exercise pushing, but the reality is, they do not get nearly as much cardio vascular exercise and calorie consumption as an able body person walking. We need to encourage, educate and motivate wheelchair users to take control of their life and exercise. Many gyms now have accessible equipment and many rehab centers have exercise programs tailored for people with disabilities, but few insurance programs help with the expenses, so very few wheelchair users utilize these programs. Also, rehabilitation equipment companies have developed more advanced exercise devices for the disabled to preserve range of motion, strengthen bones and muscles, and to provide good cardio vascular workouts. But again there are limited funding resources to pay for the exercise equipment. We still have a medical model that primarily pays for the treatment of the symptom but does not pay for the prevention of disease. This may have to change as the disabled (as well as the general public) age and the cost to treat all the problems associated with metabolic syndrome increase. This problem can be over come by motivated people, with access to good cardio vascular exercise, facilitated by insightful funding providers.

Are you a wheelchair user who does or does not exercise? How has it affected your health? What is your experience with convincing your insurance company to purchase exercise equipment to prevent the health problems now, rather then treat the problem later?

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