There are roughly 11 million disabled people in the UK, and around 1.5 million with a learning disability. Yet research shows people with disabilities are at significantly higher risk of poor health outcomes compared to the general population. Could exercise be the answer?
According to Mencap, people with learning disabilities are twice as likely to become obese, five times as likely to be morbidly obese and on average die 17 years younger than those without a learning disability.
While the benefits of regular exercise on physical and mental health are well-established, research suggests that people with disabilities are twice as likely to be inactive compared with non-disabled people.
One survey by the charity Activity Alliance found that nearly two thirds (59%) of people with a learning disability do not participate in sport, even as little as once a month, despite the fact that two in three people with a learning disability would like to be more active.
When the pandemic arrived and lockdowns were introduced, many of us became less active and more sedentary as gyms shut, outdoor activities were banned and we were asked to stay at home.
According to Activity Alliance, disabled people felt they did not have the opportunity to be as active as they wanted to, and many have said this had led to both their physical and mental health being harder to manage.
Fear of contracting the virus was higher for disabled people (35%) compared to the general population (23%), as many were deemed extremely clinically vulnerable. This meant many people with disabilities chose to stay inside even when lockdown restrictions were no longer imposed, with many even now feeling less confident to go out than they used to.
Activity Alliance say that it is now more important than ever that providers and decision makers in sport prioritise disabled people and close this widening inequality.
Physical activity is known to have numerous health benefits, including improved cardiorespiratory and muscle fitness, cardiometabolic health (blood pressure, dyslipidaemia, glucose, and insulin resistance) and bone health.
In fact, according to research by The Department of Health, regular exercise can help people to prevent or manage more than 20 chronic health conditions. Physical inactivity therefore puts a huge strain on the health service and is estimated to cost the NHS around £1 billion every year. Including costs to wider society, this rises to around £7.4 billion a year.
Since people with learning disabilities are at a heightened risk of being overweight or obese and suffering from multiple comorbidities, exercise can be extremely beneficial for this group.
A number of studies have demonstrated these benefits. For example, one study found that overweight or obese adolescents with learning disabilities who took part in a 12-week exercise programme, comprising of cross-circuit activities for 50 minutes five days a week, achieved reductions in weight, BMI and fat mass, as well as improvements in cardiorespiratory performance, balance, strength and endurance.
Not only does exercise have a positive effect on physical health, but it also has the potential to increase social interactions and improve mental health and wellbeing. Team sports in particular can provide people with a way to make friends and feel included in the community.
In this way, physical activity can contribute to improved overall quality of life for people with learning disabilities.
The reasons for lower levels of participation in physical activity among people with disabilities are complex and multifactorial.
Barriers can be internal (such as pain before during or after physical activity, fear of injury and feeling unsafe in public spaces) or external (cost, lack of transport and facilities).
A report recently published by Sense, ‘Understanding the physical activity needs of families who have children with complex disabilities’, highlights the extensive nature of these barriers. While the research specifically focused on children with disabilities, many of the practical and personal barriers experienced could also be applied to adults.
The report looked at the experiences of 127 parents and carers of children with complex disabilities (the majority of whom had visual/hearing impairment and/or a learning disability) and their access to sport and physical activity.
Barriers to physical activity were found to be personal, social or environmental, as well as relating to policy and programme delivery.
Personal barriers often presented as a lack of knowledge or skills and preferences from the child and the parent’s behaviour, while social barriers included negative attitudes towards disability from the general public, such as fear of bullying or teasing when attending organised activities.
Environmental and practical barriers, such as a lack of transport, inadequate facilities, a lack of specific disability programmes, staff capacity, and cost, were also common.
The report found that at present, not enough is being done to promote the importance of exercise for disabled children, and if we are to see increased uptake in sports, children must be provided with a choice of activities through inclusive pathways.
To do this effectively, Sense says that that schools, disability groups, local councils and the health sector must work collaboratively to create change.
Family members and support workers are known to play a vital role in supporting uptake and continued participation in physical activity. However, health professionals also have an important part to play.
While learning disability nurses are key to improving the health of people with learning disabilities, it is now recognised that the health of this group should be a shared responsibility.
Research has found that adults with disabilities are 82% more likely to be physically active if their doctor recommended it, compared to if they did not get a doctor recommendation. However, only 44% of adults with disabilities who visited a doctor in the past year received a physical activity recommendation from their doctor.
Now, Public Health England say health professionals should prescribe exercise as an intervention for people with long-term conditions as a preventative measure. They recommend that doctors and nurses should guide, support and educate their patients on the benefits of exercise, as well as discussing the barriers to physical activity and how to overcome them.
A study published in Nursing Times highlights a number of ways in which nurses can encourage physical activity in people with learning disabilities. This includes promoting:
Occupational therapists are particularly well-placed to prescribe exercise as an intervention for those with long-term conditions, and the Royal College of Occupational Therapists (RCOT) have been working with the Department of Health to deliver a social prescribing framework.
Genevieve Smyth, Professional Advisor at the RCOT said it is “crucial” that the physical activity sector and the health sector collaborate to get more disabled people active.
She said: “We need to build on bringing the physical activity and health sector together. I think occupational therapists are really good at using and advocating for a social prescribing approach, which bridges the gap between health and other community assets.
“Occupational therapists can signpost, guide and link to support services and offer individualised interventions to those with more complex needs. We need to link with social prescribing hubs, leisure centres, sports centres or local gyms that we can collaborate with – the onus of responsibility should be on us – the healthcare professionals to reach out, make contact and then build and develop these partnerships.”
To get more people with learning disabilities involved in sport, it is clear that a multipronged, collaborative approach must be adopted.
While family members play a vital role in encouraging participation in sports, support workers and healthcare professionals have an equally important part to play. However, systemic challenges (such as transport, cost and accessible facilities) can sit outside of services’ control.
Another report by Sense, ‘Support workers: attitudes, approaches and barriers to helping people with complex disabilities engage in sport and physical’, states that services and support workers could therefore benefit from being helped to deliver their own, simple, on-site adaptive sport activities to expand and diversify what they already have on offer.
The charity says to achieve this, there must be a cultural shift towards placing physical activity at the heart of the support worker role. Support workers should therefore be encouraged to integrate conversation about sport and physical activity into their everyday communication and should be enabled to deliver more adaptive activities onsite to help overcome logistical challenges.
Sense says that organisations also have a responsibility to make physical activity offerings inclusive for everyone, no matter how complex their disability. In this way, everyone will have equal opportunity to fulfil their potential, engage in social interaction, and obtain physical and mental health benefits.
As Sense Head of Sport and Physical Activity, Alissa Ayling, explains: “No one, no matter how complex their disabilities, should be isolated or left out from opportunities to maintain a healthy and active lifestyle.”
“Our research has highlighted that in order to engage more disabled children in physical activity, the focus must be on adopting a person-centred approach to activity development, selection, availability, frequency and format so that activity sessions are centred around need and are more accessible to more children and their families, rather than using a ‘one size fits all’ approach.”
Activity Alliance are also urging decision makers to listen to the experiences of disabled people. Barry Horne, Chief Executive at Activity Alliance said: “If we do not act now, we will witness inequalities widen even further, or unthinkably they may become irreversible. Prioritising disabled people is the only way to prevent this from happening. Every plan, every action and every penny spent must be tested against its impact on disabled people’s activity.”
For more information about people and organisations that can support disabled people to be more active, please visit www.activityalliance.org.uk/.
