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2013
http://informahealthcare.com/dre
ISSN 0963-8288 print/ISSN 1464-5165 online
Disabil Rehabil, Early Online: 1–8
!
2013 Informa UK Ltd. DOI: 10.3109/09638288.2013.802377
REVIEW
Benefits and barriers to physical activity for individuals with disabilities:
a social-relational model of disability perspective
Jeffrey J. Martin
Wayne State University, Detroit, MI, USA
Abstract
Purpose: To provide a qualitative overview of selected research on physical activity (PA)
engagement by people with physical disabilities
1
from a social relational model perspective.
Method: Selected articles that exemplify some of the paradoxes, nuances, contrasting
perspectives and complexities of the knowledge base in this area are discussed within a
disability studies framework. Results: PA is arguably more important for people with disabilities
relative to people without disabilities although they are quite inactive. Individuals who are
physically activity enjoy a range of benefits spanning physiological, emotional, cognitive
and social categories. Unfortunately many people cannot enjoy the benefits of PA because
of the many medical, psychological, social and environmental barriers they face making PA
quite difficult. Conclusions: Rehabilitation professionals can provide a better standard of care to
clients if they are aware of the benefits and barriers of PA.
ä Implications for Rehabilitation
Rehabilitation professionals should understand behavior change strategies and their
application to people with disabilities in order to help their clients initiate and maintain
physical activity (PA).
Rehabilitation professionals should be aware of how they might convey low PA expectations
to their clients and simultaneously understand the unique challenges faced by their clients
in attempting to incorporate PA into their lives on a regular basis.
Rehabilitation professionals should be familiar with local disability friendly exercise facilities
and adapted sport programs in order to steer their clients towards such opportunities.
Keywords
Adapted, disability, exercise, health, PA, social
psychology, sport
History
Received 29 September 2012
Revised 22 March 2013
Accepted 1 May 2013
Published online 19 June 2013
Introduction
The major purpose of this article is to provide a qualitative
overview of selected research on physical activity (PA) engage-
ment by people with physical disabilities. My goal is not to
provide a comprehensive literature review but rather to use
selected research on the barriers and benefits of PA to point out
the paradoxes, nuances, contrasting perspectives and complexities
of the findings to inform future research. My selected literature
review is wide ranging in that I do not limit myself to specific
disability groups, such as only spinal cord injured people only, or
types of PA (e.g. I include both sport and exercise). An important
secondary goal is to link the discipline of exercise and sport
psychology with disability studies by using models of disability
(i.e. social model, individual model and social relational model).
The rationale for my secondary goal is that exercise and sport
psychology researchers, with few exceptions [1] rarely acknow-
ledge models of disabilities that are so much a part of disability
studies. As a result, exercise and sport psychology researchers
miss an important opportunity to contextualize their work within
the larger sociocultural and historical landscape of disability. The
current article is a modest attempt to correct that deficiency.
Models of disability
The medical model of disability would suggest that a SCI
individual is unable to be physically active (e.g. go running)
because she cannot use her legs. The problem is viewed as a
biological and medical difficulty. The above observation has merit
from a logical perspective in that a person without the use of their
legs cannot run. Unfortunately the medical model also implies
that having a disability is a deficiency, is negative, and the person
must be cured or fixed by the medical profession. A medical
model also highlights remediation and correcting ill-being versus
prevention of ill-being and the promotion of well-being.
In contrast, a social model of disability views disability as
difference and not necessarily as good or bad. The social model
of disability would highlight a lack of opportunity (e.g. limited
local swimming pools) and discriminatory behaviors (e.g. teasing)
Address for correspondence: Jeffrey Martin, Division of Kinesiology,
Health, and Sport Studies, 266 Matthaei Building, Wayne State
University, Detroit, MI 48202, USA. Tel: 313 577 1381. E-mail:
aa3975@wayne.edu
1
I recognize that in the UK ‘‘disabled people’’ is the recommended
terminology. I choose to use ‘‘people with disabilities’’ as is common in
the USA.
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that limit or prevent PA. For instance, pool attendants and life
guards who are reluctant to make the effort to employ the poolside
wheelchair hoist to assist a person with a disability who would
like to swim. The social model would also point out various
structural barriers (e.g. lack of ramps, too steep ramps, snow
not removed from ramps during the winter, doors too narrow for
wheelchairs). At the same time, the social model (e.g. legislation)
could also be used to acknowledge the guidelines and rules that
required the pool to have a wheelchair hoist at poolside.
A common criticism of both medical and social models is that
they tend to emphasize extreme positions and frame each position
as mutually exclusive of the other position.
In response to the above and other criticisms a social relational
model of disability suggests that impairments such as being
physically unable to use ones legs, and social and environmental
barriers can all operate simultaneously [2,3]. According to a
social relational model of disability restrictions of activity such
as PA can be caused by social reasons (e.g. discrimination)
and by impairment (e.g. lack of sight). Additionally, in different
situations and different moments in time people’s ability to
engage in PA can be influenced by a host of different factors
reflective of elements of a medical and social model of disability.
I find the social relational model a much more reasonable and
logical model relative to the medical or social models of
disabilities for two major reasons. First, the social relational
model essentially acknowledges the merits of both the medical
and social models and as a result is more comprehensive. For
example, the social relational model acknowledges that both
impairment and psycho-emotional oppression are important
influences. Second, because the medical model fails to adequately
acknowledge how social and environmental factors influence
behavior it is incomplete. Similarly, the social model ignores the
obvious functional implications of, for example, not being able to
use ones legs, and as a result also fails to address an important
reality for many people.
Physical activity
Over 50 million people in the USA have disabilities [4] and a
large number of these individuals are overweight and manage
secondary health conditions (e.g. diabetes) in addition to their
disability. However, despite the above alarming numbers it is
important to understand that having a disability and being
unhealthy are not synonymous as a medical model would imply.
Preliminary research indicates that people with disabilities who
are not ill view themselves as healthy [5]. Furthermore, according
to the Centers for Disease Control (CDC), 27.2% of people with
disabilities rate their health as excellent or very good [6]. It is
also important to recognize that the way in which people with
disabilities evaluate their health likely differs from how people
without disabilities evaluate their health [7]. For example, based
on a similar number of self-reported unhealthy days, people with
disabilities rate their health as better than people without
disabilities [7].
Unfortunately, 40.3% of people with disabilities rate their
health as fair or poor compared to 9% of people without
disabilities [6]. For the many people with disabilities who have
poor health and secondary conditions (e.g. diabetes), PA is critical
for quality of life reasons and as a public health mechanism.
As adults age, they are more likely to cite disease and injury as
a barrier to PA [8]. As Rimmer succinctly points out, older people
with disabilities have to simultaneously manage their primary
disability, associated secondary conditions (e.g. obesity) and
health related (e.g. more illness) aspects of aging while finding
it more and more difficult to engage in PA [9]. It is also of value
to recognize that older people face the above challenges while
simultaneously having reduced social support from fewer friends
and relatives.
In the following sections, the amplified importance of PA
is discussed followed by research examining the benefits
associated with PA. I then overview selected barriers to PA that
range from individual level constructs to social and environmental
characteristics. I do not comment on all the barriers to PA found
in the research (e.g. Martin [10]) but rather focus on barriers
that often interact with other barriers or can plausibly be viewed
from different perspectives. For instance, there are barriers that
can reasonably be reflective of medical, social relational and
social models of disability or combinations of all three models.
A summary of my salient points and their implications for
future research concludes the article.
Amplified importance of PA
Similar to a large body of research with able bodied individuals,
researchers have established that there are a host of benefits linked
to PA for people with disabilities. Anderson and Heyne [11] assert
that PA for people with disabilities is more important than PA
for people without disabilities. Their argument for the amplified
importance of PA is grounded in higher rates of deleterious
conditions, such as obesity and diabetes that PA can help
ameliorate or prevent. According to Rimmer and Wang [12]
people with disabilities have a 66% higher rate of obesity
compared to people without disabilities. Rimmer and Wang [12]
examined 306 adults with disabilities and found that 62% were
obese and 22% were extremely obese, with minority women at the
greatest risk. Given the relationship between mortality and obesity
the above numbers are quite alarming. PA also helps people guard
against becoming disabled. In a 3-year longitudinal study of over
1300 older (465 years) Taiwanese individuals, exercisers were
less likely to become chronically (43 months) disabled compared
to inactive people [13]. Social difficulties experienced by many
minority groups, such as discrimination and stigmatization, are
higher among people with disabilities compared to able bodied
individuals but PA can attenuate the stigmatization process
[14,15]. PA also contributes to enhanced social status. Arbour,
Latimer, Martin Ginis and Jung [16] found that non-disabled
individuals (N ¼ 446) viewed physically active individuals with
disabilities more favorably than non-active individuals. Exercisers
were viewed as more friendly, self-reliant and persistent as well as
healthier and more fit compared to non-exercising and control
groups [16]. Thus, PA engaged in by people with disabilities has
the unintended consequences of potentially mitigating discrimin-
atory attitudes held by the able bodied public, which according
to a social model of disability, contributes to the marginalization
of people with disabilities.
Anderson and Heyne [11] make similar ‘‘amplified import-
ance’’ arguments for cognitive (e.g. Attention Deficit Disorder:
ADD), emotional (e.g. depression) and social (e.g. loneliness)
difficulties. That is, because these conditions exist in high rates
among people with disabilities, PA is particularly important
in helping prevent or attenuate such conditions.
Benefits of PA
People with disabilities are often defined solely by their disability
and denigrated, marginalized and pitied. In many cases, they
are viewed as incapable and limited in their ability to be
independent and successful. Hence, the major psychological
benefits of successful PA experiences are enhanced self-percep-
tions ranging from global self-esteem to more discrete and
specific competence and self-efficacy judgments. Students with
disabilities ranging from elementary to high school level
have reported enhanced perceptions of competence as a result
2 J. J. Martin
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of increased strength and fitness [17]. Students also recognized
that the successes they enjoyed in PA helped them change
the negative stereotypes held by their classmates. As a result
of therapeutic riding programs, adults have also experienced
enhanced physical confidence and self-efficacy [18]. Increased
self-efficacy and physical confidence were thought to be a
function of mastery experiences (e.g. being able to more easily
and quickly mount a horse) and positive feedback from significant
others (e.g. an instructor commenting on how much a rider has
improved their riding skills).
In addition to common cognitive self-perceptions individuals
with disabilities experience affective benefits. Adults with
Spinal Cord Injury (SCI) have reported increased positive affect
and decreased negative affect as a result of exercising [19].
In particular, the mood benefits of exercise were especially
helpful when participants were having bad days and individuals
with neurotic tendencies seemed to gain the most [19]. Emotional
functioning has also been cited as the biggest benefit in
another study of adults with disabilities [20]. The enjoyment
derived from the social interactions of both fitness staff and
other participants has also been cited as a major benefit linked
to PA [21].
In addition to the cognitive and affective benefits already
noted, researchers (e.g. [22,23] have documented social benefits,
particularly for females [22]). The social nature of many physical
activities and team sports leads to increased social integration,
social bonding and friendships. For example, children with
Cerebral Palsy (CP) and Spina Bifida (SB) who participated in
an after school adapted sport program remarked on the import-
ance of being able to connect with other youth who had
disabilities. Connecting with other youth with disabilities
contributed to a feeling of freedom in allowing them to be
themselves [24]. When PA is obtained via sport, youth athletes
also get the opportunity to travel with their team and experience
feelings of independence, enjoyment and wonderment that often
accompanies discovering and seeing new sights and unfamiliar
cultures [25]. The affective benefits of PA are not limited to
increasing positive mood states such as enjoyment: they also
decrease negative affective experiences.
Martin Ginis, Latimer and colleagues line of research has
demonstrated that PA for individuals with SCI can reduce stress,
depression and pain [26–35]. The anxiety reduction benefits
have been associated with both acute and chronic PA programs.
The above research is particularly noteworthy because the results
have been derived from mostly randomized control trials (RCT).
Some of the research noted above [35] suggests that quality
of life benefits associated with PA are mediated by reductions
in stress and pain. Similar research focused on meditation
processes supports reductions in pain as mediating the PA
benefit of reduced stress [31]. Improved muscle function in
injury prone muscle groups is thought to lead to reductions in pain
which in turn reduced stress. A third series of mediated
associations suggests that increases in physical self-efficacy for
ADL as a result of PA led to reductions in stress related to
managing ADL. Research by Martin Ginis et al. [34] also
supports the above link as the most cited benefits of PA were
increased ease of wheeling and engaging in ADL’s. In brief,
PA doesn’t make ADL easier simply via increased physiological
(e.g. increased muscle strength) adaptations. ADL’s are also
perceived to be easier partly as a result of reductions in important
negative affective states such as pain, anxiety, stress and
depression. Despite the plethora of benefits associated with PA
most people with disabilities are insufficiently active. In the
following section, I discuss the barriers to PA that make it
exceedingly difficult for people with disabilities to be active on
a regular basis.
Barriers to PA
Given the value of PA and the low levels of PA engagement by
most people with disabilities it is not surprising that a major
focus of research among disability and PA researchers has been
identifying PA barriers. Many researchers have documented
lists of barriers to PA that people with disabilities encounter
[e.g. 5,7,37,38,44,45,48,53,58,62,63]. Some of these barriers
are shared among all people (e.g. perceptions of limited time to
engage in PA) whereas other barriers are much more prevalent
to individuals with disabilities (e.g. discrimination). However,
it is important to acknowledge some complexities regarding
the research presented. A counterintuitive yet prevalent finding in
the literature is that wheelchair users often view their wheelchair
as a barrier to PA despite the obvious benefits a wheelchair
provides (e.g. increased access) [36]. Wheelchairs that are
uncomfortable, too heavy and too wide are often noted as
significant problems. Given that most suppliers and clinicians
have limited training in prescribing wheelchairs this finding is not
surprising [36].
A manual wheelchair that is too wide can readily be
categorized as a barrier to entering a fitness facility to engage
in PA. However, the same manual wheelchair allows the user to
obtain day to day PA as they wheel about conducting Activities of
Daily Living (ADL). So, in one instance the wheelchair is a
barrier and in many other situations it facilitates PA. Additionally,
a ramp may be a barrier for someone lacking upper body strength
and irrelevant for a very strong Paralympian. Furthermore,
consider the case of a person who, similar to the fitness center
example above, cannot use the ramp to enter a shopping mall in a
wheelchair to participate in a mall wheeling program in order to
increase their PA. Not being able to wheel up the ramp could
be located in the wheelchair (i.e. it is too heavy), in the person
(i.e. not strong enough), a lack of aid (i.e. no functional social
support) or in the environment (i.e. poorly designed too steep
ramp). The above complexities are best explained by a social-
relational model whereas a medical or social model explanation
would fail to recognize the diverse and multiple reasons behind
the ‘‘simple’’ act of wheeling up a ramp. Finally, most of the
research on barriers doesn’t tend to distinguish among active
versus inactive people but by default tends to reflect the
barriers encountered by inactive individuals. As Malone and
colleagues argue, it is likely that the barriers preventing people
from initiating PA differ from barriers that active individuals
manage successfully on an ongoing basis [37]. In the following
sections I categorize and discuss barriers according to whether
they are predominately individual, social, or environmental
barriers while recognizing such categorizations are not always
clear cut.
Individual-level barriers
Many people with disabilities indicate that their disability
influences their PA behavior [38]. Gardner and colleagues [39]
indicated that participants (20.6%) in their study indicated that
their disability and related symptoms was the number one cited
barrier to PA [39]. Over one half of the Australians (N ¼ 2298)
surveyed by Finch et al. [38] reported that their injury or disability
was the major barrier preventing them from increasing their PA.
Finally, in a study of 113 American adults, Kinne and colleagues
found that impairment was considered the number one external
barrier to exercise [40].
Results of research indicating that PA levels drop from pre-
injury to post-injury periods is also suggestive that disability and
disability related factors (e.g. reduced social support) contribute
to lower PA engagement [41]. The severity of the disability also
plays a role. For instance, more barriers to PA have been noted by
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parents of blind children compared to parents of children with low
vision [42].
A significant barrier to PA for adults with CP living in nursing
or group home environments is a lack of knowledge about
where to exercise [43]. Rimmer, Rubin and Braddock [44] have
remarked that many (i.e. 58%) older (e.g. 35–64 years) low
income urban African American women with severe disabilities
do not know where to exercise. Similar findings have been
reported for individuals with SCI [45] and Amosun, Mutimura
and Frantz [46] found that one of the top barriers to PA for SCI
adults in living in Rwanda was a lack of knowledge about where
to be active.
Fear of falling, especially for individuals with severe mobility
limitations is a major barrier [5]. Other fears include a fear of
developing tight muscles/joints [33] and a fear of crime. Similar
to able bodied people, time is also a barrier. Zhu [47] found that
a lack of time was the second most severe barrier to PA.
Another highly ranked barrier was a lack of a block of time.
The latter barrier suggests that respondents viewed a set amount
of time as a necessary, or at least an important, prerequisite for
PA. This perception is in contrast to the national recommendation
[1] for daily PA that conveys the appropriateness of obtaining PA
in small chunks of time (e.g. 10 min) over the course of a day.
In addition to disability related functional limitations, the
nature of the impairment can produce pain which becomes a
barrier. For instance, children report pain or discomfort as a major
barrier to PA [48]. Up to two-thirds of children with moderate and
severe CP experience pain [49,50]. In particular pain interferes
with running short distances, climbing stairs, walking, riding a
bike and engaging in games in PE and recreation settings [50].
Out of 31 specific activities pain interfered the most (i.e. 45.5%)
with recreation participation.
Henderson and Bedini [51] reported that the most important
factor limiting PA was pain and/or lack of energy. Women often
felt the need to pace themselves in order to avoid excessive
fatigue. Many women report making daily judgments of their
energy level and feelings of fatigue or pain and then decided on
how much PA to engage in, as well as how hard to work [51].
Goodwin and Compton [52] have also found pain to be a
dominant theme in their study of six active women with
disabilities. Pain was often seen as more limiting to their PA
than their disability. Rollins and Nichols [53] also reported that
28% of the participants in their study indicated that PA itself was
somewhat painful. Wilber and colleagues reported that chronic
pain and fatigue are two of the most common secondary
conditions associated with disability [54]. Gardner et al. [39]
found that fatigue (16.6%) and pain (13.9%) were the 3rd and 4th
most common barriers to PA. Pain may be a particularly relevant
barrier for individuals with a SCI compared to, for instance,
visually impaired individuals because up to 94% of people with
SCI indicate that they have pain [32,33]. In brief, pain can become
comingled with feelings of fatigue, and sometimes PA can
alleviate pain and fatigue, while at other times it can produce
additional fatigue and more pain. For instance, acute exercise
bouts may exacerbate chronic pain whereas chronic exercise over
time can attenuate chronic pain [52].
The above complexities also illustrate how pain is simply not a
biological event. The pain-PA relationship exemplifies how the
intuitive appeal to categorize pain as a biological and individual
experience is incomplete and representative of a medical model of
disability. Perceptions of pain are a complex function of biology
(e.g. natural opiates), behavior (e.g. exercise), cognition (e.g. self-
efficacy), affect (e.g. depression), socialization processes (e.g.
parenting influences, gender) and cultural factors (e.g. ethnicity)
[55]. Viewing pain solely as a biological or medical problem
ignores important cultural and psychosocial considerations of a
person’s experience of pain. Smith and Sparkes [56], rely on a
social-relational model of disability, to describe the ‘‘effects of
impairment’’ such as pain which is the direct result or effect of the
impairment (i.e. a SCI), but cannot be explained by a medical
model which would cite the SCI, or the social model which would
evoke social oppression reasons.
Social-level barriers
Children often depend on their parents to facilitate their PA
involvement (e.g. transportation, equipment, functional assist-
ance, etc). Children’s dependence on adults is amplified when
they have disabilities. For example, upon arriving at a beach, a
child in a wheelchair cannot spontaneously charge into the surf
like a child without a disability. Parent’s may also be restricted in
the degree to which they provide PA opportunities because of
financial difficulties or fear for their child’s physical and
emotional safety [57]. According to parents, community recre-
ation personal do not understand how to adapt games for children
with disabilities or how to effectively communicate with children
that might have speech or hearing difficulties [42]. Similar
criticisms have also been leveled at Physical Education (PE)
teachers [58,59] by parents and substantiated by PE teachers
themselves who cite their own lack of professional preparation as
a barrier to being an effective teacher of adapted PE [58].
Teachers’ lack of preparation leads them to often exclude students
with disabilities from their classes [59,60]. Of course, consistent
with previous commentary on the complexity of barriers, even
well prepared teachers suffer from a lack of adapted equipment
(e.g. auditory balls) that is necessary for some adapted sports.
Furthermore, teachers sometimes perceive students as lacking
adequate skills and confidence. Doctors are also implicated in the
above scenario as they sometimes provide unnecessary blanket
medical excuses allowing students to skip PE while simultan-
eously legitimatizing such decisions as a function of the status of
the medical profession. In conclusion, it is not difficult to see how
teachers who feel unprepared, lack equipment, view students as
lacking motivation and skills, and having medical doctors tacitly
providing approval that it is okay for children with disabilities to
not engage in PE, fail to persist in getting students to be active
in PE. Nevertheless, given their ethical responsibilities to teach
all children, and research that indicates adapted PE teachers can
be very effective [7], it is clear that students, school administrators
and parents should expect and vigorously advocate for quality PE
for children with disabilities.
In addition to adult influence, a lack of friends to play has been
reported as a barrier to PA [61,62]. Tsai and Fung [63] examined
adolescents with severe or profound hearing loss and they also
reported that a lack of friends to engage in leisure time PA was
a barrier. Kang et al. [48] also reported that ‘‘a lack of a place
to exercise with peers’’ was in the top five (out of 45) obstacles to
PA. Stuart et al. [59] also found that parents of children with low
vision, and the children themselves, viewed a lack of peers to play
with as a major barrier [59].
French and Hainsworth [64] interviewed individuals repre-
senting various sport and PA organizations (e.g. national disability
sport organizations) as well as individuals with disabilities in the
UK. At the local government level a common approach to
providing PA and sport opportunities was to schedule a ‘‘taster
day or session’’ to introduce sport to people with disabilities.
Representatives of local governments sponsoring these activities
often commented that although the events were heavily
publicized, attendance was typically low which likely contributed
to the belief that demand was not high [62]. The above scenario
is illustrative of two different attributions for low attendance.
On one hand, sport administrators attribute a lack of attendance
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to an individual (i.e. medical model) reason of limited interest.
On the other hand, potential participants indicate that policy,
attitudinal and environmental barriers (e.g. lack of transportation)
indicative of a social model prevent them from attending.
A lack of opportunity has also been noted in the USA.
For instance, Gardner et al.’s [39] participants (17%) reported that
a lack of access to programs, equipment and fitness sites was
a significant barrier (i.e. in the top ten). Heller et al. [42]
examined barriers to PA for adults with CP and found that half the
caregivers did not believe an exercise program would help their
residents and about a third believed exercise would not help their
CP. Some caregivers (16.1%) also thought that exercise would
make their client’s CP worse. These paradoxical results suggest
that the knowledge and attitudes of significant health profes-
sionals who should be helping their clients becoming more active
and healthier, do not believe exercise is beneficial and may, in
fact, be harmful.
A recent report would also seem to partly substantiate the
Heller et al. [42] results. In a survey of physical medicine and
rehabilitation resident physicians, Staley and Worsowicz [65]
found that less than half had attended a class or lecture on
disability sport and PA and only a little over half had received
similar information from an attending doctor. Fortunately, 88%
indicated they were interested in learning more.
Finally, Levins, Redenbach and Dyck [66] interviewed eight
adults with SCI in order to understand PA influences. Most
participants suggested that their experiences in rehabilitation did
not prepare them for PA. For instance, they reported not having
access to information or resources (i.e. facilities) about PA.
A common theme emerging from one study [45] was a sense by
individuals with disabilities that their physical abilities were
underestimated, even by their physical therapists. Hence, a major
benefit noted earlier (i.e. enhanced confidence) may be under-
mined by the very health and rehabilitation professionals who
should be fostering it. The research described earlier indicating
some caregivers believe exercise is harmful combined with some
physical therapists having minimal physical ability expectations
of their clients is disconcerting. If the above scenarios are not
isolated incidents and are widespread, it would seem that the
training practices of some professional programs may be lacking.
Individuals with disabilities perceived that owners and
employees of fitness centers viewed accessibility as a necessary
evil [67] or as unimportant. Similarly, focus group members in
the fitness profession also cited fitness professional’s negative
attitudes, lack of work ethic and liability concerns as barriers.
These same focus group members also noted that fitness and
recreation facilities often lacked any policies related to disabil-
ities. For instance, because of the extra transportation, changing
and access time needed to be ready to swim, the open swim time
period was not long enough. In general, all focus group members
cited a lack of PA programming for individuals with disabilities.
Environment barriers
In some research presented earlier, children often noted that not
having a friend to play with and a lack of a place to play were
barriers. Such research illustrates how both social (i.e. a friend)
and environmental (i.e. an appropriate disability friendly place)
considerations are often perceived as necessary for PA. Many
children with disabilities have reported that there are limited
places to engage in PA [23]. Parents of blind children viewed a
lack of opportunity as one of the top three barriers to their
children’s PA [58]. Scholl et al. [57] reported that the limited PA
opportunities dwindled as children got older and were often
limited to competitive sport. Even when opportunities exist, they
can be illusionary. Wheelchair basketball leagues sometimes
prevent children who use motorized chairs from playing [23].
Tsai and Fung [63] reported that while PA facilities might
be available, they can be inconveniently located. Even when
opportunities for PA appear available (e.g. sidewalks) they often
are not. For instance, many built environment barriers exist such
as a lack of curb cuts at streets that prevent wheelchair users from
crossing the street. Other built environment barriers are less
obvious. For instance, in a United Kingdom study, although
swimming for individuals with disabilities was frequently offered
in many sport centers the water was often too cold to swim
in [64].
In addition to examining fitness club personal, Rimmer and
colleagues [67] examined how accessible health clubs were.
Thirty-five health clubs across the USA in urban and suburban
settings were evaluated for their accessibility. Most facilities were
likely (450%) to have helpful assistive devices such as grab bars
in the showers or automatic entrance doors. In contrast, most
facilities were not likely (550%) to have curb cuts for easy access
or unblocked paths to lockers Most facilities did not allow
adequate room for wheelchair to exercise equipment transfers but
they did have adequate access to the exercise area in general.
Many of the exercise facility shortcomings (e.g. no adaptive
exercise equipment) were costly. In summary, Rimmer et al.’s
[67,68] concluded that people with mobility disabilities and
visual impairments would ‘‘have difficulty accessing various
areas of fitness facilities and health clubs (p. 2022). Martin Ginis
and colleagues affirmed that sentiment by noting that 10 out of 15
SCI participants listed inaccessible facility/equipment as barriers
to PA [33].
Researchers have also found that individuals with disabilities
viewed a lack of access to PA facilities to be an impediment to
maintaining an active lifestyle [69]. Clearly the built environment
(and perceptions of the built environment) should be construed as
barriers to PA for persons with disabilities. Barriers found in
the built environment extend beyond barriers found in exercise
facilities.
Mall walking opportunities for PA are restricted for individuals
with disabilities. McClain [70] studied three large shopping malls
in the USA to determine their compliance with the Americans
with Disabilities Act (ADA) of 1990. She examined the parking
lots, elevators, ramps, restrooms, food courts, telephones, dressing
rooms, store aisles and store shelf heights. McClain [70] found
mixed results with compliance ranging from 0 to 100% depending
on the category. For example, although the malls had ramps for
wheelchairs, two of the three malls had too steep slopes. No food
court tables had adequate knee space for wheelchair users.
French and Hainsworth [64] noted that members of disabled
sport groups cited difficulties accessing and using toilet and
changing facilities in sport facilities, a lack of ramps, and a lack
of room to accommodate a wheelchair as common barriers.
In their study of SCI adults living in the UK, Tasiemski and
colleagues [71] reported that the second most significant barrier
to participating in sports was a lack of accessible facilities.
Even outdoor areas designed for PA can inadvertently present
barriers to individuals with disabilities. For example, poorly lit
walking paths or wooded walking trails with rocks or fallen
branches can be barriers to individuals with vision loss [72].
A lack of audible signals at traffic lights and curb cuts that do
not have high-color contrast markings that make them distinctly
visible are also barriers [68].
Other researchers have started to substantiate the shortcomings
noted by Rimmer [68]. For instance, Spivock, Gauvin and
Brodeur [73] surveyed 112 neighborhoods in Montreal, Canada to
determine if the environment made it easy or difficult for people
with disabilities to integrate PA into their lifestyles. They assessed
walking surfaces (e.g. paths wide enough for a wheelchair),
DOI: 10.3109/09638288.2013.802377 Benefits and barriers to physical activity 5
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signage (e.g. auditory signals on the crosswalks) and surroundings
(e.g. access ramps, parking for people with disabilities). Mean
scores were low in absolute terms (i.e. under the mid-point of
the scale). In relative terms, there were significantly lower than
reference items for the active living friendliness of neighborhoods
for non-disabled individuals.
In summary, barriers to PA span individual, social and
environmental categories. Often barriers functional additively
such that a lack of knowledge about how to exercise, limited
time to travel to an exercise club that is ‘‘disability friendly’’
and limited funds combine to prevent PA engagement. Other
barriers may interact such that a person with low muscle
strength views a steep ramp as a barrier whereas a person with a
strong upper body (or a lighter wheelchair) views a steep ramp
as a non-barrier.
Conclusions
In conclusion, the readers should take home a number of salient
points. First, people with disabilities are, in general, less healthier
compared to people without disabilities but having a disability
doesn’t automatically equate with being unhealthy. Second, PA
may be more valuable for quality of life and ADL for individuals
with disabilities relative to individuals without disabilities. Third,
PA engagement confers physiological, emotional, cognitive and
social benefits to individuals with disabilities. Fourth, a signifi-
cant number of barriers to PA engagement exist for people with
disabilities. Some barriers can easily be categorized as individual,
social and environmental barriers that support medical/individual
and social models of disability. However, many barriers
and situations defy easy classification making the labeling of
various barriers as simplistic and unrepresentative of the reality
faced by people with disabilities. For instance, stake holders
(i.e. participants and administrators) in youth sport can legitim-
ately disagree on the reasons (i.e. lack of interest vs. lack
of opportunity) for low attendance. Fifth, pain influences PA
engagement for many people with disabilities. However, the
experience of pain, historically viewed as a biological event, is
much more than that with ethnic, social and psychological
implications. Sixth, barriers can exist across the spectrum of
medical, social, and environmental categories, and cumulatively
limit PA. Other barriers can interact such that a barrier for one
person is irrelevant for another person. Finally, barriers in one
moment of time (e.g. pain) that might exist for a beginning
exerciser cease to become barriers once that person becomes
stronger as a function of PA involvement.
Researchers examining the PA experiences of people with
disabilities are encouraged to design studies that further
illuminate some of the complexities outlined in the current
article. Given the medical and technological advancements made
in the 20th century, a long history of discrimination and
marginalization of people with disabilities, and the political
goals of many disability scholars, it is understandable how both
the medical and social models have been used to explain the
negative aspects of living with a disability. Far fewer writers have
pointed out any positive elements to both models. For example,
people without disabilities have developed more positive percep-
tions of people with disabilities when they exercise [14]. In other
words, the social dynamics at the heart of the social model
of disability can also reduce stereotypical attitudes and not simply
contribute to them. Similarly, the medical and technology fields
have been responsible for advances in wheelchair technology that
have aided the everyday wheelchair user as well as elite level
athletes. Future researchers are encouraged to consider the social-
relational model in PA settings and the ways in which the
mechanisms underlying both models contribute to both ill-being
and well-being. As an example, Smith [74] described how men
engaged in PA for pragmatic reasons (e.g. increased strength
to wheel their chair) which helped them minimize impairment
effects, which in turn, reduced psychosocial ill-being that was a
function of both impairment and social oppression.
Declaration of interest
The authors report no conflicts of interest. The authors alone are
responsible for the content and writing of this article.
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