In 2020, the World Health Organization (WHO) released their Guidelines on Physical Activity and Sedentary Behaviour for people living with disabilities.
The new WHO guidelines recommend that:
- Adults living with disabilities should do at least 150 to 300 minutes of moderate-intensity aerobic physical activity, or at least 75 to 150 minutes of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate and vigorous-intensity activity throughout the week for substantial health benefits.1
- Adults living with disabilities should limit the amount of time spent being sedentary. Replacing sedentary time with physical activity of any intensity produces health benefits.1
We know physical activity is important for health and wellbeing, especially for persons with disabilities.2 Accordingly, it is important to have inclusive physical activity guidelines for people living with disabilities—but are the WHO's guidelines themselves inclusive? Drs. Martin Ginis, Latimer-Cheung, and West explored this question in their commentary on the WHO guidelines, discussing why the guidelines may not be inclusive or appropriate for persons with disabilities. Continue reading to better understand this perspective.
Why Might the WHO Guidelines not be Appropriate for People Living with Disabilities?
The scientific evidence base for the WHO physical activity guidelines for persons with disabilities consists largely of studies that do not include people living with disabilities.1 This is considered indirect evidence and is not optimal for informing population-specific guidelines. The WHO used indirect evidence from these studies to create its guidelines, applying guidelines for able-bodied people to people living with disabilities.3 This approach is akin to baking a chocolate cake by only using the ingredients for baking bread.
Application of this indirect evidence may be problematic given emerging research that shows persons living with certain types of disabilities (e.g., neurological disorders, severely shortened limbs) may exhibit different physiological responses to exercise. Because physiological responses to physical activity are not consistent among persons with disabilities, it’s questionable whether accepting indirect evidence and applying guidelines for able-bodied people to people living with disabilities is appropriate.
Additionally, if the physiological response to physical activity is different for people living with disabilities, then the amount of physical activity needed to achieve health benefits may also be different.3 At this point in time, it is unknown whether the WHO guidelines produce the same health outcomes in people with and without physical impairments.
What’s at Risk?
For some persons living with a disability, the risks of following the WHO guidelines could outweigh the benefits. For example, virtually all the guideline evidence is based on lower limb activities such as walking.1 No studies have tested the long-term effects of 150 to 300 minutes per week of upper body physical activity (e.g., pushing a wheelchair), or walking with a prosthesis or gait aid.3 In fact, physicians and healthcare clinicians often caution persons with lower limb impairments against this volume of physical activity because of the associated health risks (e.g., overuse injuries, skin breakdown).3
There is also overwhelming evidence that people living with disabilities can achieve significant health benefits from engaging in much less than 150 minutes of aerobic activity per week.4,5 Given this evidence, the risks associated with meeting the WHO’s guidelines for people with disabilities are difficult to justify.
Future Work
People living with disabilities deserve physical activity and sedentary behaviour guidelines developed with and for them, which address the diversity of their experiences. This means using research that includes only persons with disabilities to alleviate the risks and unintended consequences of applying evidence from able-bodied individuals to persons living with disabilities.3 Taking this approach could potentially enhance uptake, as people living with disabilities may feel the guidelines are more realistic and achievable.3
What Guidelines are Appropriate for People Living with Disabilities?
The WHO’s physical activity guidelines may be relevant for certain people living with disabilities, but not all. So, what should physicians, other health care clinicians, and persons with disabilities use as a guide for physical activity?
Individuals should consider consulting the Get Active Questionnaire and its accompanying Reference Document and potentially using the Physical Activity Guidelines for Adults with Spinal Cord Injury and the Canadian Physical Activity Guidelines for Adults with Multiple Sclerosis as a guide.
The Spinal Cord Injury Guidelines have two levels: a starting level and an advanced level.6 Which level an individual chooses to work toward depends on their goals, ability, and fitness level. If an individual is just starting to engage in physical activity, the guidelines suggest working up to the starting level and then, ideally, working up to the advanced level.6 If an individual is already physically active, the guidelines suggest beginning with the advanced level.6
[Image Description: Starting Level: 20 minutes, 2 times per week, of aerobic moderate to vigorous-intensity activity and strength-training activity of 3 sets, 10 repetitions, 2 times per week for each major muscle group. Advanced Level: 30 minutes, 3 times per week, of aerobic moderate to vigorous-intensity activity and strength-training activity of 3 sets, 10 repetitions, 2 times per week for each major muscle group.]
The Spinal Cord Injury Guidelines' statement, ‘Start, Meet, Exceed,’ may be a useful concept for people living with disabilities in general. Individuals could apply this concept to the physical activity guidelines they feel are most appropriate for them to follow. ‘Start, Meet, Exceed’ also reinforces the idea that engaging in any amount of physical activity/movement will result in health benefits for people living with disabilities. Every move counts!
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Authors: Stephanie Flood and Hannah Strasdin on behalf of the Canadian Disability Participation Project (CDPP).
Stephanie Flood is the Knowledge Translation Coordinator for the CDPP Sport and Exercise Team and has a MSc in Health Promotion.
Hannah Strasdin is a summer intern with the CDPP and is entering her fourth year as an undergraduate Psychology student at Queen’s University.
About the Canadian Disability Partnership Program: The CDPP is a SSHRC-funded alliance of university, public, private and government sector partners working together to enhance community participation among Canadians with disabilities. The CDPP’s Sport and Exercise Team works to develop, test, and implement evidence-based best practices to increase the number of people with disabilities who participate in sport and exercise, and to improve the quality of their participation experiences. You can follow the CDPP on twitter or visit their website to learn more about their research and resources.