A Preliminary Study of Nutrition and Physical Activity Habits of Women with Physical Disabilities

This article examines the behavioral habits of women with physical disabilities six months after a didactic and experiential three-hour training session regarding healthy nutrition and physical activity. It includes these women’s perceptions of supportive factors and barriers to healthy nutrition and physical activity. All of the women made behavioral changes as a result of the training. They face more barriers than support in continuing with these changes. Access to healthy nutrition and physical activity continues to be problematic. Doorways, aisles, and sidewalks were problems noted as barriers. © 2006 Californian Journal of Health Promotion. All rights reserved.


Introduction
Approximately one in five women in the United States lives with a disability (National Center on Birth Defects and Developmental Disabilities, 2004).According to the National Institute on Disability and Rehabilitation Research, 28.6 million females have disabilities, or 21.3% of the female population in the United States (Jans & Stoddard, 1999).According to the United States Department of Health and Human Services, people with disabilities are less likely than those without disabilities to report moderate physical activity (Health Promotion, 2000).
People with disabilities report higher incidences of being overweight (Center for Disease Control and Prevention, n.d.).Forty percent of people with disabilities age 20 years and older reported being overweight compared with 35% of the general populations.
Also, people with disabilities showed a decline in the amount of physical activity engaged in from 35% in 1985to 29% in 1995(U. S. Department of Health and Human Services, 2000).
Women with physical disabilities encounter numerous challenges to maintaining overall physical health.They develop health problems in conjunction with their disability.Research regarding this problem is limited (Taylor, Baranowski, & Young, 1998).
Women with physical disabilities encounter numerous challenges to maintaining their overall physical health.One of the biggest challenges is the stress that results from living in a society that imposes many limitations on them.Environmental barriers often restrict them from socializing and participating in community functions.Nosek et al. (2004) observed that women with physical disabilities feel limited in the places they can go and the people with whom they socialize.They must think about whether they can negotiate the environment based on adequate accommodations (Nosek et al., 2004).Blinde and McCallister (1999) found that women participate in physical fitness programs because it helps them enhance their view of their capabilities.Physical activity helped them to view their bodies as a source of strength, rather than a weakness.They also benefited from the socialization during the activity.
In a study conducted with women with physical disabilities, most women met the Body Mass Index criterion for obesity (Jones & Bell, 2004).Obesity contributes to a variety of health problems.The problems include elevated cholesterol, high blood pressure, cardiovascular problems, and diabetes (Center for Disease Control and Prevention, n.d.;Krummel, Koffman, Bronner, Davis, Greenland, Tessaro, 2001;Stampfer, Hu, Manson, Rimm, & Willett, 2000).
The purpose of this study was two fold.First, it was to evaluate the behavioral outcomes of nutrition and physical activity training six months following the training.Second, it was meant to identify the positive and negative factors associated with maintaining healthy nutrition and physical activity in the community for women with physical disabilities.

Method
During the month of July, six women attended a three hour training session aimed at improving their overall health through improved healthy eating and physical activity.This was both didactic and experiential.During the first hour didactic information was presented regarding the food guide pyramid, portion sizes, and nutrient content of foods.This included providing the participants with the information verbally by nutritionist, accompanied by an educational film.A variety of visual displays were used during this time which included the effects of obesity on the body, the food guide pyramid, sugar content display, salt content display, and a portion size display.These items were passed to the participants for their appraisal so they could be as engaged as possible in the assimilation of the didactic information.
Following this didactic information presentation, two experiential opportunities were offered to the group.First, the nutritionist provided a cooking demonstration which reinforced the didactic presentation.This was done by explaining the contents of the food, food's effect on the body, and portion sizes.The result of the cooking demonstration was a healthy meal.Second, the participants and trainers ate a family style meal together which provided an opportunity for the participants to ask questions in a casual setting.
During the third hour, information regarding physical activity was provided by an individual with a degree in kinesiology, including the benefits of physical activity and accommodations needed for exercise.This was followed with participating in an activity that could be performed at home, typically from a sitting position.All the participants left with a cookbook and exercise pamphlet.
During the month of January, all of the participants were called in order to assess whether the training had changed their nutrition and physical activity related behavior.During this telephone interview, the participant was also asked about the positive and negative factors they encounter in the community that were related to nutrition and physical activity.Each telephone conversation lasted a minimum of 45 minutes.

Participants
The six women who participated in the study ranged in age from 29 to 59 years, with an average age of 46.Two of the participants identified themselves as Hispanic, two as Caucasian, and two as other.Two participants identified themselves as graduated from high school, two had some college experience, and two graduated from college.Their physical disabilities included degenerative muscular disease, multiple sclerosis, diabetes, arthritis, and peripheral neuropath.

Findings
These responses from the participants are organized under two major topics, nutrition and physical activity.Each topic contains major themes that emerged from the interviews, which include any behavior changes made that resulted from the training, supportive factors to continuing this behavior change, and barriers to continuing this behavior change.This discussion includes comments from the women regarding these topics.

Nutrition
Behavioral Change.Table 1 contains the study findings related to nutrition.All six women indicated they benefited from the training regarding healthy eating.All of the women stated they had made behavioral changes as the result of the training.All of the women stated they had been eating more fruits and vegetables during the six months since they attended the training.Two participants, or 33%, believed the training helped them to eat leaner meats, such as baked chicken instead of beef.Two women, or 33%, also indicated they had stopped drinking regular sodas due to the sugar content they learned about.Comments made include the following: "I have lost 20 pounds since the training just by limiting the amount of sugar I eat" and "I have really cut down on sugar and carbohydrates which has helped my diabetes."  2 contains the findings regarding this section.All the women believed they benefited from the training relative to physical activity.All of the participants indicated they had increased their physical activity as a result of the training.Their activities included swimming and stretching.They all stated they had the booklet regarding upper body exercises and were using the arm exercises.Sixty seven percent, or four out of six, stated they had begun exercising on a daily basis.Barriers.Table 2 summarizes the findings relative to barriers to physical activity.Fifty percent (n=3), of the participants stated that there were no exercise gyms that could accommodate them.Sixty seven percent (n=4), women stated that the sidewalks they use with their wheelchair or scooter are not in good repair and could cause them to fall onto the sidewalk.
One participant who did belong to a gym does not exercise there very often because "no one can help me use the different machines so I don't go as often as I can." "I also feel isolated and I think it would be better if I had more contact with people."Another participant stated that "there are no places for people who are amputees to go and exercise, so I have to depend on physical therapy now."Four participants, or 67%, stated "the sidewalks are too bumpy for my scooter to get over."Four, or 67%, explained that "some roads have no sidewalks." A structured interview guide was used to interview each participant on the telephone.The following open ended questions were asked:

Table 1
Participant Results Related to Nutrition (Behavior Change, Supportive Factors, and Barriers) (N=6)

Table 2
Participant Results Related to Physical Activity (Behavior Change, Supportive Factors, and Barriers) (N=6)