December 6 — 7, 2007 Advisory Committee Meeting Minutes

Special Populations

Dr. Haskell introduced the development of this chapter as the result of the need to address special situations that do not fit neatly within other chapters as well as the need to address individuals with disabilities as well as other population subgroups.

James Rimmer, Ph.D., led discussion on physical activity relative to people with disabilities. A central focus in this area is to identify if there is evidence that physical activity improves key health outcomes in people with physical, cognitive and sensory disabilities. Additionally, a key goal is to begin formulating research questions that will be pertinent to this area as research progresses.

While the group has identified 15 different categories of disabilities the focus of the presentation will deal with physical, cognitive and sensory disabilities with research examples from individuals with strokes, spinal cord injury and Multiple Sclerosis (M.S.).

Much of the work was devoted to refining the database search as the group only wanted to review data from individuals with a disability, excluding studies with specific therapeutic exercises. Many of the studies did not look at a specific health outcome; however, when looking at disabled populations one is really looking at two areas: can physical activity improve mental health and can it improve functional health. The data is not available to compare discrete changes in VO2 max at this point. Refining the research will be a continuing work in progress.

In the area of M.S. one may have difficulty developing recommendations as someone recently diagnosed with M.S. will have different symptoms then someone who has lived with M.S. for a long period of time.

There has not been much work done in the area of musculoskeletal health relative to disabilities. Most studies that were available did show benefits in bone health in all groups (individuals with strokes, spinal cord injury and M.S.).

For functional health the outcomes the group were able to identify included balance, functional independence, quality of life and pain. Outside of balance, the other three categories are mostly self-report measures, but again, most of the evidence seems to be positive in nature.

In mental health, the outcomes that were identified include depression, interpersonal relationships, mood, emotional well being and fatigue. Once again, there were a very limited number of studies but of those available, in general, showed significant improvements in these areas.

Dr. Yancey continued the subcommittee presentation with respect to ethnic and socio-economic (SES) subgroups. As a subset of the Energy Balance Subcommittee, we looked specifically at race, ethnicity and to some extent SES influences and their relationship to physical activity and weight status.

Why could there be differences in recommendations in this area along ethnic and SES lines? One possibility is differences in the energy cost of physical activity, such that some ethnic groups appeared to derive lesser benefits for weight maintenance at the same level of physical activity. Additionally, different physiology along ethnic lines can also account for the need for different approaches. Overall though there is insufficient data to conclude that physical activity recommendations should be different for race, ethnic or SES groups. There is however significant confounding which may lead the group to re-analyze the data only on SES criteria. This however leads to other issues as low-income whites are very much under-represented in most studies and many studies simply do not report SES.