June 28 - 29, 2007 Advisory Committee Meeting
Additional Discussion on Disabilities
Dr. Haskell requested Dr. Rimmer lead additional follow-up discussion
regarding disability issues.
When trying to understand how physical activity impacts health for
individuals with disabilities we typically try to tease outcomes from chronic
conditions versus secondary conditions. Much of the funding is directed towards
methods for reducing secondary conditions in people with disabilities (health
conditions that occur as a result of having a disability).
Real caution needs to be exercised when attempting to make recommendations
for this population. There are no large cohort studies in this group similar to
women's health for example. Thought should be given towards building that body
of data. However, there is enough literature (from rehabilitation literature,
exercise studies) to justify that exercise is beneficial to persons with
A challenge in this area of study is defining disability. There are at least
40 different definitions of disability used by other organizations. One possible
way to address this is to look at the new international classification of
function and disability and health, which looks at disability on a continuum and
relating to a person's ability to do various types of activity.
Another challenge will be interpreting adverse event data in this group as
many studies do not take into account who drops out of a study (versus people
who actually do the physical activity). However, in all of the studies that I
was able to review for the IOM meeting in October as well as a meeting that
occurred the year before that at the IOM for a book called "Disability in
America," no negative studies were found that show exercise being dangerous or
harmful to people with neurological or muscular-skeletal conditions.
There is a rich body of non-randomized control trials that show positive
effects of exercise on reducing secondary conditions, although, less evidence on
the effects of exercise in reducing chronic diseases.
A more global goal to possibly keep in mind, while not within the specific
charge of the Committee, is the removal of perceived barriers many people with
disabilities experience because of their limitations, whether cognitive,
physical or sensory.
During open discussion Dr. Haskell reminded the Committee their charge was to
interpret the science and not actually make recommendations. However,
recognizing the importance of this area, it is hoped the Committee's report will
enable HHS to make comments about physical activity for people with disabilities
and the prevention of secondary conditions as well as chronic conditions.
Dr. Haskell also commented on that while there are an enormous number of
issues in this area, the Committee cannot possibly address everything. As such,
it will important to address the big issues well.
During further discussion the issue of publication bias arose as the studies
did not report a negative effect. It was commented during the Dietary Guidelines
process the Dietary Guidelines Committee was not in a position to deal directly
with bias. The final report should include a caveat commenting on issues such as
strength of evidence, study design (whether an individual performed the physical
activity or just didn't do it) and publication bias.