Why Does Inclusion Matter? Physical Activity and Disability

Ensuring that that our research considers and promotes equality, diversity and inclusion is central to the work we do at the School for Policy Studies. Working in partnership with communities and stake holders to identify research questions that matter and ensuring that studies are co-produced wherever possible helps achieve these aims. This series of blogs looks at some of the ways what we research and how we go about it incorporates EDI principles.


In this blog, Kate Bowen-Viner (Social Policy PhD student) explores how research in the Centre for Exercise, Nutrition and Health is helping to make physical activity guidelines more inclusive.

The way we talk about physical activity matters. Instructions that try to encourage people to be more active like “stand up more often” or “chairs are killers” may be well-intentioned, but they are ableist and can harm disabled adults and children.

In the Centre for Exercise, Nutrition and Health Sciences, researchers have been working to improve physical activity guidelines, including collaborating with disabled adults, young people and children to develop sets of activity guidelines that are applicable to disabled people.

In this blog, I set out the problem with physical activity guidelines that do not consider disabled people and explain how co-produced research in the Centre for Exercise, Nutrition and Health Sciences is helping to ensure that guidelines for physical activity are not ableist, but more inclusive.

What’s the problem?

Research indicates that disabled people are twice as likely to be inactive compared to non-disabled people. In 2017 Sport England reported that 43% of disabled people were inactive (doing less than 30 minutes physical activity a day) compared to 21% of non-disabled adults in England. Inactivity is a problem for disabled people’s health as evidence suggests that engaging in physical activity is related to positive health outcomes. It is therefore vital that activity guidelines are inclusive of, and applicable to, disabled people.

In 2011, the Department of Health published UK physical health guidelines, issued by the Chief Medical Officers. These were the first nationwide activity guidelines in the UK and they included guidance for adults and children of all ages. A set of related infographics were also produced to support health professionals to promote healthy living and to empower individuals to stay active. However, with little evidence on disability and activity at the time they were produced, the guidelines had limited applicability to disabled adults and children. The 2011 guidelines did not specifically consider disabled people and disabled people’s voices were not included in the public health messaging around physical activity.

To promote health equitably, it is crucial that the development and roll-out of national activity guidelines include disabled people’s voices and take account of their experiences. This is especially important given that harmful ableist language features in many everyday discussions about the importance of physical activity (e.g. “don’t sit for too long”) and needs to be challenged.

In collaboration with disabled people and other researchers, Charlie Foster OBE from the Centre for Exercise, Nutrition and Health’s has been working to address these issues. Embracing inclusive practices and being open to challenge has been of utmost importance for this work. As Professor Foster explained:

We need to consider inclusivity at every stage of the research process and be open to challenge. If you’re not considering equalities, diversity and inclusion, you’re going to overlook the people who would benefit most from the work. I don’t mean the government; I mean the users and participants.”

Below, I describe two projects conducted in collaboration with disabled adults and children and explain how co-production and attentiveness to inclusivity has helped, and is helping, to improve activity guidelines for disabled people.

Collaborating with disabled adults

Starting in 2018, Professor Charlie Foster led a review of the UK Chief Medical Officers’ 2011 physical activity guidelines, which included analysing existing evidence regarding the benefits of physical activity in disabled adults. This involved collating evidence on disabled adults and physical activity for health benefits and comparing evidence to the CMO’s 2011 physical activity guidelines. The review found little evidence to show ‘that physical activity is unsafe for disabled adults when it is performed at an appropriate dose for their current level of activity and health conditions’ and provided evidence, aligning with the CMO’s 2011 guidelines, that disabled adults should do 150 minutes of physical activity at a moderate to vigorous intensity for health benefits.

Importantly, the review also involved collaborations with disabled adults, disability groups and healthcare professionals to produce public health recommendations. It also led to researchers and disabled people working together to create a set of infographics which summarised key evidence-based messages regarding physical activity. The colour and layout of the infographics were designed considering the needs of learning-disabled people. This resulted in more accessible infographics that would not have been possible without disabled adults’ input.

The co-produced review and infographics informed the CMO’s adult physical activity guidelines which were published in 2019, meaning that disabled people’s voices and experiences informed national guidelines. This was the first-time disabled adults were explicitly considered in physical activity guidelines.

 

Collaborating with disabled children

Professor Charlie Foster OBE is now supporting an evidence review of physical activity guidelines for children, with a particular focus on disabled children. This review will help to fill a gap in the existing physical activity guidelines. With limited evidence regarding disabled children and activity at the time the 2011 and 2019 guidelines were published, disabled children were not considered specifically in the guidelines.  Similar to the review of the benefits of physical activity for disabled adults, this review will involve analysing the existing research base regarding disabled children and activity. Publication is expected in mid-November 2021.

The project now involves collaborating with disabled school pupils to develop public health messaging and infographics to summarise and promote key messages about activity and health for disabled children, led by Professor Brett Smith at the University of Durham With a focus on prioritising disabled children’s voices and learning from their experiences, this is the first physical activity project of its kind.

The process of collaborating with disabled children in this project highlights the benefits of inclusive approaches to research. Co-production will be integral for ensuring that disabled children’s voices inform national guidelines on physical activity. By drawing on their personal experience, the pupils who take part in this project will contribute to making physical activity guidelines relevant to disabled children.

Improving health outcomes equitably

To improve health outcomes equitably, disabled people must be considered and their voices must be included in the development of physical activity guidelines. Research in the Centre for Exercise, Nutrition and Health Sciences demonstrates the benefits of working with disabled adults and children to promote the health benefits disabled people can achieve by engaging in regular physical activity.

 

 

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