Showing papers on "Physical disability published in 2010"

Handbook of disease burdens and quality of life measures

Abstract: Many diseases and injuries result in the need for either temporary or permanent wheelchair use and research now confirms that multiple dimensions of life are affected when significant disability occurs. These dimensions typically include increases in health concerns and health care burden; loss of >functional independence; reduced participation in social, occupational and recreational opportunities; and subsequent association with psychosocial sequelae. This chapter summarizes current literature on Quality of Life (QoL) in wheelchair-users. The review highlights that a wide range of generic QoL, health-related QoL and disability-specific QoL instruments are used across studies with largely inconsistent findings. There is now a growing movement towards the development of valid and reliable measures for use with people with a range of disabilities. Given the observed challenges of measuring the broad QoL construct in populations of wheelchair-users, more specific aspects of QoL such as levels of stress are now being investigated. It is proposed that these more specific QoL domains may be more accessible to measurement and to therapeutic interventions aiming to improve adjustment to disability. The development of the >Physical Disability Stress Scale (PDSS) is described with recommendations for future clinical and research application. A copy of the PDSS and its scoring instructions are appended.

Loss of muscle strength, mass (sarcopenia), and quality (specific force) and its relationship with functional limitation and physical disability: the Concord Health and Ageing in Men Project.

Abstract: OBJECTIVES: To determine the association between loss of muscle strength, mass, and quality and functional limitation and physical disability in older men. DESIGN: Cross-sectional study of older men participating in the Concord Health and Ageing in Men Project (CHAMP). SETTING: Elderly men living in a defined geographical region in Sydney, Australia. PARTICIPANTS: One thousand seven hundred five community-dwelling men aged 70 and older who participated in the baseline assessments of CHAMP. MEASUREMENTS: Upper and lower extremity strength were measured using dynamometers for grip and quadriceps strength. Appendicular skeletal lean mass was assessed using dual X-ray absorptiometry. Muscle quality was defined as the ratio of strength to mass in upper and lower extremities. For each parameter, subjects in the lowest 20% of the distribution were defined as below normal. Functional limitation was assessed according to self-report and objective lower extremity performance measures. Physical disability was measured according to self-report questionnaire. RESULTS: After adjusting for important confounders, the prevalence ratio (PR) for poor quadriceps strength and self-reported functional limitation was 1.91 (95% confidence interval (CI) 51.10-2.40); for performance-based functional limitation the PR was 1.81 (95% CI = 1.45-2.24). The adjusted PR for poor grip strength and physical disability in instrumental activities of daily living (IADLs) was 1.37 (95% CI = 1.20-1.56). The adjusted PR for low skeletal lean mass (adjusted for fat mass) and physical disability in basic activities of daily living was 2.08 (95% CI = 1.37-3.15). For muscle quality, the PR for lower extremity specific force and functional limitation and physical disability was stronger than upper extremity specific force. CONCLUSION: Muscle strength is the single best measure of age-related muscle change and is associated with physical disability in IADLs and functional limitation. J Am Geriatr Soc 58:2055-2062, 2010.

Moving against frailty: does physical activity matter?

Abstract: Frailty is a common condition in older persons and has been described as a geriatric syndrome resulting from age-related cumulative declines across multiple physiologic systems, with impaired homeostatic reserve and a reduced capacity of the organism to resist stress. Therefore, frailty is considered as a state of high vulnerability for adverse health outcomes, such as disability, falls, hospitalization, institutionalization, and mortality. Regular physical activity has been shown to protect against diverse components of the frailty syndrome in men and women of all ages and frailty is not a contra-indication to physical activity, rather it may be one of the most important reasons to prescribe physical exercise. It has been recognized that physical activity can have an impact on different components of the frailty syndrome. This review will address the role of physical activity on the most relevant components of frailty syndrome, with specific reference to: (i) sarcopenia, as a condition which frequently overlaps with frailty; (ii) functional impairment, considering the role of physical inactivity as one of the strongest predictors of physical disability in elders; (iii) cognitive performance, including evidence on how exercise and physical activity decrease the risk of early cognitive decline and poor cognition in late life; and (iv) depression by reviewing the effect of exercise on improving mood and increasing positive well-being.

Online we are all able bodied: Online psychological sense of community and social support found through membership of disability‐specific websites promotes well‐being for people living with a physical disability

Abstract: People with a physical disability are a population who for a number of reasons may be vulnerable to social isolation. Research into Internet-based support sites has found that social support and an online sense of community can be developed through computer mediated communication channels. This study aims to gain an understanding of the benefits that membership of disability-specific online communities may have for people with a physical disability. An online survey was administered to a sample of users of such sites (N = 160). Results indicated that users did receive moral support and personal advice through participating in such online communities. Further, results indicated that online social support and feeling a sense of community online were positively associated with participants' well-being in the areas of personal relations and personal growth. Copyright © 2010 John Wiley & Sons, Ltd.

Promoting Functional Health in Midlife and Old Age: Long-Term Protective Effects of Control Beliefs, Social Support, and Physical Exercise

Abstract: BACKGROUND: Previous studies have examined physical risk factors in relation to functional health, but less work has focused on the protective role of psychological and social factors. We examined the individual and joint protective contribution of control beliefs, social support and physical exercise to changes in functional health, beyond the influence of health status and physical risk factors in middle-aged and older adults. Given that functional health typically declines throughout adulthood, it is important to identify modifiable factors that can be implemented to maintain functioning, improve quality of life, and reduce disability. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a national longitudinal study, Midlife in the United States (MIDUS), with assessments in 1995-1996 and 2004-2006, and 3,626 community-residing adults, aged 32 to 84, were included in the analyses. Functional health (Physical Functioning subscale of the SF-36) and protective factors were measured at both occasions. While controlling for socio-demographic, health status, and physical risk factors (large waist circumference, smoking, and alcohol or drug problems), a composite of the three protective variables (control beliefs, social support, and physical exercise) at Time 1 was significantly related to functional health change. The more of these factors at Time 1, the better the health maintenance over 10 years. Among middle-aged and older adults, declines in health were significantly reduced with an increased number of protective factors. CONCLUSION/SIGNIFICANCE: Age-related declines in health were reduced among those with more protective factors up to a decade earlier in life. Modifiable psychological, social, and physical protective factors, individually and in the aggregate, are associated with maintenance of functional health, beyond the damaging effects of physical risk factors. The results are encouraging for the prospect of developing interventions to promote functional health and for reducing public health expenditures for physical disability in later life.

Impact of comorbidity on physical function in patients with rheumatoid arthritis

Abstract: Background Physical disability is a main outcome in rheumatoid arthritis (RA) which tends to increase with comorbidities. However, the extent to which comorbidities contribute to the multifactorial process of disability has not been investigated. Objective To quantify the contribution of comorbidity to physical disability in patients with RA. Methods In a prospective cohort study, age-adjusted Charlson comorbidity index (CCI A ), serial measurements of disease activity and functional disability (evaluated by the Health Assessment Questionnaire Disability Index, HAQ) of 380 patients with established RA seen at an outpatient clinic over 1 year (June 2007 to July 2008) were ascertained. The association between comorbidity and physical disability was assessed using analysis of variance (ANOVA) and adjusted general linear regression models. Results Four patient groups with increasing levels of comorbidity (CCI A 0, 1–2, 3–4 and 5–9; potential range 0–38) were defined. Mean HAQ scores were significantly different across these groups (0.67, 0.80, 1.24, 1.40, respectively; p A on disability were similar within different strata of disease activity: namely, remission (0.26, 0.31, 0.48 and 0.88, p Conclusion Physical disability becomes worse with increasing levels of comorbidity, irrespective of disease activity.

Obesity, Intentional Weight Loss, and Physical Disability in Older Adults

Abstract: We examine obesity, intentional weight loss and physical disability in older adults. Based on prospective epidemiological studies, body mass index exhibits a curvilinear relationship with physical disability; there appears to be some protective effect associated with older adults being overweight. Whereas the greatest risk for physical disability occurs in older adults who are ≥class II obesity, the effects of obesity on physical disability appears to be moderated by both sex and race. Obesity at age 30 years constitutes a greater risk for disability later in life than when obesity develops at age 50 years or later; however, physical activity may buffer the adverse effects obesity has on late life physical disability. Data from a limited number of randomized clinical trials reinforce the important role that physical activity plays in weight loss programmes for older adults. Furthermore, short-term studies have found that resistance training may be particularly beneficial in these programmes as this mode of exercise attenuates the loss of fat-free mass during caloric restriction. Multi-year randomized clinical trials are needed to examine whether weight loss can alter the course of physical disablement in aging and to determine the long-term feasibility and effects of combining resistance exercise with weight loss in older adults.

Uncovering Health Care Inequalities among Adults with Intellectual and Developmental Disabilities

Abstract: Even as attention is drawn to the increasing number of individuals who experience health inequalities in the United States, little is known about the health inequalities experienced by individuals with intellectual and developmental disabilities. Current disability research mainly focuses on physical disabilities. This article discusses the health disparities experienced by individuals with intellectual and developmental disabilities.The authors conducted focus groups with parents/guardians, self-advocates, and community support professionals and key informant interviews with health care professionals to assess the needs of this less frequently documented population. Results from this study indicate that individuals with intellectual and developmental disabilities face health care disparities and inequities in four areas: access, knowledge, communication, and quality.

Prevalence and correlates of physical disability and functional limitation among community dwelling older people in rural Malaysia, a middle income country

Abstract: The prevalence and correlates of physical disability and functional limitation among older people have been studied in many developed countries but not in a middle income country such as Malaysia. The present study investigated the epidemiology of physical disability and functional limitation among older people in Malaysia and compares findings to other countries. A population-based cross sectional study was conducted in Alor Gajah, Malacca. Seven hundred and sixty five older people aged 60 years and above underwent tests of functional limitation (Tinetti Performance Oriented Mobility Assessment Tool). Data were also collected for self reported activities of daily living (ADL) using the Barthel Index (ten items). To compare prevalence with other studies, ADL disability was also defined using six basic ADL's (eating, bathing, dressing, transferring, toileting and walking) and five basic ADL's (eating, bathing, dressing, transferring and toileting). Ten, six and five basic ADL disability was reported by 24.7% (95% CI 21.6-27.9), 14.4% (95% CI 11.9-17.2) and 10.6% (95% CI 8.5-13.1), respectively. Functional limitation was found in 19.5% (95% CI 16.8-22.5) of participants. Variables independently associated with 10 item ADL disability physical disability, were advanced age (≥ 75 years: prevalence ratio (PR) 7.9; 95% CI 4.8-12.9), presence of diabetes (PR 1.8; 95% CI 1.4-2.3), stroke (PR 1.5; 95% CI 1.1-2.2), depressive symptomology (PR 1.3; 95% CI 1.1-1.8) and visual impairment (blind: PR 2.0; 95% CI 1.1-3.6). Advancing age (≥ 75 years: PR 3.0; 95% CI 1.7-5.2) being female (PR 2.7; 95% CI 1.2-6.1), presence of arthritis (PR 1.6; 95% CI 1.2-2.1) and depressive symptomology (PR 2.0; 95% CI 1.5-2.7) were significantly associated with functional limitation. The prevalence of physical disability and functional limitation among older Malaysians appears to be much higher than in developed countries but is comparable to developing countries. Associations with socio-demographic and other health related variables were consistent with other studies.

Type 2 Diabetes and Risk for Functional Decline and Disability in Older Persons

Abstract: As older adults make up an increasingly lager proportion of the diabetic population, the spectrum of chronic diabetes complications will change and expand. Aside from the traditional long-term complications, diabetes has been associated with excess risk of a number of clinical conditions typical of the geriatric population, including functional decline, physical disability, falls, fractures, cognitive impairment and depression. These conditions are common and profoundly affect the quality of life of older patients with diabetes. The identification of effective ways of preventing and treating these emerging complications, thus improving quality of life among older diabetic patients, is already a major issue in geriatric medicine. In this narrative review, we describe current epidemiological and clinical evidence supporting the association between diabetes and physical disability in older persons. Furthermore, the potential biological mechanisms underlying such an association are analyzed.

Are adolescent girls with a physical disability at increased risk for sexual violence

Abstract: BACKGROUND: The purpose of this study was to investigate whether US female adolescents who self-reported having a physical disability or long-term health problem were more likely to report having been physically forced to have sexual intercourse than US female adolescents without a physical disability or long-term health problem. METHODS: Using data from the 2005 U.S. National Youth Risk Behavior Survey (YRBS), we employed logistic regression analyses to estimate the association between physical disability (and other variables) and the risk for sexual violence among US high school girls. RESULTS: Female high school students who reported a physical disability or long-term health problem were more likely to report having been physically forced to have sexual intercourse than those who did not (19.6% vs 9.4%;chi(2) = 14.51, p = .003). Results from our multivariate analysis reveal that this association remained significant (adjusted odds ratio [AOR], 1.57; 95% confidence interval [CI], 1.10-2.23) after adjusting for certain demographic characteristics, physical health problems, behavioral health risks, and violent conduct. CONCLUSIONS: Our findings suggest that adolescent girls in the United States with a physical disability or long-term health problem may be at increased risk for sexual violence. It is important that national efforts to reduce sexual violence consider how to address the unmet needs of children and adolescents with disabilities. As most adolescent girls spend the majority of their time in a school setting, it is of particular importance that school health professionals are aware of the current findings. Language: en

Risk factors for physical disability at diagnosis of 19,283 new cases of leprosy

Abstract: INTRODUCTION: The purpose of this study was to evaluate risk factors for physical disability at the moment of leprosy diagnosis. METHODS: This is a retrospective, descriptive and exploratory investigation of 19,283 patients with leprosy, registered in the State of Minas Gerais, Brazil, between 2000 and 2005. RESULTS: The risk of Grade 2 disability was 16.5-fold higher in patients with lepromatous leprosy, and 12.8-fold higher in patients presenting the borderline form, compared to patients presenting indeterminate leprosy. The occurrence of more than one thickened nerve increased the odds of a patient developing Grade 2 disability, 8.4-fold. Age <15 years, multibacillary leprosy and no formal education presented 7.0, 5.7 and 5.6 odds of developing physical disability, respectively. CONCLUSIONS: These factors should be considered as strong prognostic indicators in the development of physical disability at diagnosis.

Sarcopenia, Cardiopulmonary Fitness, and Physical Disability in Community-Dwelling Elderly People

Abstract: Background Sarcopenia refers to the loss of skeletal muscle mass with aging. It is believed to be associated with functional impairment and physical disability. Objective The purposes of this study were: (1) to compare the physical activity, muscle strength (force-generating capacity), cardiopulmonary fitness, and physical disability in community-dwelling elderly people with sarcopenia, borderline sarcopenia, and normal skeletal muscle mass in Taiwan and (2) to test the hypothesis that sarcopenia is associated with physical disability and examine whether the association is mediated by decreased muscle strength or cardiopulmonary fitness. Design This was a cross-sectional investigation. Methods Two hundred seventy-five community-dwelling elderly people (148 men, 127 women) aged ≥65 years participated in the study. The participants were recruited from communities in the district of Zhongzheng, Taipei. Predicted skeletal muscle mass was estimated using a bioelectrical impedance analysis equation. The skeletal muscle mass index (SMI) was calculated by dividing skeletal muscle mass by height squared. Physical disability was assessed using the Groningen Activity Restriction Scale. Physical activity was assessed using a 7-day recall physical activity questionnaire. Cardiopulmonary fitness was assessed using a 3-minute step test, and grip strength was measured to represent muscle strength. Results Cardiopulmonary fitness was significantly lower in elderly people with sarcopenia than in those with normal SMIs. Grip strength and daily energy expenditure (kcal/kg/day) were not significantly different between the participants with sarcopenia and those with normal SMIs. The odds ratio for physical disability between the participants with sarcopenia and those with normal SMIs was 3.03 (95% confidence interval=1.21–7.61). The odds ratio decreased and the significant difference diminished after controlling for cardiopulmonary fitness. Limitations A causal relationship between sarcopenia and physical activity, cardiopulmonary fitness, and physical disability cannot be established because of the cross-sectional nature of study design. Conclusions Sarcopenia was associated with physical disability in elderly men. The association between sarcopenia and physical disability was mediated to a large extent by decreased cardiopulmonary fitness.

Disability and health-related quality of life after breast cancer surgery: relation to impairments.

Abstract: Background The aim of this study was to determine the prevalence of impairments relevant to upper extremity following breast cancer surgery and its impact on disability and health-related quality of life. Methods Sixty-seven female patients being treated with modified radical mastectomy or breast conserving surgery were included. They were evaluated for impairments (arm edema, loss of handgrip strength, limited shoulder joint range of motion, and pain), physical disability using the disabilities of the arm, shoulder, and hand (DASH) questionnaire, and for health related quality of life by means of the functional assessment of cancer therapy-breast+4 (FACT-B+4). Results The most common impairment observed was arm pain on motion; the cause of 20% variance in disability score (r = 0.203, P = 0.000). Arm pain on motion, anterior chest wall pain, loss of grip strength, and shoulder flexion were significant factors in different domains of quality of life according to the FACT-B+4 questionnaire. Conclusion Pain relief should be the priority of treatment along with the prevention of joint movement restriction to ensure a sufficient quality of life for surgically treated breast cancer patients.

Sleep-Related Factors and Mobility in Older Men and Women

Abstract: SHORT and long sleep duration, sleep-related disturbances, and their daytime consequences are common in older adults, and they are associated with decreased health and increased mortality (1–4). Because aging is associated with decline in physical performance often leading to physical disability and loss of independence, concomitant sleep problems may exacerbate the age-related decline in physical function. Previous studies suggest that self-reported and measured insomnia and sleep-related problems are associated with decline in psychomotor performance (5) as well as with poor balance and increased risk of falls (6–8). In addition, Goldman and coworkers (2007) (9) reported that short (<6 hours) and long (≥7.5 hours) sleep, increased sleep fragmentation, and longer daytime sleep are all associated with decreased physical performance and increased functional limitations in older women. However, the cutpoints used in this study differ from widely used classification: short sleep (≤6 hours) and long sleep (≥9 hours) (2–4). Besides insomnia-related symptoms, daytime consequences of inadequate sleep are frequent among older adults and may have negative effect on physical function. One component of fatigue, tiredness, is associated with walking limitation and development of activities of daily living (ADL) disability in older adults (10–12). Despite the previously described studies concerning sleep-related factors and physical function, several important questions still remain open, such as what is the association of sleep-related factors and mobility. Furthermore, it is not known whether the association between sleep-related factors and measured and self-reported mobility varies across sex or age groups. Examining these questions may help us to recognize persons with an increased risk for mobility limitation. Thus, the aim of this representative population-based study was to examine whether self-reported sleep duration, insomnia-related symptoms, and fatigue are associated with walking speed and self-reported mobility limitation in men and women aged 55–64 and 65 or more years.

Physical Disability and Depression: Clarifying Racial/Ethnic Contrasts:

Abstract: Objective: This study assesses racial/ethnic disparities in depressive symptoms among persons who are physically disabled and evaluates the extent to which variation in stress exposure, coping resources, and feelings of shame associated with disability account for observed differences. Method: Data are drawn from a Miami-Dade County study that oversampled persons with physical disabilities. The sample used in this study includes individuals of Cuban and other Hispanic heritage, African Americans, and non-Hispanic Whites who identify as physically disabled (N = 550). Results: Cubans and other Hispanics report higher levels of depressive symptoms. This elevation in risk is largely explained by variations in stress exposure, available coping resources, and shame. Findings also suggest that feelings of shame may condition the relationships between both stress exposure and coping resources and depressive symptomatology. Discussion: Findings demonstrate racial/ethnic differences in depressive symptoms among persons with physical disabilities and highlight the importance of stress exposure, coping resources, and shame for understanding these differences.

Sleep-Related Factors and Mobility in Older Men and Women

Abstract: SHORT and long sleep duration, sleep-related disturbances, and their daytime consequences are common in older adults, and they are associated with decreased health and increased mortality (1–4). Because aging is associated with decline in physical performance often leading to physical disability and loss of independence, concomitant sleep problems may exacerbate the age-related decline in physical function. Previous studies suggest that self-reported and measured insomnia and sleep-related problems are associated with decline in psychomotor performance (5) as well as with poor balance and increased risk of falls (6–8). In addition, Goldman and coworkers (2007) (9) reported that short (<6 hours) and long (≥7.5 hours) sleep, increased sleep fragmentation, and longer daytime sleep are all associated with decreased physical performance and increased functional limitations in older women. However, the cutpoints used in this study differ from widely used classification: short sleep (≤6 hours) and long sleep (≥9 hours) (2–4). Besides insomnia-related symptoms, daytime consequences of inadequate sleep are frequent among older adults and may have negative effect on physical function. One component of fatigue, tiredness, is associated with walking limitation and development of activities of daily living (ADL) disability in older adults (10–12). Despite the previously described studies concerning sleep-related factors and physical function, several important questions still remain open, such as what is the association of sleep-related factors and mobility. Furthermore, it is not known whether the association between sleep-related factors and measured and self-reported mobility varies across sex or age groups. Examining these questions may help us to recognize persons with an increased risk for mobility limitation. Thus, the aim of this representative population-based study was to examine whether self-reported sleep duration, insomnia-related symptoms, and fatigue are associated with walking speed and self-reported mobility limitation in men and women aged 55–64 and 65 or more years.

Work task disability in employed breast and prostate cancer patients

Abstract: Nearly 60% of cancer survivors are of working age, making inquiries into work-related disabilities particularly relevant. This paper describes work-related physical and cognitive disability estimates 12 and 18 months after diagnosis and treatment in a sample of employed breast and prostate cancer patients. We recruited employed, newly diagnosed patients (n = 447 breast, n = 267 prostate) from the Metropolitan Detroit Cancer Surveillance System for telephone interviews 12 and 18 months after diagnosis. We defined disability by work task activity limitation. Disability estimates and employment were compared using Pearson chi-square tests. Duration of hours worked was compared by disability status using t-tests. Approximately 60% of women reported physical disability at 12 months which decreased to 36% at 18 months. Cognitive disability was reported by 34% and 22% of women at 12 and 18 months, respectively. Fewer men reported physical disability, only 29% at 12 months, decreasing to 17% at 18 months. Cognitive disability was reported by 12% and 7% of men at 12 and 18 months, respectively. More individuals with disability left the workforce at each timeframe than those without disability. A significant proportion of breast and prostate cancer patients experienced work-related disabilities 1 year or more following treatment. Physical disability was more problematic than cognitive disability.

Alternative items for identifying hierarchical levels of physical disability by using physical performance tests in women aged 75 years and older.

Abstract: Aim: To identify individuals at hierarchical levels of physical disability by using physical performance tests and to determine threshold values for the discriminating of levels of physical disability in women aged 75 years or older. Methods: A cross-sectional observational study was conducted on 306 community-dwelling women aged 75 years or order (range, 75–99 years). Physical disability was categorized into no disability, mobility disability and activities of daily living (ADL) disability, by evaluating selected ADL and mobility-related functional tasks. Physical function tests comprised nine items (such as strength, balance, mobility and walking ability). To assess the observed threshold values, receiver–operator curves were prepared for all the scales. Results: The results revealed significant differences among all the pairwise group comparisons in all the performance tests, except in the one-legged stance, tandem stance and tandem walk tests. The individuals with ADL disability were unable to perform the one-legged stance (28.9%), tandem stance (32.5%), functional reach (19.3%), tandem walk (61.4%), alternate step (53.0%) and 5-chair sit-to-stand (31.3%) tests. The observed thresholds for discriminating between the no disability and mobility disability groups and between the mobility disability and ADL disability groups were as follows: timed Up & Go test, 8.5 s and 12.7 s; usual gait speed, 1.05 m/s and 0.79 m/s; and grip strength, 19.5 kg and 16.3 kg, respectively. Conclusion: Tests for balance and lower extremity strength can be used together to identify or monitor the characteristics of the hierarchical levels of physical disability in women aged 75 years or older. Geriatr Gerontol Int 2010; 10: 302–310.

Validated instruments used to measure attitudes of healthcare students and professionals towards patients with physical disability: a systematic review

Abstract: Background Instruments to detect changes in attitudes towards people with disabilities are important for evaluation of training programs and for research. While we were interested in instruments specific for medical students, we aimed to systematically review the medical literature for validated survey instruments used to measure attitudes of healthcare students and professionals towards patients with physical disability.

“We don’t have a box”: Understanding Hidden Disability Identity Utilizing Narrative Research Methodology

Abstract: A "hidden disability," one unapparent to outside observers, defies the outward social construction of disability. A narrative research approach is used to understand the process of personal identification (or lack thereof) with being "disabled." Self-narratives were elicited from three men and three women, ranging in age from 21 to 53 years who have had a hidden physical disability since before age thirteen. The conditions represented are: Juvenile Diabetes, Asthma, Juvenile Rheumatoid Arthritis, Epilepsy, Muscular Dystrophy, and Celiac Disease. While persons with hidden disabilities are afforded a sense of anonymity, they must contend with different challenges, including learning strategic self-disclosure and impression management; when to disclose and make disability visible and when to "pass" and give society the impression of "able-bodiedness." The choice, to be or not to be disabled, has important implications for the way we conceptualize disability, and the concept of identity as a whole.

Evidence Regarding the Benefits of Physical Exercise

Abstract: Just over a quarter of a century ago, thought leaders in the aging research arena recognized that the promotion of increased physical activity was a relatively unexplored but potentially powerful avenue to promoting healthy aging.1,2 Since that mandate to examine the role of exercise in preventive gerontology was issued, and during the past decade in particular, a growing body of evidence has accumulated that has given legs to the hypothesis that the promotion of physical activity may be the most effective prescription that physicians can dispense for the purposes of promoting successful aging. Today it is recognized that virtually all of the diseases and conditions that lead to physical disability in older adults have as part of their etiology a component of personal lifestyle choices (eg, physical inactivity) in addition to biological aging and environmental exposure. Improving our understanding of the relative contributions of these factors to aging-related loss of independence and the subsequent development and implementation of prevention and treatment approaches is the essence of the present research mission for scientists working in the areas of geriatric medicine and gerontology. It is also now well established that higher quantities of physical activity have beneficial effects on numerous age-related conditions such as osteoarthritis, falls and hip fracture, cardiovascular disease, respiratory diseases, cancer, diabetes mellitus, osteoporosis, low fitness and obesity, and decreased functional capacity, all conditions that greatly increase the risk of reduced independence in late life.3 Regular physical activity has also been associated with greater longevity as well as reduced risk of physical disability and dependence, the most important health outcome, even more than death, for most older people. In this issue of the Archives, 4 new articles move the scientific enterprise in this area further along the path toward the goal of understanding the full range of important aging-related outcomes for which exercise has a clinically relevant impact. Two of these studies4,5 evaluated the relationship between physical exercise and decline in cognitive function, a major contributor to loss of independence and related institutionalization in elderly individuals. Optimism in this area, especially cognition, is sorely needed owing to the failure of promising interventions aimed at preventing cognitive decline and dementia in the recent past.6,7 In the study by Etgen et al,4 physical activity was independently associated with reduced risk for cognitive function decline in a group of self-selected volunteers residing in a single community in the Bavarian region of Germany. Cognitive function was assessed using a brief measure of global cognitive function, and the results essentially confirm similar epidemiologic findings by other investigators while leaving open the question of whether these results should be generalized beyond the study population. These results essentially add to the existing data supporting the need for well-designed clinical trials testing the impact of physical activity on clinically meaningful cognitive outcomes. In another article, Liu-Ambrose et al5 describe the use of a broader battery of neuropsychological tests to evaluate the impact of a 1-year weekly or twice-weekly resistance training program on cognitive decline in 155 Canadian women aged 65 to 75 years. The authors show that resistance training reduced the risk for decline in measures of executive function. Individuals who had high adherence to the resistance training program in this study had better Stroop test scores, a measure of selective attention and conflict resolution. Interestingly, although lower brain volume is typically associated with poorer cognitive function, the intervention that had a positive impact on executive function showed that the total brain volume as measured by magnetic resonance imaging was actually lower after 12 months of exercise in the resistance training group. The intervention did not, however, have an impact on other domains of cognition, such as working memory, nor did the sample size, duration, and study population help in determining the impact of the intervention on dementia incidence. In the other 2 articles, the authors examined a composite measure of healthy aging8 and a measure of cost-effectiveness,9 both increasingly important outcomes related to debates on best practices for maintaining the health and independence of aging populations in developed countries. In the article by Sun et al,8 data from the Nurses’ Health Study demonstrate that modest levels of physical exercise during middle age increased the probability of successful aging beyond 70 years, defined by low burden of comorbidity, no mental health disease, and preserved physical and cognitive function. The study by Kemmler et al9 again shows the health benefits of physical exercise on risk factors for disability in older adults but does not establish definitive evidence for the cost-effectiveness of these interventions in this population. In summary, the findings of all 4 of these articles fit into the larger and optimistic view of gerontologists regarding the power of higher levels of physical activity to aid in the prevention of late-life disability owing to either cognitive impairment or physical impairment, separately or together. The impact of unsuccessful aging is readily apparent to both clinicians and nonclinicians. Physical inactivity is one of the strongest predictors of such unsuccessful aging for older adults and is perhaps the root cause of many unnecessary and premature admissions to long-term care. Clinical trials targeting the diseases and conditions that populate the pathway to disability for older people have demonstrated the efficacy of physical activity to prevent or delay complications. However, while scientific value of these studies cannot be disputed, whether the results can or should be translated into recommendations for preventing disability progression in the broader community of older adults typically seeking care in the outpatient setting is the burning question that remains. This is because most of these studies and other published studies have enrolled younger and generally healthier older people. A few major issues remain from the original mandate to explore the efficacy of exercise in the 1980s. Of these, the primary issue is the lack of randomized controlled trials (RCTs) of adequate scope examining the feasibility, safety, and impact of exercise over a long duration (>2 years) in persons who are at highest risk for loss of independence on relevant geriatric outcomes, such as onset of major disability. To address this important clinical and public health question, the Lifestyle Interventions and Independence for Elders (LIFE) study, a phase 3 multicenter RCT of physical activity to prevent major mobility disability, will start recruiting early next year. A total of 1600 older sedentary persons who are at risk for major mobility disability will be randomized to a physical activity or to a health education program and followed for up to approximately 4 years to assess the effects on major mobility disability, defined as inability to walk 400 m, cognition, injurious falls, and other health outcomes. The LIFE study expands on the promising results of a pilot study10 that found the rate of onset of mobility disability was lower among a group of older adults who engaged in a structured exercise program for a year compared with a group of seniors who took part in a health education program for a year. The LIFE study will provide definitive evidence regarding whether physical activity is effective and practical for preventing major mobility disability. These results will have crucial implications for public health prevention in a rapidly aging society and will fill an important gap in knowledge for practicing evidence-based geriatric medicine. The study will also yield valuable information concerning the efficacy and effectiveness of physical activity across a broad spectrum of important health outcomes. The study will have an impact on both clinical practice and public health policy and will, therefore, benefit individuals and society. Along with the expected results of the LIFE study, the 4 new studies in this issue of the Archives, and the evidence from clinical studies over the past 25 years, we have never had greater reason to be hopeful regarding the potential for exercise to become a proven and generalizable strategy for promoting successful aging in the expanding population of older adults.

Physical Disability, Stigma, and Physical Activity in Children

Abstract: Using the stereotype content model as a guiding framework, this study explored whether the stigma that able‐bodied adults have towards children with a physical disability is reduced when the child is portrayed as being active. In a 2 (physical activity status) x 2 (ability status) study design, 178 university students rated a child described in one of four vignettes on 12 dimensions of perceived warmth and competence. Results revealed a main effect of ability status on warmth (p < 0.001) such that children with a physical disability were rated significantly higher in perceived warmth than able‐bodied children, regardless of activity status (d = 0.86). Also, there was a significant interaction (p = 0.02) of ability and activity status on perceived competence, indicating that ratings of perceived competence were significantly higher for active children with a physical disability than for all other children (d = 0.54–0.64). Results suggest that physical activity should be explored as a way to mitigate the st...

Fatigue and physical disability in patients with multiple sclerosis: a structural equation modeling approach

Abstract: Although fatigue is one of the most common and disabling symptoms in patients with multiple sclerosis (MS), its pathogenesis is still poorly understood and it is difficult to treat. The aim of the current study was to test the assumptions of a cognitive-behavioral model that explains fatigue and physical disability in MS patients, by comparing this approach with a more traditional biomedical approach. Structural equation modeling was applied to a sample of 262 MS patients. Neither the cognitive-behavioral, nor the biomedical model showed an adequate fit of our data. The modification indices supported an integration of both models, which showed a better fit than those of the separate models. This final model, is notable for at least three features: (1) fatigue is associated with depression and physical disability, (2) physical disability is associated with disease severity and fatigue-related fear and avoidance behavior, and (3) catastrophic interpretations about fatigue, fueled by depression, mediated the relationship between fatigue and fatigue-related fear and avoidance behavior. Our results suggest that an integrated approach, including the modification of catastrophic thoughts about fatigue, would be beneficial in the treatment of fatigue in MS patients.