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Guest blog in preparation for #WeLDnurse chat on LD and exercise

In the first blog, I examined my some of my life experiences, the rationale for Equal Teams and the progress made. In this piece I wanted to spend a little time considering the public health evidence and what might be possible for people with learning disabilities as these are the main issues for discussion in the @WeLDNurses Twitter chat on 20th February from 8-30 until 9-30pm

Conversations with Ann Gates (@exerciseworks) over the past 6 months helped us identify the strength of the evidence of public health for other groups of people.

Dr David Shiers (a retired GP, with a special interest in physical health in mental health) joined the conversation and shared a very useful and moving lecture about public health issues and people with mental health issues delivered Professor Helen Lester. This held startling parallels with my understanding of the same issues within the learning disability field which prompted me to reconsider the Disability Right Commission report Equal Treatment : Closing the Gap (2006) where it was observed that there are more obese adults with learning disabilities in the UK, than there are in Birmingham and Coventry combined. While people in those areas would not be excluded from public health programmes, access to those programmes, for people with learning disabilities, was sadly lacking. 

Many studies (McGuire et al. 2007; Melville et al, 2007) have identified the issues that obesity poses particularly in people with learning disabilities and authors have identified that within this group obesity can act as a secondary disability. Salaun et al (2014) suggests that this group are particularly vulnerable due to individuals being unable to or wanting to identify with the negative consequences of their weight issues which serves to protect their self esteem. This in itself gives some indication of ways to encourage young people into sporting activities, focussing on the health benefits, is almost always the wrong tack, observing the social opportunities and inviting people to join a group. While there is much debate about any linkages between self esteem and weight loss, it is clear that moving from a position of no exercise, to doing some exercise is definitely an improvement. If I reflect on my own experience, as a man who likes looking good – or at least not looking too bad!- those first few runs in 2004/5 had me feel nervous and self conscious, but the satisfied having taken the risk to start, somewhere. Then the experience of finding a running partner who was willing to accept me as a novice and all that that entailed enabled me to progress and find myself in running. 

Grandisson et al (2012) extols the virtues of inclusive sports, that of people with and without learning disabilities playing on the same teams but also highlights the challenges that this poses to peoples attitudes, through portrayal in the media and the competence of coaches to manage mixed ability groups. In Equal Teams FC experience, it was identified that participating in the Kent Disability League was the best course of action in the absence of any ‘unified’ leagues being available, and while that has bought players in to the club, the game and therefore getting exercise and a social outlet, there are questions how we might further encourage integration and inclusion. Equal Teams FC has been lucky to have a senior coach from the outset, who is also a parent carer who has a good understanding of the requirements and has adapted his coaching to the mixed abilities of the participants. 

Along with the positive public health results of participation in sports, the supplementary benefits are not inconsiderable, and these gains appear to be generalizable to other areas of life like employment and education (Roswal & Damentko 2006) along with the development of healthy life habits and social competency. Whilst the opportunities for integration and inclusion through sports such as Equal Teams FC and the work that Carolyn Rogers is doing with the Football Healthy 4 Life project (Penfold, 2014), further support is required to develop greater unified sports experiences and to continue to review, develop and facilitate new exciting opportunities to engage people with learning disabilities in sports and exercise. Further frameworks need to be developed to ensure that all healthcare professional are ensuring that their public health assessments and messages are right for that patient group. 

This blog has been written by Daniel Marsden (@dmarsden49) in preparation for the @WeLDNurses & @EqualteamsFC chat on 20th February 2014 on exercise and public health and people with learning disabilities. 

This is to support Daniel’s fund raising efforts for Equal Teams FC by running the London Marathon. If you would like to sponsor him go to http://uk.virginmoneygiving.com/DanielMarsden49  


Disability Rights Commission (2006) Equal Treatment – Closing the Gap. Available online at http://disability-studies.leeds.ac.uk/files/library/DRC-Health-FI-main.pdf 

Grandisson, M et al (2012) Enabling Integration in Sports for Adolescents

with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities 2012, 25, 217–230 

McGuire B. E., Daly P. & Smyth F. (2007) Lifestyle and health behaviours of adults with an intellectual disability. Journal of Intellectual Disability Research 51, 497–510. 

Melville C. A., Hamilton S., Hankey C. R., Miller S. & Boyle S. (2007) The prevalence and determinants of obesity in adults with intellectual disabilities. Obesity Reviews 8, 223–230. 

Penfold, J. (2014) Community sports project helps clients reach their goals. Learning Disability Practice. 17 (1) 8-9. 

Roswal G. M. & Damentko M. (2006) A review of completed research in sports for individuals with intellectual disabilities. Research Yearbook 12, 181–183. 

Salaun, L et al (2014) Adapted Physical Activity Programme and Self-Perception in Obese Adolescents with Intellectual Disability: Between Morphological Awareness and Positive Illusory Bias. Journal of Applied Research in Intellectual Disabilities, 27, 112–124



Exercise and Sport for learning disability

Guest blog via @exerciseworks and @dmarsden49

Physical activity is a basic right for all to access. We know that fun physical activities and structured exercise work to maintain a healthy weight, help prevent serious chronic diseases, and has many benefits that help promote physical health in learning disability. These other benefits are often hard to qualify such as better sleep, better cognition and ….just a feeling of health- but evidence shows that regular exercise significantly improves heart, brain and lung health! There are many opportunities for all those in the care of learning disability patients together with carers and health care professionals to identify fun ways to include physical activity into daily life, school and work.

How can you help the person you care for build more physical activity into their day?

Planning fun daily physical activities is essential to ensuring the day to day health of patients. It is also essential in preventing and treating diseases such as heart disease, cancer, type 2 diabetes and many other long term diseases.

To help and support the person you care for in getting enough exercise, check what their recommended physical activity guidelines are. For example, adults aged 19-64 should try to be active daily and should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking, every week. They should also have access to twice weekly strength, flexibility and balance exercises to maintain strong bones and age healthily. They should also be encouraged to limit their sitting time and try and use the stairs more, and maintain their physical activities throughout the day.

Find physical activity guidelines for: young people (5-18 years old), adults (19-64 years old) and older adults (65 and over) and identify ways in which you can help someone with learning disability increase their daily physical activities. This can be indoors or outdoors exercise activities, in a local gym or leisure centre, or specifically designed sport opportunities run in and by local communities

There are increasing numbers of sports and leisure activities available- so identify what’s available and works in your local community! Here are some great examples of best practice for physical activities and learning disability:

Pedal Power: run by physiotherapists and inspiring programme using tricycles to help learning disability patients to enjoy cycling safely, fresh air and nature!

There is increasing evidence of the public health challenges that society faces in our increasingly sedentary society that enjoys it’s sugary and fatty foods. Evidence shows that this is particularly the case for people with learning disabilities, and we know that the UK Sports Association for people with learning disabilities draws together hundreds of excellent national regional and local organisations that offer opportunities for people with learning disabilities to get involved in exercise.

Daniel Marsden’s blogs for exercise works emphatically identifies that while exercise and sport can have health benefits, to concentrate on this would be reductionist and would miss the many other benefits of being with other people, communication and interaction, support and challenge and working together. While inclusion appears to have driven these two projects:



the health benefits for the respective players and teams are significant, and it is the outcomes that draw people into exercise.

If as health professionals we can enable the person we are working with to get what they want from exercise and sport we really will be #makingeverycontactcount 

Blog moderated by Ann Gates, Founder of Exercise Works!.... and on a mission to improve heart health for all- as part of the World Heart Federation Emerging Leaders Programme.


Wheelchair dance works!

Guest blog via @WDSAUK

Wheelchair Dance

What is it? 

What benefit is it to my clientele? 

Well, let me explain all about it.  Wheelchair Dance is a very successful form of exercise which promotes better posture and balance within the wheelchair and increases spacial awareness and the correct use of the wheelchair in day to day life.  By having a better posture, breathing increases in depth and duration, which leads on to improved digestion and metabolism. Co-ordination, strength and circulation also show a marked improvement, while the elevation to the heart rate turns the activity into a cardiovascular exercise, whilst still remaining a fun event. A good explanation of why everyone needs regular exercise to stay healthy is described here.

Music and dance are wonderful tools to enhance mood and will give a burst of natural endorphins to aid in control of pain, and especially help those with learning disabilities.  These are not just glib, throwaway statements.  The Wheelchair Dance and Sports Association (UK) have seen this in action and we have a number of case studies to back this up:

Chas:   A man in his late 30’s who came to a workshop in a large, attendant operated power chair.  The carer stated that if he stayed awake that meant that he was enjoying himself and the activity.  He was partnered in several couple’s dances and some group dancing and he was engaged and awake, and was enjoying the dancing.  He has limited facial expression and no verbal communication that we observed. However, during a short break in the dancing, some other music was playing as background music.  One piece, “Footloose” was played and this induced a dramatic change in Chas’s behaviour.  He became very animated and began to vocalise and move around in his wheelchair.  The carer was very surprised and we actively began to use that piece of music in future classes to trigger this extra movement and awareness.

Kelly:  A student at a special school in her teens.  She was in a manual wheelchair that the carers propelled on her behalf.  We were advised not to touch her as this would trigger either, biting, scratching or a spitting session from her.  She was pushed in a couple of easy introduction dances and then whilst the instructor taught the next dance steps she was wheeled to the side of the floor.   The music was played and the instructor disregarded the advice of the care staff and went over to Kelly and placing her hand of hers, asking her to dance as her partner.  Kelly looked at the hand and then at the face of the instructor, who smiled and led her out onto the floor again.  Despite the collective gasp from the care staff, nothing happened!  She danced with the instructors hand on hers and then continued to dance with her and by the end of the session was actively holding the instructors hand.  The care staff reported later that for several hours after the dance lesson, Kelly was calm and there were no incidents of previous violent behaviour.

Sharon:   A 26 year old lady with cerebral palsy who uses a power chair attended a wheelchair dance group over a period of 8 weeks.  At the start of each dance lesson there is always a short warm up routine which involves raising, lowering and opening the arms, hands and fingers, moving the shoulders and head and some trunk rotation.  Following the 8 week period her physiotherapist noted a sharp increase in her stretch ability and her co-ordination.  As Sharon had not been receiving any other physiotherapy activity, other than the dance lessons, the physiotherapist had no other explanation other than that the dancing and the warm up routine had produced a marked improvement on her overall stretch ability, core strength, trunk rotation and special awareness.

As you can see from the above case studies, Wheelchair Dance is a fantastic activity and sport that can engage any individual whether they are using a wheelchair or standing.

If you would like more information on anything to do with the WDSA (UK), it’s activities or courses call 0300 111 30 45 email info@wdsauk.co.uk or have a look at our website www.wdsauk.co.uk

Blog moderated by:

Ann Gates BPharm(Hons) MRPharmS

Founder of Exercise Works!