Exercise and Amputations

Around 19% of people in the UK have an impairment but exercise in this population is very low. Less than a quarter of people with multiple sclerosis regularly exercise and over 30% of people with MS are overweight. Only 13% of disabled children meet the daily exercise recommendations; that’s 87% of children with a disability who are not exercising enough.

So why are they not exercising?


Firstly, there are issues relating to the facility itself; is the facility accessible and inclusive? Does it have any inclusive equipment? Are the staff knowledgeable and welcoming? Sometimes the disability itself can be a barrier as people believe exercise will be too difficult for them, others will discriminate against them, their condition may be exacerbated by physical activity or they will be too tired, or they simply cannot engage in exercise. Finally, body image also acts as a barrier to exercise.

Body image is your attitude towards your own body; how you see yourself, how you think and feel about the way you look, and how you think others perceive you. Poor body image is linked to social physique anxiety; people who are obese and have social physique anxiety can be scared to enter a gym environment due to how their body might be perceived by others, and how they themselves see their body. For people with disabilities, particularly visible ones like amputations, social physique anxiety can prevent them from exercising. Breakey (1997) found a correlation between positive body image and psychological well being in people with amputations – these individuals had lower levels of anxiety and depression, and higher levels of life satisfaction. Atherton and Robertson (2006) found that negative appearance related beliefs towards amputations contributed to distress and adjustment difficulties.  Interestingly, although body image is correlated to levels of activity, people with an amputation display high levels of social physique anxiety; that is to say although exercise will benefit their body image, there is an initial fear to engage in exercise due to lack of confidence. The research on this area is sparse; it could be that this is a population that would experience more social physique anxiety due to scarring, stumps, and prosthetics, yet it’s not really been thoroughly looked into. The goal of rehabilitation following an amputation is to get the individual mobile and self-dependent, often through resistance training and physiotherapy, but not focused on regular exercise programme.


Exercise in Old Age

This week I had a big girl job interview and as part of it I had to present a ten minute speech about increasing exercise participation in a target population. I researched it quite a lot and there was a large amount I couldn’t actually fit into the time frame so I decided to write it up into a post. Enjoy!

There is a general trend that as our age increases our exercise levels decrease. There are many reasons for this; time constraints, money constraints, or general tiredness from our busy lives. However 3/4s of the older adult population are not exercising to recommended levels. Evans (1999) went so far as to say that there is no segment of the population that can benefit more from exercise than the elderly.

Exercise is of course wonderful for our health – even if it doesn’t feel like it at the time. For the elderly population, exercise can reduce the risk of diabetes, lower blood pressure, reduce risks of osteoarthritis and osteoporosis, and help with weight management. Exercise programmes that focus on improving balance and strength can decrease the number of falls and reduce physical frailty, so any falls are less risk. In depressed elderly adults, meeting for group exercise can provide social support and reduce depression symptoms.

If exercise is so great then why aren’t they doing it? It could be a generational thing – my generation has a greater exposure to gyms, races, activities, even healthy food, yet for the older generation this is relatively new; they’ve never had cross-fit, wolf runs, or tough mudders. Gyms can be a scary place – there’s a lot of equipment that they don’t know how to work. Bodies suffer wear and tear so this generation has a fear of injury – particularly re-injury of joint replacements. Another factor is that many of this generation must rely on public transport to get around so that can take a lot of effort and may not be on a route to a sports centre.

What exercises can this group do?

Any casual exercise programme should be straightforward and fun – aerobics and dancercise classes fit that bill. The music can be adjusted to songs from their “heyday” such as Chuck Berry, Elvis Presley, old school fifties Rock and Roll. It can also be adapted to different abilities: for people who find it easy, small hand weights can be provided of a few kilograms which emulates lifting shopping and laundry; for people who struggle with balance then exercises can be performed whilst sitting down like swinging legs and tapping feet; aerobics can also be performed in the water which relieves the impact on joints and reduces risk of injury. health-fitness_04_temp-1306750736-4de36f10-620x348Another great, but under performed, activity is Tai Chi. It’s a martial art but not a typical combat one. It involves balance and shifting weight between the legs which makes it excellent for elderly people because the focus is on improving balance. It is also a low demand activity involving slow, flowing movements – perfect for people who currently do not exercise, or are unable to exert themselves too much. It can be adapted for people in wheelchairs, and can settle people who are perhaps restless in retirement. Tai Chi can also reduce the number of falls in this population too.

Sooooo, anyone for Tai Chi?

Exercise Psychology

Sport psychology features a heck of a lot more here than exercise psychology so I thought I’d an 8 month late post about general exercise psychology…

Exercise psychology is concerned with understanding the psychological factors associated with health related physical activity – the determinants, consequences, and correlates.

  • Determinants – adoption and adherence, dropout rates, non-participation, excessive participation, the self, intensity, duration, frequency, barriers to exercise, participation motives.
  • Consequences – psychological and emotional effects of exercise, body image, mental health, emotional responses, stress reactivity, interventions.

After living in Scandinavia where people seem to exercise because they don’t know what else to do with free time, why the heck do people exercise?

  1. Improved physiological health/physical fitness
    1. lowered mortality and morbidity.
    2. Reduced risk of cardiovascular disease, some cancers, diabetes
    3. lower blood pressure
    4. helps with weight loss/management
  2. Improved psychological/emotional health
    1. reduces/alleviates depression, stress, anxiety and negative mood
    2. enhances positive mood, self esteem and sleep
    3. improved body image
    4. improves social relationships

There seems to be a bombardment of healthy lifestyles that we should follow – which is not necessarily a bad thing – but 20-50% exercisers drop out within the first six months and there is a gap between people’s intentions and their actual exercise behaviour. We’ve all been there on New Year’s Day with big hopes of the year ahead more often than not fall flat.

A lot of it is down to self-efficacy, which in simple terms is the belief that you can do it! Whatever it may be. Unless you believe you have the ability to do something then you’re unlikely to have the incentive to do it.


We are also influenced by impression motivation, as can be seen on instagram and facebook. Individuals are motivated by the impressions of themselves in others’ minds e.g. I want to be seen as this great vegan cross-fitter. And impression construction is used to facilitate this process by enhancing self-concept; individuals will alter their social image and meet target values e.g. to be seen as super vegan cross-fitter, I will train 4 times a week at the gym and live a vegan life, I’ll post gym selfies. Often on social media you post your highlights, you don’t post the photos of you laying on the sofa with a double chin with food wrappers all round you like a graveyard of shame.

Thirdly, self-presentation is involved because we are motivated to engage in exercise for appearance (social physique anxiety) and social identity. Our choice of exercise is limited by this factor as is the quality of the exercise. We’ve seen the memes that vilify women who wear a full face of make up to the gym as only being there to win a man’s affection rather than actually exercising.

So there you have it… a quick and dirty toe dip into the realm of exercise psychology!

Components of Fitness

There are some key areas of fitness that can be targeted to improve sport performance as seen below. This is your quick and dirty whistle stop tour into what they are and how to improve. fitness.jpg

The longer it lasts, the greater the endurance. This can be short, high intensity exercises like sprinting versus ultra-marathons. It can be broken into two distinct areas: cardiorespiratory and muscular endurance, also known as stamina. This can be improved with continuous running, Fartlek running, or interval running (short & fast versus long & slow).

The range of movement in a joint during passive movements. Flexibility can prevent injuries because the muscle is able to move further before an injury occurs (have you ever tried to do the splits and regretted that decision horribly the next day?). It can also improve speed and agility by maximising muscle range. It depends in part upon the sport – gymnasts are far more flexible than rugby players – however individual differences will also play a role; some people just have longer and looser ligaments than others! Static stretching can improve flexibility.

Pretty much what it says on the tin – obviously some people are na
turally quicker than others, we can’t all be Usain Bolt, but speed is an indicator of fitness. The quickest way to improve speed is by improving your body composition and increasing general physical prep e.g. start exercising more. Technique training, acceleration sprints, and reaction drills are good ways of improving speed.

This is the ability to exert a maximum force. Power = speed + strength. This can be broken into absolute, aerobic, anaerobic, limit, and speed categories and each one has different training methods. Obviously, it’s important to recognise again that individual differences will play a role – I’m 5ft2 and will never be able to lift as much as the Mountain from Game of Thrones. Strength exercises include free weights, circuit training, fixed apparatus – and remember never skip leg day.

This focuses on how well you can apply explosive movements to rapid changes of direction – think Sonic the Hedgehog. It requires good balance, speed, co-ordination, and strength, among others. Very important when marking the opposition who will be trying to escape from you e.g. in netball. Agility is developed with short sprints and sharp turns around a set of markers, the Illinois Agility Test is a common one.