Exercising With a Disability

The Chris Kaag who people know is the no-nonsense former Marine who runs a gym and a foundation with the motto "No excuses. Just move!" He's the fitness buff who mountain bikes 8 miles every day -- with a 30-pound ammo can strapped to a trailer that he pulls behind. He's the guy they look to for inspiration and motivation.

But to be that Chris Kaag isn't easy.

Diagnosed with a neurodegenerative disorder the day before his 21st birthday, Kaag, now 38, has limited control of his legs. When he wakes up, they shoot up. When he tries to get dressed, they're not trying with him. If he bends too far to pull up his pants, he falls.

"People see me doing the things that I do ... but they don't see the behind-the-scenes things," says Kaag, founder and president of Corps Fitness and the IM ABLE Foundation in Wyomissing, Pennsylvania.

Kaag is an exception to an uncomfortable reality: While more than one-third of Americans are obese, the statistics are even more dire for people with disabilities. Over 40 percent are obese and more than 9 percent are "extremely obese," according to a 2013 study of 31,990 adults in the American Journal of Preventive Medicine. By contrast, under 4 percent of Americans without a disability fall into that "extreme" category. What's more, people with disabilities -- no matter their weight -- are more likely than those without disabilities to have hypertension, high cholesterol or diabetes, the study found.

Other research out last year in Obesity Review concluded that effective nutrition and weight-loss interventions for people with mobility impairments -- and particularly those like Kaag with neurological conditions -- are few and far between. "This is really a health disparity that we need to start addressing," says Matthew Plow, an assistant professor at Case Western Reserve University's School of Nursing who led the study.

A Vicious Cycle

No time, no money, no fun. The average American has no problem coming up with reasons not to exercise. But for people with disabilities, those reasons are multiplied. "Barriers for persons with disabilities ... are as unique as the people themselves," says Dolores Cimini, a psychologist who directs the University at Albany's Counseling Center substance abuse prevention program.

For people like Cimini who are visually impaired, for example, mimicking an instructor's pose in a yoga class, adjusting the speed on a treadmill or following an exercise video can all require special attention or devices. "I've known individuals who've gone to exercise classes and not been able to have full access to them ... and quit," Cimini says.

Another barrier is cost. Not only is accessible equipment expensive -- a hand-powered bike for a kid who's paralyzed below the waist can cost upward of $7,000, Kaag says -- but people with disabilities are also more likely to be unemployed or underemployed than the rest of the population, Cimini says. "That certainly can play into obesity and not eating in a healthy way" since they may not be able to afford or access healthier food, she says.

Eating healthfully can also be complicated by nutritional misinformation, Plow says. "You're just bombarded," he says. "That's true for the general public, but for people with chronic conditions, there's always that new hype diet that's supposed to help either cure your symptoms or manage your symptoms."

Plow's research has found people with disabilities face at least one of four barriers when trying to become or stay active. Fatigue, pain, mobility impairments, stress or all of the above can create a "vicious cycle," he says. "That makes it difficult to engage in healthy behaviors, and that results in these secondary conditions such as obesity, depression and deconditioning, which then increases the symptoms, making it harder to engage in physical activity. So a lot of [my work] is trying to address that vicious cycle that happens -- and how best to do that is very unclear."

Just Move

On the upside, technology to help people with disabilities get moving is improving. "It's the best time to be disabled, as crazy at that sounds," Kaag says. When he first started to lose control of his legs, he stopped mountain biking. A year later, he found hand cycles. "[They] gave me another whole level of fitness that I had been missing," Kaag says.

For Cimini, Bluetooth technology allows her to sync her Fitbit to her phone and computer, which use voice technology to relay how far she's walked, how many steps she's climbed and more. "I'm still on my weight-loss regimen, and I'm continuing to make progress," she says.

Other helpful interventions are technology-free. Plow often helps study participants manage their stress by teaching them relaxation techniques like meditation or encouraging them to take more time for leisure -- something people with disabilities often push aside, he says. "If you have these unmanageable symptoms, you get stressed out, and because of that stress, you're more likely to engage in unhealthy behaviors," he says.

Kaag's trick for helping members of his gym -- no matter their abilities -- stay active? Creativity. He's figured out how to strap his legs into rings and do pushups, adjusting the straps according to his legs' cooperation level that day. He got the idea from a young man at his gym who is paraplegic and does pushups off the side of his bed.

"We all have challenges. We all have excuses," Kaag says. "Let's get over them, and let's try to lead as active a lifestyle as we can."