To the Editor:
I appreciated the clarity with which Jones and Bell presented the association between participation in adverse health behaviors and the occurrence of disabling conditions in their article, "Adverse Health Behaviors and Chronic Conditions in Working-Age Women."1 Their data accentuate the problems we see in practice (ie, the need for successful interventions to help disabled women maintain a healthy weight, increase physical activity [PA], stop smoking, and decrease alcohol consumption). Although the authors offered ideas for helpful interventions, in the spirit of evidence-based practice, the most recent research results should be applied to this topic.
For example, Jones and Bell suggest that health care providers should "provide strategies to help women increase their amount of PA in their daily routines [horizontal ellipsis] without the aid of another person."1(p34) Sounds logical, but does this strategy work? When Di Loretto et al2 tested the effectiveness of individualized counseling to increase PA in patients with type 2 diabetes in Italy, 70% of the sample group voluntarily brought a partner to the initial counseling session. The Surgeon General's Report to the United States regarding the efficacy of the interventions to increase PA includes "receiving support from family, friends, and peers" as a "central determining factor."3 Perhaps the PA might be performed alone, but studies show that for long-term change in behavior, support from others is an important ingredient.
Jones and Bell also pointed out that interventions to enhance PA should be "cost-free."1(p34) Sadly, the cheapest and most logical interventions are not necessarily the ones that work, and so it behooves us to continue to research the problem, searching for low-cost strategies to enhance PA in specific population groups, such as African American women with disabilities. In a recent review of the literature looking at randomized controlled trials for assessing PA increase in African American women with diabetes, I found only one study whose intervention showed long-term, statistically significant results, and that study used labor-intensive methods of trained peer-counselors and phone calls for follow-up.4 Among the quasi-experimental studies with effective outcomes, one incorporated an intervention using expensive exercise equipment and specialized personnel.5 This program would be hard to duplicate in most settings. Other church-based interventions had a modest effect on PA; and interestingly, the studies revealed that self-help programs in this population received an almost total lack of interest.6,7 Certainly, successful, tested interventions for increasing PA in this population are few and the need for further research is apparent. Controlled studies need to report cost as well as feasibility and effectiveness. It appears to me that Jones and Bell's suggestions to have disabled women increase PA without cost and without others' aid amounts to reverting to the individual-focused, acute care model. Rather, we should be focusing on community involvement. When Taylor, Baranowski, and Young8 summarized the literature studying PA interventions used for persons with low-income, ethnic minorities, and populations with disabilities, they pointed out two promising factors. The first was "meaningful participation of the community," and the second was a "thorough assessment of needs, attitudes, preferences, and unique barriers prior to implementation of the intervention."8(p340) Jones and Bell rightfully show there is an enormous amount of diversity in the group labeled "disabled." Thus, we should devise programs or suggestions that will work in different situations. By using a community participation paradigm, we can explore community-based interventions and broaden the possibilities for people with disabilities while incorporating the necessary support from others.
Sincerely,
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