Chapter 14

Activities

1. Use your knowledge of HRQoL to make decisions about exercise prescription for the following two cases:
   

   Case 1. You are studying the effects of aerobic exercise on the progression of a newly identified disease. Although blood samples reveal that exercise is curbing disease progress, patients are so fatigued after working out and experience such a large increase in pain due to exercise that they are unable to perform activities of daily living or to socialize with their families and friends. Thus, despite medical improvements, patients have significant decrements in their HRQoL. Should you recommend exercise as a treatment for this disease? Defend your position.

   Case 2. You have been asked to implement an exercise training program at a local nursing home where the caregivers are hoping to decrease the risk of heart disease among residents. After six months of light chair exercises (exercises performed while seated), no improvement is seen in participants’ risk for heart disease. However, participants note that, since starting the exercise program, they have felt happier with their ability to walk short distances and their level of energy for participating in social activities. When their families visit, family members remark that the patients seem more positive. Do you continue the exercise program even though it is not producing any change in risk for heart disease? Construct an argument defending your position to present to the director of the home.

2. Conduct a literature search to find exercise intervention studies that have used the SF-36 scale to measure changes in HRQoL. Choose two studies that involved two different populations (e.g., arthritis patients and the elderly). Compare and contrast the effects of exercise on SF-36 scores for these two different groups of people.
3. Develop an exercise training program for the frail elderly that has the specific goal of improving their HRQoL. Pay careful attention to:
   • the types of exercises and activities that you prescribe
   • the instructions and information that you give participants about the relationship between exercise and HRQoL
   • strategies to enhance perceptions of improvement and control.
4. Choose a particular disease or disability (e.g., heart disease, hearing loss) and conduct an Internet search to find a questionnaire measuring HRQoL designed specifically for people who have this condition. If you were to administer this measure to patients at the start of an exercise program and then three months into the exercise program, how do you think their responses to the questionnaire would change?
5. People with chronic disease and disability cannot derive exercise-related improvements in HRQoL unless, of course, they are able to exercise. Environmental barriers are a primary deterrent to exercise among people with chronic disease and disability, particularly among those with a mobility impairment (i.e., people who use a wheelchair, cane, or other mobility aid to move about their communities). For these individuals, it is often difficult or even impossible to use public exercise facilities.
   • Choose a particular population with a mobility impairment (e.g., people with arthritis, spinal cord injury, multiple sclerosis) and generate a list of physical activity barriers that this population would face.
   • Conduct an audit or survey of a local fitness facility to determine whether the facility would be accessible to your population of choice. Your audit could include an evaluation of features such as the availability and proximity of wheelchair-accessible parking, ramps, and elevators; the spacing in and around exercise equipment (i.e., is there enough space for a wheelchair to move about?); the height of drinking fountains and service desks; and the availability of staff to help these exercisers.
   • Write a report that summarizes the accessible and inaccessible elements of the facility and makes recommendations to improve accessibility.

Vocabulary

Activities of daily living (ADL) - Actions completed during the normal course of the day, such as going up and down stairs, carrying groceries, and walking.

Disease-specific measure - An assessment of people who have a specific disease or disabling condition.

Generic measure - Measures designed to assess multiple aspects of HRQoL across a wide range of patient populations (e.g., the SF-36).

Health-related quality of life (HRQoL) - Subjective perceptions of the “goodness” of those aspects of life that can be affected by health and health interventions.

Objective measure - A measure that can be made by someone other than the patient; such measures are usually quantitative in nature.

Proxy measure - A measure of HRQoL completed by a proxy (a person other than the patient), who is asked to rate the patient’s HRQoL because the patient cannot complete the questionnaire due to some physical or cognitive limitation.

Quality-adjusted life years (QALY) - An objective, numerical measure of QoL that represents the number of years a person is expected to live, adjusted for (or taking into account) health problems that may affect the quality of those remaining years.

Quality of life (QoL) - The overall “goodness” of a person’s life; includes both subjective and objective evaluations of all the factors that contribute to one’s life.

Special population - People with circumstances or conditions that require special attention (e.g., people with, or at increased risk for, chronic disease or disability).

Subjective measure - A measure of a patient’s perceptions, usually qualitative in nature.

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