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SCI Forum Reports

Body Image and Wellness - Part 1

February 6, 2001

"No person is exempt from the relationship between body image and self-esteem," said Nancy Kenney, professor in the UW Department of Psychology. "And when we start thinking about body image, we start dealing with the societal ideals that each of us carries inside us about what a man and a woman should be like."

Unfortunately, many of these ideals are derived from magazines and movies and are nearly impossible to achieve, Kenney said, "because we don't have crews of people helping us to look like that all the time." If we compare ourselves to these images, "we all fail. The ideal is designed to be unachievable."

While ideals vary with gender, age, socioeconomic group and culture, in our society today "the ideals for men are more stringent than are the ideals for women," she said. "It's okay for women to assume male roles, but not okay for men to cross over into female roles."

"The effect of disability on men is huge because the ideal of man is often a physically based ideal," Kenney said. Ideally, a man is supposed to be "strong, active, in control, a wage earner, and he's certainly never helpless." A man with SCI who compares himself to that ideal can suffer devastating loss of self-esteem unless he adjusts his image of the ideal.

Strength is one of the characteristics that can be redefined, Kenney said. "When it comes to strength, we don't have to talk about physical strength. One can talk about inner strength, which is the strength that really matters when the going gets tough. Most people go through life without ever having to lift 300 lbs. Why should that be an ideal?"

"Ideals are given to us," Kenney said. "We rarely stop and think about them. Instead, I can say the ideal person has these intellectual, social, and communication abilities, and the physical side really isn't that important, and I can work toward that for myself."

While we may think others are judging us according to harsh societal ideals, "data show that is not the case," Kenney said. "The comparison to the ideal is done more by the individual than by anyone else. Your friends love you because of your character strengths, not your physical characteristics."

Kenney urged people to think about what characteristics go into their concept of the ideal, and which of those characteristics they can accentuate. "Think about it - mobility has very little to do with the ideal person," Kenney said. "But as long as you believe it does, it's going to have a severe effect on you self-esteem."

"Now that you've heard about feeling good about your body and yourself, I'm going to refocus the discussion toward just plain feeling good," said Cathy Warms, RN, who is a PhD candidate conducting research on SCI and exercise in the Department of Rehabilitation Medicine. "I believe it's possible for every person to achieve wellness, or at least to be working in that direction."

Definitions of wellness include "exuberant well-being," "a chosen way of life," "feeling good," and "health," Warms said. "Wellness is not something you're born with, but rather, something you need to work to get. When you feel good, you are more likely to feel good about yourself."

Health promotion is a term encompassing all the things people do to become healthier or achieve wellness, and includes work on physical, mental, social, and spiritual health. "Obviously, health promotion is never finished but something we all work on continuously," Warms said.

Components of health promotion include nutrition and weight control, physical activity and exercise, smoking cessation, stress management, good sleep habits, and an interest in learning about healthy lifestyles. Warms is focusing her research on physical activity in part because it gives "the most bang for the buck" of all the health promotion activities.

"The changes in the body that happen as a result of SCI may make being active difficult," Warms said. When moving about becomes difficult, it is natural to become inactive. But inactivity causes changes in the body that make it even more difficult to be active. This is called "the cycle of deconditioning," and as the cycle repeats itself, people may find they have less strength and energy and do not feel well. Furthermore, there is research evidence to suggest that inactivity may increase the likelihood of urinary tract infections, pressure sores, respiratory infections, and constipation.

Benefits of exercise are numerous and include improvements in posture, strength, circulation, blood sugar, energy level, bone density, and ability to burn fat, as well as a decreased risk of heart disease, diabetes, and digestive problems. "See what I mean about more bang for the buck?" Warms said.

The effect of SCI on one's response to exercise depends on the level and completeness of injury. People with T4 injuries and above will have less ability to increase heart rate (pulse) and regulate blood pressure during exercise, which means the good effects of activity on the heart and circulation will not be as strong as they are in people without SCI. And while people with all levels of SCI may have low blood pressure during vigorous exercise, this should not prevent moderate levels of activity and usually not vigorous activity either as long as people work up to it gradually.

There are many ways to be active, from planned exercise to sports done purely for fun. Recently, researchers have identified a new category of fitness activity called "lifestyle physical activity," defined as the accumulation of at least 30 minutes of moderate intensity physical activity on most days of the week in a way uniquely adapted to each person's lifestyle.

"Research is showing that the amount of activity necessary to improve one's health is not as much as we used to believe," Warms said, "and three 10-minute sessions or bursts of activity worked into the course of a day may have the same positive health impact as longer sessions." Another benefit to the short bursts approach is that people are more likely to stick with it. "Some people think of it as building inefficiencies into their day," Warms said, "like walking instead of taking the bus, parking farther away, or working in the garden for an hour instead of watching TV."

Planning a lifestyle activity program is highly individual and requires each person to take stock of his or her current activity level and lifestyle. Warms suggested that people begin by identifying long periods of inactivity in the typical day and think about how it might be broken up. A good general guideline is to ask, What can I do now? Whatever that is, begin by doing it three to four times a week and then plan to increase by 10% to 20% each week. Warms urges people to choose things that are enjoyable and require no new equipment. She also suggested starting with activities that feel safe and comfortable, building gradually to more difficult activities as strength and stamina permit, and keeping track of progress. Comfortable clothing, companionship, and a reward system can also help.

"Becoming a little more active will help you have the energy, strength and stamina to continue increasing your activity," Warms said. "The opposite of the cycle of deconditioning is also true: the more you do, the more you can do."

Resources for Increasing Physical Activity

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(See also Body Image and Wellness - Part 2 , which took place on February 13, 2001)