Physical activity and inmate health.

A few months ago, I was asked to visit a correctional facility in Shelby, Mont., to assess a situation: A group of inmates was not taking advantage of recreation time, and administration officials were concerned that there may be some adverse effects related to their sedentary lifestyles. This article will focus on two issues: the effects of physical activity on health and disease, and the general recommendations from the American College of Sports Medicine (ACSM) on physical activity for prevention of chronic disease.

Physical Activity And Health

The relationship between physical activity and health is clear. The surgeon general's report, Physical Activity and Health, states that higher levels of regular physical activity are associated with lower death rates (U.S. Department of Health and Human Services, 1996). Even those who only participate in moderately intense activities have lower mortality rates than those who are less active. This is true of the general public and inmates alike. Many experts have concluded that medical science has done all it can for chronic lifestyle-related disorders and that additional expenditures for health care will not produce further financial benefits that could be achieved if every American improved his or her health simply by becoming more physically active (Gibbons and Stoedefalke, 1995).

The report also states that there is a favorable relationship between exercise and cardiovascular health. Cardiovascular diseases are the leading cause of death in American society. Unfortunately, 78 percent of the population is completely sedentary or inadequately active (Paffenbarger, 1995). Inadequately active implies that the individual may be getting some exercise, but not enough to affect morbidity or mortality rates. Additionally, exercise has a positive effect on other significant health issues prevalent in society and prison systems. Research shows that regular physical activity is associated with a decreased risk of colon cancer, noninsulin-dependent diabetes mellitus, osteoarthritis, osteoporosis and obesity. These are important statements when considering that the prison system must pay for inmate health care during their incarceration. In fact, recent research suggests that exercise programs for elderly inmates may have a positive effect on the number of infirmary visits, which may have a long-term effect on inmate health care costs.

Further, the report states that physical activity may relieve symptoms of depression and anxiety -- an important consideration for prison officials. If exercise improves mood, as the report suggests, then there may be less inmate violence toward other inmates or staff.

In light of these published facts, health promotion programs have become more visible in American society. These kinds of programs have long been heralded as powerful forces to promote overall well-being and vigor to the general population, and they also should be considered to promote health within the nation's prisons. For example, Smyer, Gragert and Lamere suggested that interventions with elderly inmates could include measures to enhance environmental factors related to security and safety needs, attention to acute and chronic illness behaviors and emphasis on wellness and preventive care (1996).

Chronic lifestyle-related diseases are the leading cause of death in the United States (Nieman, 1996), and leading a sedentary lifestyle is considered a risk factor for the development of many of these diseases as well. Physical activity can produce desirable physiological effects that are protective in nature against these chronic diseases (ACSM, 2000). This is true for inmates as well as society.

Recommendations

In light of these relationships, prison administration and staff should encourage healthy inmate behavior. This especially is true for older inmates who may have less of an opportunity during open gym times to participate in healthy activities due to younger inmates monopolizing the equipment. ACSM has established guidelines for promoting health through physical activity for cardiorespiratory and musculoskeletal components of fitness (2000). For cardiorespiratory fitness, ACSM recommends activities that can be sustained for a prolonged period of time, including walking, jogging, stationary cycling and jumping rope. Inmates should have the opportunity to participate in these activities three to five days per week for 20 to 60 minutes per session. Their exercise intensity could be self-monitored and should be anywhere between 55 percent and 90 percent of their maximum heart rate. To estimate maximum heart rate, subtract the inmate's age from 220. Multiply this -- the age-predicted maximum heart rate -- by 55 percent and 90 percent to calculate the lower and upper limits of the target heart rate. (See below.)

For musculoskeletal fitness, ACSM recommends performing eight to 10 separate exercises that train the major muscle groups. A major goal should be to develop the body in a balanced manner, rather than just exercising the chest and arms, as many inmates do. Performing one set of eight to 12 repetitions to the point of volitional fatigue, two to three days per week is effective in developing musculoskeletal fitness. Prison administrators and staff should ensure that every inmate has the opportunity to participate in musculoskeletal fitness-developing activities. These activities are of special benefit to older inmates.

Musculoskeletal flexibility often is ignored. Lack of flexibility in the lower back and posterior thigh regions may be associated with an increased risk for development of chronic lower back pain. Therefore, activities that promote flexibility in these regions should be encouraged. ACSM recommends participation in a general stretching routine that focuses on the major muscle groups a minimum of two to three days per week. Each stretch should be held for 10 to 30 seconds and should be repeated three to four times.

These are the basic guidelines to follow when considering whether inmates are receiving opportunities to improve their health. Prison administrators should ask questions related to these guidelines, such as do inmates have:

* Enough time to elevate their heart rates for a cardiorespiratory training benefit?

* Enough space to safely participate in activities that will improve cardiorespiratory endurance?

* Access to a facility that allows for the development of muscular strength, endurance and flexibility? If they do not, are there staff who can educate inmates on how to develop musculoskeletal fitness without the use of machines and/or free weights?

Safety Considerations

Prior to implementing exercise recommendations, it is important to ensure participant safety. Medical clearance and follow-up, including exercise testing, may be necessary. Prison administrators may consider hiring staff with exercise physiology and/or physical education backgrounds, or training staff in these areas to help promote participant education. Staff should encourage any inmate beginning an exercise program to start with mild to moderate exercise intensities. Also, emphasizing appropriate warm-up and cool-down procedures that incorporate stretching is vital.

There are other safety concerns to be aware of. The National Correctional Recreation Association (NCRA) believes that weight lifting is part of a comprehensive rehabilitation program that provides opportunities for inmates to improve psychologically and emotionally, as well as physically. NCRA concedes, however, that there are some negative issues concerning weight lifting in prisons (2000) including:

* Inmates may use their improved size and strength as a weapon against correctional officers, other inmates or the public upon release;

* Correctional officers are intimidated by massive inmates;

* Many citizens do not want their tax money being used to provide gyms and new weight rooms for offenders;

* Equipment, which is expensive to purchase and maintain, could be used as weapons or as tools to escape;

* Inmates could be injured while weight lifting, which would cost taxpayers money;

* The popular notions that there should not be better weight rooms in prisons than in schools, that it is time to get tough on offenders, and that prison is not supposed to be a nice place to spend time; and

* Weight lifting could lead to the use of illegal steroids and association with those who sell them and other illegal drags after release.

However, NCRA also offers some important points in support of weight lifting programs in prison (2000):

* Weight lifting privileges can be used as a behavioral tool;

* Weight lifting teaches discipline, record-keeping and goal-setting; it fills time, reduces boredom, bums off tension and improves self-esteem;

* Weight training may reduce health costs, especially in aging populations;

* Weight training can keep a large number of inmates busy at once. Inmates require less supervision when participating in constructive open yard recreational activities than in many other situations;

* Inmates preparing for a competition will rarely get involved in prohibited activities because they do not want to lose weight lifting privileges;

* Well-conditioned inmates are more employable upon release; and

* Most crimes occur during leisure time. Inmates who fill their leisure time with recreational activities such as weight training, and continue to do so upon release, are less likely to return.

Nonetheless, it is important to note that there are effective methods, such as body weight training exercises and calisthenics, for developing musculoskeletal fitness without the use of expensive machines or free weights.

Motivation

As in society, most inmates have the opportunity to exercise but are not motivated to do so or are unaware of what to do. This can be addressed by implementing educational components into the prison orientation program that include modules such as why exercise is important physically and mentally, and why and how to exercise for cardiorespiratory efficiency and musculoskeletal fitness. If inmates, like the general public, are educated about why they should be exercising, then maybe more of them will be motivated to begin and continue an exercise program that may have positive effects on their health.

There are many reasons prison administrators and staff should provide the opportunity for and encouragement to inmates to participate in healthy activities. The surgeon general's report is very clear about the benefits of regular physical activity and ACSM's recommendations are straightforward and easy to understand. Educating inmates may be the key to motivating them to increase their physical activity and possibly create a healthier atmosphere overall.

Table 1: Calculating
Target Heart Rate

220-50 (age) = 170
170 x .55    = 93.5
170 x .90    = 153

REFERENCES

Amtmann, John A. 2000. Case study of a service learning partnership. Unpublished doctoral dissertation. University of Montana.

American College of Sports Medicine. 2000. National Correctional Recreation Association. ACSM's guidelines for exercise testing and prescription. Philadelphia: Lippincott, Williams and Wilkins.

Gibbons, Larry and Karl Stoedefalke. 1995. Exercise is medicine. In The fitness handbook, eds. J. Peterson and C. Bryant, 13. Champaign, Ill.: Sagamore Publishing.

National Correctional Recreation Association. 2000. NCRA position statement on weight lifting programs in correctional settings [Online]. Available: www.strengthtech.com/correct/ ncra/ncra.htm#position.

Nieman, D.C. 1996. The sports medicine fitness course. Palo Alto, Calif.: Bull Publishing.

Paffenbarger, Ralph. 1995. Physical activity, physical fitness and health: An overview. In The Fitness Handbook, J. Peterson and C. Bryant, 1. Champaign, Ill.: Sagamore Publishing.

Smyer, T., M. Gragert and S. Lamere. 1996. Stay safe! Stay healthy! Surviving old age in prison. Unpublished manuscript.

United States Department of Health and Human Services. 1996. Physical activity and health: A report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion.

John Amtmann, Ed.D., is an associate professor of applied health and head of the Safety, Health and Industrial Hygiene Department at Montana Tech of the University of Montana in Butte.