Significance of exercise: Effects of participation in the National Veterans Wheelchair Games and Winter Sports Clinic

Michelle L. Sporner, BS; Shirley G. Fitzgerald, PhD1,2; Rory A. Cooper, PhD1,2; Emily Teodorski, BS; Brad E. Dicianno, M.D.1,3; Diane M. Collins, PhD, OTR/L1,2; Paul F. Pasquina, M.D.4
1 Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA;
2 Department of Rehabilitation Science and Technology, University of Pittsburgh;
3 Department of Physical Medicine and Rehabilitation, University of Pittsburgh;
4 Walter Reed Army Medical Center, Bethesda, MD


Many veterans currently serving in Iraq are returning home with injuries that may have been fatal in the past.  Studies have shown that acquiring a disability may have a negative impact on psychosocial well-being and quality of life.  Research has also shown significant physiological and psychological benefits from the participation of recreational sporting activities.  Self-esteem and quality of life data from 132 individuals who participated in the National Veterans Wheelchair Games or Winter Sports Clinic were collected.  After controlling for age and disability years, no significant differences between new and existing participants were found in psychosocial well-being or quality of life.  Despite these findings, participation in events such as these may still provide psychosocial benefits to veterans.


Veterans, disability, exercise, sports, participation, self-esteem


Improvements in technology and medical procedures have increased the number of people surviving from similar injuries that in the past would have been fatal (1).  These medical advances have significantly impacted the number of soldiers currently serving in the war in Iraq who return home with amputations, spinal cord injuries, traumatic brain injuries and blast injuries.  Research has shown that as a result of disability, psychosocial effects may occur (2). 

Research has also shown that participation in exercise can have positive psychological benefits such as reduced stress levels and increases mood and well-being when exercising with others (3).  Wetterhahn, Hanson, and Levy (2002) examined the differences between minimally active and active individuals with lower limb amputations.  Significant differences between the groups were seen in outcome measures of appearance assessment, fitness evaluation, and fitness orientation (as measured by the Multidimensional Body–Self Relations Questionnaire).  These findings link the benefits of exercise in individuals with amputations, citing increase in body image as a benefit (4).  As a result, participation in the National Veteran Wheelchair Games or the Winter Sports Clinic (hereafter known collectively as ‘Games’) may help increase self-esteem and quality of life for veterans. It is hypothesized that veterans who have participated in the Games longer will have higher psychosocial measures than veterans who are new participants.



While at the Games, individuals who participated were asked to enroll.  Each subject completed demographic (age, disability, years since injury or diagnosis, gender, race) and community participation surveys along with questions focused on participation in recreational physical activity, training issues within sports participation and mobility issues.  Although many variables were collected, this paper focuses only on psychosocial outcome measures as a result of participation in recreation activity.  We divided individuals based on new participation, defined as less than or equal to one year of participation in the Games and existing participation, defined as individuals who have participated for greater than one year.  Distribution of years participating in the Games yielded a mode of one and as a result was selected as the dividing point for new and on-going participants.  Psychosocial measures include self-esteem and perceived quality of life as measured by the Rosenberg Self-Esteem Scale (5) and the World Health Organization-Quality of Life-BREF (WHOQOL) (6).  For the purpose of this study, only Domains 1 and 4 of the WHOQOL were used.  Domain 1 refers to physical health such as activities of daily living, mobility, and pain and discomfort, while Domain 4 reflects the environment including accessibility, transportation, and participation in and opportunities for recreation (6).


Inclusion criteria included individuals who were 18 years of age or older and defined themselves as having a physical disability or visual impairment, or who use an assistive technology device, such as a wheelchair, visual aid, or prosthesis, for mobility or to assist with activities of daily living. 

Data Analysis

All data were examined for normality and missing data.  Appropriate statistical analyses were then used as needed.  Demographic information was described for missing or skewed data using means and standard deviations for continuous variables (e.g., age and years since diagnosis or injury) and frequencies and percentages for categorical variables (e.g., disability type, gender, and race).  Race was dichotomized prior to data analyses as white or non-white and participation was classified as new or existing participation.

Univariate statistics (chi-square, t-test) were used to determine comparability of new and on-going participants.  Independent t-tests were used for data that were normally distributed and Mann-Whitney for data that were not normally distributed.  SPSSv14.0 was used for all analyses and statistical significance was set at p< 0.05 a priori.


One hundred and thirty two individuals at the Games participated in data collection with 52 new and 80 existing individuals.  Mean age of participants was 47.4+13.4 years and time since injury or diagnosis at 13.4+12.1 years.  Eighty-seven percent of the participants were male and 67% were Caucasian.  Existing participants were significantly older (p=0.004) and had higher years of disability (p=0.001) than new participants at the Games.  These differences were controlled for in subsequent analyses.

Table 1: Demographic data



New Participation at the Games(n=52)

On-going Participation at the Games (n=80)

Mean Age (std. dev)*
47.4 (13.4)
43.0 (14.8)
50.2 (11.6)
Mean Disability years (std. dev)*
13.4 (12.1)
7.4 (9.5)
17.0 (12.1)
% Men (n)
87.1 (115)
88.5 (46)
86.3 (69)
% White
66.7 (88)
67.3 (35)
66.3 (53)
Number of total sports*
2.8 (2.1)
1.9 (1.6)
3.4 (2.2)

Significant differences were found between individuals with new and on-going participation at the Games in physical health and environment of the WHOQOL questionnaire as well as total quality of life score.  However, when controlling for differences in age and disability years, significant differences were no longer found.  No significant differences were found in self-esteem.

Table 2: Quality of Life Measures



New Participation at the Games (n=52)

On-going Participation at the Games (n=80)






34.3 (5.5)
34.2 (4.4)
34.4 (6.1)

Quality of Life
- Physical health

14.2 (2.7)
15.4 (2.6)
63.6 (9.1)
13.5 (2.9)
14.7 (2.7)
60.6 (9.3)
14.7 (2.4)
15.8 (2.4)
65.5 (8.5)
1. Uncontrolled
2. Controlling for age and disability years


As people age, they become susceptible to a wide array of diseases and disorders.  Some of the conditions that frequently affect the elderly include cancer, cardiovascular disease, cerebrovascular or neurological conditions, dermatologic issues, vision impairments, and respiratory problems (7).  Research has shown that as the prevalence of these diseases and disorders increase, perceived quality of life decreases (7).   It has also been shown that participation in recreational activities and sporting events increases well being (3-4).  In this sample population, one group is significantly older.  When this difference was controlled for in our analyses, quality of life was not impacted by participation in the Games.  As a result, longer participation at the Games does not necessarily mean higher quality of life.  In our sample population, quality of life is a function of age and disability years.

Similarities in self-esteem scores may be a result of the population attending the Games.  This group of people may already be motivated because they are traveling across the country to participate.  In addition, for many of the individuals who are new participants, the Games represented the first trip an individual had taken since their injury.  As a result, these veterans may be experiencing an emotional high from their participation in the games.

There are a few limitations to this study.  First, there is a lack of an appropriate control group.  The population represented in this study is biased as they are willing to travel across the country to participate in the Games and research.  In addition, a few of the individuals who appeared at the Games for the first time completed the questionnaire before competing in any events.  Although they may have had higher psychosocial measures as a result of their emotional high from traveling to the Games, the benefits of their participation in recreational activities may not have been recorded.  Although significant differences were not found, participation in the Games may provide some psychosocial benefits to veterans.


This study was supported by The Telemedicine and Advanced Technology Research Center under Proposal Number 06053001, HSRRB Log Number A-13839.  

Michelle Sporner,
Human Engineering Research Labs,
VA Pittsburgh Healthcare System,
Pittsburgh, PA 15206,
Phone: (412) 365- 4944,
Fax: (412) 365-4858,


  1. Okie, S. (2005). Traumatic brain injury in the war zone. New England Journal of Medicine, 352, 2043   2047.
  2. Watanabe, Y., McCluskie, P.J.A., Hakim, E., Asami, T., Watanabe, H. (1999). Lower limb amputee patients’ satisfaction with information and rehabilitation. International Journal of Rehabilitation and Research, 22, 67-69.
  3. Plante, T. G., Coscarelli, L., Ford, M. (2001). Does exercising with another enhance the stress-reducing benefits of exercise? International Journal of Stress Management, 8, 201-213.
  4. Wetterhahn, K.A., Hanson, C., Levy, C.E. (2002). Effect of participation in physical activity on body image of amputees. American Journal of Physical Medicine and Rehabilitation, 81(3), 194-201.
  5. Rosenberg M. (1965). Society and the Adolescent Self-image. Princeton, NJ: Princeton Univ. Press.
  6. World Health Organization (1993). WHOQoL Study Protocol. WHO (MNH7PSF/93.9).
  7. Sprangers, M.A.G., de Regt, E.B., Andries, F., van Agt, H.M.E., Bijl, R.V., de Boer, J.B., et al. (2000). Which chronic conditions are associated with better or poorer quality of life? Journal of Clinical Epidemiology, 53, 895-907.


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