Am J Cardiol concern-trolling: “But mobility aids will stop them EXERCISING!”

So I stumble across this at Mobility Scooters Can Increase Your Risk of Developing Daibetes and Heart Disease

“O really?”, thought I, “I wonder how well-controlled that scoldy little piece of disability panic was?” So I read on.

However, recent research suggests that mobility scooters can do more harm than good by heightening the risk of diabetes and heart disease .

“More harm than good?”, thought I, “I wonder who measured that? How did they decide which effects outweighed which in the goodness vs. badness stakes?” So I read on.

Astonishingly, a study of scooter users in the U.S.A discovered that almost one in five developed diabetes after buying one to get around.

“Huh”, though I. “One in five, eh? Hm, that doesn’t sound all that different from the baseline prevalence in the population, let alone the older/ill/disabled population.” So I read on.

The research, published in the American Journal of Cardiology, highlights how multiple benefits to patients’ health from being able to get around more easily are being erased by the effects on the cardiovascular system.

“Erased?”, thought I. “Completely wiped out? Huh. Was it the people concerned who decided this, or someone else?” So I read on.

Researchers are urging doctors to consider the risks of scooter use before making recommendations to patients invest in a scooter.

“*Doubletake*”, thought I. “Doctors should consider the risks? Doctors? Not, say, people with disabilities? Just doctors? Doctors should weigh up the risks before offering any options at all? Doctors should decide?” So I read on.

[…] There have even been incidents when scooters have killed individuals.


Moving on.

They recruited 102 patients, with an average age of 68, who had obtained medical approval for a scooter and monitored their health over six years. Even though patients stated that they felt better physically and mentally, tests demonstrated that 18.7 per cent developed diabetes during the follow-up period.

“Erm”, thought I, “Right then. Sure enough, it was an older population- nearly seventy years old on average. The prevalence of diabetes in the population older than 60 in the USA is 23.1%, and that’s not people who are already ill and have other risk factors. That’s not really a surprising number.”

“I wonder,” thought I, “I wonder how that control group did, the age- and disability-matched control group, the one who didn’t get scooters at the same time?”


Yeah, there wasn’t one. No control group.

Just a group of elderly people with cardiac failure, neurologic disease, disabling arthritis, and chronic lung disease. Just a group of people with disabilities trying to eke out a life and getting used as a Lesson To All Of Us about the dangers of sloth.

The abstract is here, in the American Journal of Cardiology. Effect of Motorized Scooters on Quality of Life and Cardiovascular Risk, Brian W Zagol and Richard A. Krasuski, Volume 105, Issue 5, Pages 672-676 (1 March 2010).

This sterling little doctor-centric chastisement does contain one really useful piece of information:

[…] significant physical and psychological improvements in all quality-of-life categories (p <0.001) [...]

I’ll say that again, ‘cos they buried the lead. After getting a scooter, people experienced:

[…] significant physical and psychological improvements in all quality-of-life categories (p <0.001) [...]

But the authors decided to slap a big ol’ “DESPITE” before this statement about how the lives of people with disabilities were improved by appropriate mobility aids, and instead go on to list the way several laboratory parameters became “worse” over time in this group of ill elderly people. In a study with NO. CONTROL. GROUP.

We have absolutely no idea how these laboratory parameters would have fared had the people concerned not obtained mobility scooters. All we know is that their quality of life improved significantly in all domains.

What the study fails to recognise – among other things – is that the alternative to getting about on mobility aids isn’t a day of jaunty strolling; it’s immobility. The alternative to going out sitting on a scooter isn’t a doubles tennis match and a brisk swim followed by a bootscooting class; it’s sitting at home.

But the quality of life of PWD, the lack of alternatives, is dismissed by these concerned medicos as a relatively trivial aside; as just one factor for doctors to consider before deciding whether to withhold their blessing – and their financial rubber-stamp – to mobility aids:

In conclusion, interventions, such as scooters, that improve self-perceived quality of life, can have detrimental long-term effects by increasing cardiovascular risk, particularly insulin resistance. Physicians should carefully weigh such risks before approving their use, as well as ensure healthy levels of activity afterward.

Dudes. Newsflash. You’re not the ones who should be carefully weighing this hypothetical “risk”. We are. And you sitting there planning to deliberately withhold mobility aid funding to the poorest people in the population because you think they might – not will, only might – see their blood glucose tweak a few points? Not ok.

You don’t get to dismiss the importance our self-perceived quality of life (“self-perceived”? Who do you think is the best person to assess our quality of life? You?) with a parenthetical “Despite”. What is important to us is important to us; you don’t get to override that with your misinformed concern-trolling. You don’t get to decide on your own, then inform us what’s important in our lives. You don’t get to exclude us from the conversation. You don’t get to tell us which risks are worth taking.

You don’t have the moral right to immobilise us based on your imposition of your own value system on our lives. You wouldn’t even have that right if this was good research. When it’s fucked-up hand-waving? Put the journal down, and start seeing real people. The people right in front of you, who are looking for independence, the ability to shop, the ability to socialise, the ability to go to the fucking doctor, the choice to have a better life. The life you’re planning to say “no” to.

18 thoughts on “Am J Cardiol concern-trolling: “But mobility aids will stop them EXERCISING!”

  1. OMG, go disability shame, presumably TAB doctors! And of course strip the autonomy away from disabled, older people! Ableist and ageist epic fail.

  2. Subtext: scooters aren’t used by disabled people, they’re used by lazy fat [non-disabled] people.

    Nice analysis!

  3. Do they print letters? Perhaps highlighting the lack of control group and the logic fail would do some good. Or do you have to be in the hierarchy before you’re allowed to point out the obvious?
    .-= Susan´s last blog ..Dear BBC, =-.

  4. My jaw is dropped.

    Seriously? I’ve seen how much people’s quality of life improves when getting a scooter. People who suddenly are able to get around and see their friends and family and participate in their community a lot more — they happier! They get to spend time with people!

    Arg! This makes me so angry.

  5. This makes me furious. My scooter is the best thing that’s happened to me since becoming ill.

    Suddenly going shopping, going to the cinema and going into uni more than once a day were things I could do and I no longer had to be in awful pain and exhaustion or worry about my muscles suddenly giving out and causing me to fall over in the middle of the street. The thought that someone could be deprived of that through medical arrogance is fury inducing. I never consulted with my doctor before getting the scooter and I don’t see why it’s their business what decisions people make to deal with disability.

    Thanks lauredhel for the great take down.

  6. just…gah.

    Of course, us TAB types have to get carefully-considered doctor’s approval before we’re allowed to buy a car or a public transit pass rather than walking or biking everywhere. So it only makes sense that doctors would apply the same restrictions to scooters.

  7. Complete and utter study FAIL*. Just FAIL FAIL FAIL.

    (capslock is shorthand for rage)

    I… I can’t even think what to say, except word. To everything you’ve written.

    *I’m in the medical study field myself, and that study? Absolutely worthless. The statistical outcome that they report themselves is no different (actually, slightly less, but the group studied is too small to extrapolate anything significant from the lower incidence) from the general population, and they completely fail to account for the bias inherent in confusing correlation for causation (as in, the people that developed diabetes would have developed it anyway, scooter or no, which is what the control group is for).

    It’s so feccking puritanical, this advocation of denial – “You have sinned against normalcy! No scooter for you!” – and the disgusting trope of a patient can’t decide for themselves what risks to take, so the doctor needs to do it for them? AAAaaaaaarrrrggggggh.

  8. Hi everyone – just wanted to thank you for making my comment holiday worth returning from!

    (I have nothing to add, I just love saying “(capslock is shorthand for rage)”.)

  9. “(I have nothing to add, I just love saying “(capslock is shorthand for rage)”.)”

    Hee! 🙂 It truly is a great takedown of that article and study of TAB fail.

  10. I don’t think the study is successful in terms of number of actual respondents, but I do think this is important: “The possible adverse effects of regular motorized scooter use, recently popularized for patients with physical limitations, has not been previously examined.” I think possible adverse effects should always be examined. Also, the conclusions these authors arrive at are not policy; they are just their own conclusions. I don’t think it’s unreasonable for cardiologists who have patients using scooters to talk with their patients about what effect these can have on their cardiovascular health. Ultimately it is always the patient’s choice to buy or not buy one.

    A close relation of mine (almost 80) wanted a scooter very badly. This prospect made our family very anxious. Her history of cerebrovascular events had damaged her memory, decision making ability and reaction time. Any concerns we raised she dismissed as us trying to control her or restrict her freedom. It’s true a scooter would have allowed her more independence, which we certainly wanted her to have. But they are not a good idea for everyone, and some research into what characteristics make a good candidate would probably be useful.

  11. This reminded me of the common practice of denying autistic children the means of seeking what they need for themselves in the name of “forcing them to learn to speak.”

    Or maybe denying Deaf children sign language because it might allow them an alternative to oralism and thus “make them less verbal.”

    Or back to autism again: how about forcing children who can’t communicate vocally to communicate vocally rather than though an AAC device or with sign?

    You know, you don’t even need to restrict this to disability at all. I’m a transsexual woman who’s hormone therapies have made all the difference in my quality of life. My doctor, on the other hand, believed that the hormones might have been linked to a small change in my blood glucose levels and threatened to deny me my medications because they MIGHT cause me to develop diabetes. Of course, the decision of whether or not this was an acceptable risk, or even an acceptable trade-off, wasn’t left up to me, it was left up to a doctor to decide what was best for my life. (ps: I fired this doctor)

  12. Thank you for this. It needed to be done and said. Publishing bad research isn’t just an academic embarrassment or a waste of paper; PUBLISHING BAD RESEARCH HURTS PEOPLE.

  13. What the everlovin’ fuck? You can’t have a scooter, even though the study shows that this will make you feel happier about life, because then you’ll just…die?

    My reading comprehension is usually spot-on, but this study has made me doubt my own bloody mind. GAH, FAIL.

  14. Funny. I am fighting this right now for a wheelchair. I am crawling through my house most of the time to get to the bathroom, if my caregiver isn’t here (and she has three whole hours here for five days a week) I can’t eat or get a drink without CRAWLING. So I don’t eat a lot. This is a big risk for diabetes…

    I had a scooter but it is busted, again. The insurance has denied me three times in three weeks for a wheelchair, which would fit my actual needs. I can’t get to the doctor. I can’t go out. The concern is I won’t move enough. If I could get OUT OF MY DAMNED HOUSE I would go swim, the only exercise that I am allowed by… my… DOCTORS.

    *slathering rage here and all over the above*

  15. @Kateryna Fury – OMG, I am so sorry. That is horrible and wrong, but come on, if you got the scooter, you’d just be even lazier than you are now. “I can’t physically walk” is really just an excuse! /bitter sarcasm (My mom tells me to lessen my pain by walking, when I have had episodes that have left me curled up on the floor gasping for breath because I dared walk 5 feet.)

    I hope this changes soon!

    I had a side effect to a thyroid drug that made it painful to walk (my ankle joints hurt) and I got around on my butt. My mom was horrified, and it was less fun everywhere but the stairs, where we already did that. Thankfully, that was solved with a medication change.

    Best of luck Kateryna!

  16. Yeah, I did some fun math, and the cost of the wheelchair I need is 10,000 or less depending on the where. I think it will be closer to 7000. My average annual cost of preventable ER visits is around 50,000. Those are only the visits caused by a lack of chair.

    With women especially there is a general conception that we just are being weak etc. I don’t care where it came from, it kills people daily.

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