Physical Activity in Prison The effects that prison incarceration has on the health and well-being of inmates are multi-faceted and complex. The prison environment presents stressors not experienced outside of the prison context that can bring about exacerbated health problems and psychological difficulties. Health care delivery in prisons is an important issue, as primary healthcare initiatives designed to focus on disease prevention are required in order to maintain health in the prison population that is comparable to the outside world. An important component for many primary health programs is a physical exercise regimen. The following discussion outlines the issue of including organized physical activity as a component to prison programming, examining its many benefits and suggestions are made with regard to how exercise programs within prisons could be improved upon in order to best serve the health and well-being of prisoners and contribute to inmate rehabilitation.

Prisoners' rights to physical activity in prison

Since prisoners are not a visible demographic to the general population, the health and well-being of this group is not often reflected upon in typical healthcare considerations. Little is known about the health conditions and needs for healthcare within prison because in the United States, inmates are not included in national health surveys that assess the prevalence of chronic diseases (Binswanger et al., 2009). Health care in prisons, especially primary care focused on the prevention of disease is very important from both human rights and public health perspectives (Elger, 2011). Primary care efforts are designed in order to provide individuals with information and tools in order to best choose behaviors that are conducive to optimal health. Physical exercise programs are an important part of primary care due to the powerful effects exercise has on the prevention and treatment of many ailments. It has been determined by the European Court of Human Rights that it is inhumane and degrading for prisoners to receive insufficient healthcare in relation to the general population (Elger, 2011). Furthermore, depriving prisoners of valuable physical activity programming targeted at improving health outcomes would be considered in violation to the European convention on Human Rights. However, although denying health promotional activities to inmates is considered to be inhumane, most countries do not place the protection of prisoners' right to adequate health care as a high priority (Elger, 2011).

It has been demonstrated through research that there exist dramatic health inequalities for inmates in correctional institutions, especially in regard to exercise and nutrition (Agozino & Volpe, 2009). Furthermore, inmates do not have access to the same level of primary preventive healthcare with regard to exercise and diet in comparison to the community. The researchers looked at the exercise and diet practices of inmates and compared them to those of the community. Findings indicated that poor diet and exercise lifestyle factors among inmates correlated with increased frequency of obesity, type 2 diabetes, and hypertension among both populations (Agozino & Volpe, 2009). This provides evidence indicating a crucial need for more effective primary healthcare in prisons that includes a physical activity component.

Why is it important that prisoners have access to physical activity programs in prison? There are several reasons why importance should be place on initiating and implementing exercise programs in prison that affect not only the prisoner, but also the staff within the prison context, as well as society at large. How is it possible for this type of programming to have a ripple effect outwards that impacts all of society? Physical activity positively impacts the physical, mental, and emotional health of individuals. Improved well-being among inmates in these respects may contribute to less demands placed on the staff in the prison. Furthermore, physical activity may contribute to more effective rehabilitation of inmates, which may result in inmates transitioning more successfully back into society upon their release from prison.

Essentially, prisoners have a right to health just as much as any member of the general population. However, the health care available to prisoners in the United States often falls below standards that would be considered as acceptable (Exworthy et al., 2012). Improvements have been made in regards to health services offered to inmates, but the demand for quality services is growing at a rate too fast for services to keep up to, due to growing numbers of inmates and the fact that prisoners present with needs that are often more numerous ad complex than those of individuals in the general population (Exworthy et al., 2012). Health care services and programs in prisons need to be improved in order to address the many and complex needs of inmates, and the inclusion of physical exercise components as a part of this care could significantly...

A framework promoting equivalence in healthcare for inmates was proposed by Exworthy et al. (2012). This framework promoted healthcare for prisoners that is available, accessible, acceptable, and demonstrating high quality, represented by the acronym AAAQ. In regards to physical activity programming, its inclusion in healthcare services could also be promoted through this type of framework. The authors suggested that the AAAQ framework would result in healthcare that meets more acceptable standards for the inmate population (Exworthy et al., 2012).
Physical activity as an important component to primary healthcare

Exercise is an important and effective component to the prevention of many illnesses, and furthermore may be useful as a part of primary care programs for health promotion in prisons. The effectiveness of the promotion of exercise based in primary healthcare was investigated by Orrow et al. (2012). These researchers explored whether physical activity promotion delivered as part of primary care was effective in developing into sustained effects on fitness with sedentary adults. The results of the study indicated that exercise promotion as a part of primary care was effective at increasing the physical activity levels of sedentary adults 12 months after intervention thus also sustaining the beneficial effects resulting from the regular exercise including disease prevention, weight control, and stress relief (Orrow et al., 2012). Based on these findings it may be suggested that inmates also would respond similarly to physical activity as a component of primary care, with sedentary inmates especially benefiting from the intervention.

Health conditions among inmates that would benefit from exercise interventions

Healthcare personnel in prisons are continually implementing programming aimed at health promotion for inmates (Condon et al., 2007). It is important to have a comprehensive understanding of the specific healthcare needs present among the inmate population. Condon et al. (2007) conducted a study in which they provided an overview of literature pertaining to the needs of prisoners with regard to primary healthcare. The results of this study indicated that with regard to the areas of general health needs demonstrated by the prisoners, chronic disease management, and health promotion, the inmate population exhibited greater health needs than that shown by the community at large (Condon et al., 2007). Furthermore, these demanding health needs necessitate a greater demand for effective primary healthcare, which may often be insufficient in the prison setting (Condon et al., 2007). The researchers concluded that future research must explore aspects pertaining to primary care nursing in the prison context that effectively address the healthcare needs of inmates (Condon et al., 2007). Physical activity as a component to this primary care should be investigated as a potential enhancement for the healthcare provided to inmates.

The healthcare needs of prisoners were also explored through a review conducted by Watson et al. (2004). The researchers recognized that the ever-increasing population of inmates in prison are presenting with considerable health conditions and issues necessitating primary and treatment interventions. Also, it was described how the main aims and objectives of prisons, which are punishment, correction, and community rehabilitation may be at odds with healthcare goals (Watson et al., 2004). It was also suggested by these researchers that one of the main desirable aims of healthcare within prisons is health promotion as a part of primary care, which would include the development and implementation of physical activity programs. Furthermore it was emphasized that effective health care for prisoners is highly dependent on cooperative partnerships between prison services and health services (Condon et al., 2007). Therefore effective exercise programming for inmates would require collaboration with professionals, such as exercise physiologists, who could develop the most effective exercise programs as part of primary care that would most effectively improve health outcomes for inmates.

How healthy are inmates in general? Research has indicated that prisoners present higher incidences of physical and psychological issues and disorders in comparison to the general population (Voller et al., 2011). The health conditions exhibited by inmates may be due to various lifestyle and behavioral factors. Voller et al. (2011) showed that a vastly greater proportion of inmates smoke tobacco than the general population, with 70.6% of prisoners and only 33.6% of the general population smoking cigarettes. Common health conditions experienced by the inmates included digestive disorders, parasitic conditions, pathologies of the teeth and oral cavity, diseases of the bones and connective tissues, circulatory disorders, conditions affective the endocrine and metabolic systems including diabetes, heart disease,…