A study on the physical activity levels of people with alopecia areata (AA) found that nearly 82% of participants did not meet the physical activity guidelines recommended by the World Health Organisation (WHO). In addition to that startling figure, participants who did not meet those guidelines and who had more than 50% hair loss on their scalp were more likely to report depression, anxiety, and stress.

While there are much research done on how to increase physical activity levels among the general population, however, there are no research was done on the AA population.

A study was done by Yamuna Rajoo et al., to understand the barriers and enablers to physical activity to fill in that gap. The authors developed a model that can be used to inform future physical activity directions. 

The model shows that an individual with AA moves along four phases of the path to accept their condition. At each phase, some behaviours and emotions act as barriers or enablers to physical activity participation. 

The 4 phases are:

Phase 1:  Onset of AA (Mainly hair loss due to AA) 

Phase 2: Reaction towards the condition

Phase 3: Adjustment

Phase 4: Acceptance

Phase 1 and 2 

Phases 1 and 2 of the process of accepting AA are closely connected. An individual in phase 1 has recognized their hair loss and received a diagnosis. Upon receiving the diagnosis, the individual moves into phase 2. In the second phase, participants of the study spoke about the physical, psychological, and emotional changes that occurred after finding out they have AA. These changes were characterised by psychological distress, which represents the first barrier to physical activity experienced by individuals with AA. Participants in phase 2 described a psychological and emotional state characterized by symptoms of depression, anxiety, and stress. This psychological distress is the first barrier to physical activity in people with AA. Emotions of depression, anxiety, and stress manifested as shyness, embarrassment, and self-consciousness when considering participation in physical activity.

Phase 3

Phase 3 of the process is the adjustment. The authors identify three barriers to physical activity in this phase: physical, environmental, and psychosocial. There were also two enablers to physical activity

identified in this phase. The first barrier to participation in phase 3 was physical. This barrier has to do with the visible physical difference of hair loss and often involves wearing a wig. Participants described avoiding physical activity due to concerns about the noticeability of the wig, having to remove the wig to participate, and a feeling that removing the wig would cause others discomfort. The second barrier to physical activity participation is environmental. This barrier is related to literal environmental concerns while wearing a wig, such as a discomfort of wearing a wig in heat and humidity or wind removing the wig. It also referred to the inability to wear a wig for certain activities, such as water sports. The final barrier to physical activity participation in phase 3 is psychosocial. This was not only a barrier to physical activity participation, but a barrier to participating in many common social activities, including shopping, socializing with friends, and even leaving the house. The reluctance to participate is caused by the anxiety, self-consciousness, and embarrassment associated with hair loss being noticed or the noticeability of a wig.

On the other hand, psychosocial factors sometimes acted as enablers to physical activity participation. Specifically, having social support from friends, family, social media, and in support groups was correlated with physical activity participation. Some participants reported relying on social supports to help them start and continue the activity and, more importantly, social support facilitated the movement from the adjustment phase to the acceptance phase. The other enabler identified in phase 3 was body image coping. Participants who were physically active at this stage of the process were able to do so by adapting three aspects of body image coping factors: avoidance, appearance fixing, and acceptance. These strategies minimized the impact of physical activity on an individuals’ self-concept and body image. With that said, in some cases, the effort put into appearance fixing in terms of concealing hair loss and managing a wig was burdensome. Not only did managing a wig comes with negative experiences, but it also impacted an individual’s sense of authenticity, which in turn affected social relationships.

Phase 4

Phase 4 could be the most important phase of the 4-phase journey. In this phase, participants exhibit far higher levels of physical activity participation. For that reason, the acceptance phase is also known as the enabling phase. By phase 4, participants had accepted their hair loss condition. This acceptance is viewed as the key factor in physical activity participation. When individuals accepted their condition, they were more comfortable in physical activity settings and exhibited higher adherence to physical activity.

Takeaways

Rajoo et al., have identified a 4-phase path toward the acceptance of AA, noting the barriers and enablers to physical activity at each phase. Those barriers include psychological distress in phase 2 and physical, environmental, and psychosocial barriers in phase 3. Enablers in phase 3 included psychosocial factors (specifically, social support), and body image coping factors. However, phase 4 is seen as the enabling phase, where individuals have accepted their AA and that acceptance correlated with increased physical activity levels.

This study is intended to inform the development of evidence-based interventions into physical activity among people with AA. It suggests that helping people along the path to acceptance will, in turn, help them embrace increased physical activity participation. Because increased physical activity is associated with better mental health outcomes in diverse populations, this information is invaluable to assuring the mental wellness of people with AA.

The full publication can be viewed at https://link.springer.com/article/10.1186/s40359-020-00502-5

Help Us Fund More Studies Like These

Studies like these seek to improve the lives of people with AA. While similar studies exist for the general population, more research that considers the specific experiences of individuals with AA is needed.

The AAAF supports a multitude of research projects aimed at doing exactly that, and you are a big part of that mission. Please consider donating to the AAAF so that we can continue to fund important research such as the report we dissected today.