Promoting active living among people with physical disabilities evidence for neighborhood-level buoys

Outdoor E-trike cycling: A low intensity physical activity

For people with disabilities or chronic diseases, an electrically supported tricycle (e-trike) could facilitate independence and participation in physical activity, and improve health conditions. This study investigates the exercise intensity and perceived exertion of e-trike cycling. Twenty healthy participants cycled on an e-trike with different speeds (12 and 18 km/h) and different levels of electric pedal support at an outdoor athletics track. Exercise intensity was measured with oxygen consumption (V˙O2) using a Cosmed K4B2 analysis unit, perceived exertion was measured with the Borg Rating of Perceived Exertion scale, pedaling power, and engine power were measured with a torque sensor. The effect of speed and support was analyzed with a Linear Mixed Effects model. V˙O2 was 18.67 ± 3.13 ml/kg/min without support, with electric support the exercise intensity was significantly below moderate intensity (i.e. 10.5 ml/kg/min) at t = 11.37, p < .001, 95% CI: 1.90, 2.77. The Borg score without support was 9.79 ± 1.72 and all other conditions below this, which were significantly below moderate intensity (i.e. 11) at t = -3.07, p = .007, 95% CI: -2.04, -0.38. Speed and support significantly affected V˙O2 (F = 185.49, p < .001). E-trike cycling is a low intensity activity, but intensity can be influenced by changing speed and support level.

Impact of Adaptive Sports Participation on Quality of Life

The health benefits of regular recreational physical activity are well known in reducing secondary health consequences of a sedentary lifestyle in the general population. However, individuals with physical disabilities participate less frequently in recreational activity compared with those without disabilities. Although evidence on the impact of recreational physical activity on quality of life in this population is in its infancy, regular recreational and sports activity participation has shown to have a positive association with improvements in quality of life, life satisfaction, community reintegration, mood, and employment in those with disabilities. Facilitators of participating in adaptive sports include a desire to improve social support, physical fitness, health, and fun. Unfortunately, those with disabilities face numerous barriers to participate in adaptive sports including accessibility, transportation, awareness, finances, and physical and cognitive impairments. Further studies are needed to investigate facilitators and barriers to participating in adaptive sports to capitalize on the physical and psychosocial benefits of regular recreational activity. The aim of this article is to review the available literature on the effects of adaptive sports participation on quality of life.

Does the built environment moderate the relationship between having a disability and lower levels of physical activity? A systematic review

The relationship between the built environment and physical activity has been well documented. However, little is known about how the built environment affects physical activity among people with disabilities, who have disproportionately higher rates of physical inactivity and obesity. This study is the first systematic review to examine the role of the built environment as a moderator of the relationship between having a disability (physical, sensory or cognitive) and lower levels of physical activity. After conducting an extensive search of the literature published between 1990 and 2015, 2039 articles were screened, 126 were evaluated by abstract and 66 by full text for eligibility in the review. Data were abstracted using a predefined coding guide and synthesized from both qualitative and quantitative studies to examine evidence of moderation. Nine quantitative and six qualitative articles met the inclusion criteria. Results showed that most research to date has been on older adults with physical disabilities. People with disabilities described how aspects of the built environment affect neighborhood walking, suggesting a positive moderating role of features related to safety and aesthetic qualities, such as benches, lighting and stop light timing. There were mixed results among studies that examined the relationship quantitatively. Most of the studies were not designed to appropriately examine moderation. Future research should utilize valid and reliable built environment measures that are more specific to disability and should include people with and without disabilities to allow for testing of moderation of the built environment.

Does Neighborhood Disorder Predict Recovery From Mobility Limitation? Findings From the Health and Retirement Study

OBJECTIVE

This research explores whether perceptions of physical neighborhood disorder predict recovery from mobility limitation over a 2-year period and examines whether psychosocial factors (i.e., depressive symptomology and mastery) and physical activity are salient mediators.

METHOD

Using data from the Health and Retirement Study (HRS): Participant Lifestyle Questionnaire (2008-2010), odds ratio estimates of recovery were ascertained using binary logistic regression, and post hoc Sobel tests were conducted to formally assess mediation.

RESULTS

Net of demographic characteristics and socioeconomic status, increased neighborhood disorder was associated with lower odds of recovery. However, both psychosocial indicators and physical activity were significant individual partial mediators, which suggest neighborhood disorder influences recovery from physical impairment via psychosocial processes and barriers to physical activity.

DISCUSSION

Reducing neighborhood disorder may enhance older residents' psychosocial well-being and improve participation in physical activity, thus increasing recovery from mobility limitation and preventing subsequent disability.

A triple play: psychological distress, physical comorbidities, and access and use of health services among U.S. adults with disabilities

PURPOSE

Among adults with disabilities, we examined whether increasing levels of psychological distress were associated with higher estimated prevalences of chronic conditions, obesity, health care access, and use of preventive services.

METHODS

We analyzed data from the 2007 Behavioral Risk Factor Surveillance System. The Kessler-6 scale was used to assess psychological distress.

RESULTS

Increasing levels of psychological distress were associated with an increased prevalence of chronic diseases and conditions, and decreased access to health care and utilization of preventive services in keeping with what has been established for non-disabled populations. Among adults with disabilities, aged 18-64 years and 65 years or older, increasing levels of distress were also associated with increased receipt of mental health treatment. However, compared to adults aged 18-64 years, larger proportions of older adults reported non-receipt of mental health treatment (mild to moderate psychological distress: 58.0% versus 70.6%; serious psychological distress: 40.5% versus 54.5%).

CONCLUSIONS

While adults with disabilities who had increased levels of psychological distress were more likely to receive mental health services, they also had higher estimated prevalences of chronic conditions, barriers to health care, and non-receipt of preventive cancer screenings.

Outdoor built environment barriers and facilitators to activity among midlife and older adults with mobility disabilities

PURPOSE

To gain better understanding of how the built environment impacts neighborhood-based physical activity among midlife and older adults with mobility disabilities.

DESIGN AND METHODS

We conducted in-depth interviews with 35 adults over age 50, which used an assistive device and lived in King County, Washington, U.S. In addition, participants wore global positioning systems (GPS) devices for 3 days prior to the interview. The GPS maps were used as prompts during the interviews. Open coding of the 35 interviews using latent content analysis resulted in key themes and subthemes that achieved consensus between coders. Two investigators independently coded the text of each interview.

RESULTS

Participants were on average of 67 years of age (range: 50-86) and predominantly used canes (57%), walkers (57%), or wheelchairs (46%). Key themes pertained to curb ramp availability and condition, sidewalk availability and condition, hills, aesthetics, lighting, ramp availability, weather, presence and features of crosswalks, availability of resting places and shelter on streets, paved or smooth walking paths, safety, and traffic on roads.

IMPLICATIONS

A variety of built environment barriers and facilitators to neighborhood-based activity exist for midlife and older adults with mobility disabilities. Preparing our neighborhood environments for an aging population that uses assistive devices will be important to foster independence and health.

Built environment instruments for walkability, bikeability, and recreation: disability and universal design relevant?

BACKGROUND

Despite a plethora of instruments that measure the built environment with respect to its effect on potential physical activity, little is known about how relevant these instruments are for people with disabilities (PWDs).

OBJECTIVE

This review comprises an in-depth review of instruments related to the built environment and physical activity, as well as an examination of such instruments to determine their applicability for PWDs.

METHODS

In this paper, the term "built environment" refers to human-made structures (e.g., urban and rural design characteristics, recreational structures) that may facilitate or impede an individual's ability to be physically active. A content analysis was conducted on 95 instruments measuring walkability, bikeability, and recreation with respect to disability and universal design (UD) relevance. Instruments were also cataloged according to other dimensions, including psychometric properties, data collection modalities, and impact or use.

RESULTS

Roughly one third of all instruments include some disability-specific items, and only a few UD principles are consistently demonstrated across all instruments. Psychometric information is available for approximately one half of the instruments. Most instruments use objective/audit methods of data collection, with less using subjective/perceived and Geographic Information System (GIS) methods. With respect to instrument impact/use, just over one half of the instruments have articles cited in the peer-reviewed literature.

CONCLUSIONS

Recommendations for new and revised built environment instruments include more focus on specific disability populations, incorporation of all UD principles, as well as attention to psychometric quality and measurement specificity.

Difficult to measure constructs: conceptual and methodological issues concerning participation and environmental factors

For rehabilitation and disability research, participation and environment are 2 crucial constructs that have been placed center stage by the International Classification of Functioning, Disability and Health (ICF). However, neither construct is adequately conceptualized by the ICF, and both are difficult to measure. This article addresses conceptual and methodologic issues related to these ICF constructs, and recommends an improved distinction between activities and participation, as well as elaboration of environment. A division of the combined ICF categories for activity and participation into 2 separate taxonomies is proposed to guide future research. The issue of measuring participation from objective and subjective perspectives is examined, and maintaining these distinct conceptual domains in the measurement of participation is recommended. The methodological issues contributing to the difficulty of measuring participation are discussed, including potential dimensionality, alternative metrics, and the appropriateness of various measurement models. For environment, the need for theory to focus research on those aspects of the environment that interact with individuals' impairments and functional limitations in affecting activities and participation is discussed, along with potential measurement models for those aspects. The limitations resulting from reliance on research participants as reporters on their own environment are set forth. Addressing these conceptual and methodological issues is required before the measurement of participation and environmental factors can advance and these important constructs can be used more effectively in rehabilitation and disability observational research and trials.

Examining methodological details of neighbourhood observations and the relationship to health: a literature review

Neighbourhood research has been growing steadily over the past two decades across the social sciences, and, in particular in the area of public health. Despite this increase, there is currently no consensus on which measure and data source researchers should use to assess neighbourhood attributes. In the past, researchers have relied on census data and household surveys to assess neighbourhood conditions, but in recent years, neighbourhood observations have become a popular alternative method for characterizing neighbourhood environments. Rooted in sociology of crime research, observations are conducted by trained observers who use a checklist to observe and rate neighbourhoods on a number of conditions such as physical (e.g., traffic volume, housing conditions) and social (e.g., presence of people, gang activity) attributes. While this methodology has been gaining momentum in recent years, notably absent from the literature is a review to examine this methodology in detail. The purpose of the present study was to examine research that has used neighbourhood observations as a method. We do so by critically reviewing 51 English language studies published from 1990 onward paying particular attention to the areas of (1) methodological rigor (i.e. how observations are carried out in the field and how data are analyzed), (2) geographical boundaries (i.e. how neighbourhoods and areas of observation are spatially defined), and (3) the relationship between neighbourhood observations and residents' health (i.e. how studies examine and analyze the link between observed neighbourhood attributes and health). We find that little attention is given to details of neighbourhood observations as a method. Further, there is wide variability in how observations are conducted and analyzed making it impossible to confidently compare findings across studies. We see this review as a first step in developing sound observational measures of neighbourhood factors and conclude by providing recommendations for researchers undertaking neighbourhood observations in the future.