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Morgan KA, Taylor KL, Walker CW, Tucker S, Dashner JL, Hollingsworth H. Mobility Disability and Exercise: Health Outcomes of an Accessible Community-Based Center. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:836655. [PMID: 36188910 PMCID: PMC9397740 DOI: 10.3389/fresc.2022.836655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/25/2022] [Indexed: 11/13/2022]
Abstract
ObjectiveThe purpose of this study was to determine how support and guidance provided by trained professionals during a 12-week, community-based transition exercise program, impact health outcomes and continued engagement in physical activity for persons with a mobility disability (PwMD).DesignA single arm pre-post design was used.SettingAccessible community-based health and wellness center.ParticipantsThe study included 244 PwMD using a mobility device.InterventionsParticipants completed a 12-week transition exercise program provided through an accessible community facility that provided education and support to complete endurance and strength related exercises as well as programming to encourage transition to self-directed engagement in exercise.Main Outcome MeasuresBodyweight, BMI, pain, perceived exertion, speed, and distance during cardiovascular fitness testing, and strength were measured pre and post exercise program. The number of participants that signed up for a monthly membership after the program was also monitored.ResultsFor the total group, average pain reported over previous 30 days decreased significantly (p < 0.01), current daily pain decreased significantly (p < 0.05), perceived exertion at the end of the 9-min endurance test decreased significantly (p < 0.05), and the four upper extremity strength exercises showed large, significant strength gains (p < 0.01) after the program. There was no significant change in bodyweight, BMI, or speed and distance completed during endurance testing. At the completion of the program, 76% of participants enrolled in a monthly membership at the facility with the intentions to continue to exercise regularly.ConclusionsThis study provides evidence that an accessible community-based exercise program, with a transitional component supported by trained professionals, can support the exercise goals of PwMD and improve strength, decrease pain, and may promote regular exercise adoption for PwMD.
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Affiliation(s)
- Kerri A. Morgan
- Enabling Mobility in the Community Laboratory, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
- *Correspondence: Kerri A. Morgan
| | - Kelly L. Taylor
- Occupational Therapy Program, Murray State University, Paducah, KY, United States
| | - Carla Wilson Walker
- Enabling Mobility in the Community Laboratory, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Susan Tucker
- Enabling Mobility in the Community Laboratory, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Jessica L. Dashner
- Enabling Mobility in the Community Laboratory, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Holly Hollingsworth
- Enabling Mobility in the Community Laboratory, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
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Rimmer JH, Wilroy J, Galea P, Jeter A, Lai BW. Retrospective evaluation of a pilot eHealth/mHealth telewellness program for people with disabilities: Mindfulness, Exercise, and Nutrition To Optimize Resilience (MENTOR). Mhealth 2022; 8:15. [PMID: 35449508 PMCID: PMC9014229 DOI: 10.21037/mhealth-21-34] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/23/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND People with disabilities have few options to participate in wellness programs that are tailored to their health, functional level, specific interests/needs, and available in the comfort of their home. To address this need, we evaluated a mobile health wellness program for people with physical disabilities. METHODS Retrospective pilot evaluation of MENTOR (Mindfulness, Exercise, and Nutrition To Optimize Resilience), an 8-week, 40-hour online telewellness program adapted from the peer reviewed literature on wellness. The three core wellness domains-mindfulness, exercise, and nutrition-were delivered via Zoom to groups of participants with a disability. Each group met weekly with an assigned health coach who responded to Q&A about the program and presented new material on several additional wellness domains that could impact their health (e.g., relationships, contribution to society/community, spending outdoor time in nature). Pre/post measures included the Godin Leisure-Time Exercise Questionnaire (GLTEQ) and the UAB/Lakeshore Wellness Assessment (LWA). Participants were also interviewed and provided feedback after the program, which was thematically analyzed. RESULTS A total of 154 people from 15 states enrolled in the MENTOR program and 135 completed it (87.7% completers). Data were analyzed from a subset of participants (n=53) who were asked to complete a pre/post assessment and had complete data. Participants who were physically inactive at baseline improved their GLTEQ total activity (P=0.002; effect size =0.56) and moderate-to-vigorous activity scores (P=0.005; effect size =0.53). LWA results demonstrated that participants increased their exercise behavior (P=0.006; effect sizes =0.39) and contribution to society/community (P=0.013; effect size =0.37). Participants with low overall wellness (mental, physical & emotional health) at baseline had statistically significant improvements in exercise, nutrition, sleep, core values, self-care, hobbies, contribution to society/community, relationships, and overall wellness (all P<0.05 with effect sizes ranging from 0.43 to 1.07). Resultant qualitative themes were: (I) lifestyle transformation occurred through new positive experiences, physical and mental health benefits, and adoption of healthy behaviors; and (II) engagement through accessible online bonding through enjoyable and professional experiences. CONCLUSIONS A pilot telewellness program for people with disabilities is feasible and potentially effective in improving several domains of wellness. There is a need for precision-based mobile health (mHealth) programs that are tailored for people with disabilities and that can be accessed from various portable devices including their phone and/or tablet.
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Affiliation(s)
- James H. Rimmer
- Dean’s Office, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- Lakeshore Foundation, Homewood, AL, USA
| | - Jereme Wilroy
- Lakeshore Foundation, Homewood, AL, USA
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pierre Galea
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Byron W. Lai
- Lakeshore Foundation, Homewood, AL, USA
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
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Young HJ, Lai B, Mehta T, Thirumalai M, Wilroy J, Yates A, Kane B, Rimmer JH. The movement-to-music (M2M) study: study protocol for a randomized controlled efficacy trial examining a rhythmic teleexercise intervention for people with physical disabilities. Trials 2021; 22:779. [PMID: 34743701 PMCID: PMC8574035 DOI: 10.1186/s13063-021-05751-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with physical disabilities need exercise routines that are enjoyable, readily available in the home, adapted to their functional level, and eliminate common barriers to exercise participation related to transportation and time commitment. The purpose of the movement-to-music (M2M) study is to address these issues by establishing a remotely delivered, rhythmic exercise program for people with physical disabilities. METHODS The study is a two-arm randomized controlled efficacy trial examining a 12-week remotely delivered M2M intervention (eM2M) in 108 people with physical disabilities. The primary outcomes are changes in cardiorespiratory fitness and muscle strength at post 12-week intervention. DISCUSSION The eM2M study will enhance our understanding of an alternative intervention design and delivery mode that removes common barriers to exercise participation experienced by people with physical disabilities. The eM2M intervention may be an alternative option for people with physical disabilities to obtain regular exercise, especially during a pandemic when exercising in indoor facilities may be problematic. TRIAL REGISTRATION ClinicalTrials.gov NCT03797378. Registered on January 9, 2019, with the trial name "Movement-to-Music: Lakeshore Examination of Activity, Disability, and Exercise Response Study (M2M LEADERS)".
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Affiliation(s)
- Hui-Ju Young
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Byron Lai
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Pediatric and Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tapan Mehta
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mohanraj Thirumalai
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jereme Wilroy
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alex Yates
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brandon Kane
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James H Rimmer
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
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"Just Going to a Spin Class": Participant Experiences of Inclusion Within an Integrated Indoor Cycling Program. Adapt Phys Activ Q 2021; 38:359-376. [PMID: 33785662 DOI: 10.1123/apaq.2020-0107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/08/2020] [Accepted: 10/27/2020] [Indexed: 11/18/2022] Open
Abstract
Justifications for access to physical activity for people who experience disability tend to focus on the health benefits associated with a medical model of disability. The result is often programs that are segregated and impairment-focused, with limited access to integrated settings that are also potentially inclusive. In this instrumental case study, the authors engaged 20 participants with and without impairment from an adult integrated indoor cycling program to explore what contributed to meaningful and inclusive experiences in this setting. Data were generated through semistructured interviews and reflective notes. Thematic analysis led to three themes: (a) "just going to a spin class" (b) "seamless"? and (c) "deliberate community." Using a relational ethics framework, the findings are discussed with regard to their potential to inform the development of integrated and inclusive physical activity programs, with emphasis on program structure and instructor reflexivity and training.
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Wilroy JD, Lai B, Davlyatov G, Mehta T, Thirumalai M, Rimmer JH. Correlates of adherence in a home-based, self-managed exercise program tailored to wheelchair users with spinal cord injury. Spinal Cord 2020; 59:55-62. [PMID: 32541883 DOI: 10.1038/s41393-020-0497-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional design. OBJECTIVES To examine personal factors, secondary health conditions, and environmental factors as potential correlates of adherence to a 12-week home-based exercise trial in people with spinal cord injury. SETTING Home METHODS: Participants (n = 28) were prescribed a set of exercise videos that they were asked to complete three times each week for 12 weeks (36 total sessions). The videos were accessible through a custom-designed mobile application and included movements targeting strength, cardiorespiratory fitness, and balance that were accompanied with music. Watched video minutes were automatically recorded on the web-based platform. At baseline, participants completed self-report questionnaires that measured personal (e.g., age, self-efficacy) and environmental (e.g., barriers) factors and secondary health conditions (e.g., depression). Data were analyzed using quantile (median) regression analysis. RESULTS Race (African American; β = -65.62, p = 0.004), community barriers (β = -9.12, p = 0.026), anxiety (β = -3.84, p = <0.001), depression (β = -1.42, p = 0.038), physical function (β = -1.35, p = 0.048), and self-efficacy (β = -0.61, p = 0.007) were associated with a lower number of exercise video minutes. Pain intensity (β = 2.03, p = 0.032), pain interference (β = 1.84, p = 0.012), and age (β = 1.13, p = 0.013) were associated with a higher number of exercise video minutes. Total variance explained by the model was 77% (pseudo R2 = 0.77). CONCLUSIONS Factors associated with lower and higher adherence to home-based exercise should guide future research efforts in creating more precision-based approaches for self-managed home exercise.
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Affiliation(s)
- Jereme D Wilroy
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35233, USA.
| | - Byron Lai
- Division of Pediatric Rehabilitation Medicine, Children's of Alabama Hospital, Birmingham, AL, 35233, USA
| | - Ganisher Davlyatov
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Tapan Mehta
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Mohanraj Thirumalai
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - James H Rimmer
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
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Menzies A, Mazan C, Borisoff JF, Mattie JL, Mortenson WB. Outdoor recreation among wheeled mobility users: perceived barriers and facilitators. Disabil Rehabil Assist Technol 2020; 16:384-390. [PMID: 31937161 DOI: 10.1080/17483107.2019.1710772] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Participation in outdoor recreation is associated with improvements in mental, emotional, and physical health. Individuals with impairments affecting mobility, such as wheelchair users, face environmental, physical, and social barriers to participation in outdoor recreation. There is limited research on outdoor recreation participation among wheelchair users, especially concerning informal recreational opportunities. Formal programmes that offer access to outdoor recreation are often oversubscribed and also do not enable opportunities to participate more spontaneously. OBJECTIVES (1) To explore the experiences and impact of participation in outdoor recreation activities by wheelchair users, with an emphasis on more informal activities; and (2) to identify perceived barriers and facilitators to participation in outdoor recreation activities. METHODS Semi-structured interviews were the main means of data collection in this interpretive description study; this was supplemented by photographs of activity involvement provided by participants. These data were analysed thematically. RESULTS Fifteen Canadian wheelchair users participated in the study. Three themes emerged following analysis: (1) Into the Woods explores participants' current outdoor recreation experiences, (2) Ain't No Mountain High Enough looks at the barriers and challenges participants face, and (3) Just Around the Riverbend discusses participants' desired changes to enable their further participation. CONCLUSIONS The study highlighted participants' current experiences, their perceived barriers, and several ways to enhance outdoor recreation participation among wheelchair users, including: developing new adaptations, creating policies, increasing access to affordable equipment and programmes, and reducing barriers in built and natural environments.Implications for rehabilitationWheelchair users participate in a wide variety of outdoor activities.Wheelchair users experience various barriers and challenges when participating in outdoor recreation.Despite recent improvements, environmental changes are needed to allow wheelchair users to access outdoor recreation.Further development of adaptive equipment is needed in order for wheelchair users to access their desired outdoor recreation activities.
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Affiliation(s)
- Ashley Menzies
- Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Carolyn Mazan
- Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Jaimie F Borisoff
- Rehabilitation Engineering Design Lab, British Columbia Institute of Technology, Burnaby, Canada
| | - Johanne L Mattie
- Technology and Product Evaluation Group, British Columbia Institute of Technology, Burnaby, Canada
| | - W Ben Mortenson
- Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discovery, Vancouver, British Columbia, Canada.,GF Strong Rehabilitation Research Program, Vancouver, British Columbia, Canada
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Hoekstra F, Hoekstra T, van der Schans CP, Hettinga FJ, van der Woude LHV, Dekker R. The implementation of a physical activity counseling program in rehabilitation care: findings from the ReSpAct study. Disabil Rehabil 2019; 43:1710-1721. [PMID: 31622120 DOI: 10.1080/09638288.2019.1675188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE This study aimed to evaluate the implementation of a physical activity counseling program in rehabilitation and to study heterogeneity in received counseling and investigate its association with changes in patients' physical activity outcomes. METHODS This prospective cohort study was conducted in 18 rehabilitation institutions. Data were collected using surveys completed by professionals (n= ±70) and patients (n = 1719). Implementation was evaluated using different process outcomes: reach, dosage, satisfaction, maintenance. Patients' physical activity outcomes included changes in total minutes/week of physical activity. Latent class analyses were conducted to identify profiles of received counseling characteristics and multilevel models were used to investigate associations with physical activity outcomes. RESULTS 5873 Patients were provided with motivational interviewing-based counseling after rehabilitation. Professionals and patients were positive about the program. Sixteen institutions (89%) formally agreed to continue the program. The four identified profiles of counseling characteristics illustrate a large variation in received counseling among patients. No substantial differences in physical activity outcomes were found between profiles. CONCLUSION After a three-year program period, the physical activity counseling centers were sustainably implemented in Dutch rehabilitation care. This study illustrated an innovative approach to assess heterogeneity in implementation outcomes (e.g., counseling profiles) in relation to program outcomes (e.g., physical activity).Implications for rehabilitationPhysical activity counseling after rehabilitation is important to support people with disabilities in making the step from rehabilitation-based physical activities to community-based physical activities.Establishing "Physical Activity Counseling Centers" is a promising "disability-overarching" strategy to promote physical activity after rehabilitation.Although the actual received counseling (dosage) varied among patients, this did not coincide with large differences in physical activity outcomes.The training in Motivational Interviewing, the financial incentives, and the advisory support were considered as important or essential ingredients for a successful implementation of the counseling program in rehabilitation practice.
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Affiliation(s)
- Femke Hoekstra
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Center for Rehabilitation, Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Trynke Hoekstra
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Center for Rehabilitation, Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cees P van der Schans
- Center for Rehabilitation, Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Dept Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Florentina J Hettinga
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, United Kingdom
| | - Lucas H V van der Woude
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Center for Rehabilitation, Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rienk Dekker
- Center for Rehabilitation, Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Center for Sports Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Rimmer JH, Mehta T, Wilroy J, Lai B, Young HJ, Kim Y, Pekmezi D, Thirumalai M. Rationale and design of a Scale-Up Project Evaluating Responsiveness to Home Exercise And Lifestyle Tele-Health (SUPER-HEALTH) in people with physical/mobility disabilities: a type 1 hybrid design effectiveness trial. BMJ Open 2019; 9:e023538. [PMID: 30928927 PMCID: PMC6475257 DOI: 10.1136/bmjopen-2018-023538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Rates of physical inactivity among people with physical disabilities are substantially higher than in the general population and access to home-based tailored exercise programmes is almost non-existent. Using a theory-driven eHealth platform, an innovative exercise programme referred to as movement-to-music (M2M) will be delivered as a customised, home-based exercise intervention for adults with mobility disabilities. METHODS AND ANALYSIS Participants are being recruited for this type 1 hybrid design based effectiveness trial through outpatient clinics at a large rehabilitation centre and randomised to one of three groups: (1) M2M, (2) M2M plus social networking (M2Mplus) and (3) attention control (AC). The intervention includes a 12-week adoption phase, 12-week transition phase and 24-week maintenance phase, at which the collection of objective measures on exercise, fitness and self-reported measures on health will be obtained at the start of each phase and at follow-up. The study compares the effectiveness of M2M and M2Mplus in increasing physical activity (primary outcome), adherence, fitness and physical functioning compared with the AC group and examines the mediators and moderators of the treatment effect. ETHICS AND DISSEMINATION The Institutional Review Board of The University of Alabama at Birmingham granted full approval: (IRB-160923002). Dissemination of findings will include publication in peer-reviewed journals, presentations at regional, national and/or international meetings, and the National Center on Health, Physical Activity and Disability (NCHPAD, www.nchpad.org). This study will strengthen our understanding of the potential benefits of eHealth exercise interventions for people with physical disabilities and build on strategies that aim to recruit larger samples in exercise trials. TRIAL REGISTRATION NUMBER NCT03024320; Pre-results.
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Affiliation(s)
- James H Rimmer
- UAB/Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tapan Mehta
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jereme Wilroy
- UAB/Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Byron Lai
- UAB/Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hui-Ju Young
- UAB/Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yumi Kim
- UAB/Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Dorothy Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mohanraj Thirumalai
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
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9
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The accessibility of fitness centers for people with disabilities: A systematic review. Disabil Health J 2018; 11:525-536. [DOI: 10.1016/j.dhjo.2018.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/09/2018] [Accepted: 04/28/2018] [Indexed: 11/23/2022]
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10
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Lai B, Bond K, Kim Y, Barstow B, Jovanov E, Bickel CS. Exploring the uptake and implementation of tele-monitored home-exercise programmes in adults with Parkinson's disease: A mixed-methods pilot study. J Telemed Telecare 2018; 26:53-63. [PMID: 30134777 DOI: 10.1177/1357633x18794315] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with Parkinson's disease experience numerous barriers to exercise participation at fitness facilities. Advances in tele-monitoring technologies create alternative channels for managing and supervising exercise programmes in the home. However, the success of these programmes will depend on participants' perceptions of using the technology and their exercise adherence. Thus, this pilot explored the uptake and implementation of two common methods of Internet-exercise training in Parkinson's disease. METHODS Twenty adults with Parkinson's disease were randomized into either: telecoach-assisted exercise (TAE) or self-regulated exercise (SRE) groups. Both groups received the same eight-week exercise prescription (combined strength and aerobic exercise) and telehealth system that streamed and recorded vital signs and exercise data. TAE participants exercised under a telecoach's supervision via videoconferencing. SRE participants independently managed their exercise training. Quantitative data were described and qualitative data underwent thematic analysis. RESULTS Quantitative results demonstrated that TAE participants achieved strong attendance (99.2%), whereas SRE participants demonstrated 35.9% lower attendance, 48% less total time exercising, and 74.5% less time exercising at moderate intensity. Qualitatively, TAE participants reported overtly favourable programme experiences and that assistance from a telecoach enhanced their exercise motivation. SRE participants noted several challenges that impeded adherence. CONCLUSION Findings demonstrate that adults with Parkinson's disease acknowledge benefits of exercising through a telehealth system and are open to utilizing this channel as a means of exercise. However, human-interactive support may be required to overcome unique impediments to participation. Study findings warrant validation in larger trials that can transfer the success of TAE towards more scalable methods of delivery.
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Affiliation(s)
- Byron Lai
- Electrical & Computer Engineering University of Alabama at Birmingham, USA
| | - Kristina Bond
- Electrical & Computer Engineering University of Alabama at Birmingham, USA
| | - Yumi Kim
- Electrical & Computer Engineering University of Alabama at Birmingham, USA
| | - Beth Barstow
- Electrical & Computer Engineering University of Alabama at Birmingham, USA
| | - Emil Jovanov
- Electrical & Computer Engineering University of Alabama at Birmingham, USA
| | - C Scott Bickel
- Electrical & Computer Engineering University of Alabama at Birmingham, USA
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11
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Thirumalai M, Rimmer JH, Johnson G, Wilroy J, Young HJ, Mehta T, Lai B. TEAMS (Tele-Exercise and Multiple Sclerosis), a Tailored Telerehabilitation mHealth App: Participant-Centered Development and Usability Study. JMIR Mhealth Uhealth 2018; 6:e10181. [PMID: 29798832 PMCID: PMC5992455 DOI: 10.2196/10181] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/15/2018] [Accepted: 05/08/2018] [Indexed: 01/30/2023] Open
Abstract
Background People with multiple sclerosis face varying levels of disability and symptoms, thus requiring highly trained therapists and/or exercise trainers to design personalized exercise programs. However, for people living in geographically isolated communities, access to such trained professionals can be challenging due to a number of barriers associated with cost, access to transportation, and travel distance. Generic mobile health exercise apps often fall short of what people with multiple sclerosis need to become physically active (ie, exercise content that has been adapted to accommodate a wide range of functional limitations). Objective This usability study describes the development process of the TEAMS (Tele-Exercise and Multiple Sclerosis) app, which is being used by people with multiple sclerosis in a large randomized controlled trial to engage in home-based telerehabilitation. Methods Twenty-one participants with disabilities (10 people with multiple sclerosis) were involved in the double iterative design, which included the simultaneous development of the app features and exercise content (exercise videos and articles). Framed within a user-centered design approach, the development process included 2 stages: ground-level creation (focus group followed by early stage evaluations and developments), and proof of concept through 2 usability tests. Usability (effectiveness, usefulness, and satisfaction) was evaluated using a mixed-methods approach. Results During testing of the app’s effectiveness, the second usability test resulted in an average of 1 problem per participant, a decrease of 53% compared to the initial usability test. Five themes were constructed from the qualitative data that related to app usefulness and satisfaction, namely: high perceived confidence for app usability, positive perceptions of exercise videos, viable exercise option at home, orientation and familiarity required for successful participation, and app issues. Participants acknowledged that the final app was ready to be delivered to the public after minor revisions. After including these revisions, the project team released the final app that is being used in the randomized controlled trial. Conclusions A multi-level user-centered development process resulted in the development of an inclusive exercise program for people with multiple sclerosis operated through an easy-to-use app. The promotion of exercise through self-regulated mHealth programs requires a stakeholder-driven approach to app development. This ensures that app and content match the preferences and functional abilities of the end user (ie, people with varying levels of multiple sclerosis).
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Affiliation(s)
- Mohanraj Thirumalai
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James H Rimmer
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - George Johnson
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jereme Wilroy
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Hui-Ju Young
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tapan Mehta
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Byron Lai
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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Lai B, Kim Y, Wilroy J, Bickel CS, Rimmer JH, Motl RW. Sustainability of exercise intervention outcomes among people with disabilities: a secondary review. Disabil Rehabil 2018; 41:1584-1595. [PMID: 29409367 DOI: 10.1080/09638288.2018.1432704] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND This review explored the sustainability of health and physical activity-based outcomes following exercise trials that were conducted for people with disabilities, and characterised the influence of technology and behaviour change strategies. METHODS A total of 132 studies were screened from an existing database. RESULTS Only 22 studies featured follow-up periods and met eligibility criteria. At follow-up, studies typically reported at least one significant health outcome that was maintained (n = 18/21; 86%). However, significant health outcomes accounted for only 32% of the total volume of outcomes that were measured at follow-up. For physical activity-based outcomes, six studies (n = 6/8; 75%) reported that intervention gains were maintained throughout follow-up. The incorporation of technology or behaviour change strategies appeared to be linked with sustainable intervention effects. CONCLUSIONS Overall, some evidence demonstrated that post-intervention effects were sustainable. However, the strength of the evidence was weak and several existing gaps in knowledge were identified. Moreover, most studies did not focus on sustainability, but instead emphasised short-term effects of exercise participation on health and physical activity outcomes. Study findings call for greater research and programme efforts to maintain health, function, and physical activity behaviour after supports provided by research studies are removed. Implications for rehabilitation Short-term exercise programmes may require additional strategies designed specifically to enhance the sustainability of exercise outcomes and physical activity participation. Incorporating technology within exercise interventions may enhance the likelihood of sustaining health and function outcomes. Exercise programmes framed within behaviour change theory can equip individuals with the appropriate strategies necessary to maintain their physical activity participation.
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Affiliation(s)
- Byron Lai
- a Department of Physical and Occupational Therapy , School of Health Professions, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Yumi Kim
- a Department of Physical and Occupational Therapy , School of Health Professions, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Jereme Wilroy
- b Department of Physical Medicine and Rehabilitation , University of Alabama at Birmingham , Birmingham , AL , USA
| | - C Scott Bickel
- c Department of Physical Therapy , Samford University , Birmingham , AL , USA
| | - James H Rimmer
- d Department of Occupational Therapy, School of Health Professions , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Robert W Motl
- e Department of Physical Therapy, School of Health Professions , University of Alabama at Birmingham , Birmingham , AL , USA
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Current Trends in Exercise Intervention Research, Technology, and Behavioral Change Strategies for People With Disabilities. Am J Phys Med Rehabil 2017; 96:748-761. [DOI: 10.1097/phm.0000000000000743] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Malone LA, Padalabalanarayanan S, McCroskey J, Thirumalai M. Assessment of Active Video Gaming Using Adapted Controllers by Individuals With Physical Disabilities: A Protocol. JMIR Res Protoc 2017. [PMID: 28623186 PMCID: PMC5493786 DOI: 10.2196/resprot.7621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Individuals with disabilities are typically more sedentary and less fit compared to their peers without disabilities. Furthermore, engaging in physical activity can be extremely challenging due to physical impairments associated with disability and fewer opportunities to participate. One option for increasing physical activity is playing active video games (AVG), a category of video games that requires much more body movement for successful play than conventional push-button or joystick actions. However, many current AVGs are inaccessible or offer limited play options for individuals who are unable to stand, have balance issues, poor motor control, or cannot use their lower body to perform game activities. Making AVGs accessible to people with disabilities offers an innovative approach to overcoming various barriers to participation in physical activity. Objective Our aim was to compare the effect of off-the-shelf and adapted game controllers on quality of game play, enjoyment, and energy expenditure during active video gaming in persons with physical disabilities, specifically those with mobility impairments (ie, unable to stand, balance issues, poor motor control, unable to use lower extremity for gameplay). The gaming controllers to be evaluated include off-the-shelf and adapted versions of the Wii Fit balance board and gaming mat. Methods Participants (10-60 years old) came to the laboratory a total of three times. During the first visit, participants completed a functional assessment and became familiar with the equipment and games to be played. For the functional assessment, participants performed 18 functional movement tasks from the International Classification of Functioning, Disability, and Health. They also answered a series of questions from the Patient Reported Outcomes Measurement Information System and Quality of Life in Neurological Conditions measurement tools, to provide a personal perspective regarding their own functional ability. For Visit 2, metabolic data were collected during an initial 20-minute baseline, followed by 40 minutes of game play. The controller (balance board or gaming mat) played was randomly selected. A set of games was played for 10 minutes, followed by 5 minutes of rest, and then another set of games was played for 10 minutes, followed by rest. Quality of game play was observed and documented for each set. During rest, the participant completed questions regarding enjoyment. Following the same procedures, the participant then played the two sets of games using the other version (off-the-shelf or adapted) of the controller. The entire procedure was repeated during Visit 3 with the controller that was not played. Results Enrollment began in February 2016 and ended in September 2016. Study results will be reported in late 2017. Conclusions We hypothesized that the adapted versions of the Wii Fit balance board and gaming mat would produce greater quality of game play, enjoyment, and energy expenditure in persons with mobility impairments compared to off-the-shelf versions. Trial Registration ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by WebCite at http://www.webcitation.org/6qpPszPJ7)
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Affiliation(s)
- Laurie A Malone
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | | | - Justin McCroskey
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, Birmingham, AL, United States
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Williams TL, Ma JK, Martin Ginis KA. Participant experiences and perceptions of physical activity-enhancing interventions for people with physical impairments and mobility limitations: a meta-synthesis of qualitative research evidence. Health Psychol Rev 2017; 11:179-196. [PMID: 28278003 DOI: 10.1080/17437199.2017.1299027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Disabled people face multiple personal, environmental and social barriers that interfere with leading a physically active lifestyle. Thus, there is an urgent need for behaviour change interventions to increase physical activity (PA) by specifically addressing the situations of disabled people, and barriers to participation. This original meta-synthesis of qualitative research was undertaken to explore participants' experiences and perceptions of PA-enhancing interventions for adults with physical impairments resulting in mobility limitations. Published articles were identified through a rigorous systematic search. Based on the inclusion/exclusion criteria, 10 articles were included for review. Following a critical appraisal of the articles, methods of thematic synthesis were drawn upon to generate overarching concepts through interpretation and conceptual synthesis. Seven interrelated concepts were constructed representing both components and outcomes of the interventions. These were (i) Diversity of interventions; (ii) Importance of communication; (iii) Need for social support; (iv) Behavioural strategies; (v) Gaining knowledge; (vi) Re-framing thoughts about exercise and the self and (vii) Health and well-being. The results revealed that a combination of informational, social and behavioural interventions is perceived as crucial for PA initiation and maintenance. Furthermore, key elements of effective intervention design and implications for policies and practices to increase PA participation are proposed.
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Affiliation(s)
- Toni L Williams
- a Carnegie School of Sport , Leeds Beckett University , Leeds , UK
| | - Jasmin K Ma
- b School of Health and Exercise Sciences , The University of British Columbia , Kelowna , British Columbia , Canada
| | - Kathleen A Martin Ginis
- b School of Health and Exercise Sciences , The University of British Columbia , Kelowna , British Columbia , Canada
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Rimmer JH. Equity in active living for people with disabilities: Less talk and more action. Prev Med 2017; 95 Suppl:S154-S156. [PMID: 28039069 DOI: 10.1016/j.ypmed.2016.12.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 11/16/2022]
Affiliation(s)
- James H Rimmer
- Lakeshore Foundation Endowed Chair in Health Promotion and Rehabilitation Sciences, University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, 331 School of Health Professions Building, 1705 University Blvd., Birmingham, AL 35292-1212, USA.
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White DK, Nash MS. It Is Time to Invite Patients to the Physical Activity Party…. Arch Phys Med Rehabil 2016; 97:S183-4. [PMID: 27566482 DOI: 10.1016/j.apmr.2016.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/03/2016] [Accepted: 03/08/2016] [Indexed: 10/20/2022]
Abstract
Physical activity is associated with a myriad of health benefits relevant to adults who commonly receive rehabilitation. Unfortunately, the prescription for exercise and overall activity still continues to be overlooked, which is a missed opportunity because those receiving rehabilitation are most likely to benefit from the effects of physical activity. The purpose of this supplement is to fill this knowledge gap by featuring articles that examine the efficacy of physical activity, and describe mechanisms underlying changes in physical activity and how physical activity in rehabilitation populations fits within broader medical and public health frameworks.
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Affiliation(s)
- Daniel K White
- Department of Physical Therapy, University of Delaware, Newark, DE.
| | - Mark S Nash
- University of Miami Miller School of Medicine, Miami, FL
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