Meaningful components of a community-based exercise program for individuals with disabilities: A qualitative study

Community-based exercise goals of persons with spinal cord injury: Interpreted using the International Classification of Functioning, Disability, and Health

OBJECTIVE

To identify goals for exercising among community-dwelling persons with spinal cord injury (PwSCI).

DESIGN

Qualitative descriptive study.

SETTING

Community-based exercise facility for persons with a disability.

PARTICIPANTS

Fifty-five PwSCI identified their exercise goals prior to participation in a community-based exercise intervention.

INTERVENTIONS

None.

OUTCOME MEASURES

A modified version of the Canadian Occupational Performance Measure was used to ask about exercise goals. The International Classification of Functioning, Disability, and Health (ICF) was used to code the goals for themes.

RESULTS

The participants were predominantly male (76%) and Black (56%) with thoracic-level injury (51%) and a mean age of 39.44 (standard deviation [SD] 13.62). A total of 231 goals (mean 4.2 goals per participant; SD 1.25) were identified. Participants rated their performance and satisfaction with their goals as 4.256 (SD 1.55) and 3.57 (SD 1.67), respectively. Participants most frequently reported goals related to endurance, muscle strengthening, weight loss, activities of daily living, transferring, and home and community mobility. The most commonly reported goals fell into five ICF domains: Functions of Cardiovascular, Hematological, Immunological, and Respiratory Systems; Neuromusculoskeletal and Movement-Related Functions; Structures Related to Movement; Mobility; and Self-Care.

CONCLUSION

PwSCI have goals they would like to achieve through participation in exercise. The goals are multifaceted and encompass improving health and fitness as well as improving performance in everyday activities such as transferring and mobility. Identifying themes of goals for PwSCI to achieve through exercise is an important step in developing programs and interventions needed to support PwSCI living in the community.

Feasibility of a community-based structured exercise program for persons with spinal cord injury

OBJECTIVES

(1) Examine the feasibility of a community-based exercise intervention for persons with spinal cord injury and (2) compare the cardiorespiratory fitness, skeletal muscle strength, and psychosocial well-being of participants in the intervention group versus control group.

DESIGN

Community-based pilot randomized controlled trial. Setting: Accessible community-based health and wellness center. Participants: Thirty-two sedentary community-dwelling adults with any level of spinal cord injury. Interventions: Participants were randomized to a 36-session/12-week community-based exercise program (intervention; EG) or to a 36-session/12-week physical activity education group (control; CG). Outcome measures: Primary outcome measures included cardiorespiratory fitness measured by a VO2peak test, a composite score of four upper extremity musculoskeletal strength 1-repetition maximum exercises, and feasibility measured by EG participants' adherence and exercise intensity achieved during the program. EG participants' acceptance of the program was also evaluated using a self-reported satisfaction scale. Self-efficacy, motivation, pain, and goal performance and satisfaction were secondary outcome measures. Adherence and acceptability were also measured.

RESULTS

Fifteen participants (n = 15) completed the community-based exercise intervention and seventeen (n = 17) completed the education program. While no statistically significant differences were found, the EG experienced changes of moderate effect size in cardiorespiratory fitness, strength, motivation, and satisfaction with their goals. The EG attended, on average, two sessions per week. The community-based exercise intervention was highly accepted by and satisfying for participants to engage in.

CONCLUSIONS

The EG had improvements in the two primary measures, cardiorespiratory fitness and musculoskeletal strength, following the intervention. The community-based exercise intervention was feasible and accepted by participants.

Exercise prescription for persons with spinal cord injury: a review of physiological considerations and evidence-based guidelines

Persons with spinal cord injury (SCI) experience gains in fitness, physical and mental health from regular participation in exercise and physical activity. Due to changes in physiological function of the cardiovascular, nervous, and muscular systems, general population physical activity guidelines and traditional exercise prescription methods are not appropriate for the SCI population. Exercise guidelines specific to persons with SCI recommend progressive training beginning at 20 min of moderate to vigorous intensity aerobic exercise twice per week transitioning to 30 min three times per week, with strength training of the major muscle groups two times per week. These population-specific guidelines were designed considering the substantial barriers to physical activity for persons with SCI and can be used to frame an individual exercise prescription. Rating of perceived exertion (i.e., perceptually regulated exercise) is a practical way to indicate moderate to vigorous intensity exercise in community settings. Adapted exercise modes include arm cycle ergometry, hybrid arm-leg cycling, and recumbent elliptical equipment. Body weight-supported treadmill training and other rehabilitation modalities may improve some aspects of health and fitness for people with SCI if completed at sufficient intensity. Disability-specific community programs offer beneficial opportunities for persons with SCI to experience quality exercise opportunities but are not universally available.

'On-the ground' strategy matrix for fostering quality participation experiences among persons with disabilities in community-based exercise programs

OBJECTIVE

The purposes of this paper are to (1) document the generation and refinement of a quality participation strategy list to ensure resonance and applicability within community-based exercise programs (CBEPs) for persons with physical and intellectual disabilities, and (2) identify theoretical links between strategies and the quality participation constructs.

METHODS

To address purpose one, a list of strategies to foster quality participation among members was extracted from qualitative interviews with providers from nine CBEPs serving persons with physical disabilities. Next, providers from CBEPs serving persons with physical (n = 9) and intellectual disabilities (n = 6) were asked to identify the strategies used, and examples of their implementation, within their programs. Additional strategies noted by providers and in recent published syntheses were added to the preliminary list. A re-categorization and revision process was conducted. To address purpose two, 22 researchers with expertise in physical and/or intellectual disability, physical activity, participation and/or health behaviour change theory completed a closed-sort task to theoretically link each strategy to the constructs of quality participation.

RESULTS

The final list of 85 strategies is presented in a matrix. Each strategy has explicit examples and proposed theoretical links to the constructs of quality participation.

CONCLUSIONS

The strategy matrix offers a theoretically-meaningful representation of how quality participation-enhancing strategies can be practically implemented "on-the-ground" in CBEPs for persons with disabilities.

Exploring a peer-based physical activity program in the community for adults with moderate-to-severe traumatic brain injury

PRIMARY OBJECTIVE

To explore the experiences of program mentors, participants, and employees involved in a peer-based physical activity (PA) program for adults with moderate-to-severe TBI, being piloted by a community fitness center, to develop the program as a measurable intervention.

RESEARCH DESIGN

We adopted an exploratory case study approach through an interpretivist paradigm, which focused on discovering realities about the peer-based PA program across the study participants' views, backgrounds, and experiences.

METHODS AND PROCEDURES

Semi-structured focus groups and individual interviews were conducted with nine adult program participants (3 peer mentors, 6 participants), and three program employees. Inductive content analysis was used to develop themes about their perceived experiences.

MAIN OUTCOMES AND RESULTS

44 open-codes were grouped into 10 subthemes and three final themes: 1) program impacts identified the importance of the program in daily life and resulting psychological, physical, and social outcomes; 2) program characteristics highlighted program leaders, accessibility, and social inclusion; 3) program sustainability included program adherence, benefits for the center, and the program's future.

CONCLUSIONS

Perceptions of program experiences and outcomes identified how peer-based PA for adults with moderate-to-severe TBI can lead to meaningful activities, functioning better, and buy-in from all parties. Implications for research and practice related to supporting health-related behaviors after TBI through group-based, autonomy-supporting approaches are discussed.

The demographic and disability characteristics of individuals who regularly attend an urban adaptive fitness center: An observational study

INTRODUCTION

While it is well known that regular physical activity provides significant physical and psychosocial health benefits, people with disabilities have disproportionately lower rates of exercise compared to the able-bodied population. Reduced levels of physical activity can put this population at an increased risk of chronic health conditions, highlighting the importance of ensuring that our communities have accessible adaptive fitness opportunities.

OBJECTIVES

To evaluate the demographic and disability characteristics in individuals who regularly attend a specialized urban adaptive fitness center, to provide foundational understanding about the population that uses such resources.

DESIGN

Cross-sectional study SETTING: Specialized urban adaptive fitness center PARTICIPANTS: Sixty-three (n = 63) participants who regularly attend an urban Adaptive Sports and Fitness Center INTERVENTION: Not applicable MAIN OUTCOME MEASURE: World Health Organization (WHO) Disability Assessment Schedule (WHODAS) 2.0, evaluating disability in six domains: cognition, mobility, self-care, getting along, life activities, and participation. Results were converted into scores ranging from 0 (no disability) to 100 (total disability) and compared to WHO published norms for the general population and a demographics intake form.

RESULTS

Participants with mean age of 52.9 ±14.3 years were grouped into three diagnostic categories: spinal cord injury (30.2%), traumatic brain injury/stroke (36.5%), and other neurologic disease/chronic medical disease (33.3%). A total of 45.9% live alone, 96.8% exercise at least twice/week, and 43.5% participate in adaptive sports. Participants travel 8.0 miles on average for attendance. WHODAS disability summary score was 26.48 (86th percentile).

CONCLUSIONS

Although adaptive fitness center participants had a higher level of disability than 80% to 90% of the general population, regular participation was realistic and feasible. Further understanding of the barriers in those who do not engage in such facilities is needed.

Physical Activity and Public Health among People with Disabilities: Research Gaps and Recommendations

Physical activity has become an integral component of public health systems modeling the public health core functions of assessment, policy development, and assurance. However, people with disabilities have often not been included in public health efforts to assess, develop policies, or evaluate the impact of physical activity interventions to promote health and prevent disease among people with disabilities. Addressing the core function of assessment, current physical activity epidemiology, and surveillance among people with disabilities across the globe highlights the paucity of surveillance systems that include physical activity estimates among people with disabilities. The status of valid and reliable physical activity measures among people with condition-specific disabilities is explored, including self-report measures along with wearable devices, and deficiencies in measurement of physical activity. The core functions of policy development and assurance are described in the context of community-based intervention strategies to promote physical activity among people with disabilities. The identification of research gaps in health behavior change, policy, and environmental approaches to promoting physical activity among people with disabilities is explored, along with recommendations based on the principles of inclusive and engaged research partnerships between investigators and the members of the disability community.

Exploring the Relationship Between Quality and Quantity of Physical Activity Participation in Community-Based Exercise Programs for Persons With Physical Disabilities

Community-based exercise programs for persons with disabilities promote greater quantity of leisure-time physical activity (LTPA) participation among their members, perhaps because of the quality experiences fostered by the program. This study aimed to explore the relationship between quality and quantity of physical activity participation in the context of community-based exercise programming and the role that gender plays in this relationship. Adults with physical disabilities (N = 91; Mage = 55, 49 men) from three community-based exercise programs across Canada completed a survey asking about quality participation (Measure of Experiential Aspects of Participation [MeEAP]) and LTPA. Structural equation modeling was used to examine the relationship between MeEAP scores and LTPA. Quality participation was not related to LTPA, even with gender included as a moderator. Men reported higher levels of LTPA and quality participation than women, highlighting gender differences that should be considered when researching and designing exercise programs for individuals with disabilities.

Effects of a consumer driven home modification intervention on community participation for people with mobility disabilities

BACKGROUND

Community participation has become a key outcome measure for people with disabilities. This has resulted in a shift in researchers focus from the individual to the environment. However, research has focused primarily on participation barriers in the community with limited research examining the role of the home environment. For people with mobility disabilities the home environment is the starting place for community participation and research is needed to understand the relationship between the home and participation outcomes.

OBJECTIVE

This study explores the effects of a consumer-driven home modification intervention on community participation for people with mobility disabilities.

METHODS

We conducted a randomized control trial (from June 2017-April 2019) of the effects of a consumer-directed home modification intervention on community participation. The intervention, the Home Usability Program, was implemented with consumers at two different Centers for Independent Living (N = 195) and included a self-assessment of their home environment and implementation of a home usability change.

RESULTS

The Home Usability program positively affected the community participation of people with mobility disabilities. Overall, intervention participants reported a 39.5% (p < .05) increase in social and recreational activities immediately following the intervention relative to the control group after controlling for health status and month when outcome data were collected. Six months after the intervention, this effect returned to baseline.

CONCLUSIONS

Community-based, consumer-driven home modification programs show promise for improving community participation outcomes among people with disabilities, however, more research is needed to understand why results did not persist.

"It Helps Me With Everything": A Qualitative Study of the Importance of Exercise for Individuals With Spinal Cord Injury

Background

The influence of exercise after spinal cord injury (SCI) is a topic important to both clinicians and researchers. The impact of exercise for individuals with SCI is often studied quantitively, with a large focus on the physiological adaptations to exercise intervention.

Objectives

This study explores individualized experiences of exercise for people with SCI.

Methods

A phenomenological approach was utilized to qualitatively study the experiences of exercise for 16 individuals with SCI.

Results

Participants described multiple benefits of exercise, including increased independence, improved mental health, and increased engagement in social activity.

Conclusion

This study provides novel information about attitudes toward exercise held by individuals with SCI and a more thorough understanding of concepts that are well researched.

Long Term Exercise Engagement of Adults Living With Type Two Diabetes Is Enhanced by a Person-Centred Care Approach Delivered by Knowledgeable, Well Trained Health Care Professionals

Background: Regular engagement in exercise or physical activity is a key evidence-based recommendation in the self-management of type 2 diabetes (T2D). The Diabetes Community Exercise Programme (DCEP) is an exercise and educational programme aimed at supporting adults living with T2D to take control of their health and to live well with T2D. It was specifically developed to enhance the self-efficacy of people to engage in exercise for a long term and is underpinned by the spirit of motivational interviewing. This study explores what DCEP attendees and health care professionals (HCPs) who deliver the programme perceived DCEP to be and what motivated attendance. Such insights further the knowledge of how people with T2D can be supported to engage in exercise or physical activity programmes.

Method: This qualitative study used open-ended interviews of 17 DCEP attendees and 12 HCPs delivering DCEP. Interviews occurred at the completion of the initial twice-a-week, 12-week duration part of the programme and prior to attendees starting with a twice-weekly maintenance exercise class, which forms the second part of the programme. Interviews were audio-recorded, transcribed verbatim and analysed with the General Inductive Approach.

Results: The two themes constructed from the analysis were person-centred care and attention to logistics and administration. Person-centred care comprised four subthemes: monitoring, individualised exercise within a sociable group setting, flexible education and discussion, and HCP training, and these components appeared to support attendees to engage in exercise. The second theme spoke about the processes, that was either present or that should be included, that enabled DCEP delivery, such as appropriate venues, flexible approaches to time of day and the requirement of good administrative support.

Conclusion: The Diabetes Community Exercise Programme did motivate people with T2D to engage in exercise. Important to this was the emphasis on a person-centred approach that focussed on the health status monitoring and educational and social aspects of the programme, which in turn facilitated exercise engagement. Knowledgeable HCPs who require training in the delivery of person-centred care to tailor the exercise and education to the individual is imperative. Equally important are optimal exercise environments and well-trained administrative support.