Equity in active living for people with disabilities: Less talk and more action

Addressing Disability Inequities: Let's Stop Admiring the Problem and Do Something about It

The healthcare system and public health community are often underprepared to support the needs of people with disabilities and to include them equitably in wellness programs (e.g., exercise, leisure, nutrition, stress management) offered to the general community. Consequently, the vast majority of people with disabilities are unable to make the transition from "patient" to "participant," which contributes to many of the health disparities reported in this population. People with disabilities have a disproportionately higher rate of acquiring secondary conditions such as obesity, cardiovascular comorbidity, pain, fatigue, depression, deconditioning, and type 2 diabetes, often resulting from poor access to home and community-based health promotion/wellness programs that include physical activity, nutrition, stress reduction, and sleep hygiene, among others. Achieving health equity in people with disabilities requires a multi-stage approach that includes person-centered referral to wellness programs, empowering people with disabilities to become self-managers of their own health and ensuring that community-based programs and services are inclusive. A three-stage model for addressing health and wellness needs across the home and community settings is described, which is currently being used in a large federally funded center in the US with potential generalizability across the world.

Demonstrating the vital role of physiatry throughout the health care continuum: Lessons learned from impacts of the COVID-19 pandemic on the disability community

COVID White Paper Series

Electromyography-Driven Exergaming in Wheelchairs on a Mobile Platform: Bench and Pilot Testing of the WOW-Mobile Fitness System

BACKGROUND

Implementing exercises in the form of video games, otherwise known as exergaming, has gained recent attention as a way to combat health issues resulting from sedentary lifestyles. However, these exergaming apps have not been developed for exercises that can be performed in wheelchairs, and they tend to rely on whole-body movements.

OBJECTIVE

This study aims to develop a mobile phone app that implements electromyography (EMG)-driven exergaming, to test the feasibility of using this app to enable people in wheelchairs to perform exergames independently and flexibly in their own home, and to assess the perceived usefulness and usability of this mobile health system.

METHODS

We developed an Android mobile phone app (Workout on Wheels, WOW-Mobile) that senses upper limb muscle activity (EMG) from wireless body-worn sensors to drive 3 different video games that implement upper limb exercises designed for people in wheelchairs. Cloud server recordings of EMG enabled long-term monitoring and feedback as well as multiplayer gaming. Bench testing of data transmission and power consumption were tested. Pilot testing was conducted on 4 individuals with spinal cord injury. Each had a WOW-Mobile system at home for 8 weeks. We measured the minutes for which the app was used and the exergames were played, and we integrated EMG as a measure of energy expended. We also conducted a perceived usefulness and usability questionnaire.

RESULTS

Bench test results revealed that the app meets performance specifications to enable real-time gaming, cloud storage of data, and live cloud server transmission for multiplayer gaming. The EMG sampling rate of 64 samples per second, in combination with zero-loss data communication with the cloud server within a 10-m range, provided seamless control over the app exergames and allowed for offline data analysis. Each participant successfully used the WOW-Mobile system at home for 8 weeks, using the app for an average of 146 (range 89-267) minutes per week with the system, actively exergaming for an average of 53% of that time (39%-59%). Energy expenditure, as measured by integrated EMG, was found to be directly proportional to the time spent on the app (Pearson correlation coefficient, r=0.57-0.86, depending on the game). Of the 4 participants, 2 did not exercise regularly before the study; these 2 participants increased from reportedly exercising close to 0 minutes per week to exergaming 58 and 158 minutes on average using the WOW-Mobile fitness system. The perceived usefulness of WOW-Mobile in motivating participants to exercise averaged 4.5 on a 5-point Likert scale and averaged 5 for the 3 participants with thoracic level injuries. The mean overall ease of use score was 4.25 out of 5.

CONCLUSIONS

Mobile app exergames driven by EMG have promising potential for encouraging and facilitating fitness for individuals in wheelchairs who have maintained arm and hand mobility.

Profile and opinion of people with disability with respect to adapted physical activity participation in Ethiopia

BACKGROUND

Physical activity provides long-term health benefits for everyone and it is considered to play an important role in the deterioration of health predictors, such as overweight and the associated increase in cardiovascular and all-cause mortality.

OBJECTIVE

To explore the profile and opinion of people with disability in Ethiopia, with respect to physical activity participation.

METHOD

The study comprised a questionnaire survey among male and female participants (N = 334) with visual and limb impairment, aged 15-50 years, living in urban and sub-urban areas of Ethiopia. The analyses entailed descriptive frequencies and percentages, with the chi-square statistic to test for significance between subsets of data at p ≤ 0.05.

RESULTS

The profile showed participants were mostly male (n = 221, 66.2%; p ≤ 0.05), had completed secondary school (n = 204, 61.1%; p ≤ 0.05), were not formally employed with some being day-labourers (n = 92, 27.5%) and petty traders (n = 71, 21.3%). The majority (p ≤ 0.05) had limb disabilities (n = 190, 57%) as opposed to vision impairment. Only 10% (n = 34; p ≤ 0.0001) confirmed participation in physical activity. More than half (n = 175, 52.7%; p ≤ 0.0001) were unsure whether exercise improves health but the majority (n = 175, 52.4%; p ≤ 0.0001) did agree that participation in adapted physical activity requires better facilities.

CONCLUSION

Ethiopian persons with disabilities are physically inactive. There is need to raise awareness on the benefits of physical activity amongst people with disabilities and for disability friendly facilities to encourage physical activity.

How can we get more people with long-term health conditions involved in parkrun? A qualitative study evaluating parkrun's PROVE project

Background

People with long-term health conditions face barriers to physical activity and community health interventions despite potential life-changing benefits for self-management of their condition and wellbeing. A weekly mass participation running, walking and volunteering event called parkrun launched a project called PROVE in 2016 to engage people living with long-term health conditions in England. Over the 3 year project, parkrun appointed volunteer Outreach Ambassadors with a specialist interest in the health condition they represented whose role was to ensure parkrun was welcoming, supportive and inclusive. This qualitative study aimed to understand the experience of the PROVE project for people with long-term health conditions.

Methods

Semi-structured interviews were conducted with 15 PROVE Outreach Ambassadors representing 13 different long-term health conditions in England. Interviews were recorded, transcribed verbatim and analysed using thematic analysis. Rigour and transparency were sought in addition to utilising independent researchers to offer alternative interpretations of the data.

Results

Data analysis resulted in 4 overarching themes and 13 subthemes. Outreach Ambassadors believed that parkrun was already supportive of people with long-term health conditions, but that the PROVE project enabled the support to be delivered in a more structured way across health conditions and locations. Outreach Ambassadors believed that the PROVE project had the potential to create a welcoming, safe space for people with long-term health conditions to participate as walkers, runners or volunteers. Success of the PROVE project was believed to be dependent on being realistic about the potential to bring about change, challenging people's perceptions of parkrun and engaging with key stakeholders and advocacy groups. Challenges for parkrun were believed to be around communication, demonstrating impact and the project's dependence on volunteers for delivery.

Conclusions

This is the first study of its kind to explore the public health potential of parkrun for people with long-term health conditions. parkrun's PROVE project was regarded to be important for ensuring that people with long-term health conditions can engage in physical activity and volunteering in a safe and supportive environment. The findings have important implications for parkrun, policy makers and physical activity providers looking to deliver inclusive community physical activity opportunities.

Physical activity of university students with disabilities: accomplishment of recommendations and differences by age, sex, disability and weight status

OBJECTIVES

This article aims to study physical activity and the achievement of World Health Organization physical activity recommendations in university students with disabilities, and to examine differences by sex, age, disability characteristics and weight status.

STUDY DESIGN

Cross-sectional data from a wider research project conducted at the Spanish universities from Autumn 2016 to Autumn 2017 were analysed.

METHODS

The International Physical Activity Questionnaire-Short Form was administered to 1103 Spanish university students with different disabilities. Nonparametric tests were performed to examine the differences in physical activity based on the interest variables.

RESULTS

The mean metabolic equivalent (MET)-minutes/week was 1772.75 (±2161.00) for total physical activity, 642.93 (±1303.08) for vigorous physical activity, 344.31 (±699.53) for moderate physical activity and 785.50 (±1053.31) for walking intensity physical activity. Overall, 72.2% of the participants did not meet the recommendation of 75 min/week of vigorous physical activity, 80.3% did not meet the recommendation of 150 min/week of moderate physical activity and 63.1% did not meet any of these recommendations. Nonparametric tests revealed that students with multiple disabilities, chronic illnesses, acquired disabilities, older students, obese students and women were less active than their counterparts.

CONCLUSIONS

A high number of participants did not meet the World Health Organization physical activity recommendations, and some subgroups were especially inactive. Public health policies should implement interventions to encourage people with disabilities to engage in physical activity, paying extra attention to the most inactive subgroups.

Disparities in Life Course Outcomes for Transition-Aged Youth with Disabilities

Close to 750,000 youth with special health care needs transition to adult health care in the United States every year; however, less than one-half receive transition-planning services. Using the "F-words" organizing framework, this article explores life course outcomes and disparities in transition-aged youth with disabilities, with a special focus on youth with autism, Down syndrome, and cerebral palsy. Despite the importance of transition, a review of the available literature revealed that (1) youth with disabilities continue to have poor outcomes in all six "F-words" domains (ie, function, family, fitness, fun, friends, and future) and (2) transition outcomes vary by race/ethnicity and disability. Professionals need to adopt a holistic framework to examine transition outcomes within a broader social-ecological context, as well as implement evidence-based transition practices to help improve postsecondary outcomes of youth with disabilities. [Pediatr Ann. 2017;46(10):e371-e376.].