Barriers to, and Facilitators of, Exercising in Fitness Centres among Adults with and without Physical Disabilities: A Scoping Review

A review of adaptive equipment and technology for exercise and sports activities for people with disabilities

Individuals with disabilities face psychological, environmental, and resource-related barriers to participating in exercise and sports. The lack of participation in exercise observed in the disability community poses great concern to this population's health. This review discusses commercially available adaptive equipment and technology for exercise and sports that help people with disabilities circumvent barriers to exercise. The methods section highlights various categories of adaptive tools and their cost, accessibility, ease of learning, and progress level to help people with disabilities determine points of entry to fitness that align with their needs. Additionally, fitness-related businesses, fitness device developers, and researchers can leverage the discussed findings to understand gaps in this field to further advance adaptive equipment and technology and help facilitate widespread use. The paper serves as a comprehensive resource to researchers, entrepreneurs, and consumers to guide developing, accessing, and marketing adaptive exercise technology.

Understanding the experience of community-based fitness professionals supporting people with disability to engage in sport and exercise: a national survey

PURPOSE

The benefits of sport and exercise participation for people with disability are well acknowledged. However, people with disability report numerous barriers to participating in sport and exercise, including negative interactions with fitness professionals. Limited research is available from the perspective of fitness professionals. This study aimed to understand the experience of fitness professionals supporting people with disability to engage in sport and exercise.

MATERIALS AND METHODS

A cross sectional survey study was used to gather quantitative and qualitative data on community-based fitness professionals from Australia, with or without experience working with a person with disability.

RESULTS

A total of 72 fitness professionals took part in the study with most reporting experience and confidence in working with people with disabilities. Several barriers were identified with participants highlighting the lack of disability-specific training. Participants also identified potential facilitators, including effective collaboration with allied health professionals.

CONCLUSION

There is emerging interest for fitness professionals to support people with disability to engage in sport and exercise. However, changes are required within the education provided to fitness professionals and with the current collaborative model with allied health professionals to better support the participation of people with disability in sport and exercise.

Assessment of park paths and trails to promote physical accessibility among wheelchair users in Saudi Arabia

Background

Individuals with mobility disabilities are less likely to meet physical activity standards and are at greater risk of developing non-communicable chronic diseases at earlier ages. Public parks are an essential resource for participation in physical activity. However, environmental factors may limit the participation of wheelchair users. The objective of this study was to evaluate the feasibility of using the Path Environment Audit Tool (PEAT) and to explore the wheelchair accessibility of five public parks in Saudi Arabia through descriptive analysis.

Methods

A descriptive study design was implemented to evaluate wheelchair accessibility features of five public parks in Riyadh, Saudi Arabia, and process, resource, and management assessments were conducted. Phone GPS-App Strava was used to track the segments and measure their distances.

Results

Audits in multiple parks using PEAT were time-consuming despite being user-friendly. The descriptive analysis of paths and trails across the five parks showed some positive features, such as adequate bollard/gate clearance, but the path slope and condition of the path surfaces were more variable.

Conclusion

This study is the first to examine wheelchair accessibility in public parks in Saudi Arabia. Preliminary audits of paths/trials in five public parks revealed the strengths and weaknesses of accessibility and features that promote physical activity participation for wheelchair users. These findings can guide future use of PEAT in large-scale studies and inform environmental modifications.

A co-designed mixed methods study on community-based gym exercise for non-ambulant adults with childhood onset disability

PURPOSE

Explore community-based gym exercise for non-ambulant adults with childhood-onset disability.

MATERIALS AND METHODS

Non-ambulant adults with childhood-onset disability participated in four, weekly gym sessions co-facilitated by physiotherapists and exercise professionals. Practicalities of participating in the sessions were recorded via uptake and attrition, weekly surveys, and focus groups. Perspectives of those who designed/delivered the study were gathered via weekly debrief meetings. Quantitative data were analysed descriptively, qualitative data were analysed thematically.

RESULTS

Ten non-ambulant adults with childhood-onset disability participated; 70% completed all exercise sessions. Focus groups identified three themes. "I wouldn't be able to exercise…there's no option for a community-based setting" described the lack of opportunities for exercise in gyms. "You don't realise the benefit of coming here" highlighted benefits of exercise. "We can do better" had two sub-themes: problem solving and ingredients for community-based gym exercise. Weekly feedback and debrief meetings identified practicalities related to equipment, exercises, and collaborative working between facilitators.

CONCLUSIONS

Whilst there is an interest in community-based gym exercise for non-ambulant adults with childhood-onset disability, there remains a lack of inclusive gyms. Co-design of inclusive gym guidelines and condition-specific physical activity referral scheme may enhance opportunities for participation in gym exercise for adults with childhood-onset disability.

Barriers and enablers to exercise adherence in people with nonspecific chronic low back pain: a systematic review of qualitative evidence

ABSTRACT

Exercise is a first-line treatment for chronic low back pain (CLBP), reducing pain and disability in the short term. However, exercise benefits decrease over time, with a lack of long-term exercise adherence a potential reason for this. This study aimed to synthesize the perceptions and beliefs of individuals with CLBP and identify their barriers and enablers to exercise adherence. We searched CENTRAL, Embase, CINAHL, SPORTDiscus, PubMed, PsycINFO, and Scopus databases from inception to February 28, 2023, for qualitative studies that explored the factors influencing exercise adherence for people with CLBP. A hybrid approach combining thematic synthesis with the Theoretical Domains Framework was used to analyze data. We assessed methodological quality using the Critical Appraisal Skills Programme checklist and the level of confidence of the themes generated using the Confidence in the Evidence from Reviews of Qualitative Studies. Twenty-three papers (n = 21 studies) were included (n = 677 participants). Four main themes affected exercise adherence: (1) exercise, pain, and the body, (2) psychological factors, (3) social factors, and (4) external factors. These themes contained 16 subthemes that were predominantly both barriers and enablers to exercise adherence. The individual's experiences of barriers and enablers were most appropriately represented across a spectrum, where influencing factors could be a barrier or enabler to exercise adherence, and these could be specific to pre-exercise, during-exercise, and post-exercise situations. These findings may be used to improve exercise adherence and ultimately treatment outcomes in people with CLBP.

Identifying Factors That Influence Physical Activity and Healthy Aging Among Older Latino Adults

BACKGROUND

For older Latinos, some benefits of leisure-time physical activity (LTPA) include enhanced cognitive functioning, decreased loneliness, and reduced premature mortality. Despite LTPA benefits, adults ≥50 years are one of the most inactive age groups in the United States.

METHODS

This qualitative study aimed to add to the limited evidence of LTPA in older Latino adults by exploring the barriers and facilitators for fitness class uptake and park use. Guided by a Social-Ecological Model of Health and Social Determinants of Health theoretical and a phenomenological research design, qualitative research data were collected via 27 personal interviews with Latino adults using a semistructured interview guide. Participants were recruited using purposive sampling strategies in collaboration with community partners. Bicultural data collectors conducted the semistructured interviews over Zoom. Thematic analysis was performed using Dedoose, following an inductive and deductive approach.

RESULTS

The main barriers to fitness class attendance and park use were family and/or work commitments, perceived safety, and perceived discrimination. Conversely, the critical facilitators for participation were socialization into a group, social connectedness with group members, fitness instructor characteristics, and exercise history.

CONCLUSIONS

Findings from this study hold important implications for the design of fitness programming and park-based recreation, including the need to increase the cultural diversity of recreation staff and culturally relevant programming. Future research is needed on time poverty related to family/work commitments and whether discriminatory practices at fitness centers, like ageism and race/ethnicity, influence physical activity behavior.

Priority populations' experiences of the accessibility and inclusion of recreation centres: a qualitative study

BACKGROUND

Although the health benefits of physical activity are well documented, certain priority populations are often disproportionately insufficiently active and at higher risk of poor health. Recreation centres have the potential to provide accessible and supportive environments for physical activity for all. However, little is known about priority populations' experiences of these venues and their views of how accessibility and inclusion can be optimised. This study aimed to gain in-depth insights of recreation centre experiences and potential strategies for improving inclusion and accessibility amongst priority populations (women, older adults, ethnic minorities, persons living with disabilities/additional needs, individuals identifying as LGBTQIA+, low socio-economic position).

METHODS

This qualitative study (2021-2022) involved 18 semi-structured individual interviews with adult priority population users of recreation centres (50% 65 + years, 61.2% female) in one Melbourne municipality. Participants were asked to discuss their positive and negative experiences at the centres and to identify strategies for enhancing accessibility and inclusion. Interviews were audio-recorded and transcribed verbatim. Content analysis was performed for data analysis.

RESULTS

While many participants had positive views of the facilities and programs at the centres, as they met their needs, they also had suggestions for improving accessibility and inclusion. Similarly, most participants were happy with the communications, felt included, and perceived the culture positively. Those who did not feel included at the centres offered many potential strategies for changing the culture, modifying communications (e.g., signage), and establishing partnerships for better access and inclusion.

CONCLUSIONS

The present study adds to essential knowledge concerning priority populations' experiences of recreation centres. For recreation facilities that were generally perceived as having positive inclusion and accessibility, the findings nonetheless highlighted suggestions for further enhancement. These strategies may be useful more broadly for improving accessibility and inclusion, thereby promoting physical activity and ultimately health for all.

Engagement in an mHealth-Guided Exercise Therapy Program Is Associated With Reductions in Chronic Musculoskeletal Pain

CONTEXT

Chronic musculoskeletal pain costs the US $980 billion annually. Conservative treatments are the criterion standard, but scalable methods of treatment remain to be evaluated.

OBJECTIVE

The aim of the study is to determine the effects of pain reduction and the perceived benefits of an mHealth exercise therapy program.

DESIGN

This is a retrospective observational study on data from 3109 people (18-98, 49% female) with musculoskeletal pain in an mHealth exercise program. Presession pain was measured via 11-point numeric rating scale and nonstandardized single-item questions for work and quality of life; all were analyzed using mixed-effects models.

RESULTS

By 11 sessions, there was an estimated a 2.09-point decrease in average numeric rating scale pain levels. There was an average percent increase of approximately 0.7 points for work life and quality of life ( tdf =6,632 = 12.06, P < 0.001). User engagement was high; 46% of participants were performing more than one session per day, and 88% were engaging within a week, indicating the feasibility of the deployment of an mHealth exercise app.

CONCLUSIONS

An mHealth exercise program was associated with significant decrease in pain and increased perceived benefits in a large population. These findings serve as preliminary findings of the feasibility for mHealth exercise interventions as scalable tools to improve chronic musculoskeletal pain outcomes.

Investigation of physical playfulness in physiotherapy students

BACKGROUND

Physiotherapists show a positive attitude towards playing games in order to be a role model for pediatric patients and to increase the success of therapy. The aim of the present study is to investigate the physical playfulness of physiotherapy students and the relationship of physical playfulness and individual and environmental factors.

METHODS

The sociodemographic data, regular physical activity habits of the students were examined as well as their computer game playing status and duration. "Attitudes of 18-22 Age Adults for Playing Games That Contain Physical Activity" scale was used for assessing playfulness.

RESULTS

A total of 268 students participated in the study. Among the game proneness scale subsections, the highest score was obtained in the Social Adjustment while the lowest scores were obtained in the "Desire to Play Game" and "To take pleasure from playing game" subsections. Male students scored higher in "Risk Taking and "To take pleasure from playing game" in comparison with the female students. There was a statistically significant difference between physical activity habits and "Game Compassion", "Risk Taking", "Social Adjustment" and "To take pleasure from playing game scores".

CONCLUSION

Physiotherapy students were found to be more playful, particularly in terms of social adaptation. Men take more risks in the plays and also play the games more enjoyable. Students with regular physical activity habits were more playful overall. The present study suggests that monitoring physical activity levels, computer games types might be beneficial for evaluating the playfulness.

Adults with Cerebral Palsy: Navigating the Complexities of Aging

The goal of this narrative review is to highlight the healthcare challenges faced by adults with cerebral palsy, including the management of long-term motor deficits, difficulty finding clinicians with expertise in these long-term impairments, and scarcity of rehabilitation options. Additionally, this narrative review seeks to examine potential methods for maintaining functional independence, promoting social integration, and community participation. Although the brain lesion that causes the movement disorder is non-progressive, the neurodevelopmental disorder worsens from secondary complications of existing sensory, motor, and cognitive impairments. Therefore, maintaining the continuum of care across one's lifespan is of utmost importance. Advancements in healthcare services over the past decade have resulted in lower mortality rates and increased the average life expectancy of people with cerebral palsy. However, once they transition from adolescence to adulthood, limited federal and community resources, and health care professionals' lack of expertise present significant obstacles to achieving quality healthcare and long-term benefits. This paper highlights the common impairments seen in adults with cerebral palsy. Additionally, it underscores the critical role of long-term healthcare and management to prevent functional decline and enhance quality of life across physical, cognitive, and social domains.

Lifelong Fitness in Ambulatory Children and Adolescents with Cerebral Palsy I: Key Ingredients for Bone and Muscle Health

Physical activity of a sufficient amount and intensity is essential to health and the prevention of a sedentary lifestyle in all children as they transition into adolescence and adulthood. While fostering a fit lifestyle in all children can be challenging, it may be even more so for those with cerebral palsy (CP). Evidence suggests that bone and muscle health can improve with targeted exercise programs for children with CP. Yet, it is not clear how musculoskeletal improvements are sustained into adulthood. In this perspective, we introduce key ingredients and guidelines to promote bone and muscle health in ambulatory children with CP (GMFCS I-III), which could lay the foundation for sustained fitness and musculoskeletal health as they transition from childhood to adolescence and adulthood. First, one must consider crucial characteristics of the skeletal and muscular systems as well as key factors to augment bone and muscle integrity. Second, to build a better foundation, we must consider critical time periods and essential ingredients for programming. Finally, to foster the sustainability of a fit lifestyle, we must encourage commitment and self-initiated action while ensuring the attainment of skill acquisition and function. Thus, the overall objective of this perspective paper is to guide exercise programming and community implementation to truly alter lifelong fitness in persons with CP.

Conditions and strategies influencing sustainability of a community-based exercise program incorporating a healthcare-community partnership for people with balance and mobility limitations in Canada: A collective case study of the Together in Movement and Exercise (TIME™) program

Background

Community-based exercise programs delivered through healthcare-community partnerships (CBEP-HCPs) are beneficial to individuals with balance and mobility limitations. For the community to benefit, however, these programs must be sustained over time.

Purpose

To identify conditions influencing the sustainability of CBEP-HCPs for people with balance and mobility limitations and strategies used to promote sustainability based on experiences of program providers, exercise participants, and caregivers.

Methods

Using a qualitative collective case study design, we invited stakeholders (program providers, exercise participants, and caregivers) from sites that had been running a CBEP-HCP for people with balance and mobility limitations for ≥4 years; and sites where the CBEP-HCP had been discontinued, to participate. We used two sustainability models to inform development of interview guides and data analysis. Qualitative data from each site were integrated using a narrative approach to foster deeper understanding of within-organization experiences.

Results

Twenty-nine individuals from 4 sustained and 4 discontinued sites in Ontario (n = 6) and British Columbia (n = 2), Canada, participated. Sites with sustained programs were characterized by conditions such as need for the program in the community, presence of secure funding or cost recovery mechanisms, presence of community partners, availability of experienced and motivated instructors, and the capacity to allocate resources towards program marketing and participant recruitment. For sites where programs discontinued, diminished participation and/or enrollment and an inability to allocate sufficient financial, human, and logistical resources towards the program affected program continuity. Participants from discontinued sites also identified issues such as staff with low motivation and limited experience, and presence of competing programs within the organization or the community. Staff associated the absence of referral pathways, insufficient community awareness of the program, and the inability to recover program cost due to poor participation, with program discontinuation.

Conclusion

Sustainability of CBEP-HCPs for people with balance and mobility limitations is influenced by conditions that exist during program implementation and delivery, including the need for the program in the community, and organization and community capacity to bear the program's financial and resource requirements. Complex interactions among these factors, in addition to strategies employed by program staff to promote sustainability, influence program sustainability.

Development and Pilot Testing of the Disability Awareness Training and Education Program Among Community-Based Group Fitness Instructors

Lack of disability awareness of fitness professionals is a well-established barrier to exercise participation among people with disabilities that is likely related to the lack of disability awareness training for group fitness instructors. The purposes of this study were to develop, implement, and evaluate a disability awareness training for group fitness instructors. A 90-min video training and resource manual were developed. We recruited 10 group fitness instructors from one recreation center to participate. Participants completed baseline, posttraining, and 2-month follow-up testing on survey-based outcomes including disability attitudes, confidence in exercise adaptations, and training satisfaction. Participants' confidence to adapt fitness classes was significantly improved; however, disability attitudes were high in the pretest and not significantly different posttraining. Semistructured interviews were conducted posttraining and revealed three themes: Formal disability training is needed, Managing inclusive class dynamics, and Training suggestions and satisfaction. This training demonstrated a feasible intervention for increasing disability awareness among community-based group fitness instructors.

A retrospective evaluation of the Brain and Body Fitness Studio service on functional capacity and quality of life in people with neurological disorders

Background

People with neurological disorders (ND) are less physically active than the general population due to physical, sensory, and/or cognitive impairments. These individuals often feel intimidated to join mainstream health and wellness centers due to lack of specialized support for people with ND. The Brain and Body Fitness Studio (BBFS) is one of the first Accredited Exercise Physiologist-led interprofessional services in Adelaide South Australia to provide individualized evidence-based multimodal exercise prescription and social support for this population. This comprehensive retrospective study evaluated the impact of BBFS on functional capacity (FC) determined as the 6-min walk distance (6 MWD) achieved during a 6-min walk test (6 MWT), of its members with ND.

Methods

Sixty-two BBFS members (age, 66 ± 10 years; 60% male) with ND (85% Parkinson's Disease; average time since diagnosis, 4 years [IQR, 2 to 12 years]) and complete pre- and post-6-month clinical assessment of the primary outcome of the study, the 6 MWD, were included in this retrospective analysis. A series of sub-analyses were also performed to investigate the effects of adherence to the recommended prescription of at least twice a week in the program (≥80 vs. < 80% adherence), and disease stage (time since diagnosis; ≥6 vs. < 6 years) on FC.

Results

Although there was no statistically significant change in 6 MWD from pre- to post-6-month BBFS program (+15 ± 90 m, p = 0.19), a clinically meaningful improvement of >14 m was evident. Improvement in 6 MWD was significantly greater in members who attended at least 80% of the recommended visits (≥80% visits, +37 ± 58 m; ≤ 80% visits,-1 ± 105 m, p = 0.046). We also found a 6 MWD improvement from pre- to post-6 months in those in the early years of their ND (< 6 years since diagnosis, +39 ± 76 m), but not in those in the later years of their ND (≥6 years since diagnosis, -36 ± 123 m, between group difference, p = 0.029).

Conclusion

A clinically meaningful 6 MWD improvement may be elicited by services provided by BBFS in people with ND. Overall, the benefits appear to be more evident in members who attended the BBFS for at least 80% of the recommended visits and those who were in the early stage of their ND diagnosis.

Walking Attenuates Postprandial Glycemic Response: What Else Can We Do without Leaving Home or the Office?

We evaluated the effects of different exercise types suitable for a home/work setting on the postprandial glucose response. Twenty-three healthy, active, young individuals performed one of two studies (12 in Study 1 and 11 in Study 2), with four randomized protocols each. After a meal high in carbohydrate content (1 g of carbohydrate per kg of body weight), in Study 1, participants performed 30 min of either walking (WALK), bench stepping exercise (STEP) or isometric wall squat (SQUAT); in Study 2, participants performed 30 min of either walking (WALK), neuromuscular electrical stimulation alone (P_NMES) or superimposed on voluntary muscle contraction (VC_NMES). In both studies, participants performed a prolonged sitting condition (CON) that was compared to the exercise sessions. In Study 1, WALK and STEP significantly reduced the glucose peak compared to CON (p < 0.011). In Study 2, the peak was significantly reduced in WALK compared to CON, P_NMES and VC_NMES (p < 0.011) and in VC_NMES compared to CON and P_NMES (p < 0.011). A significant reduction of 3 h glucose iAUC was found for WALK and VC_NMES compared to CON and P_NMES (p < 0.033). In conclusion, WALK is the most effective strategy for improving the postprandial glycemic response. However, STEP and VC_NMES can also be used for reducing postprandial glycemia.

The Coronavirus pandemic and closed fitness clubs negatively affected members exercise habits

Introduction

Due to the Coronavirus pandemic, politicians enacted directions to reduce social interactions, including lockdown of fitness clubs. We aimed to investigate how this changed exercise habits of Norwegian gym members.

Method

Based on survey data, men and women (≥18 years, n = 233, data collection from Aug. 2020 to Jan. 2021) were recruited to this study by an email-invitation from their fitness club chain or by Facebook advertisement. The participants reported on background variables (e.g., age, gender, total household income, occupation, and education), and exercise habits pre- and during social lockdown. Data were analyzed using independent or student t-test, chi-squared test, or McNemar's test, as appropriate.

Results

Home-based exercise (18.0 vs. 72.5%, p = <0.001), walking (49.8 vs. 65.2%, p = <0.001), and cycling (16.7 vs. 24.5%, p = 0.004) was more common during than pre-lockdown. Also, men (4.33 to 3.68 days/week, p =0.013) and women (4.20 to 3.79 days/week, p = 0.001) reported a lower exercise frequency, and a shorter duration. Exercise frequency was lower in those with a BMI ≥25 than in those with BMI <25 (3.95 vs. 4.48 days/week, p = <0.007) pre-lockdown. High exercise attendees (≥3 sessions/week, 66.5%) reported a smaller decrease in exercise frequency (mean change: 0.06 vs. 1.24 days/week, p = <0.001) and duration (>60 min. per session: 33.0 vs. 3.8%, p = <0.001) than low exercise attendees during lockdown.

Discussion

Home-based exercise, walking, and cycling were most frequently reported during lockdown. Participants reported a small decrease in exercise duration and frequency compared with pre-lockdown. Closure of fitness clubs impacted low attendees more than high attendees.

"I wouldn't have joined if it wasn't online": understanding older people's engagement with teleyoga classes for fall prevention

BACKGROUND

Yoga-based exercise is a promising strategy for promoting healthy ageing, with the potential to reduce falls and increase physical, cognitive and psychological wellbeing. Teleyoga (real-time yoga provided via interactive videoconferencing) can deliver yoga programs at scale, potentially reducing costs, increasing convenience, and reaching people who cannot attend studio-based classes. But better understanding of how older people perceive and engage with teleyoga is needed to optimise its design, implementation and promotion.

METHODS

This study built on a previous realist process evaluation of the SAGE yoga trial which is testing the effect of a yoga-based exercise program on falls among 700 community-dwelling people aged 60 + years. In this second phase of evaluation we conducted focus groups with participants who had completed the SAGE program online and with the yoga instructors who were delivering it. We also conducted interviews with participants who had withdrawn from the trial. Six program theories developed in the earlier evaluation provided a framework for data analysis, supplemented by inductive coding and an analytical workshop.

RESULTS

Participants described physical and psychological benefits from the SAGE teleyoga program. While noting that teleyoga cannot facilitate hands-on correction or the same quality of observation or interaction as studio classes, participants were highly appreciative of their yoga instructors' strategies for optimising visibility, instruction, social connection and therapeutic alliance, and for adapting to constrained home environments. Some participants argued that teleyoga was superior to studio classes due to its accessibility and convenience, its lower exposure to potential embarrassment about physical appearance or capabilities, and a reduced sense of peer competition and distraction. Our program theories applied across studio and online modes of delivery.

CONCLUSION

Teleyoga increases accessibility for people in diverse locations and circumstances; it provides a psychologically safer space which combats self-consciousness and unwanted competitiveness; it may enhance embodiment and mindfulness for some; and it has the potential to be offered relatively cheaply at scale which could support free or reduced price classes for people on low incomes and pensions, thereby encouraging a wider population to engage in yoga for healthy ageing and fall prevention.

Prevention of Physical Risk and Rehabilitation of Muscle Injury in Sanda Competition

The Target. The purpose of this study is to explore the reduction of sports injury risk and verify the effective methods and means of athlete's muscle injury rehabilitation. Methods. In this study, 80 sanda athletes from a university were randomly selected as subjects, and the main parts of injury of all subjects were counted. After 12 weeks of muscle injury rehabilitation intervention, the pain, acute injury, and technical and tactical evaluation levels of subjects in the intervention group and the control group were compared. Results/Discussion. The overall performance of the 80 subjects' basic exercise ability was at a moderate level, and there was no significant difference between male and female subjects (P >0.05). After 12 weeks of rehabilitation intervention, there was no significant difference in the scores of shoulder joint flexibility, supine straight leg raising, and trunk stable support between male and female subjects in the intervention group in more than 7 sports (P >0.05). In the control group, there were significant differences in the scores of shoulder flexibility and trunk stability of male and female subjects (P < 0.05). Future research should further explore the effect of muscle injury rehabilitation on effectively reducing potential sports injuries and introduce advanced and effective medical rehabilitation methods.

Developing Indicators to Evaluate Instructor Management of Sports Centers for the People With Disabilities Based on Universal Design Principles in South Korea

This study was conducted to develop evaluation indicators for instructor-led management of sports centers for the disabled using universal design (UD) principles in South Korea. These indicators have been developed through Delphi technique to identify the effectiveness of an instructor's management skills. There were 11 documents related to UD used in the literature review, and seven were related to the evaluation index. Through reading and analyzing the relevant contents of the collected literature and many rounds of the Delphi technique, we selected the method and criteria for deriving the evaluation index. In this study, we developed a method that constitutes an evaluation index. The index comprises one evaluation criterion and four evaluation indices. First, for the sub-items of the “recruitment” category, four principles of UD and one supplementary principle of product performance program (PPP) were applied to create items for the evaluation index. Second, the sub-items of the “education” category comprise three evaluation criteria and 10 evaluation indicators. These were applied to the fourth principle of UD and the first and second by-supplementary principles of PPP. The third category, “welfare,” comprised two evaluation criteria and six evaluation indices, and the first by-supplementary principle of PPP was applied to the evaluation indices. The index created for evaluating instructors in sports centers using the method elucidated in this study was adequately reliable. Following a similar method, more evaluation indicators should be developed for evaluations of other functions (such as programs, public relations, safety, and finance) based on the principles of UD.

The (In)Accessibility of YouTube Fitness Videos for Disabled Individuals Before and During the COVID-19 Pandemic: A Preliminary Application of a Text Analytics Approach

Background

People with disabilities face barriers to in-person physical activity (PA), including a lack of adaptive equipment and knowledgeable instructors. Given this and the increased need for digital resources due to widespread COVID-19 lockdowns, it is necessary to assess the accessibility of digital fitness resources for people with disabilities. To investigate whether YouTube fitness content creators have made videos accessible to people with disabilities would be informative about access to PA during COVID-19 and could also provide insight into the feasibility of individuals who are disabled relying on YouTube for PA in a post–COVID-19 world.

Objective

This study aims to ascertain if disability-friendly PA videos on YouTube are accessible through searching general fitness terms and whether a change in the availability of accessible fitness resources for people with disabilities occurred on YouTube between before and during the COVID-19 pandemic on “Hospital/Medical Institutions,” “Individual(s),” and “Other(s)” channels. Secondary aims are to investigate if different categories of YouTube channels produce more accessible fitness content and highlight any disparities in disability-friendly PA content on YouTube.

Methods

A cross-sectional text analysis of exercise-related YouTube videos was conducted. The authors used Python (version 3.0) to access the YouTube database via its data application programming interface. Terms pertaining to PA that were searched on YouTube were at-home exercise, exercise at home, exercise no equipment, home exercise, home-based exercise, no equipment workout, and workout no equipment. Various elements (eg, view count and content generation) of the videos published between January 1 and June 30, 2019 (n=700), were compared to the elements of videos published between January 1 and June 30, 2020 (n=700). To capture a broad idea of disability-friendly videos on YouTube, videos were labeled “accessible” if they were found in the first 100 video results and if their title, description, or tags contained the following terms: para, paralympic, adaptive, adapted, disabled, disability, differently abled, disability-friendly, wheelchair accessible, and inclusive. Each video and channel were categorized as “Hospitals/Medical Institutions,” “Individuals,” or “Other(s).”

Results

The analysis revealed a statistically significant increase in viewership of fitness content on YouTube (P=.001) and in fitness content generated by Hospitals/Medical Institutions (P=.004). Accessible terms applicable to people with disabilities had minimal appearances in 2019 (21 videos) and 2020 (19 videos). None of the top viewed fitness videos that populated on YouTube from 2019 or 2020 were accessible.

Conclusions

The proportion of accessible disability-friendly videos remains diminutive relative to the prevalence of disability in the general population, revealing that disability-friendly videos are seldom findable on YouTube. Thus, the need for disability-friendly fitness content to be easily searched and found remains urgent if access to digital fitness resources is to improve.

Fitness center use and subsequent achievement of exercise goals. A prospective study on long-term fitness center members

Background

Knowledge on the relationship between fitness center use and long-term members’ subsequent goal achievement is limited. Therefore, the aim was to investigate the prospective association between the use of fitness centers during 18 months and subsequent self-reported goal achievement among long-term members.

Methods

This was a registry- and survey-based longitudinal study of 2851 people who had been members at a Norwegian fitness center chain for more than two years. Fitness center use from December 2016 to June 2018 was obtained from registry data. Subsequent goal achievement was measured in a survey in June 2018, assessed by a 1–100 visual analogue scale, and a score between 0 and 50 was defined as low goal achievement.

Results

Visiting the fitness center frequently and regularly, and having frequent group activity bookings were associated with higher subsequent self-reported goal achievement. Participants with fewest visits (1–57 days) during 18 months were more likely to report low goal achievement than participants with most visits (118–543 days) (OR = 8.5; 95% CI 6.3–11.4). Fitness trainer bookings was not clearly associated with subsequent goal achievement.

Conclusions

Frequent and regular long-term fitness center use were associated with higher subsequent self-reported goal achievement.

Fitness for all: how do non-disabled people respond to inclusive fitness centres?

Background

Representation of people with disabilities in fitness centres is lacking, despite initiatives to promote inclusion mainly in the UK and USA. Success creating these inclusive spaces is mixed and few were crafted taking into account attitudes and biases of non-disabled co-members. Inclusive fitness centres have not gained much attention in Denmark, and the campaign ‘Fitness for All - fitness for people with physical disabilities’ was initiated. The aim of this study was shaped by two key questions; 1) what is the ideal fitness space from the perception of non-disabled fitness users? and 2) how might their dis/ableist attitudes negate inclusion in three future pilot inclusive fitness centres across Denmark?

Method

Three focus groups involving 5–7 (total n = 18) adult non-disabled participants were conducted. Aged ranged between 19 and 75 years, both men and women were involved, with fitness centre experiences ranging from 0 to 20+ years. Interviews were transcribed and analysed using Malterud’s four-step method of systematic text condensation.

Results

Of most importance was a pleasant atmosphere which should make them feel welcome and comfortable. Good social relations within the space were also highly valued. Participants welcomed people with physical disabilities but predicted many challenges with an inclusive fitness centre and expressed unconscious ableist attitudes.

Conclusion

The current study adds essential knowledge regarding how non-disabled people perceive the ideal inclusive fitness centre. A welcoming and inviting atmosphere is essential whereas social skills, ableism, ignorance, and preconceptions are important barriers that may hinder inclusion of participants with disabilities in inclusive fitness centres.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-021-00303-2.