Be Active Your Way Blog - People with Disabilities

Emphasizing Function

bHiss — Fri, 15 Apr 2011 14:23:00 -0400

"If you always put limits on everything you do, physical or anything else, it will spread into your work and into your life. There are no limits. There are only plateaus, and you must not stay there, you must go beyond them." - Bruce Lee

As important as it is for health and fitness professionals to know what limitations an individual may have in terms of creating appropriate activities, especially for safety and medical considerations, it's also important to consider what that individual CAN do, and what they can do in context with their environment. The social model of disability has taught us that systemic barriers, negative attitudes and exclusion by society (whether purposely or not) are the main contributing factors in disabling people, not the disability itself.

The International Classification of Functioning, Disability, and Health, or ICF, is a comprehensive framework used by the World Health Organization (WHO) for describing and measuring health and disability at both the individual and population levels. This framework is used to assess the relationship among an individual's function, activities, and participation while also considering these in the context of the environmental and personal factors that influence an individual's overall health.

The ICF puts the idea of 'health' and 'disability' in a new light and recognizes that any person can experience peaks and valleys in health, and therefore any person is prone to experiencing some kind of disability. It shifts the focus from what caused a disability to the impact that it has on the person. In addition, ICF considers the social aspects of disability and does not see disability as a medical condition. By including these contextual factors, the ICF helps us to assess the impact of the environment on the person's functioning, and therefore possibly assess potential "limitations" a bit differently.

The health domain and health-related domain contained in the ICF are described fromt he perspective of the body, the individual, and society in two basic categories: (1) Body Functions and Structures (system level); and (2) Activities and Participation (person level and person-environment interaction). The ICF can be used as a tool in exercise physiology to conduct a needs assessment or as an outcome evaluation. It allows the fitness professional to identify the barriers and facilitators that affect the health of the client with the disability and then find or create modifications for the specific individual in order to facilitate participation in an activity. The ICF emphasizes function, NOT the health condition, and categorizes the situation, NOT the person. Here is an example.

Do you see the ICF as having application in your field?

Reference: http://www.who.int/classifications/icf/en

Can Physical Activity Help Children with ADHD?

SLier — Tue, 01 Mar 2011 13:46:00 -0400

Inattentiveness, procrastination, fidgetiness, and disorganized work habits are just a few of the symptoms of ADHD. For a child with ADHD, such behaviors impair functioning at school, home, and their ability to maintain relationships with peers. The cause of ADHD is largely unknown and likely to be a multi-factorial interplay between genetic and environmental influences. Current strategies for management include medications and intensive behavioral therapy which are not optimal for long term management of the disorder.

Can physical activity help symptoms of ADHD? There is burgeoning research in this area that suggests this may be the case. A recent review paper published by Jeffery M. Halperin and colleagues from Queens College of the City University of New York, in Neuroscience and Behavioral Reviews, January 2011, suggests ADHD in children should be viewed within the context of a “developmental trajectory” rather than a fixed medical condition. As such, ADHD can be modified by environmental influences, including exercise. Individuals with ADHD are never cured, but they can compensate. Environmental influences, including exercise, may affect the degree of later brain development and hence determine the extent to which an individual can compensate.

Functional magnetic resonance imaging (fMRI) scans of the brains of children show that exercise increases activity in the frontal lobes, which are responsible for executive function (see USA Today article). The executive functions consist of processes responsible for planning, rule acquisition, initiating appropriate actions/inhibiting inappropriate actions, and selecting relevant sensory information. ADHD is a disorder of executive function. In an NIH funded study performed by Catherine Davis and colleagues at the Medical College of Georgia, on 94 sedentary children randomized to a high dose exercise intervention group, found improvement in planning scores (i.e., executive function) in the high dose group compared to controls.

Studies are underway to determine the optimal frequency and amount of physical activity appropriate for children with ADHD. There is some consensus however, that certain types of physical activities may be more beneficial in children with ADHD (see article). Activities that require memorization and sequencing of behaviors help focus attention and repeat learned movement patterns, e.g., yoga, martial arts, dance/ballet, gymnastics, swimming and team sports. One study of the brains of judo players (adults) by Jacini and colleagues found significantly higher volume of gray matter in the frontal, parietal, occipital, temporal, and cerebellar regions of the brains of judo players versus controls. Interestingly, neuroimaging studies have shown reduced volume of the frontal, posterior, and cerebellar areas of brains of children with ADHD.

There is also evidence that physical activity outdoors may be more beneficial for children with ADHD. Dr. Frances Kuo from the University of Illinois found that green outdoor settings (green backyard, park, or neighborhood space) appeared to reduce the symptoms of ADHD in children compared to the same activities performed in indoor settings AND built outdoor settings (concrete areas, not much green). Lastly, in July 2010, Yale Researcher, Dr. David Katz published preliminary results of the ABC Fitness Program (Activity Bursts in the Classroom) which focuses on physical activity during the school day. The study compared an intervention group (schools that incorporated bursts of physical activity throughout the day) versus a control group. Preliminary results indicated that medication use for ADHD decreased in the intervention group. Green settings for playgrounds at schools, physical activity in the morning before class (tai chi on the lawn anyone?), and incorporating physical activity during the day in the classroom, may be just the prescription needed to help children overcome the hurdles of ADHD.

Thanks to Farzana L. Walcott, MD, MPH, for submission of this post.

Using the Web to Promote Physical Activity for Everybody!

bHiss — Wed, 04 Aug 2010 13:01:00 -0400

There is a critical need to increase participation in physical activity for everyone, this we already know. Unfortunately, many physical activity programs are not designed in a way that includes people with disabilities. Recognizing the need for inclusive programming and the common barriers to physical activity for people with disabilities (cost, transportation, don’t know where/how to exercise, inaccessible facilities, lack of knowledgeable staff) the staff at the National Center on Physical Activity and Disability (NCPAD) knew it was time to put their heads together to come up with something creative, something that hadn’t been tried before.

It quickly became clear that the internet is a growing platform for delivering health promotion programs that can tackle many of the barriers faced by people with disabilities and reach large numbers of people. The existing web-based programs, though, didn’t seem to be providing modifications to allow people with a variety of different abilities to be able to participate. This was NCPAD’s niche! After much discussion and research, the 14-Week Program to a Healthier You was born; an inclusive web-based program that uses three stages of progression to promote physical activity (that can be done anywhere, without specialized equipment) and healthy eating for people of all abilities.

We had learned that, in general, the more a web-based program is tailored and interactive, the better the results. Understanding that one of our greatest challenges was going to be providing resources and exercises that fit the needs of each participant regardless of individual fitness level, exercise experience, and type of impairment, we knew that the opportunity for individualized interaction was crucial.

With these things in mind, the features of the program were developed. They include:

Communication with NCPAD’s 14-Week Coaches via live chat, toll-free hotline, and/or e-mail
SMS (text) option
Commitment pledge
Goal, physical activity, and dietary intake logs
Weekly e-mails
Weekly updates to the website, including:
- Motivational note from the coaches
- Resources on physical activity and nutrition
- Strength, flexibility, and balance exercises (step-by-step instructions included written description, pictures, videos, and modifications)
- Aerobic exercise videos and suggestions (a sample video can be viewed at http://www.youtube.com/user/NCPAD#p/u/42/mz4
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- Advice on frequency, intensity, and duration of physical activity
- Video blog of one participant’s experience with the program
Follow-up wellness coaching with one of the 14-Week Coaches after the 14 weeks had ended

The results, so far, have been fantastic! Interest in the program far-surpassed what we ever dreamed possible, with 3,500 people registering in 2010. Although we have yet to do a detailed evaluation of the program, preliminary review shows that people of all abilities increased their levels of physical activity, enjoyed the program, and would highly recommend it to others in their social circle! We are excited to run the program next spring and work in new ideas to continue to assist individuals of all abilities in becoming more physically active!

How are you creatively promoting physical activity for people of all abilities?

Meeting the Physical Activity Guidelines – A Call to Fitness Professionals

bHiss — Wed, 24 Feb 2010 12:01:00 -0400

Physical activity has been shown to improve cardiovascular and muscular fitness, mental health, and the ability to perform activities of daily living. And though I hope it’s of no surprise, this holds true for everyone.

For the most part, the guidelines for people with disabilities are not much different from the guidelines designated for “active” adults. The main difference seems to be the incorporation of the phrase “who are able to” into the specific recommendations as well as the removal of the suggestion that individuals should continue to increase or progress activity to reap even further health benefits (i.e. “the more the better”). There is also an additional recommendation for people with disabilities to consult a health-care provider about the amounts and types of physical activity that are appropriate for their abilities.

So let’s break this down:

Physical activity provides the same benefits to everyone.
Everyone should work toward performing the same amount and types of physical activity on a daily basis.
BUT, if you have a disability, you should find out how to do so.

Sounds simple.

But how do you find out how and where to exercise if (for example) you were born with spina bifida and the only person that you have ever seen for exercise (physical therapy) is at the rehabilitation hospital 2 hours away? PLUS, you use crutches to ambulate to work so don’t have enough energy reserve to take additional walks around your neighborhood but there are no curb cuts for using your wheelchair on the sidewalks. PLUS, your local gym doesn’t have any upper body machines or staff members who seem comfortable with your disability. PLUS, you have trouble regulating your body temperature and are concerned that any exercise will exacerbate your spasticity or other neurological symptoms.

That doesn’t make it sound so easy, does it?

People with disabilities may find more difficulty than most in meeting the recommended Physical Activity Guidelines based on the barriers they face when seeking out physical activity. Barriers can be architectural (there is no curb cut), programmatic (chairs are not available in exercise classes), or attitudinal (assumptions based on a diagnosis or the use of an assistive device).

Studies show that physical activity can be done safely when the program is matched to an individual’s abilities. We all have different abilities, different strengths and weaknesses, different levels of activity, different needs, different interests, etc. As fitness professionals, we have the opportunity of a lifetime to provide a much needed and appreciated service to millions of people (with and without disabilities) by becoming trained, knowledgeable and willing to adapt activities to address society’s differences, regardless of the existence of medical diagnoses.

So what do we do now? Here are a few suggestions:

Look at what the person can do, not their limitations.
Seek training and educational opportunities.
1. For example, there is a new specialty certification from the American College of Sports Medicine and the National Center on Physical Activity and Disability called a Certified Inclusive Fitness Trainer
Expand your marketing. The world of disability is a large one, 54 million, and it is also a well connected. Often one member/client will mean many more to follow.

For more information about physical activity for people with disabilities, go to www.ncpad.org.

What else can fitness professionals do? What are you already doing?

Physical Activity - When Movement May Already be a Challenge

LCulver — Wed, 17 Feb 2010 10:13:00 -0400

The benefits of physical activity are well documented and participation in regular physical activity can prevent or reduce the risk of numerous diseases and health conditions. In addition, physical activity has been shown to improve a person’s function and allow him or her to better participate in their chosen life roles. These benefits extend to individuals with functional impairments and movement limitations. In 2008 there were more than 35 million persons in the United States living with a disability in the US. Individuals with mobility challenges often experience difficulties participating in their routine physical activities. They also may experience access problems to typical environments for exercise. Others may be fearful of further injury or have co-morbidities which they perceive as a barrier to activity. These individuals may often require additional education, counseling, and other assistance to overcome barriers and optimally participate in physical activity.

Connecting the Dots: Community Participation

All healthcare professionals need to actively engage patients in conversations about physical activity and its lifelong health benefits. In doing so we need to consider not only their individual needs and capabilities, but also the environment in which they live. But do we provide enough input and advice to our patients to support them in this endeavor? In order to be successful, physical activity needs to be integrated into their lives – where they live, work, learn and play. All healthcare providers should be knowledgeable about and collaborate with the available resources in the local community to meet patients’ needs as they move from rehabilitation to managing their own care.

How well do you know your community resources? Do you know...

Where your patients can go in the community to be physically active?
Where there is a gym that is accessible for individuals with mobility complications?
If there is a local shopping center that opens its doors to ‘mall walkers’ in the morning?
If there are municipal sites (parks, trails) that might encourage physical activity?
If your community supports programs such as bike to work, walking school bus, stroller moms group, etc?

Collaborative Leadership: Community Advocacy

As health care providers we can play an essential role in our local communities through leadership and advocacy for a well designed community plan that encourages activity and reduces barriers for people with disabilities. We are well aware that the external environment can significantly help or hinder an individual’s ability to participate in all of life’s roles, and this holds true for participation in physical activity.

How can organizations collaboratively address the crisis of inactivity for those with movement or other challenges?