Physical activity patterns of African-American women with physical disabilities

Association between timed up and go test and future incidence of disability: A nationwide representative longitudinal study in Korea

Although previous studies examined the association between mobility and disability, they have used either subjective measure disability such as activity of daily living or instrumental activity of daily living or indirect measure such as long-term care service use with small size of participants. This study aimed to examine the association between timed up and go (TUG) test and disability incidence with national disability registration data in Korea longitudinally, by using a national representative sample. We used the National Health Insurance Service–National Health Screening Cohort (NHIS–HEALS) database of National Health Information Database. The NHIS–HEALS dataset includes disability information of National Screening Programme participants, including registration date and type of disability, which is merged from Korean National Disability Registry (KNDR). We used Cox proportional hazard models to evaluate the association between TUG and disability incidence. We constructed three models with different levels of adjustment; Model 3 was a fully adjusted model. We conducted subgroup analysis according to the risk factors for disability. The study population comprised 81,473 participants; 86 of them were newly registered to KNDR, which were observed during a mean follow-up of 4.1 ± 2.6 (maximum, 8.9) years. For 334,200.9 person-year (PY) follow-up, the disability incidence rate was 0.208 per 1,000 PY. Disability incidence was significantly higher in participants with abnormal TUG results than in those with normal TUG results. (adjusted hazard ratio [aHR] 1.600, 95% confidence interval [CI] 1.036–2.472). In subgroup analysis, the disability incidence increased in participants of normal cognition, without obesity or without cardiovascular (CV) disease. Increased incidence in disability was noted in participants with abnormal TUG results. The increase was more evident for participants with normal cognition, without obesity or CV disease.

Association between disability and cardiovascular event and mortality: A nationwide representative longitudinal study in Korea

This study aimed to examine the association between disability and cardiovascular (CV) disease incidence and mortality in Korea longitudinally, using a national representative sample. We used the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) database, which includes information on the disability of the National Screening Program participants such as severity and type of disability, which were obtained from the Korean National Disability Registry. Cox proportional hazard models were used to evaluate the association between disability and CV disease incidence and mortality. We constructed four models with different levels of adjustment, in which Model 3 was a fully adjusted model. This study included 514,679 participants, and 7,317 CV deaths were reported within a mean follow up of 10.8 ± 3.9 years (maximum, 13.9 years). For 5,572,130 person-year (PY) follow-up, the CV mortality rate was 1.313 per 1,000 PY. In Models 1 and 2, CV disease incidence was significantly higher in participants with disability than in those without disability. In Model 3, the incidence was higher only among participants aged 50–64 years and severe disabled participants aged <50 years. CV mortality was significantly higher in participants with disability than in those without disability in all Models, and the mortality increased in both sexes in Models 1 and 2 but only increased in men in Model 3. Similar results were observed in the subgroup analysis of health behavior and chronic diseases. People with disability showed higher CV disease incidence and mortality than those without disability, regardless of the type of disability or risk factors for CV disease.

The Need for Health Promotion for Adults who are Visually Impaired

Health promotion interventions for adults who are visually impaired have received little attention. This article reports what is currently known about the health, overweight and obesity, and levels of physical activity reported by these adults. Conclusions about the need for health promotion activities based on this information are provided, and suggestions for implementing these activities or interventions are offered.

Facilitators of and Barriers to Providing Access to Community-Based Exercise Programmes for Adults with Post-Stroke Aphasia from the Perspective of Programme Representatives

Purpose: Individuals with post-stroke aphasia (PSA) engage in inadequate levels of physical activity (PA), hindering physical and psychosocial recovery. The purpose of this study was to identify the extent to which community-based exercise programmes (CBEPs) in the Greater Toronto Area (GTA) are accessible to adults living with PSA and the characteristics of such programmes from the perspective of CBEP representatives. Methods: A cross-sectional, Web-based survey was administered to representatives of CBEPs open to adults post-stroke in the GTA to identify the CBEPs' relevant characteristics and perceived facilitators of and barriers to accessibility. Results: A total of 17 eligible CBEP representatives completed the survey, for a response rate of 32%. The most commonly used exercise instructors were personal trainers (8; 47%). Of the 17 eligible CBEP representatives, 10 (59%) identified a lack of qualified personnel as the main barrier to providing access to adults with PSA. Verbal strategies were among the most commonly used methods of communication with adults with PSA (16; 94%), and written material was the least used (5; 29%). Conclusion: Understanding the common facilitators of and barriers to providing adults with PSA access to CBEPs will assist programme developers to improve the accessibility of CBEPs and facilitate PA in this population.

The Conspicuous Absence of People with Disabilities in Public Fitness and Recreation Facilities: Lack of Interest or Lack of Access?

Critical Issues and Trends More than 50 million Americans have a disability. These people face enormous physical, social, and attitudinal barriers toward their participation in physical and recreational activities that they need to maintain their health and wellness. Furthermore, the concept of being "healthy" and "disabled" or "physically active" and "disabled" is not a common visualization in the mainstream media. This paper calls for a more inclusive vision within public health messages that target physical activity participation among its citizens, especially those with disability who are at greater risk for developing health problems associated with sedentary living.

Facilitating Community-Based Exercise for People With Stroke: Cross-Sectional e-Survey of Physical Therapist Practice and Perceived Needs

BACKGROUND

Educating people with stroke about community-based exercise programs (CBEPs) is a recommended practice that physical therapists are well positioned to implement.

OBJECTIVE

The aim of this study was to evaluate the provision of education about CBEPs to people with stroke, barriers to providing education, and preferences for resources to facilitate education among physical therapists in neurological practice.

DESIGN

A cross-sectional e-survey of physical therapists treating adults with stroke in Ontario, Canada, was conducted.

METHODS

A link to the questionnaire was emailed to physical therapists in a provincial stroke network, a provincial physical therapy association, and on hospital and previous research lists.

RESULTS

Responses from 186 physical therapists were analyzed. The percentage of respondents who reported providing CBEP education was 84.4%. Only 36.6% reported typically providing education to ≥7 out of 10 patients with stroke. Physical (90.5%) and preventative (84.6%) health benefits of exercise were most frequently discussed. Therapists reported most commonly delivering education at discharge (73.7%). Most frequently cited barriers to educating patients were a perceived lack of suitable programs (53.2%) and a lack of awareness of local CBEPs (23.8%). Lists of CBEPs (94.1%) or brochures (94.1%) were considered to be facilitators. The percentage of physical therapists providing CBEP education varied across acute, rehabilitation, and public outpatient settings.

LIMITATIONS

The percentage of physical therapists providing education may have been overestimated if respondents who deliver CBEP education were more likely to participate and if participants answered in a socially desirable way.

CONCLUSIONS

Even though a high proportion of physical therapists provide CBEP education, education is not consistently delivered to the majority of patients poststroke. Although a CBEP list or brochure would facilitate education regarding existing CBEPs, efforts to implement CBEPs are needed to help overcome the lack of suitable programs.

Disparities in Adverse Preconception Risk Factors Between Women with and Without Disabilities

OBJECTIVE

The objective of this study was to compare the prevalence of select preconception health indicators among women with and without disabilities.

METHODS

2010 Behavioral Risk Factor Surveillance System data were used to estimate the prevalence of health behaviors, health status indicators, and preventive health care among non-pregnant women ages 18-44 years with (N = 8370) and without (N = 48,036) disabilities. Crude percentages were compared with Chi square statistics. Multivariable logistic regressions adjusted for socio-demographic factors.

RESULTS

Women with disabilities were more likely than women without disabilities to currently smoke (30.5 vs. 14.5 %, p < 0.0001) and less likely to exercise in the past month (67.1 vs. 79.8 %, p < 0.0001). Heavy drinking was similar in the two groups (4.4 vs. 4.5 %, p = 0.9). Health status indicators were worse among women with disabilities, with 35.0 % reporting fair/poor health and 12.4 % reporting diabetes, compared with 6.7 and 5.6 %, respectively, among women with no disabilities (p < 0.0001 for both). Frequent mental distress, obesity, asthma, and lack of emotional support were also higher among women with disabilities compared with their non-disabled counterparts. Women with disabilities were more likely to receive some types of preventive care, (HIV), but less likely to receive others (recent dental cleaning, routine checkup). Disparities in health behaviors and health status indicators between the two groups remained after adjusting for socio-demographic factors.

CONCLUSION

Women with disabilities at reproductive age are more vulnerable to risk factors associated with adverse pregnancy outcomes compared to their counterparts without disabilities. Our findings highlight the need for preconception health care for women with disabilities.

Perceived barriers to physical activity among Nigerian stroke survivors

INTRODUCTION

Benefits of physical activity in the prevention and management of stroke are well documented in the literature. There is increasing evidence that stroke survivors in South-West Nigeria are physically inactive. Data on barriers to the achievement of the recommended physical activity levels including its differences along socio-demographic characteristics among stroke survivors in South-West Nigeria are needed.

METHODS

The Exercise Benefits and Barrier Scale and the International Physical Activity Questionnaire were administered on 121 stroke survivors to determine their perceived barriers to physical activity and physical activity levels respectively. Information on socio-demographic data and clinical variables were also collected.

RESULTS

The sample included 70.2% males, with majority of the participants reporting low physical activity levels (80.2%) and high perceived barriers (Mean = 48.13, SD = 7.88). The four most reported common barriers among stroke survivors were access to exercise facilities (95.0%), being embarrassed to exercise (94.2%), economic cost demands of exercise (94.2%) and notion that people in exercise clothes look funny (94.2%) respectively. There were no significant differences found in barriers to physical activity between gender (U = 1471.00, P = 0.74) and across each of: occupational status (H = 4.37, P = 0.22), age group (H = 0.82, P = 0.84) and educational levels (H = 4.56, P = 0.33). Significant difference however existed in perceived barriers across marital status categories (H = 12.87, P = 0.05).

CONCLUSION

Stroke survivors indicated high perceived barriers to physical activity and these barriers were associated with marital status.

Barrier removal in increasing physical activity levels in obese African American women with disabilities

BACKGROUND

This pilot study examined the effectiveness of a telephone-based intervention to increase physical activity in obese African American women with mobility disabilities by targeting the removal of barriers to participation.

METHODS

Severely obese (mean body mass index [BMI] = 49.1 kg.m²) African American women (n = 33) with mobility disabilities completed a 6-month telephone-based physical activity coaching intervention.

RESULTS

The major environmental/facility barriers at preintervention were cost of the program (66.7%), lack of transportation (48.5%), not aware of fitness center in the area (45.5%), and lack of accessible facilities (45.5%). The major personal barriers were pain (63.6%), don't know how to exercise (45.5%), health concerns (39.4%), don't know where to exercise (39.4%), and lack of energy (36.4%). Despite only two personal barriers being significantly lower at posttest (don't know where to exercise and don't know how to exercise) (p < 0.01), total exercise time increased from < 6 minutes/day to 27 minutes/day at posttest (p < 0.001), and total physical activity time (structured exercise, leisure, indoor and outdoor household activity) increased from 26 minutes/day to 89 minutes/day at posttest (p < 0.001).

CONCLUSIONS

Interventions aimed at increasing physical activity participation among obese African American women with mobility disabilities should start with increasing their awareness/knowledge on where and how to exercise. Other reported barriers (e.g., cost, transportation, finding an accessible facility, health concerns, pain) may not be as critical to alter/remove as identifying where participants can exercise (i.e., home, outdoors, gym) and providing them with a variety of routines that can be performed safely in their desired setting.

Built environment instruments for walkability, bikeability, and recreation: disability and universal design relevant?

BACKGROUND

Despite a plethora of instruments that measure the built environment with respect to its effect on potential physical activity, little is known about how relevant these instruments are for people with disabilities (PWDs).

OBJECTIVE

This review comprises an in-depth review of instruments related to the built environment and physical activity, as well as an examination of such instruments to determine their applicability for PWDs.

METHODS

In this paper, the term "built environment" refers to human-made structures (e.g., urban and rural design characteristics, recreational structures) that may facilitate or impede an individual's ability to be physically active. A content analysis was conducted on 95 instruments measuring walkability, bikeability, and recreation with respect to disability and universal design (UD) relevance. Instruments were also cataloged according to other dimensions, including psychometric properties, data collection modalities, and impact or use.

RESULTS

Roughly one third of all instruments include some disability-specific items, and only a few UD principles are consistently demonstrated across all instruments. Psychometric information is available for approximately one half of the instruments. Most instruments use objective/audit methods of data collection, with less using subjective/perceived and Geographic Information System (GIS) methods. With respect to instrument impact/use, just over one half of the instruments have articles cited in the peer-reviewed literature.

CONCLUSIONS

Recommendations for new and revised built environment instruments include more focus on specific disability populations, incorporation of all UD principles, as well as attention to psychometric quality and measurement specificity.

Effects of disability-associated low energy expenditure deconditioning syndrome

People with neuromuscular disabilities have high rates of sedentary behavior predisposing them to severe deconditioning and significant health risk. We describe this as disability-associated low energy expenditure deconditioning syndrome and propose new approaches for promoting light-to-moderate intensity physical activity in people with disabilities.

Disparities in health-risk behaviors, preventive health care utilizations, and chronic health conditions for people with disabilities: the Korean National Health and Nutrition Examination Survey

OBJECTIVE

To examine how disability status is related with health disparities in South Korea.

DESIGN

The study compared 3 indicators of health (health-risk behaviors, preventive health care utilizations, and chronic health conditions) according to the presence of disabilities using the Third Korean National Health and Nutrition Examination Survey, 2005 (KNHANES III).

SETTING

We obtained data from the KNHANES III, which is the third nationwide representative study using a stratified, multistage probability sampling design.

PARTICIPANTS

Subjects (N=5475) aged 20 years or older were included in the study; persons with disabilities (n=218) and persons without disabilities (n=5257).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Nonconditional multiple logistic regression and adjusted mean were used to identify health disparities in health-risk behaviors, preventive health care utilizations, and chronic health conditions.

RESULTS

Subjects with disabilities were more likely to be physically inactive (adjusted odds ratio [AOR]=3.06; 95% confidence interval [CI], 1.71-5.48 for no physical activity; AOR=1.70; 95% CI, 1.19-2.43 for insufficient physical activity) than those without disabilities. Women aged 40 years or older with disabilities were less likely to receive cervical cancer screening services (AOR=0.52; 95% CI, 0.27-0.98). Adults with disabilities had higher proportion of osteoporosis (AOR=2.41; 95% CI, 1.50-3.88), underweight (AOR=2.14; 95% CI, 1.07-4.28), suicidal thoughts (AOR=1.86; 95% CI, 1.35-2.56), and had impaired quality of life (95% CI of adjusted mean, 60.89-65.35 compared to 69.95-70.84 in adults without disabilities).

CONCLUSIONS

There exists substantial disability-related health disparities in South Korea. People with disabilities may be the underserved subpopulation demonstrating health disparities. The findings in this study underscore the continued needs in order to reduce health problems and disparities for people with disabilities.

Disability and race: a comparative analysis of physical activity patterns and health status

PURPOSE

Minority groups, specifically African Americans (AAs), are more likely to be physically inactive than the general population. Although the aforementioned finding is well documented, there is a dearth of literature that examines levels of physical activity among AA adults with disabilities. The purpose of this article was to study the patterns of physical activity and health status among AA adults with disabilities in comparison with their White counterparts.

METHODS

Data from the Centers for Disease Control and Preventions 2007 Behavioral Risk Factor Surveillance System survey were used to conduct comparative analyses of physical activity patterns and health status among 7315 AAs and 82 482 Whites who self-reported a disability.

RESULTS

Significant differences (p < 0.05) were found between health status and physical activity patterns across racial groups. AAs with disabilities were less likely to engage in moderate and vigorous physical activity than their White counterparts. AAs were also less likely to engage in physical activity as health status declined in comparison with White respondents.

CONCLUSION

When considering the health of minorities with disabilities, physical activity must be central to improving their health status. The authors of this study provide additional support for developing unique health programming for AAs with disabilities. Rehabilitation and health care professionals can gain insight into lifestyle patterns of minorities with disabilities, which can be useful in addressing health behaviors that may be counter to physical well-being.

Overweight and obesity in women with physical disabilities: associations with demographic and disability characteristics and secondary conditions

BACKGROUND

This cross-sectional study was designed to examine weight in association with demographic and disability characteristics and secondary conditions in a sample of community living women with physical disabilities.

METHODS

443 predominantly ethnic minority women with physical disabilities were recruited through public and private health clinics and community organizations. They completed questionnaires including measures of body mass index and a health conditions checklist.

RESULTS

Data showed that nearly three-quarters of the sample were overweight (26.6%) or obese (47.6%) with 14% extremely obese. Obesity was highest among middle aged women (aged 45-54, 52.7%; aged 55-64, 52.5%; compared to aged 18-44, 37.8%; or aged ≥65, 39.1%). Black (84.0%) and Hispanic women (83.8%) were more likely to be overweight or obese compared to non-Hispanic white women (56.7%). Women with joint and connective tissue diseases and women with more extensive functional limitations were more likely to have excess weight. Disability factors were more strongly associated with excess weight than demographic factors other than age. Weight classification was significantly related to whether or not the women had ever had diabetes or blood pressure problems. Diabetes was reported 4 times as often as among women in general (36.3% versus 8.9%), and hypertension nearly twice as often (56.2% versus 30.9%).

CONCLUSIONS

These findings indicate extremely high rates of overweight and obesity in women with physical disabilities, a growing population greatly in need of effective weight management interventions. Overweight and obesity in combination with disability in women was associated with disproportionately high rates of diabetes and hypertension.

People with mobility impairments: Physical activity and quality of participation

BACKGROUND

we sought to describe the characteristics of physical activity levels, health, community integration, and social participation of people with mobility impairments.

METHODS

based on responses to a participation survey, respondents, located primarily in the Midwestern United States, were divided into 3 physical activity groups: high, low, and inactive. We chose a purposeful sample of 604 people with mobility limitations who had a diagnosis of spinal cord injury, multiple sclerosis, cerebral palsy, stroke, or poliomyelitis. The Participation Survey/Mobility (PARTS/M) was used to measure participation in 6 domains and 20 different activities, the Physical Activity and Health Status (SF-36) was used to measure health and quality of life, and the Reintegration to Normal Living Index (RNL) was used to measure integration into the community.

RESULTS

people with mobility impairments who were identified as having a high level of physical activity reported greater participation, better health, and a higher level of reintegration to normal community living compared with participants who described their physical activity level as low or inactive.

CONCLUSION

positive health status and superior community participation were found in a high physical activity group compared with low active or inactive groups of people with mobility impairments and limitations.

Leisure-time physical activity and secondary conditions in women with physical disabilities

PURPOSE

To examine the relationship between secondary conditions and leisure-time physical activity participation (LTPA) in women with physical disabilities.

METHOD

A survey was conducted in a metropolitan urban USA area of women (n=170) with physical disabilities including MS, CP, polio, arthritis, TBI, and CVA among others and aged 21-65 years. Outcome measures were LTPA, secondary conditions (numbers and severity), and functional status.

RESULTS

Respondents experienced 11.99 (+/-6.05) secondary conditions in the past year, self-rated their severity as 'moderate problems', and reported moderate levels of functional impairment. LTPA participation (excluding calisthenics/exercise) was reported to be 2.90 (+/-5.12) times/week with 39.4% reporting no participation. After controlling for the interaction between severity of secondary conditions and functional status, the secondary conditions of physical deconditioning and isolation were significantly and inversely related to LTPA participation (r=-0.164, p=0.036; r=-0.156, p=0.045, respectively).

CONCLUSION

Reported secondary conditions of physical deconditioning and isolation are inversely related to the ability of moderately impaired women with physical disabilities to participate in LTPA when functional status was controlled and should be considered in efforts to increase involvement in this health promoting behaviour.

Use of the ICF in identifying factors that impact participation in physical activity/rehabilitation among people with disabilities

Many health professionals have expressed difficulty finding ways to keep people with disabilities engaged in community-based physical activity/rehabilitation programs. A major reason for this low adherence may be that the recommended intervention plan does not match well with the specific needs of the individual. Various personal and/or environmental factors along with the person's level of functioning can impede participation in healthful physical activity/rehabilitation. The International Classification of Functioning, Disability and Health (ICF) can be a useful tool for identifying key factors associated with participation in community-based physical activity/rehabilitation. The ICF allows health professionals to identify the level of functioning at the body, person and societal level, as well as understand the person-environment contextual factors that may impede or enhance participation. This paper describes how the ICF can assist health professionals in identifying a broader constellation of factors when prescribing physical activity/rehabilitation programs for persons with varying levels of disability.

DIFFERENCES IN EXERCISE PERFORMANCE AND LEISURE-TIME PHYSICAL ACTIVITY IN OLDER CAUCASIANS AND AFRICAN-AMERICANS

PURPOSES: (a) To compare exercise performance and leisure-time physical activity (LTPA) between older Caucasians and African-Americans, (b) to assess the relationship between exercise performance and LTPA, and (c) to determine whether group differences in exercise performance persist after adjusting for differences in LTPA. METHODS: A total of 207 Caucasians and 160 African-Americans who were 65 years of age and older participated in this study. Subjects were characterized on exercise performance by a 6-minute walk test, and by a short physical performance battery (SPPB) score consisting of a repeated chair rise test, a standing balance test, and a 4-meter walk test. Additionally, LTPA was assessed using the Minnesota LTPA questionnaire. RESULTS: African-Americans had a 16% lower SPPB value (P < 0.001), a 14% shorter 6-minute walk distance (P < 0.001), and a 34% lower LTPA value (P < 0.011) than the Caucasians. LTPA was significantly related (P < 0.01) to both SPPB and 6-minute walk distance in both groups. Differences in SPPB and 6-minute walk distance between older Caucasians and African-Americans were no longer present (P > 0.05) after controlling for LTPA. CONCLUSIONS: Older African-Americans had impaired exercise performance and lower LTPA compared to older Caucasians. Racial differences in exercise performance were no longer present after adjusting for differences in LTPA.

Measurement and description of physical activity in adult manual wheelchair users

BACKGROUND

The purposes of this study were to (1) describe physical activity of adult manual wheelchair users as measured by wrist actigraphy and two self-report measures, (2) compare exercisers and nonexercisers on measures of physical activity, and (3) examine the relationships between three activity measures.

METHODS

Fifty manual wheelchair users wore an activity monitor and completed a physical activity record for 7 days. At the completion of this period, a questionnaire that included the Physical Activity Scale for Individuals with Physical Disabilities, stage of exercise question, and demographic and health questions was completed.

RESULTS

Mean daily hours spent in bed or asleep was 9.1, mean hours of light intensity activity was 12.5, mean hours of moderate intensity activity was 1.3, and mean hours of strenuous activity was 0.33. Thirty-eight percent did not report any strenuous activity, and 56% reported less than the 150 minutes weekly of moderate or strenuous activity required to meet public health guidelines. There was variability in both self-reported and objectively measured physical activity. Regular exercisers were not significantly different from nonexercisers on objective measures of physical activity. Measured physical movement was weakly correlated with recall of physical activity or exercise.

CONCLUSION

Many wheelchair users do not meet public health guidelines for physical activity, but they are not a homogeneous group in intensity and frequency of physical activity. Multiple measurement methods can provide insights into the nature, intensity, and duration of physical activity that is more complex due to variations in abilities and ways of moving.

Multiple health disparities among minority adults with mobility limitations: san application of the ICF framework and codes

PURPOSE

To examine the interface between mobility limitations and minority status and its effect on multiple health and health-related domains among adults, using the framework of the International Classification of Functioning, Disability and Health (ICF).

METHODS

We combined 8 years of data from the 1997-2004 US National Health Interview Survey to investigate health disparities among minorities with mobility limitations as defined by the ICF. A total of 79,739 adults surveyed met these criteria.

RESULTS

Adults with both mobility limitations and minority status experienced the greatest disparities (p<0.001) in worsening health (adjusted odds ratio [AOR]=8.5), depressive symptoms (AOR=17.2), diabetes (AOR=5.5), hypertension (AOR=3.4), stroke (AOR=7.2), visual impairment (AOR=4.6), difficulty with activities of daily living (AOR=42.7) and instrumental activities of daily living (AOR=27.7), use of special equipment (AOR = 28.1), obesity (AOR=3.3), physical inactivity (AOR=2.7), and low workforce participation (AOR=0.35).

CONCLUSIONS

For most outcome measures, findings supported our hypothesis that persons with both mobility limitations and minority status experience greater health disparities than do adults with minority status or mobility limitations alone.

Promoting active living among people with physical disabilities evidence for neighborhood-level buoys

BACKGROUND

People with physical disabilities are more likely to be sedentary than the general population, possibly because they have an accrued sensitivity to environmental features.

OBJECTIVES

This paper describes the relationship between neighborhood-level active living buoys and the active living practices of adults with physical disabilities living in a large urban area.

METHODS

A sample of 205 people with physical disabilities was recruited via a local rehabilitation center and its adapted fitness center. Telephone interviews were administered by senior occupational therapy students. The interview included a modified version of the Physical Activity and Disability Survey, a validated instrument that includes questions on physical activity, active transportation, and other activities of daily living. Individuals were geocoded within their census tract of residence (n=114) using their postal codes. Data on neighborhood active living potential were gleaned from systematic social observation.

RESULTS

Multilevel logistic regression analyses showed that the association between the presence of environmental buoys and leisure activity was significant (OR=4.0, 95% CI=1.1-13.8) despite adjustments for individual difference variables while the association with active transportation became nonsignificant (OR=2.9, 95% CI=0.7-7.7) following adjustment for these variables.

CONCLUSIONS

People with physical disabilities who live in neighborhoods with more environmental buoys are more likely to report involvement in leisure-time physical activity.

Obesity and secondary conditions in adolescents with disabilities: addressing the needs of an underserved population

Children and adolescents with physical and cognitive disabilities have a higher prevalence of overweight compared to their non-disabled peers. This health risk can lead to a greater number of obesity-related secondary conditions (e.g., fatigue, pain, deconditioning, social isolation, difficulty performing activities of daily living) and can impose significant personal and economic hardship on the child and family. Effective strategies for reducing the risk of overweight/obesity in adolescents with disabilities must begin with greater awareness of the behavioral and environmental antecedents that lead to higher rates of obesity in this underserved segment of the youth population. Research on interventions to reduce obesity among adolescents with disabilities is an important area of future research for public health scientists. A range of interventions will be necessary to overcome the many barriers that youth with disabilities experience in achieving and maintaining a healthy weight.

Correlates of physical activity in adults with mobility limitations

This study identified the correlates of objectively and subjectively measured physical activity in adult wheelchair users. Fifty participants wore an activity monitor for a week and completed a questionnaire about factors associated with physical activity. Objectively measured activity correlated significantly with body mass index. Subjectively measured activity correlated significantly with age, stage of change, health, healthcare providers discussing exercise, and social support for exercise. Research on the effect of body mass index on activity in this population is needed. Intervention planners should plan programs that place emphasis on modifying the social environment (including healthcare providers) and removing attitudinal barriers.

Physical activity and nutritional behaviors of women with physical disabilities: Physical, psychological, social, and environmental influences

INTRODUCTION

We examined predictors of 2 important health behaviors, namely, physical activity and nutritional behaviors, in a sample of community-living women with physical disabilities (N = 386).

METHOD

We conducted a cross-sectional survey with regression analysis.

RESULTS

Our regression model accounted for 33.5% of the variance in physical activity. Women with joint problems or multiple sclerosis tended to engage in less physical activity than those with stroke-related disabilities. Those who had lived with their disability longer and those experiencing greater pain tended to report less physical activity. Consistent with the literature, women with greater self-efficacy for physical activity tended to engage in more physical activity. The regression model for nutritional behaviors accounted for 37.9% of the variance. Women with better mobility, greater self-efficacy for nutrition, and more vitality had better nutritional behaviors while those who needed assistance with activities of daily living, had lower social functioning scores, and were engaged in more productive activities reported poorer nutritional behaviors.

CONCLUSIONS

Our findings highlight the importance of self-efficacy for improving health behaviors. Further research is needed to develop a new paradigm for the measurement of health behaviors, one that focuses on individual improvement rather than comparison to a norm, and health promoting interventions that are responsive to the needs and life circumstances of women with physical disabilities.

Accessibility of health clubs for people with mobility disabilities and visual impairments

OBJECTIVE

We sought to examine the accessibility of health clubs to persons with mobility disabilities and visual impairments.

METHODS

We assessed 35 health clubs and fitness facilities as part of a national field trial of a new instrument, Accessibility Instruments Measuring Fitness and Recreation Environments (AIMFREE), designed to assess accessibility of fitness facilities in the following domains: (1) built environment, (2) equipment, (3) swimming pools, (4) information, (5) facility policies, and (6) professional behavior.

RESULTS

All facilities had a low to moderate level of accessibility. Some of the deficiencies concerned specific Americans with Disabilities Act guidelines pertaining to the built environment, whereas other deficiency areas were related to aspects of the facilities' equipment, information, policies, and professional staff.

CONCLUSIONS

Persons with mobility disabilities and visual impairments have difficulty accessing various areas of fitness facilities and health clubs. AIMFREE is an important tool for increasing awareness of these accessibility barriers for people with disabilities.

Aerobic exercise training in stroke survivors

Functional aerobic capacity among persons with stroke is severely compromised and may limit their full participation in community living. Even though aerobic conditioning can be potentially valuable to persons with stroke in reducing the risk of recurrent morbid events and improving overall quality of life, there is limited information on the specific dose of aerobic exercise (i.e., frequency, intensity, duration, and modality) that may achieve the most desirable health outcomes under the safest conditions in this population. Because of the many comorbidities associated with stroke (i.e., hypertension, heart disease, obesity, depression), specific recommendations for prescribing aerobic exercise must become more precise and be subsequently added to the treatment regimen for this large and diverse population. Future research must address optimal aerobic training programs necessary for reductions in cardiovascular risk factors and gains in functional status in stroke patients.

Exercise and physical activity in persons aging with a physical disability

The relationship between physical functioning and physical activity isa reciprocal one; physical functioning provides the individual with the capability to engage in physical activities, and physical activity helps to maintain and in some cases improve physical functioning. This reciprocal relationship, coupled with the high prevalence of physical inactivity among persons aging with a disability, has profound implications for rehabilitation practice, especially in evaluating intermediate and long-term outcomes of clinical practice. For rehabilitation to play a role in the long-term maintenance and enhancement of physical functioning among persons with disabilities, increasing participation in various types of physical activity in the community must be part of the recovery and maintenance continuum. There is also a critical need to identify specific doses of physical activity for specific disabilities and secondary conditions. HMOs and other health insurers will require evidence-based outcomes before establishing reimbursement procedures for physical activity programs for persons aging with a physical disability.

Adverse health behaviors and chronic conditions in working-age women with disabilities

This retrospective, cross-sectional, multiple cohort study of women with disabilities addresses two health-related areas in a nationally representative sample of women living in the community. Using data from the 1997-1998 National Health Interview Survey (NHIS), health risk behaviors and chronic conditions were examined for women with mild, moderate, and severe functional limitations, and their responses were compared to those of women who reported no limitations. Women with severe limitations evidenced the highest risk for heavy cigarette smoking. They were also more likely to meet the Body Mass Index criterion for obesity. Adverse health behaviors were strongly associated with the five potentially disabling chronic conditions that were studied.

Exercise training for African Americans with disabilities residing in difficult social environments

OBJECTIVE

To examine the feasibility, efficacy, and safety of a structured 12-week exercise training program for a predominantly African-American group of adults with multiple health conditions who reside in difficult social environments.

METHODS

A total of 37 females and 7 males (mean age, 54.1 years) participated in an exercise training regimen 3 days per week for 60 minutes per day (cardiovascular, 30 minutes; strength, 20 minutes; and flexibility, 10 minutes). Outcome measures included peak VO(2) (mL min(-1), mL kg(-1) min(-1)); upper and lower body strength (strength); hand-grip strength (GS); body weight (BW); total skin folds (TS); waist-to-hip ratio (WHR); hamstring/low-back flexibility (HLBF); and shoulder flexibility (SF).

RESULTS

Compared to the control group, the exercise group showed significant gains in peak VO(2) (p < 0.01); strength (p < 0.01); and body composition (TS, p < 0.01). There was no significant difference between the exercise and control groups on BW, WHR, HLBF, and GS. Of a total 1116 exercise sessions (31 experimental participants x 36 sessions), 87% of the sessions were attended.

CONCLUSIONS

A structured exercise-training program can provide substantial improvement in strength and cardiovascular fitness in low-income, sedentary adults with multiple chronic conditions and/or risk factors for chronic conditions. Future research should explore simple home-based and community-based physical activity interventions that provide ongoing support for increasing and maintaining physical activity participation in this cohort.

Determinants of exercise in adults with cerebral palsy

This study examined the impact of environmental factors and caregiver attitudes on exercise participation in adults with cerebral palsy using a social-cognitive model. The sample included 83 adults with cerebral palsy (47.0% males and 53.0% females). Hierarchical regression analysis was conducted with exercise frequency as the dependent variable. Independent variables included personal characteristics of persons with cerebral palsy (age, level of mental retardation, health status, mobility, and arm/hand limitation), type of residence, exercise facility access, and caregiver-perceived benefits of exercise for people with cerebral palsy. The significant determinants of exercise participation were the caregiver's perceived benefits of exercise for persons with cerebral palsy and the type of residence. When caregivers perceived greater benefits of exercise, adults with cerebral palsy were likely to exercise more frequently. Non-nursing home residents were more likely to exercise than nursing home residents. This difference was related to differences in the caregivers' perceived benefits of exercise and not because of the personal characteristics of the residents or access to the exercise facility. Results of this study point to the need to inform and educate caregivers about the benefits and importance of exercise for adults with cerebral palsy.

Health promotion for people with physical, cognitive and sensory disabilities: an emerging national priority

Despite the growth in health promotion programs for able-bodied people, very little effort has been devoted to developing programs for people with physical and cognitive disabilities. Programs for people with disabilities must be developed with full recognition of limitations caused by both the primary and secondary disability.

A new measure for assessing the physical activity behaviors of persons with disabilities and chronic health conditions: the Physical Activity and Disability Survey

PURPOSE

Assess the psychometric properties of the Physical Activity and Disability Survey (PADS), a new physical activity measure for persons with disabilities and chronic health conditions.

DESIGN

Cross-sectional and pre-post designs were employed.

SETTING

A Midwestern university fitness center.

SUBJECTS

Participants were 103 individuals with disabilities and/or chronic health conditions.

MEASURES

The Physical Activity and Disability Survey (PADS), peak oxygen uptake (peak VO2), maximum workload (MW), and time to exhaustion (TE) during exercise.

RESULTS

Factor analysis revealed a four-factor model that generally corresponded to PADS subscales. Cronbach alpha coefficients ranged from .67 (Exercise) to .77 (Time Indoors). Test-retest reliability (1-week interval) ranged from .78 (Time Indoors) to .95 (Leisure Time Physical Activity). Interrater reliability ranged from .92 (Household Activities) to .99 (Exercise, Leisure Time Physical Activity, Total Activity). Significant (p < .05) correlations were found between PADS subscales and absolute peak VO2 (Leisure Time Physical Activity, Household Activity, Total Activity), relative peak VO2 (Exercise, Time Indoors), MW (Time Indoors, Household Activity), and TE (Household Activity, Total Activity). Analyses of variance revealed that, unlike controls, health promotion program participants evidenced significant pre-post gains as measured by the Exercise subscale and Total Activity score.

CONCLUSIONS

The findings lend support for the reliability and validity of the PADS as a measure of physical activity of groups who are sedentary and disabled.

Exercise training in a predominantly African-American group of stroke survivors

PURPOSE

The purpose of this study was to determine the effects of a 12-wk exercise training program in a predominantly African-American group of stroke survivors with multiple comorbidities.

METHODS

A lag-control group design was employed to provide training to all participants (N = 35). Two 12-wk training iterations were arranged. Participants trained 3 d x wk(-1) for 60 min x d(-1) (cardiovascular, 30 min; strength, 20 min; flexibility, 10 min). Outcome measures included peak VO2 (mL x min(-1), mL x kg(-1) x min(-1), maximal workload (MW), time to exhaustion (TTE), 10 RM on two LifeFitness strength machines, grip strength (GS), body weight (BW), total skinfolds (TS), waist to hip ratio (WHR), hamstring/low back flexibility (HLBF), and shoulder flexibility (SF).

RESULTS

Compared with controls, the exercise group showed significant gains in peak VO2 (P < 0.01), strength (P < 0.01), HLBF (P < 0.01), and body composition (BW and BMI, P < 0.05; TS, P < 0.01). There was no significant difference between exercise and controls on WHR, SF, and GS.

DISCUSSION

A supervised exercise training program for stroke survivors with multiple comorbidities was highly effective in improving overall fitness, potentially reducing the risk of further disease and disability. Greater effort must be made on the part of the public health community to increase access to community-based physical activity programs for persons with stroke.

Effects of a short-term health promotion intervention for a predominantly African-American group of stroke survivors

BACKGROUND

The study examined the effects of a 12-week health promotion intervention for a predominantly urban African-American population of stroke survivors.

DESIGN

A pre-test/post-test lag control group design was employed.

PARTICIPANTS/SETTING

Participants were 35 stroke survivors (9 male, 26 female) recruited from local area hospitals and clinics.

MAIN OUTCOME MEASURES

Biomedical, fitness, nutritional, and psychosocial measures were employed to assess program outcomes.

RESULTS

Treatment group made significant gains over lag controls in the following areas: (1) reduced total cholesterol, (2) reduced weight, (3) increased cardiovascular fitness, (4) increased strength, (5) increased flexibility, (6) increased life satisfaction and ability to manage self-care needs, and (7) decreased social isolation.

CONCLUSION

A short-term health promotion intervention for predominantly African-American stroke survivors was effective in improving several physiological and psychological health outcomes.