Evaluation of the Reaching People with Disabilities through Healthy Communities Project.

BACKGROUND: People with disabilities experience disparities in chronic diseases, such as obesity, heart disease, and diabetes, in disproportionate numbers. Research suggests that healthy communities initiatives that work to implement policy, systems and environmental (PSE) changes can help reduce these disparities by improving access to healthy choices for community residents with disabilities. However, healthy communities efforts to implement PSE changes are often not inclusive of people with disabilities. OBJECTIVE: The purpose of this paper is to evaluate the implementation of an Inclusive Healthy Communities Model that was designed to reach people with disabilities through inclusive PSE changes. METHODS: Professionals from local public health agencies and disability organizations in 10 diverse communities worked to infuse disability inclusion into PSE changes promoting healthy living. Data on PSE implementation was collected and coded into categories to describe the nature of the inclusive PSEs. RESULTS: Communities implemented 507 inclusive PSEs, 466 of which were environmental changes, 25 systems changes, and 16 policy changes. A large majority of PSEs were related to improving the built environment to facilitate access to public spaces, such as parks, playgrounds, and community gardens. Many communities also implemented policy and systems changes related to the addition of inclusion into existing policies, community plans, and ongoing training of staff. CONCLUSION: Integrating disability inclusion into traditional healthy communities efforts can facilitate improved access and opportunity for healthy living among people with disabilities. This pilot project has implications for public health workforce training, current practices, and PSE development with interdisciplinary teams and multisectoral coalitions.

Changing the Paradigm in Public Health and Disability through a Knowledge Translation Center.

People with disabilities are a health disparity population that face many barriers to health promotion opportunities in their communities. Inclusion in public health initiatives is a critical approach to address the health disparities that people with disabilities experience. The National Center on Health, Physical Activity and Disability (NCHPAD) is tackling health disparities in the areas of physical activity, healthy nutrition, and healthy weight management. Using the NCHPAD Knowledge Adaptation, Translation, and Scale-up Framework, NCHPAD is systematically facilitating, monitoring, and evaluating inclusive programmatic, policy, systems, and environmental (PPSE) changes in communities and organizations at a local and national level. Through examples we will highlight the importance of adapting knowledge, facilitating uptake, developing strategic partnerships and building community capacity that ultimately creates sustainable, inclusive change.

Promoting physical activity in Out-of-School-Time programs: we built the bridge--can we walk over it?

This commentary describes physical activity standards for Out-of-School Time programs and argues that their widespread adoption presents important opportunities for research on their implementation and impact.

A randomized controlled trial to increase physical activity and reduce obesity in a predominantly African American group of women with mobility disabilities and severe obesity.

OBJECTIVE: This randomized controlled trial tested a tailored, telephone-based physical activity coaching intervention for a predominantly African American group of women with severe obesity and mobility disability. METHODS: We recruited 92 clinic patients from the University of Illinois at Chicago Medical Center referred by their physicians during 2004-2007 and randomized participants to one of three groups--awareness(informational brochure, no coaching), lower support (phone coaching only) and higher support (phone coaching plus monthly exercise support group)--to determine the efficacy of a tailored coaching intervention on key health outcomes, which included body weight and body mass index, blood pressure, cholesterol, physical activity (barriers and self-reported activity), movement and mobility, general health, and social support. RESULTS: The higher support group had the greatest reduction in Body Mass Index (BMI) (7.4%) compared with a 0.2% and 1.6% increase in BMI for the lower support and awareness groups, respectively (pb.01). Both the higher and lower support groups had a greater increase in physical activity scores (39% and 30%, respectively)compared with a decline of 13% in the awareness group (pb.05). CONCLUSION: Providing phone-based coaching and monthly in-person exercise support group sessions appear to be an effective approach for reducing body weight and increasing physical activity among severely obese, disabled adults residing in difficult social environments.

A preliminary study to examine the effects of aerobic and therapeutic (nonaerobic) exercise on cardiorespiratory fitness and coronary risk reduction in stroke survivors.

OBJECTIVES: To compare the effects of 3 different exercise training regimens on cardiorespiratory fitness and coronary risk factor reduction in subjects with unilateral stroke. DESIGN: A cluster assignment by residential location repeated-measures design. SETTING: University-based medical center. PARTICIPANTS: Fifty-five subjects with unilateral ischemic stroke were assigned to the following groups: intensity (n=18), duration (n=19), and therapeutic exercise (n=18). INTERVENTION: A 14-week intervention with subjects randomized to 1 of 3 interventions: (1) moderate intensity, shorter duration (MISD) exercise (gradually increasing exercise intensity while keeping exercise duration constant at 30 min), (2) low-intensity, longer duration (LILD) exercise (gradually increasing duration to 60 min while keeping exercise intensity constant), or (3) conventional therapeutic exercise (TE) consisting mainly of strength, balance, and range of motion activities. All groups exercised 3 days per week. MAIN OUTCOME MEASURES: Peak oxygen consumption (VO2peak), submaximal oxygen consumption (VO2), lipid panel, and resting blood pressure. RESULTS: The MISD group attained more favorable effects on systolic (P<.04) and diastolic blood pressure (P<.002) and total cholesterol (TC) (P<.036) compared with LILD and TE groups. Both MISD (P<.029) and LILD (P<.045) showed significant reductions in triglycerides compared with TE (P<.029). There was no significant change in VO2peak and submaximal VO2 in any of the groups. CONCLUSIONS: Overall, both MISD and LILD conditions achieved greater clinical and significant gains in coronary risk reduction compared with TE.

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.

Development and validation of AIMFREE: Accessibility Instruments Measuring Fitness and Recreation Environments.

PURPOSE: The purpose of this study was to develop and validate a series of 16 survey instruments measuring fitness and recreation accessibility, collectively referred to as AIMFREE (Accessibility Instruments Measuring Fitness and Recreation Environments). General domains of assessment included the built environment, equipment, programmes, policies, and training and behaviour. METHODS: Fitness and recreation professionals (n=35) assessed fitness centres/swimming pools (n=35) in nine regions across the US. Rasch analysis was used to assess the psychometric properties of the instrument. RESULTS: The AIMFREE evidenced adequate to good fit to the Rasch model and adequate to good internal consistency (r=0.70 - 0.90). Test-retest reliability ranged from 0.70 (entrance areas) to 0.97 (swimming pools). Analysis of differential item functioning indicated that item calibrations generally did not differ significantly between urban and suburban environments. CONCLUSION: The AIMFREE instruments demonstrated adequate to good fit to the Rasch model with several of the subscales demonstrating well to excellent separation of facility accessibility.

Physical activity participation among persons with disabilities: barriers and facilitators.

BACKGROUND: The purpose of this study was to identify various barriers and facilitators associated with participation in fitness and recreation programs/facilities among persons with disabilities. METHODS: Focus groups were conducted in ten regions across the United States in 2001 to 2002 with four types of participants: (1) consumers with disabilities, (2) architects, (3) fitness and recreation professionals, and (4) city planners and park district managers. Sessions were tape-recorded and content analyzed; focus group facilitators took notes of identified barriers and facilitators to access. RESULTS: Content analysis of tape recordings revealed 178 barriers and 130 facilitators. The following themes were identified: (1) barriers and facilitators related to the built and natural environment; (2) economic issues; (3) emotional and psychological barriers; (4) equipment barriers; (5) barriers related to the use and interpretation of guidelines, codes, regulations, and laws; (6) information-related barriers; (7) professional knowledge, education, and training issues; (8) perceptions and attitudes of persons who are not disabled, including professionals; (9) policies and procedures both at the facility and community level; and (10) availability of resources. CONCLUSIONS: The degree of participation in physical activity among people with disabilities is affected by a multifactorial set of barriers and facilitators that are unique to this population. Future research should utilize this information to develop intervention strategies that have a greater likelihood of success.