Inclusive fitness strategies: building wellness among developmentally disabled adults.

Relatively little is known about how the aging process and participation in active leisure affect individuals with developmental disabilities who live in the community. More precisely, relatively little is known about how, or whether, these phenomena affect such individuals compared to how they affect average adults living in the same community.

What is known is that these individuals tend to participate in sedentary leisure, the most common being watching television or listening to the radio with family and friends. As a consequence, their leisure patterns don't help them maintain their health and fitness levels. This scenario is exacerbated by a lack of coordinated community preventative health care, thereby resulting in secondary health conditions such as high blood pressure and cholesterol, heart disease, diabetes, obesity, chronic skin problems and hygiene-related issues.

This article details the results of a project--funded by a grant from the National Therapeutic Recreation Society-that investigated whether a community-based fitness program could help improve the fitness levels of adults with developmental disabilities. A second intent of the project was to identify strategies for successfully promoting fitness and exercise among such adults.

Defining Disability

As defined in legislation, developmental disabilities are:

* Physical or mental impairments manifest before age 22 that continue indefinitely, resulting in

* Substantial functional limitations in three or more life areas, and which

* Reflect a need for lifelong or extended individually coordinated services.

The belief is that the aging process among individuals with and without developmental disabilities follows a similar path. Yet age-related changes may seem greater among those with disabilities because of the interaction between the already existing deficits attributed to having a developmental disability. In addition, the community services that adults with developmental disabilities receive usually have shortcomings, such as a lack of trainer practitioners and less-than-adequate coordination of care, that exacerbate their problems. Fortunately, physiological changes associated with aging and developmental disabilities--including weight gain, increase in percent body fat and blood pressure, and decrease in trunk flexibility--can be improved with the right intervention.

While inclusion is promoted as fundamental to quality of life, evidence suggests that individuals with developmental disabilities, and especially those with severe impairments, remain limited in their social contacts. In addition, interviews with individuals with disabilities suggest that those who participate more regularly in recreation activities are significantly more satisfied with their lives. Increasingly, individuals with developmental disabilities include integration and independence in their definitions of quality of life.

Currently, little information is available to individuals with developmental disabilities on the role of physical activity, how to control health conditions by eliminating risk factors, and how to prevent secondary complications associated with sedentary lifestyles and limited social interaction. Furthermore, adults with developmental disabilities are outliving their parents, and there is a need for services to replace the informal support of the family network. It was from these starting points and assumptions that the NTRS-funded project set out to determine what sorts of inclusive fitness strategies can make a difference.

Project Parameters

The project was conducted in a rural community in the western U.S. as a collaboration among a community recreation agency, a social service agency serving individuals with developmental disabilities, therapeutic recreation specialists, a university department of human services and a school of nursing. A community recreation center was the site of the pre- and post-testing, as well as the cardiovascular exercise and weight training program. The fitness room was equipped with stationary bicycles, treadmills, a Nautilus circuit system, free weights, exercise floor pads, wall mirrors, television sets and sound system. Program participants used the community recreation center during the hours when the fitness room was being used by the public.

The therapeutic recreation specialist, community recreation agency director, university therapeutic recreation faculty member and a nurse-practitioner designed the exercise protocol using the guidelines of two organizations: the National Strength and Conditioning Association and the American College of Sports Medicine. Twice a week for 11 weeks, 11 participants did cardiovascular exercise and weight training. Each session included a 5-10 minute warm-up, 20-30 minutes of cardiovascular training, 25-30 minutes of weight training and a 5-10 minute cooldown. Based on availability of space and equipment, participants chose their cardiovascular activity (treadmill, stationary bicycle or walking in the gym) and desired form of weight training (machine or free weights).

Before the workouts, a nurse-practitioner manually collected data from all of the participants on seven variables:

* Height

* Weight

* Systolic and diastolic blood pressure 

* Resting heart rate

* Total cholesterol

* Blood sugar levels.

A number of unanticipated modifications in the exercise sessions occurred. The one-hour workout didn't always fit the transportation drivers' schedules for dropping and picking up participants; in those cases, the workouts were shortened. Also, participants' abilities to remain on task and to count repetitions varied; as a consequence, following the first two weeks of orientation, undergraduate therapeutic recreation students volunteered to coach participants to facilitate exercise compliance.

Another tweak resulted from the program being implemented during regular facility-use hours. On occasion, a participant's routine was randomly interrupted or the order reversed (weight training preceded cardiovascular activity) to accommodate community participants. Finally, the time segments in the protocol were modified when participants didn't respond to requests or directions, or when they left the exercise area to attend to personal care needs.

Post Project

Following the 11-week program, pre-to post-tests results didn't indicate that cardiovascular training and weight training with individuals with developmental disabilities made a significant difference in reducing factors that contribute to secondary health problems. That's not to say the program was ineffectual--the results did show that differences in pre- and post-tests varied among the participants, with decreases in blood pressure being the biggest change.

As experts have suggested, the meaning of fitness varies with the nature and intensity of a disability. In addition, they note that the intent with individuals with severe developmental disabilities is to increase the time of the prescription. In our project, an analysis of participation times and consumer comments indicated that each of the 11 participants increased their exercise tolerance (time of activity), independently traveled between stations and properly accessed the machines (mount and dismount) with less assistance at the conclusion of the program. These results support recommendations that the major fitness program goals for individuals with developmental disabilities should include improving functional ability to perform fitness tasks and increasing exercise capacity.

A second intent of the project was to investigate the feasibility of delivering the intervention in a community recreation center during routine operational hours. The project used a low-tech intervention in an inclusive setting. Shortcomings of community-based services--inadequate coordination of care and lack of trained practitioners--did hurt participation opportunities and, in the end, participation in an inclusive fitness program.

Several positive outcomes of the project corroborate inclusionary best practices. First, personalized social support using undergraduate therapeutic recreation students (i.e., leisure coaches) seemed to aid participant compliance and motivation. Second, collaborative planning among the agencies and university and external financial assistance resulted in the first-ever fitness program with developmentally disabled participants in this rural Western community. Third, following an orientation, adaptations in the exercise routines helped participants successfully perform specific tasks. Finally, documentation and ongoing evaluation seemed to encourage participants to continue their participation, resulting in an increase in their exercise capacity.

While the small number of participants means that the results of this project can't be generalized, the project's outcomes support fitness in an inclusionary setting as a worthwhile intervention. Participants became known to the community recreation center staff by name and were greeted upon arrival and departure. The participants requested the opportunity to return to use the fitness room after the project was completed. (This request was supported and encouraged by agency staff.) Further, the project supported inclusionary best practices cited in research literature on the topic. Strategies that promote inclusion include a "welcoming" atmosphere, partnerships, training and leisure coaches, financial and transportation assistance, adaptations, structured experiences, documentation, evaluation and the use of trained professionals to implement programs.

RELATED ARTICLE: About the participants.

The participant age range before the program was 29 to 69; following the program, the age range was 30 to 69. Mental retardation was the primary medical diagnosis of the 11 participants. Eight participants experienced mental retardation and secondary impairments.

RELATED ARTICLE: Wellness grant sources.

These funding sources can be used to support inclusive fitness programs.

Physical Education for Progress Grants

These Department of Agriculture grants are awarded to local educational agencies and community-based organizations to initiate, expand and improve physical education programs (including after-school programs) for kindergarten through 12th-grade students. The funds should be used to provide equipment and support to enable students to participate actively in physical education activities, and to finance staff and teacher training and education.

For more information, go to www.ed.gov/ offices/OESE/SDFS/pep.html, or contact Ethel Jackson at 202-260-2812 or [e-mail].

Exemplary State Programs to Prevent Chronic Disease and Promote Health

The Centers for Disease Control and Prevention supports a variety of programs aimed at preventing chronic diseases and their risk factors. Park and recreation agencies can contract with public health and education agencies to provide these services. For more information on this program, go to www.cdc.gov/nccdphp/ programs.htm. To contact your state's chronic disease director, go to www.chronicdisease.org/members.html.

Preventive Health and Health Services Block Grant

This grant provides states the latitude to fund any of 265 national health objectives available in the Healthy People 2010 health-improvement plan.

For a listing of Healthy People 2010 health-improvement plans in your state, go to http://www.cdc.gov/nccdphp/block grant/stateselection.htm.

Write to [e-mail] to find out whom to contact in your state to become involved in these plans.

WEB RESOURCES

National Center on Physical Activity and Disability: www.ncpad.org

NRPA's Public Policy pages: Select "Public Policy" at www.nrpa.org for regularly updated information on available grants.

A BRIEF BIBLIOGRAPHY

Boyd, R. (1997). Older adults with developmental disabilities: A brief examination of current knowledge. Activities, Adaptation & Aging, 21(3), 7-27.

Connolly, B. H. (1998). General effects of aging on persons with developmental disabilities. Topics in Geriatric Rehabilitation, 13(3), 1-18.

Hawkins, B. A. (1997). Health, fitness, and quality of life for older adults with developmental disabilities. Activities, Adaptation & Aging, 21(3), 29-35.

Modell, S. J., & Megginson, N. L. (2001). Life after school: A transition model for adapted physical educators. JOPERD, 72(2), 45-48, 53.

Rizzo, T. L., & Lavay, B. (2000). Inclusion: Why the confusion? JOPERD, 71(4), 32-36)

Schleien, S. J., Germ, P. A., & McAvoy, L. H. (1996). Inclusive community leisure services: Recommended professional practices and barriers encountered. Therapeutic Recreation Journal, 30(4), 260-273.

Sherrill, C. (1998). Adapted physical activity, recreation and sport crossdisciplinary and lifespan (5th ed.). Boston, MA: WCB McGraw-Hill.

Short, E X. (1995). Physical fitness. In J.P. Winnick (Ed.), Adapted physical education and sport(2nd. Ed.), (pp. 243-252). Champaign, IL: Human Kinetics.

Wilhite, B. C., & Keller, M. J. (1996). Integration, productivity, and independence among adults with developmental disabilities: Implications for therapeutic recreation. Therapeutic Recreation Journal, 30(1), 64-78.

Marcia Carter, Re.D, is assistant chair and professor with the Department of Human Services at the Univeristy of Northern Colorado.