Framing new pathways in transformative exercise for individuals with existing and newly acquired disability

Purpose: This paper describes a continuum of customized exercise options for people with an existing and newly acquired disability or diagnosis referred to as the Transformative Exercise Framework. Background: The period directly after rehabilitation is a critical juncture where many individuals return to life with high rates of sedentary behavior. After rehabilitation discharge, people with newly acquired disability or diagnoses often never make the transition into usage of community-based exercise services that are tailored, safe and effective. Methods: Narrative review. Results: The Transformative Exercise Framework supports a patient-to-participant, rehab-to-wellness model that emphasizes a linkage between physical and occupational therapists and community-based exercise trainers. The four focus areas – Rehabilitation, Condition-specific Exercise, Fitness and Lifetime Physical Activity – emphasize a range of options for people with newly acquired disability and diagnoses, or for people with existing disability and/or chronic health conditions who have a new injury, secondary condition or are severely deconditioned. Conclusion: The concept of transformative exercise is to support people with disabilities and diagnoses with a seamless restore–improve–prevent continuum of programs and services. This continuum connects individuals to rehabilitation and exercise professionals in a dynamic framework, which maximizes the expertise of both sets of professionals and provides the most effective interventions to achieve the greatest gains in health and function and/or to avoid future health decline.

• Implications for Rehabilitation

• Patients discharged from rehabilitation should be transformed into participants in lifelong physical activity through a continuum of health services, which we refer to as Transformative Exercise.

• Transformative exercise is a continuum of individually tailored exercise strategies/programs that aims to improve the function of underperforming systems, which inhibit community and/or lifelong physical activity participation.

• The Transformative Exercise Framework can be used by a therapist or exercise trainer to design a program that maximizes performance and time and is based on a specific process for identifying short and long term goals.

     

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.     

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.     

Functional and locomotive characteristics of stroke survivors in Japanese community-based rehabilitation

OBJECTIVE: The purposes of this study were as follows: (1) to compare the characteristics of functional fitness of Japanese stroke survivors with those of control subjects of a similar age; and (2) to relate these characteristics to the extent of physical impairment and the period after stroke onset to better design community-based rehabilitation programs for stroke survivors. DESIGN: One hundred fifty-three stroke survivors who participated in community-based rehabilitation and 119 control subjects were measured. Twelve performance test items were designed to assess functional fitness. RESULTS: The average functional fitness score for the stroke survivors was significantly lower than that of the control group. However, some survivors had higher performance scores than the control group. Significant correlations were shown between some functional fitness items and Brunnstrom recovery stage in the stroke survivors. CONCLUSION: The large variability in functional fitness scores for stroke survivors indicates a need to design variable rehabilitation programs so that survivors can be grouped according to their specific levels of functional fitness.     

在地震救援及灾区重建中充分发挥康复医学的作用

根据国内外地震应变和恢复的经验，包括我国最近汶川地震，康复医学无论在救援期或重建期都能发挥重大的作用。康复医疗通过早期介入、功能锻炼、特殊器具的使用和心理社会支持，可以助残展能、康复身心。灾区重建包括康复医疗机构、社区康复体系及其服务的建设应列入总体计划之内，康复医学界人士应积极参与此项重建工作。     

Hospital supervised vs home exercise in cardiac rehabilitation: effects on aerobic fitness, anxiety, and depression

This study focused on the effects of hospital supervision and type of prescribed home exercise in cardiac rehabilitation programs on aerobic fitness, anxiety, and depression. Men who had a myocardial infarction were randomly assigned to four exercise programs: The first program consisted of purely hospital-based exercise. The second and third programs combined hospital and home exercise, including either bicycling or walking at home. In the fourth program, patients were encouraged to exercise at home, but were given no specific guidance. Fifty-two patients finished the eight-week exercise program and 35 completed the psychologic questionnaires. At the end of the eight weeks, there were significant differences in the programs' effects on aerobic fitness. Purely hospital-supervised exercise and the combination of hospital-supervised bicycling with home walking increased aerobic fitness more than completely unsupervised exercise. Furthermore, there were differences in the programs' effects on manifest anxiety. The combination of home and hospital bicycling was less beneficial than home walking and hospital bicycling or even completely unsupervised exercise at home. The results indicate that the degree of hospital supervision and the type of prescribed home exercise are important design features which may affect the success of cardiac rehabilitation exercise programs. No effects of the different exercise programs on patients' depression could be found. In general, a close relationship between aerobic fitness and anxiety or depression could not be demonstrated. Implications of these findings for the design of cardiac rehabilitation exercise programs are discussed.     

基于ICF成年残疾人休闲体育活动与功能康复的Scoping综述

目的 基于《国际功能、残疾和健康分类》(ICF)的理论与方法,采用Scoping综述方法对成年残疾人的休闲体育活动和康复体育进行分析。方法 基于文献证据进行Scoping综述,在文献资料基础上,建立成年残疾人的休闲体育活动、康复体育和残疾功能改善的范畴和框架以及编码方法。采用主题检索方式检索成年残疾人休闲体育活动和功能康复的相关文献,中文检索数据库包括中国知网和万方数据库,英文数据库包括PubMed和Web of Science,检索时间为建库至2020年7月31日。提取文献内容,包括作者、国家、发表时间、发表期刊、研究目的、研究对象和年龄、数据收集工具以及主要研究结果和结论。结果 共检索文献2476篇,最终纳入18篇,来自14个国家,主要来源于医学、公共健康、锻炼、残疾人等相关的期刊,发表时间集中在2010年至2020年。研究方法主要为问卷调查法、测量法和访谈法。研究涉及的残疾人参与的休闲体育活动类型有体适能类活动、技能类活动和运动项目类活动三大类,主要有太极拳、轮椅篮球、休闲户外活动、社区娱乐性体育活动、康复体育等。根据ICF的架构,休闲体育活动促进成年残疾人功能康复主要体现在身体功能(包括b1精神功能,b4心血管、血液、免疫和呼吸系统的功能,b5消化、代谢和内分泌系统功能,b7神经肌肉骨骼和运动有关的功能)和活动与参与(包括d1学习和应用知识,d2一般任务与要求,d4活动,d5自理、d7人际交往和人际关系,d9社区、社会和公民生活),具体为体质量指数、身体指标、运动能力、平衡能力、认知功能等方面的改善,获得社会支持、应对压力、自我概念、生活满意度、幸福感、运动自我效能、健康感知的提高等。影响成年残疾人休闲体育方面的活动和参与的因素主要有环境因素和个人因素,包括e1用品和技术,e4态度,e3支持和相互关系,e5服务、体制和政策,以及家庭成员和同事的态度和支持、人际关系、社会支持、交通、器材设施、政策等。结论 残疾人康复体育是健康服务体系的重要组成部分。本文从范畴上界定了休闲体育活动及其对成年残疾人的功能效果,并基于ICF建立了残疾人休闲体育活动和康复体育的分类和结构;将康复体育及其相关因素与ICF相结合,对休闲体育活动和康复体育进行综述和讨论,并为进一步研究提出了若干建议。     

Research on physical activity and health among people with disabilities: a consensus statement

Research is required to advance the understanding of issues related to the effect of physical activity on health and disease prevention among people with disabilities. This report is the result of a consensus process using selected experts in health and exercise. The purpose of the consensus conference was to identify research priorities for physical activity and health among people with disabilities. Priorities were established by 30 participants, who were selected by the principal investigators to achieve balance in the areas of engineering, epidemiology, medicine, nutrition, exercise physiology, and psychology. Experts summarized relevant data from their research and from comprehensive review of the scientific literature on the topic areas chosen for the conference. Public commentary was provided by participants in the 1996 Paralympic Congress. Panel members discussed openly all material presented to them in executive session. Commentary from open discussion periods were recorded and transcribed. Selected panelists prepared first drafts of the consensus statements for each research priority question. All of these drafts were distributed to the panelists and pertinent experts. The documents were edited by the drafting committee to obtain consensus. This research priority setting process revealed that greater emphasis must be placed on determining the risks and benefits of exercise among people with disabilities. Exercise must be studied from the perspective of disease prevention while mitigating risk for injury. Five areas were identified as focal points for future work: epidemiological studies; effects of nutrition on health and ability to exercise; cardiovascular and pulmonary health; children with disabilities; and accessibility and safety of exercise programs. As people with disabilities live longer, the need for addressing long-term health issues and risk for secondary disability must receive greater attention. As a consequence of the consensus process, specific recommendations for future research regarding the impact of exercise on the health and quality of life of persons with disabilities were defined.     

无锡市残疾人康复需求调查

目的探讨无锡市残疾人康复和社区康复网络建设的关系。方法采用问卷调查的方法对无锡地区74387名持证残疾人的类别、康复需求和现有康复服务进行调查。结果实际调查的74387名残疾人。不同类别的残疾人的康复需求有差异;残疾人的康复服务需求对社区康复网络的建设有指导意义。结论应充分利用政府资源建立一个包括上级医院、社区康复指导中心、社区康复站、家庭康复站在内的社区康复网络,以提供不同残疾人所需的康复服务。     

Independence: the ultimate goal of rehabilitation for spinal cord-injured persons

During the late 1960s and early 1970s, a new concept related to rehabilitation and improvements in quality of life began to emerge and be expressed by people with spinal cord injuries and other disabilities. This concept, independent living, is the foundation of the independent living movement, which has helped to overcome the barriers to a higher quality of life for disabled people. Of the many organizations and programs set up to provide support for disabled people living in the community, the independent living program seems to be comparatively successful at facilitating independence by people with spinal cord injuries. Independent living programs provide the kind of community-based support services necessary to expand the range of living options for disabled people beyond those traditionally available in most communities. The role of occupational therapists in the independent living stage of the rehabilitation process can be similar in some respects to their role during earlier phases of medical rehabilitation. However, the definition of independence as a "mind process" leads to considerable expansion of the therapist's role beyond the focus on physical skills, which are usually key priorities during medical rehabilitation. Occupational therapists typically possess knowledge and skills that equip them well for assisting clients in the independent living stage of the rehabilitation process.     

A position paper on Physical & Rehabilitation Medicine programmes in post-acute settings. Union of European Medical Specialists Section of Physical & Rehabilitation Medicine (in conjunction with the European Society of Physical & Rehabilitation Medicine)

Physical & Rehabilitation Medicine (PRM) programmes in post-acute settings cover interventions for the rehabilitation of people with a variety of disabling health conditions. The setting of the intervention is more important than the timing and these programmes can be carried out in a variety of facilities. This paper describes the role of PRM services and of PRM specialists in delivering rehabilitation programmes to people, who have initially been admitted to hospital. The emphasis is on improving patients' activities and addressing participation issues. PRM programmes in post-acute settings provide a range of treatments and have a major influence in the long-term on the pace and extent of return of function and recovery from ill-health. This paper will define the meaning of post-acute settings and will describe the patient's journey through the post-acute setting. In particular, it addresses the standards of care across Europe that patients should expect. This paper also examines the general principles of funding such programmes within the context of different health care systems across Europe. Coordinated care improves outcomes and economic profiles for both payers and providers of services. This paper describes the value of PRM interventions and PRM specialist-led teams in promoting better outcomes for people with disabilities with complex needs.     

Lessons from the 2015 earthquake(s) in Nepal: implication for rehabilitation

Purpose: There has been an increase in the number of natural disasters in recent history, and the rate of disability is increasing among survivors. The most recent major natural disaster was the earthquake(s) that occurred in Nepal on 25 April 2015 and 12 May 2015. In total, more than 8500 people were killed and over 18?500 people were left injured. This article aims to demonstrate the role of rehabilitation professionals in post-disaster relief and beyond in Nepal. Method: This is an experiential account of physiotherapists present during the earthquake and participating in the post-disaster relief. Results: Rehabilitation professionals played an important role in the acute phase post-disaster by providing essential services and equipment. However, discharge planning emerged as an important role for rehabilitation providers in the early days of post-disaster and signaled a relatively new and innovative function that facilitated the heavy imbalance between little supply and tremendous demand for care. In the coming years, rehabilitation will need to support local initiatives that focus on minimizing the long-term effects among people with a newly acquired disability. Conclusions: Rehabilitation serves an important role across the continuum in post-disaster relief from the initial stages to the months and years following an event.

• Implications for Rehabilitation

• Driven by medical advances in acute field medicine, the relative proportion of casualties following natural disasters is decreasing, while relative rates of disability are rising among survivors.

• In post-disaster settings, the growing number of people with newly acquired disabilities will be added to the existing proportion of the population who lived with disabilities, creating a significant growth in the total number of people with disabilities (PWDs) in communities that are often ill prepared to provide necessary services.

• Rehabilitation interventions in the initial stages of emergency humanitarian response can minimize the long-term effects among people with newly acquired disabilities through early activation and prevention of secondary effects.

• Rehabilitation providers thus appear to have an important mediating effect on outcomes of disabilities in the early stages, but must also be strong partners with PWDs to advocate for social and political change in the long term.

     

The Paralympic Movement: Using Sports to Promote Health,Disability Rights,and Social Integration for Athletes With Disabilities

Competitive sports for people with disabilities has grown rapidly over the past several decades, and opportunities for participation are increasingly available throughout the spectrum from developmental to elite. The Paralympic Games, seen as the pinnacle sporting event that represents the broader Paralympic Movement, has provided a platform to showcase the abilities of people with disabilities while also serving as a catalyst for disability rights through ensuring integration, equality of opportunity, and accessibility of the built environment. Concurrently, media coverage of the Paralympic Games has led to an increased awareness of opportunities for sport participation for individuals with disabilities and, with it, the adjustment of norms regarding expectations for exercise as a component of preventive health. In addition, there is evidence of the power of sports to stimulate confidence, self-efficacy, and a self-perceived high quality of life for individuals with disabilities above and beyond the basic benefits to cardiometabolic fitness. When taken together, the promotion of health, disability rights, and social integration through sports has the power to transform the lives of those who participate and to further stimulate the expansion of opportunities available to the next generation of athletes with disabilities.     

Community-based nurse health coaching and its effect on fitness participation

This article reports on the characteristics of the individuals participating in Health Matters, a community-based health promotion and fitness program for the elderly. A total of 255 persons were recruited into the program. Eligibility criteria included having one or more qualifying chronic health conditions, being 65 or older, having membership in a participating health plan, and ownership of a CalPERS long-term care insurance policy. The intervention included nurse health coaching, training in self-management of chronic illness, referrals to community resources, and a fitness program. More than 90% of participants were in exercise programs at 12 months, and 30% had participated in one or more condition management classes. Health Matters' senior-oriented fitness program was more successful in attracting higher disability risk members than were either community-based or self-exercise programs. Health Matters demonstrated that it is possible to proactively recruit and retain individuals in a health-promotion program. The nurse coaches/case managers communicated with primary care physicians about the enrollees and their health action plans, but recruitment did not rely on physician referrals.     

Status of the year 2000 health goals for physical activity and fitness

In Healthy People 2000, the national strategy for improving the health of the American people by the year 2000, lifestyle factors such as physical inactivity are major determinants of chronic disease and disability. Despite the documented benefits of exercise in enhancing health and reducing the risk of premature death, only 1 of the 13 physical activity and fitness objectives of Healthy People 2000 has been met or exceeded. Although progress toward 5 objectives for the year 2000 has been made, 3 objectives are actually farther from attainment. Coronary heart disease death rates (Objective 1.1) have declined, and the prevalence of overweight people (Objective 1.2) has increased. Overall physical activity in adults (Objectives 1.3 and 1.4) and strengthening and stretching activities in children (Objective 1.6) have increased, but reduction in the percentage of sedentary persons (Objective 1.5) has showed no change. The proportion of the population adopting sound dietary practices combined with regular physical activity to attain appropriate body weight (Objective 1.7) has declined. Even though participation in daily school physical education (Objective 1.8) has shown a decline during the past several years, students who are enrolled in physical education classes are spending more time performing physical activities (Objective 1.9). The proportion of work sites offering employer-sponsored physical activity and fitness programs (Objective 1.10) has increased substantially, surpassing the year 2000 goal. Data to update progress for increasing physical activity levels of children (Objectives 1.3-1.5), community exercise facilities (Objective 1.11), clinician counseling about physical activity (Objective 1.12), and improvement in personal self-care activities (Objective 1.13) are not yet available.     

A preliminary study of a healthy-lifestyle-promoting program for nursing students in Taiwan

This pilot study evaluated the effects of a healthy-lifestyle-promoting program, taught as part of an undergraduate community health nursing course, on the physical fitness and health choices of 42 Taiwanese nursing students. A convenience sample provided quantitative indexes of physical fitness and lifestyle before and after the course. Qualitative data, in the form of student diaries, were also analyzed. The findings indicated a positive change in physical fitness, exercise, and nutrition as a result of the program. Including lifestyle programs in nursing education may help promote the long-term health of future nurses who will serve as positive patient role models.     

Health promotion for people with disabilities: the emerging paradigm shift from disability prevention to prevention of secondary conditions.

The premise of this article is that, until recently, health promotion for people with disabilities has been a neglected area of interest on the part of the general health community. Today, researchers, funding agencies, and health care providers and consumers are leading an effort to establish higher-quality health care for the millions of Americans with disabilities. The aims of a health promotion program for people with disabilities are to reduce secondary conditions (eg, obesity, hypertension, pressure sores), to maintain functional independence, to provide an opportunity for leisure and enjoyment, and to enhance the overall quality of life by reducing environmental barriers to good health. A greater emphasis must be placed on community-based health promotion initiatives for people with disabilities in order to achieve these objectives.     

Supporting community-based exercise in long-term neurological conditions: experience from the Long-term Individual Fitness Enablement (LIFE) project

Background: Patients with long-term neurological conditions often have low levels of physical activity and participation in exercise. Exercise referral schemes have been introduced in the UK to encourage physical activity in sedentary and clinical populations but typically exclude patients with long-term neurological conditions. We have developed and evaluated an exercise support system for people with long-term neurological disability, called the Physical Activity Support System, to enable them to use local gym facilities safely and effectively. The intervention: We describe the Physical Activity Support System for people with long-term neurological conditions and provide data on the use of this system in a phase II randomized controlled study trial. The system has five key components: access and transport advice, the fitness instructor, the gym, health professional support and how to exercise safely. Results: Ninety-nine patients with a range of long-term neurological conditions used six different community exercise facilities in Oxfordshire and Birmingham. Average gym attendance was one session per week for 12 weeks. Participants required an average of three 1-hour face-to-face physiotherapy contacts to achieve this. The average direct cost for the support system was ￡275. Conclusions: The scheme achieved comparable exercise participation to standard GP exercise referral schemes operating in the same centres and offers a relatively cheap, practical and feasible system for supporting people with long-term neurological conditions.