Overview Three points: Point 1: Issues Point 2: An Approach Point - PDF document

Environmental Approaches for Promoting Environmental Approaches for Promoting Environmental Approaches for Promoting Environmental Approaches for Promoting Physical Activity Adherence in People with Physical Activity Adherence in People with Physical Activity Adherence in People with Physical Activity Adherence in People with Chronic Conditions and Disability Chronic Conditions and Disability Chronic Conditions and Disability Chronic Conditions and Disability James H. Rimmer, Ph.D, Professor James James James H. Rimmer, Ph.D, Professor H. Rimmer, Ph.D, Professor H. Rimmer, Ph.D, Professor Lakeshore Foundation Endowed Chair in Health Promotion and Lakeshore Foundation Endowed Chair in Health Promotion and Lakeshore Foundation Endowed Chair in Health Promotion and Lakeshore Foundation Endowed Chair in Health Promotion and Rehabilitation Sciences Rehabilitation Sciences Rehabilitation Sciences Rehabilitation Sciences Director, UAB/Lakeshore Foundation Research Collaborative Director, UAB/Lakeshore Director, UAB/Lakeshore Director, UAB/Lakeshore Foundation Research Collaborative Foundation Research Collaborative Foundation Research Collaborative School of Health School of Health School of Health School of Health Professions Professions Professions Professions ENACT SOS Conference ENACT SOS Conference ENACT SOS Conference ENACT SOS Conference April 7, 2014 April 7, 2014 April 7, 2014 April 7, 2014 Overview � Three points: � Point 1: Issues � Point 2: An Approach � Point 3: Future Research

Barriers to Exercise Reported by People with Chronic Health Conditions and Disability PAIN 80 72 70 65 % of participants Cost Lack of Accessible Facility Don’t Know How Lack of Support Transportation 60 Don’t Know Where 53 51 49 50 44 39 39 40 36 33 32 30 22 20 19 18 18 20 19 20 7 10 6 4 4 0 P C L H D L D S L E E A L N W I L L F J T L a a a e a x a a a a a o r a o e o o x f o o a i c c l c . . r c m c c m b c s a n n t n f a r n t k k - k T I k k k k l ' ' i i s r t t t c s m i s o d t l e o h o o o e o o o y o k k o p o b s f f f t f p n f f f C n n n o o o o r p E M t I r c s a o o s d n m e r o i r o o o c m i l a u s t c n w o w i t a n f n e v l r n c i f e y d p p e t t c o e i g a i e s e r w i h c r n p o i v v c o g e u e a i s u g o n b r h a o e o n y s s t s n l r s i e t w t n t i t h m t l i e i i b r o d b t o n e t y y l n i i e o m t d l h i i o a f t e e y a n n a c t BARRIERS l i t l i h t y Rate of Secondary Conditions in PEP Participants Vs. Disabled and Non- Disabled Cohorts (Kinne et al. 2004) Rate in Rate in Total Rate in Disability Chicago Rate in No Sample, % Group, % Group, % Disability Group, Condition (n=2075) (n=545) (n=92) % (n=1530) Chronic pain in muscles, joints 23.8 55.6 62.1 14.2 Sleep problems 22.4 41.8 62.4 16.3 Extreme fatigue 20.7 44.8 54 13.2 Weight or eating problems 19.8 39 77.9 13.7 Periods of depression 17.2 33.5 31.4 12.1 Skin problems 14.2 22 22.7 9 Muscle spasms 11.4 25.5 7 Respiratory infections (not colds) 10.9 20.9 7.8 Falls or other injuries 10.2 20.6 6.9 Bowel/bladder problems 9.8 22.8 41.4 5.7 Serious episodes of anxiety 9.6 19.9 6.3 27.6 Lack of romantic relationships 8.4 14.9 6.3 Problems getting out/getting around 8.3 22.4 53.5 3.9 Problems making/seeing friends 7.4 12.7 5.7 Feelings of being isolated 5.6 14.8 55.3 5.3 Asthma 5.3 12.2 34.9 3.4 Deconditioning 100 Data compared to Kinne et al. (2004)

Environmental Approaches for Environmental Approaches for Environmental Approaches for Environmental Approaches for Promoting Physical Activity Adherence in Promoting Physical Activity Adherence in Promoting Physical Activity Adherence in Promoting Physical Activity Adherence in People with Chronic Conditions and People with Chronic Conditions and People with Chronic Conditions and People with Chronic Conditions and Disability Disability Disability Disability

Elements of Physical Activity Adherence S ocially Engaging Exercise Environments

E njoyable Environments � Was it a pleasant experience? Elements of E njoyment

L earning Environments

E xploratory Environments C ompetitive Environments

T ask Completion Environments How Do We Begin Building SELECT into communities?

Customization Lakeshore Foundation Transitional Model from Recovery to Health Functional Health Exercise Rehabilitation Fitness Conditioning Maintenance PROGRAM Recovery � Function � Fitness � Performance Prevention FOCUS Performance/ Health Health Health Trainer/ Trainer/ Telecoach Therapist Therapist/ Trainer/ PROFESSIONAL Trainer Telecoach Telecoach Outpatient Postdischarge Postdischarge Inpatient/ Postdischarge TIMELINE Outpatient Specialty Fitness Community Community Rehabilitation Community SETTING Facility Fitness Facility Facility Improving Aerobic, muscle Therapy Lifetime physical Performance- rehabilitation strength, muscle activity based skills for ExRx outcomes endurance, work, leisure, or flexibility, body sport composition participation Decline in health & function Accident (fall), new injury, exacerbation, DALEEDS* Hospitalization for major injury or health event *DALEEDS: Disability-Associated Low Energy Expenditure Syndrome

Functional Exercise Training

Health Promotion Transition Model for People with Chronic Conditions and Disabilities ���������������������� �������� ��������������������� ����������������������� !���������"������������� �������������� ������� ���� ���������� ���� �������������������� ������������������������ ����������������������� �������������������������� �������������� ������ ���� ������ ���� ����������������� ������������������ ������������ �������������� ������������������� ������������� Rehab Med, Rehabilitation Medicine; RCEP, Registered Clinical Exercise Physiologist; CIFT, Certified Inclusive Fitness Trainer Sample Transitional (or Booster) Programs � Beyond Therapy – Shepherd Center, Atlanta, GA � Brooks Rehabilitation - Stroke Wellness Program – Jacksonville, FL � Lakeshore Foundation, Birmingham, AL

Technical Assistance ACSM/NCHPAD Partnership � IFC Launch - January 24, 2007 National Press Club - Washington D.C.

Unique Aspects of Previous Research � Empowerment model � Aggressive weekly phone coaching � Constant guidance (24/7) � Weekly and monthly education through phone contacts, in person meetings, and newsletter � Support from a friendly voice � Elimination of barriers on a weekly basis Framing the Future in Activity Adherence � How can we establish a life course approach to activity adherence for people with chronic health conditions and disabilities? � How can we establish the infrastructure for monitoring activity adherence? � What role can technology play in enhancing activity adherence?