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Exercise is for everyone!

Introducing ability—seeing the potential in special populations.

Take an in-depth look into a water garden or Japanese fish pond. For years, psychologists and sociologists have pointed to the brightly colored koi fish living in these gardens as an analogy to the way we live our lives.

Koi will not grow significantly if kept in a small environment. When a koi is freed in a lake, it can stretch out and reach striking proportions. Coined the “Koi Phenomenon,” this space-growth parallel can be used to demonstrate the effects of tearing down boundaries to allow people to stretch and reach their full potential.

Many individuals with disabilities relate this analogy to the challenges they face living in restrictive environments. There once was a pervasive perception that people with developmental disabilities should be kept separate from the general population because they couldn’t lead significant lives. In recent years, however, individuals with developmental disabilities who once lived in institutions are now moving to community-based homes. Similarly many individuals with physical disabilities have experienced a trend toward better accommodations and adaptive equipment. It is clear that many individuals with disabilities are able to work, live and care for themselves when supported well in a natural environment. Caregivers, teachers and family members are beginning to develop and learn appropriate techniques to facilitate this growth.

In an era marked by slow but steady improvement for individuals with disabilities, we see the value in the lessons taught by the Koi Phenomenon. With the changing landscape of our communities we must find new ways to integrate individuals of all ability levels into everyday life. This includes exercise opportunities, leisure activities and recreational pursuits that develop social and physical growth.

Statistics and Social Change

The U.S. Census Bureau estimates one in every five households in America has a person with a disability (2003). This staggering statistic translates into approximately 54 million Americans. Despite this, individuals with physical and mental disabilities are rarely encouraged to participate fully in health and fitness routines. According to government health goals published in Healthy People 2010, 36 percent of Americans say they get no physical activity whatsoever. For individuals with disabilities, who make up 19 percent of the U.S. population, that rate climbs to 56 percent.

The National Center on Physical Activity and Disability (NCPAD) points to numerous research studies demonstrating this disturbing trend. Sadly, the only activity in recent studies in which individuals with disabilities outscored their nondisabled peers was television watching, which they do for more than 4 hours per day (39%) (NCPAD 2003). Despite such numbers, NCPAD director James Rimmer is encouraged by improvements he sees in the changing attitudes of personal fitness trainers (PFTs) and exercise facility program directors. “Attention is finally turning toward health promotion,” he says. “The next big push for social change must include more opportunities and incentives for people with disabilities to engage in higher levels of physical activity throughout the day.”

National organizations such as NCPAD, the American Association on Health and Disability, and the Special Olympics have answered this demand by encouraging others to create enjoyable and rewarding physical activity opportunities that promote substantial improvements in health and quality of life.

“Give me a gym membership and I’ll show you what I can do,” proudly exclaims Carolyn Gaulding, a 54-year-old female with mild developmental disability and cerebral palsy. Echoing the sentiments of countless others, Gaulding suggests that given the chance and proper physical accommodations, she could lead an active lifestyle and “prove everyone else wrong.”

In 1990 the Americans with Disabilities Act (ADA) became law and helped people like Gaulding accomplish such goals. The ADA, which prohibits discrimination against people with disabilities, generally requires employers, state and local governments and places of public accommodation to offer reasonable services or tools to ensure that people are not discriminated against on the basis of a disability. Rimmer says that integrating individuals with disabilities into community-based exercise programs is also mandated by law through Section 504 of the Rehabilitation Act, which protects individuals with disabilities from discrimination in programs that receive federal funds from the Individuals with Disabilities Education Act (IDEA) and the Olympics and Amateur Sports Act. The former mandates physical education programs for children with disabilities in school, while the latter requires the U.S. Olympic Committee to provide amateur athletic contests for athletes with disabilities.

An Untapped Market

Consumers with disabilities control a large purse ($175 billion in discretionary income) and are an untapped spending power (U.S. Census Bureau 2003). In the weak economic climate of recent years, program directors and gym owners have been struggling to maintain membership levels. Those who have designed accessible facilities, products and services make their customers with disabilities feel that their business is valued and appreciated. The U.S. Labor Department predicts that, as this group ages, its purchasing power will only continue to grow. Consequently PFTs and fitness facility managers cannot afford to ignore or stereotype this market. In fact personal trainers and facilities marketing to people with disabilities can reach as many as four in every 10 consumers with disabilities (U.S. Census Bureau 2003).

Don Meisner, owner of Fit 4 Life personal training services, explains, “This is a win-win situation for everyone involved. There is no excuse not to include persons with physical and mental disabilities in the development of fitness programs, camps and gyms that are offered to everyone else.” Meisner, who worked in a residential facility for adults with developmental disabilities while studying for his ACE exam, quickly realized the need for such services and created a successful business model.

Education, Training
and Liability

Surprisingly there are few specialized courses in disabilities and physical fitness. In most cases personal trainers and other fitness professionals should posses a degree or experience in kinesiology, physical education or exercise science, with some coursework in disability-adapted exercise science or therapeutic recreation. The range of social and medical issues that individuals with disabilities face when performing physical exercise can provide an intimidating backdrop for even a trained professional. However, no matter the experience level with disability issues,
personal trainers and facility managers can help remove the obstacles that traditionally get in the way of gym participation.

As with any new client, it is prudent to carefully screen all special populations by collecting a full medical history and knowing the results of a standard physical exam before beginning any physical activity program. In many cases a more in-depth medical report is also needed due to the complexity of specific disabilities.

For example an individual with Down’s syndrome, a disorder caused by the presence of an extra chromosome 21 and characterized by developmental delays, is more at risk for atlantoaxial instability and gait disturbances due to ankle joint stiffness, hypotonia and flat foot conditions. Persons with cerebral palsy, brain injury, spinal cord injury and stroke may all face spasticity in the quadriceps muscles, leading to knee pain. A person with a spinal cord injury may be at risk for thermoregulatory dysfunction because of his reduced capacity to sweat. At the same time, if there is a high-level spinal cord injury, this person must not exceed a heart rate of 90 beats per minute (National Center on Physical Activity and Disability 2003). In each of these cases, it is obvious why extensive information is needed to identify health issues that might affect a person’s participation. Involving physical therapists, rehab specialists and family members can be helpful in determining the best plan of action.

Faced at times with a dizzying array of “what if” scenarios, fitness professionals often grapple with vague liability laws and fears of increased liability insurance premiums, and thus shy away from working with this population. Adding to this gray area, the ADA does not create standards governing liability in case of injury. If an injury occurs, state negligence laws will govern. The ADA does, however, prohibit facilities from refusing service or gym membership to a person with a disability 8 because of fear of injury to the person. In the long run fitness and recreational facilities face more legal ramifications by not complying with laws governing general access and reasonable accommodations.

The Best Teachers
Think “Bigger”

Often called a “soft” or “people” skill, teaching ability is of paramount importance to today’s fitness professional, explains Mark Andrews, owner and founder of Therapeutic Adventures Inc. “The ability to observe students’ learning progress and provide new information in just the right amount and at just the right time is the essence of good teaching,” says Andrews, who is known nationally in the rehabilitation arena for his adaptive outdoor adventure program based on the framework of Outward Bound. “A skilled teacher must sense when students are confused and when they are becoming disinterested; when they are scared and when they are confident; when they are exhausted and when they are up for a challenge. In short a good teacher must step into the learner’s shoes and feel what [he is] feeling,” Andrews says. Simply put, personal trainers must develop an accommodating and all-inclusive attitude—it must be taught, developed, emphasized and renewed. But how does one do this successfully?

1. Use Enthusiasm. Despite the
positive progression in the acceptance of individuals with disabilities, those with varying degrees of physical and cognitive deficits are still at times treated like second-class citizens when it comes to exercise and community recreation programs. In a hypercompetitive sports world, it becomes increasingly important to encourage
individuals with disabilities—who have never experienced inclusive exercise opportunities—to fully participate alongside nondisabled peers.

Fitness professionals and support staff should not be afraid to offer new suggestions and exercise routines, as many of these choices and opportunities have never been afforded to individuals with disabilities. Present these healthy opportunities with enthusiasm, energy and a positive outlook on what the person can achieve with the right accommodations. It is important for the teacher not to react with pity, anxiety or a variety of other negative emotions when first meeting a person with a disability. At the same time, prompting and encouragement should not be delivered in a condescending or child-like manner, but instead with sincere enthusiasm for the unique skills and characteristics the person possesses.

2. Make Accommodations. “We receive frequent inquires from health and fitness professionals regarding training and accommodations for clients with physical, mental, emotional and learning disabilities. It’s important for trainers and facility managers to understand and be sensitive to the unique needs of this population,” says Gwen Hyatt, owner of DSW Fitness in Phoenix. Hyatt represents the changing attitudes among leading health care professionals as more fitness facilities and classrooms make appropriate
accommodations.

For example in recent years The Sports Club in Los Angeles installed chairlifts for two swimming pools, a special rail running along the length of the pool for balance, weight resistance machines that can be adjusted for people in wheelchairs, and several exercise classes designed for individuals with disabilities (Kritz 2002). In making these accommodations, trainers and gym owners need not spend endless amounts of money. In fact equipping staff members with a basic knowledge of disabilities can be even more beneficial than expensive equipment.

A facility with no specific disability programs and equipment can be just as accommodating if trainers are able to meet with a prospective member and openly discuss her goals. At times getting around a problematic area may be as simple as providing visual cues or a picture chart for those who cannot read; physically guiding a participant through a movement if she has trouble with auditory direction; or recruiting a volunteer for the “buddy system” to help a person on and off equipment such as weight resistance machines.

3. Design Age-Appropriate Activities. Individuals with disabilities are already at risk of being stigmatized and should always be encouraged to participate in fitness plans and sporting events that are age appropriate. Childlike games, toys and rewards may perpetuate the myth that a person with a disability needs “special” attention or is “different” from his peers. “Instructors and trainers should not attempt to overcompensate for a disability by
creating unnatural learning environments,” says Lucy Cantrell, director of the Hanover ARC, a support group for families and individuals with disabilities in Richmond, Virginia. “Whenever possible a person with a physical or developmental disability should learn by the same rules as a person without a disability. It’s just not natural for a person to receive a sticker or a prize for completing the same task as a nondisabled individual,” she points out.

Understanding this concept, The Chicago Cubs recently created “Buddy Baseball”—an excellent example of an age-appropriate sports model. Partnering with the Chicago Public School’s Inclusion Program, the Cubs make it possible for individuals with disabilities to play on the same team with their able-bodied classmates. Participants work in teams to catch, throw, run and hit—together. Teammates are invited to join the group, regardless of ability or disability, in order to build sportsmanship on a level playing field. Similarly, the Cubs have created “Beep Baseball” for athletes with visual impairments. On this team sighted and nonsighted individuals utilize baseballs that beep and are padded. In this manner individuals with disabilities are encouraged to participate in sporting events that are age appropriate, while experiencing defeats and accomplishments that come along with a normal baseball season.

4. Other Quick Tips

  • Initiate eye contact and introduce
    yourself. Do this just as you would
    with any new acquaintance.
  • Acknowledge the person’s presence.
    Even if she is unable to communicate,
    let her know you’re “connecting.”
  • Smile. Respond to communicative
    attempts and observe body language.
  • Shake hands. Even if the person has
    limited use of his hands or wears an
    artificial limb, it’s appropriate to shake.
  • Remember that a person with a dis-
    ability is not “handicapped,” but a
    “person with a disability.”
  • Respect personal space and understand
    that a person’s wheelchair is an
    extension of his body.
  • It is okay to use expressions like
    “running along” when speaking to the
    wheelchair user or “good to see you”
    when speaking to a person who is
    blind. It is likely that they will use
    similar expressions.
  • When a wheelchair user transfers out
    of the wheelchair to a piece of exercise
    equipment, chair, toilet, car or bed,
    do not move the wheelchair out of
    reaching distance.
  • If a person has a developmental dis-
    ability, concentrate on concrete ideas
    and skills; avoid abstract concepts.
  • Develop a preview for the next lesson.
    Provide take-home material and
    videos to practice new skills.
  • Encourage the person to pick an
    activity appropriate for the amount of
    time available, and prioritize the
    importance of activities.
  • Make instructions clear and concise
    when training a new participant.
    Break down directions into small steps
    or tasks when needed. Tailor instruc-
    tions to each participant’s level of
    understanding and retention.
  • Demonstrate whenever possible.
    Showing is often more effective than
    telling.
  • Individuals with hyperactivity disorder
    or developmental disabilities may have
    difficulty screening out extraneous
    stimuli. Cease activity to attend to
    communication and eliminate outside
    noise, bright lights and/or visual
    distractions.
  • Keep a journal or chart to record the
    positive successes and the effort
    involved in obtaining the goal at hand.
  • Observe the person’s body actions
    (eyes, face, arms/hands, posture/
    stance, etc.) while performing an
    exercise. A new client may not readily
    express discomfort.
  • Prompt a new client to keep working
    on a task even if it is challenging and he
    may not readily succeed. People with
    disabilities should not be pitied and
    handed wins or false accomplishments.

Exercise Examples and Sports Activities

The focus of flexibility training and functionality should be to improve range of motion, balance, coordination and ability to carry out the regular activities of daily living. This routine aspect of physical
fitness becomes more important for individuals with disabilities who may not be familiar with thoroughly stretching every muscle group. Extra time and attention on tight muscle groups that have rarely been utilized should be encouraged.

Classes such as yoga, t’ai chi and Pilates should be available to individuals with disabilities in an inclusive and accommodating setting. As with any beginner, trainers should not overemphasize technical terminology and complicated movements. Start with a basic step and progress only when the familiar step has been mastered.

Since its introduction in the 1940s, snow skiing by individuals with physical disabilities has been elevated to new heights. Persons with a wide variety of disabilities (including cerebral palsy, multiple sclerosis, spinal cord injury, amputation, blindness and muscular dystrophy) can all participate (American Association on Health and Disability 2003). Improved technology and adaptive equipment—including sit-skis and mono skis—have led to national competitions and Olympic notoriety.

Penny Rosenblum, author of Fitness Training for Individuals with Visual Impairments, points to her own experience with the United States Association for Blind Athletes as proof of the value in endurance training. Rosenblum, who is blind, has competed in three national events, including the 75-mile El Tour de Tucson Perimeter Cycling event, with a sighted guide. Athletes such as Rosenblum dispel the myth that individuals with disabilities must lead sedentary lifestyles. Endurance training, perhaps more important than any other form of exercise, improves breathing and posture while decreasing the likelihood of secondary disabilities. Lighter weights with more repetitions, weight training machines and cycling equipment are excellent vehicles for a person with a disability wishing to improve her overall health and well-being.

By no means a new sport, wheelchair basketball is currently enjoying a nationwide surge of popularity among individuals with and without disabilities. Action-packed games, like those regularly displayed by the 7-year national champions Dallas Wheelchair Mavericks, are a common occurrence in this well-established sporting arena. Men and women with various physical disabilities compete throughout the United States in hopes of making it to the National Wheelchair Basketball Association (NWBA) championship series.

Just as one would expect to find in the NBA, there are stars, crowd favorites and impressive physical feats. Steve Welch of the Mavericks brought home the MVP award in the most recent championship series, with his 23 points on 11-for-15 shooting statistics. Players like Welch are invited to join gold cup teams, all-star teams and the national men’s team in order to compete in exhibition games and spread the word about this sport.

With this popularity, new teams and conferences have been forming around the country. As evidence of the trend, the Seventh Annual NWBA Basketball Camp and the Officials’ Camp are taking place next summer in Indianapolis.

An Opportunity to Inspire the World to Fitness

Creating exercise programs for individuals with physical and developmental disabilities can be extremely rewarding work. Look around your community for opportunities to instill confidence and physical well-being in those who might otherwise never get a chance to try a new sport or activity and improve their health and fitness. As in the koi analogy, your guidance can create exactly the environment these special populations need to stretch out and reach their full potential!



Need Advice?

If you’re trying to decide between a recumbent stepper or an upper-body ergometer for a specific client, James Rimmer, director of the National Center on Physical Activity and Disability (NCPAD), can help. The Chicago-based NCPAD is an academic research center, funded in part by the federal Centers for Disease Control and Prevention. Rimmer encourages fitness professionals to call NCPAD at (800) 900-8086. Rimmer and his staff routinely assist personal trainers in developing classes and individual programs that best suit a client’s needs, regardless of disability. In addition, NCPAD is particularly adept at reporting on the accessibility of fitness and recreation facilities nationwide. NCPAD has developed a comprehensive assessment tool, one of the first instruments of its kind, to measure physical activity accessibility from various perspectives. For additional information visit www.ncpad.org.

Put These Studies on Your Reading List
  • Croce (1990) demonstrated the improved endurance and reduction of obesity for adults with severe mental retardation participating in aerobic activity.
  • Beasley (1982) reported an increase in stamina and endurance for adults with mental retardation participating in a jogging routine.
  • Fox, Switzky, Rotatori and Vitkus (1982) studied and reported on the positive effects of weight training for overweight children with mental retardation.
  • Dattilo and Rusch (1985) found that individuals with disabilities improve their ability to make personal choices and decisions when particpating in leisure and recreational activities.
  • Klein, Gilman and Zigler (1993) reported increased life satisfaction and social adjustment for individuals with disabilities participating in sport- ing events offered by the Special Olympics.

    Profile of a Leader: Therapeutic Adventures, Inc.

    For more than two decades, Therapeutic Adventures has provided adaptive outdoor education programs, ski camps and training workshops for individuals of all ability levels. Following the principles of Dr. Kurt Hann, the founder of Outward Bound, Therapeutic Adventures promotes self-awareness, self-confidence and self-reliance. Persons of all ages who have a disability (physical or developmental), a chronic illness or special health needs have benefited from Therapeutic Adventures by learning the skills to lead a more active and healthier lifestyle. Therapeutic Adventures Inc. is a nonprofit organization committed to promoting greater access to adaptive snow sports, adaptive water sports and adaptive wilderness sports. For more information visit www.therapeu ticadventures.com/ta/ or call (434) 295-3972.

    Access Denied?

    Fifty physical fitness facilities were evaluated in western Oregon, a locality known for its programs for persons with disabilities. Using a measuring instrument developed by Dr. Stephen Figoni, investigators determined the percentage of each program’s compliance to Americans with Disabilities Act (ADA) guidelines for buildings and facilities. Accessibility of the parking lot, exterior entrance/doors, ramps, customer service desks, restrooms/locker rooms, telephones and exercise equipment was evaluated. Ninety percent of the facilities were reported to have made physical improvements to the exterior entrance and doors to make entry completely accessible (National Center on Physical Activity and Disability 2003). However the study demonstrated that once in the door, individuals with disabilities were faced with fewer options. For instance only 37 percent of the facilities had customer service desks that were accessible and only 44 percent had accessible lockers/restrooms. Ironically, the lowest rate of compliance was found around exercise equipment, at only 8 percent. Research such as this demonstrates how the ADA has opened the doors for individuals with disabilities. However inside it is often a different story. Why spend money on a health club membership if you can’t gain access to any of the equipment or even make it to the locker rooms?For information on making your facility or studio more accessible to disabled people, visit www.healthpromotionjournal.com.

    Resources

References

References
American Association on Health and Disability (AAHD). 2003. Snow skiing for the physically disabled. www.aahd.us/exercise.htm; retrieved November 15, 2003.
Kritz, F. 2002. Fit for everyone. The Washington Post, November 12, F1.
National Center on Physical Activity and Disability (NCPAD). 2003. Children with disabilities. www.ncpad.org/whtpprs/childrenwithdisabilities.htm; retrieved November 1, 2003.
Rimmer, J.H., Braddock, D., & Pitetti, K.H. 1996. Research on physical activity and disability: An emerging national priority. Medicine and Science in Sports and Exercise, 28, 1366-72.
The Arc. 2003. Introduction to mental retardation. www.thearc.org/faqs/mrqa.html; retrieved October 30, 2003.
U.S. Census Bureau. 2003. Census bureau data on disability. www.census.gov/hhes/www/disable/intro.html; retrieved October 30, 2003.

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