Guidelines for a Community-Based Physical Fitness Program for Adults with Physical Disabilities

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Guidelines for a Community-Based Physical Fitness Program for Adults with Physical Disabilities

Exercise is a cornerstone in the rehabilitation of adults with physical disabilities; yet, many persons fail to engage in regular physical activity, outside of hospital-based therapy, due to unavailability of community-based programs. Unfortunately, inactivity can lead to disuse syndrome - decrease in optimal functional capacity of an individual (Valbona, 1982). Clinical manifestations of disuse syndrome are numerous and produce both physiologic and biochemical changes in most organs and systems of the body including decreased physical work capacity, muscle atrophy, negative nitrogen and protein balance, contracture of connective tissue, osteoporosis, renal liathisis, cardiovascular deconditioning, pulmonary restrictions, decubiti ulcers, and mental depression (Valbona, 1982). Adults who are sedentary and use wheelchairs are especially prone to disuse syndrome and significant reductions in functional capacity. Disuse syndrome, coupled with an existing physical disability, generally yields more functional loss than would be predicted by disability alone. Without minimal physical capacity, opportunities for a more independent life style are lost. For example, minimal amounts of muscular strenth, muscular endurance and motor control are required to operate hand controls for driving a car or to participate in certain types of physical recreation.

Exercise can reverse or minimize disuse syndrome and should be provided for adults with mild to severe disability. Although there are many different types and models, all exercise provides some mental and physical benefits for adults with and without disabilities including (Bjorntorp, Berchtold & Grimby, 1972; Clausen, 1977; Corbin & Lindsey, 1988; Delio, 1985; Holloszy, Skinner, Toro, & Cureton, 1964; Lipman, Raskin, & Lore, 1972; Pollock, Wilmore, & Fox, 1984; Saltin, Blomqvist, Mitchell, Johnson, Wildenthal, & Chapman, 1968; Siegel, Blomqvist, & Mitchell, 1970; Vranic & Berger, 1979):

* Maintaining optimal health and decreasing the incidence of secondary health problems related to disuse syndrome.

* Increasing muscular strength and endurance, thereby expending less energy to perform activities of daily living.

* Increasing flexibility.

* Improving cardiovascular function and blood lipid management.

* Reducing risk factors responsible for cardiovascular disease.

* Preventing obesity and glucose intolerance.

* Preventing sport-related injuries.

* Reducing mental stress.

* Improving sleep.

* Enhancing self-esteem and feeling of control.

* Improving basic motor skills which may allow an individual to develop prevocational and vocational skills.

* Improving physical recreation skills which may provide an avenue for socialization or competition.

Community-based programs can assist in maintaining levels of physical fitness after discharge from hospital-based rehabilitation programs. One form of community-based program for adults with physical disabilities is that sponsored by a department of physical education at a college or university. Undergraduate and graduate students in adapted physical education, sports medicine, and allied disciplines may receive university credit for assisting with individualized exercise programs. Participants with disabilities (from the community) do not enroll through usual admissions processes--the program is operated as an auxiliary to basic curricular offerings. Registration is handled within the program and fees charged to participants are determined by amount of financial support from the physical education department, program grants, and local agencies.

A quality physical fitness program for adults with physical disabilities should encompass diversified psychomotor and educational experiences in which teaching styles and activities are modified to insure success for each adult. Physical fitness programs should focus on developing and maintaining both health-related and skill-related aspects of fitness (Corbin & Lindsey, 1988): (a) muscular strength and endurance, (b) cardiovascular endurance, (c) flexibility, (d) body composition, (e) balance, (f) reaction time, (g) coordination, (h) power, (i) speed, and (j) agility. If a participant is receiving therapy in addition to the physical fitness program (e.g., physical therapy, kinesiotherapy), the fitness instructor should coordinate efforts with those of the therapist, providing a comprehensive and beneficial wellness plan for the participant. Opportunities should also be provided within the physical fitness program for increased social interactions and building of self-esteem.

The purpose of this article is to provide guidelines for establishing a community-based physical fitness program, within a college or university, for adults with physical disabilities. Much of the information presented is based on the model and operating procudures in use at San Diego State University's Fitness Clinic for the Physically Disabled. Many factors involved in designing, implementing, and evaluating community-based physical fitness programs for adults with physical disabilities are addressed in the following sections. More specifically, procudures for program admission, assessment, and program implementation are presented. The term participant is used throughout the article to denote the adult (18 years and older) who is physically disabled. Exercise recommendations for specific disabilities will not be discussed; the interested reader is referred to comprehensive writings by Umphred (1985) and Lasko-McCarthey and Knopf (1988).

Procedures for Program Admission

Prior to exercise assessement and programming, it is desirable for the potential participant to undergo a medical examination to rule out occult cardiovascular disease or other …