The Effects of the Cessation of Fitness

Activities for Individuals with Disabilities

Nancy Flinn PhD OTR/LDirector of Outcomes and Research

Erin Simunds MS PTDirector of Pediatric Programs

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Fitness for Persons with Disabilities

• Historically, health has been defined as “absence of disease,” did not address prevention of activities or secondary conditions

• Recent paradigm shift toward prevention and that the concept of health applies to all

• Disability does not preclude health & wellness

• Healthy People 2010 Initiative – addresses the health of people with disabilities and their risk for developing secondary conditions (SC)

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Fitness for Persons with Disabilities

• Healthy People 2010 proposed that fitness & nutrition will not only be beneficial but crucial to reduce secondary conditions

• 56% of people with disabilities report engaging in no physical activity (US Dept of Health, 2000)

• Numerous barriers exist that prevent this population from exercising (Rimmer et al., 2004)

• Limited opportunities exist for persons with complex disabilities to exercise

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Consequences of secondary conditions in this population

• ‘Thin margin of health’

• ‘Accelerated aging’

• There is a high rate of increase of secondary conditions in individuals with disabilities

• Much of the cost of care for persons with disabilities is the cost of secondary conditions

• Increased morbidity and mortality in this population related to secondary conditions

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Rates of Secondary Conditions in Persons with Disabilities

In an analysis of 90 clients in the Courage Center Transitional Rehabilitation Program discharged from June through November 2009

On average these clients had 4.8 secondary conditions

Range was 0 to 10.

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Courage Center Fitness Activities

• Fitness and Wellness services available since 2002

• 2300 individuals participate monthly

• Land-based and aquatic programming offered with various levels of support available

• Rates covered by a range of options: self-pay, health plan and waivered services

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Courage Center Fitness Activities

• Stay Fit Extra – for individuals who need assistance with their exercise program from 75% to 100% of the time

• Stay Fit - for individuals who need assistance with their exercise program from 25% to 75% of the time

• Independent Exercise – for individuals who need assistance less than 25% of the time

Exercise programs are available in 3 levels of assistance

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Effects of Cessation of Exercise

• ‘Throughout 2007, waivered service coverage terminated by the counties over the course of 1 year

• 79 consumers who had previously received county waiver coverage for fitness, no longer received this funding

• This provided a unique opportunity to examine the effects of exercise cessation for individuals with disabilities and complex health conditions

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Outcomes Study Methods

• Telephone interview asking:

Type and frequency of exercise

Length of exercise participation

Status of secondary conditions during exercise

Current status of exercise participation

Status of secondary conditions since exercise cessation

• Short Form of the Secondary Conditions Surveillance Instrument (SCSI) provided the basis for this interview format (Ravesloot et al., 2006)

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Short Form SCSI

0

Not a problem in the last 2 months

1

Mild or infrequent problem,

activity was limited by 1 to 5 hours per week

2

Moderate problem, activity

limited 6 to 10 hours per

week

3

Significant problem,

limiting activity more than 11

hours per week.

Fatigue 0 1 2 3

Joint andmuscle pain

0 1 2 3

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Outcomes Study Methods

Criteria for inclusion: Exercised weekly for at least 3 months and funding loss of > 1 month

Global List of Consumers 79

Phone Issues 19

No Answer or No Voicemail 6

Does not meet inclusion criteria 8

Total Possible Consumers 46

30 consumers participated in the interview for a response rate of 65%

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Consumer Demographics

• Gender: 17 Females and 13 Males

• Age: Range 29 – 91 with Average = 52 years old (SD=13)

• History of Exercise Adherence: Range 3 to 36 months with Average = 19.52 months (SD=22)

• Loss of Funding Length: Range 1 -13 months with Average = 6 months (SD=3)

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Consumer Demographics

Type of Exercise:

• 20 in aquatics only

• 10 in fitness only

Mobility:

• 66% ambulatory

• 17% manual wheelchair

• 17% power wheelchair

50% stopped exercising while 50% found resources to continue exercising but at lower intensity and frequency

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Outcomes Findings

Reported secondary medical conditions:

• While exercising average # = 3

• Following exercise cessation = 5.63

• Wilcoxon Signed Ranks Test significant at p=.0001

Reported severity of Secondary Medical Conditions:

• While exercising average severity = .73

• Following exercise cessation = 1.26

• Wilcoxon Signed Ranks Test significant at p=.0001

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Age

Number of Secondary Conditions by Age

0

1

2

3

4

5

6

7

8

29-40 41-50 51-60 61-90

Nu

mb

er

of

Se

con

da

ry C

on

dit

ion

s

Number of SecondaryConditions DuringExercise

Number of SecondaryConditions AfterCessation of Exercise

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Age

17

Gender

18

Gender

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Mobility

20

Mobility Type

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Aquatics Compared to Land

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Aquatics Compared to Land

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Incidence of Secondary Condition

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Incidence of Secondary Condition

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Secondary Condition Natural Progression- what we don’t know

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Reported Changes Since Exercise Cessation

Theme %

Endurance 18

Mental health concerns 21

Physical Function 33

Falls or increased fear of falling 17

Loss of Social Interaction 23

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Comparison to Literature

• Other research has generally examined the effect of reducing secondary conditions following participation of exercises

• Research Findings: - Decreasing the # of secondary

conditions

- Better cardiac and physical function

- Reduced BP, cholesterol, and weight

- Improved psychosocial outcomes

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Conclusions

•Regular exercise appears to help individuals control the presence and severity of secondary conditions

•The loss of the opportunity to exercise appears to reverse this trend

•Need to consider: - Policy that promotes wellness activities

- Further research that investigates this issue more rigorously

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Questions?

Nancy A. Flinn

Nancy.flinn@couragecenter.org