Adapt the Fun for Everyone! - Physical Activity and People with Disabilities
Bridget Ciulla, fitness specialist
Capital District YMCA,
Southern Saratoga County Branch
- "All individuals should and can exercise regularly for an improved quality of life as well as maintaining their independence. With the support of other professionals and your own creativity, any exercise can be modified to meet the goals of regular physical activity for a lifetime."
Jackie Stack, fitness instructor
Healthy State Program, NYS Education Department's
Employee Health and Wellness Promotion Program
- "The benefit of adapting exercise for the individual with disabilities is two fold: The participant successfully achieves his or her goal of being healthier, and the instructor gains the reputation for being knowledgeable and caring."
Judith Goldberg, Director,
Elly and Steve Hammerman, Wellness Center
Competitive swimmer with Wheelchair Sports USA.
- "All too often people with disabilities are not encouraged to exercise or they may equate it to physical therapy and the medical model. With the help of other fitness professionals and your own creativity, exercise and fitness programs can be adapted to meet fitness goals and be fun. Exercise and fitness are lifelong activities to maintain a healthy and active lifestyle."
As a fitness instructor or wellness program coordinator, you know how rewarding it is when you are able to ignite people's enthusiasm for physical activity. You are in the unique position of being able to improve the health of people you assist and instruct, and share in their pride as they feel better.
"Yes, that's true, but there are still many more people, including people with disabilities, who could be discovering - and enjoying - the benefits of physical activity. How can I encourage people who have an interest, but are reluctant to join an exercise program, dance class or their local gym?"
By using your knowledge and thinking creatively, you can expand your audience to include people of all abilities. The 1996 U.S. Surgeon General's Report on Physical Activity recommends that everyone, including people with disabilities, engage in regular physical activity. People with disabilities, however, often face barriers to participation. You may be surprised how easily you, as a fitness instructor, can remove these barriers.
This is designed to help fitness instructors and wellness program coordinators modify physical activities so that people of all abilities can participate. In addition, it suggests ways for developing programs to integrate people with disabilities.
How do I start to design a "universally accessible" program?
Ask people with disabilities about their needs and expectations.
- Include them in planning, implementing and evaluating your program. Encourage feedback and listen to their concerns. No one sees the obstacles to access like someone who must overcome them.
Check that programming is accessible.
- For example, look for safe, well-lit and attractive walkways with ample width and curb cuts for bicycling, walking and wheelchair activities; and, parking spaces that provide room for vehicles' ramps. Ask a person with a disability for an assessment of your facility's accessibility.
Think about how activities can be adapted and what adaptive equipment is available.
- The professional associations and resources listed at the end of this brochure can provide guidance and identify sources of assistance or adaptive equipment.
I believe physical activity is important for everyone, but I don't feel confident that I have enough information to create a universally accessible program or enough experience with disabling conditions. Why is it important that I make this effort? And, what will these modifications cost?
There are many important reasons to make the effort to create a universally accessible program:
People with disabilities benefit from physical activity.
- When people with disabilities stay physically fit, they accrue the same health benefits enjoyed by others and, at the same time, reduce their risks for developing additional health problems.
A modified program or class will attract a more diversified audience.
- It is estimated that one in five Americans will become disabled during his or her lifetime. Not all disabilities are visible, and many people develop disabilities as they grow older. These factors may influence the composition of your audience in future years.
Inclusive, universally accessible activities contribute to a truly integrated community, where people of all abilities work and live together.
- Wellness and recreation activities are social occasions at which people enjoy themselves and make new friends. When people of different abilities and backgrounds come together, they can develop positive perceptions, break down barriers, and banish stereotypes.
Many modifications are often simple and inexpensive.
- You may only have to move an activity to an accessible room with a doorway that is wide enough for a wheelchair. Or, you can show an individual how to perform an exercise differently or with adaptive equipment. You can also move equipment along the paths that already exist between equipment in your gym.
- Some exercises and sports can be modified with adaptive equipment, such as a hand-pedaled, stationary bicycle; or by performing them differently, such as by sitting for an aerobic or hand-weights class. Adaptive equipment is available for most activities, and prices vary.
- Together with the individual with a disability, decide what is needed. For more ideas and assistance, contact the professional organizations and agencies listed at the end of this brochure.
OK. That makes sense. I like believing I can help people feel better and healthier. But, how can I adapt programs and exercises? I don't have any special training.
- The first step is to relax! Use your imagination and professional experience and work together with the individual to design a program.
- The usual recommendation to consult with one's physician before beginning any physical activity program holds true for people with disabilities. The health care professional may suggest certain exercises or activities that the person should perform, as well as those that he or she should avoid.
- Safety measures should be matched to the person's functional level. For instance, make spotters available for people with disabilities who are using free weights, or offer floatation devices for pools.
- Next you need to learn about the individual's physical capabilities; health goals; special interests and strengths; and, learning style. You also need to identify activities that may be difficult to perform safely, as well as the person's current level of functional ability. Most importantly find out what they like to do . You do all this by simply asking. Get to know the person, just as you would any new member.
- Adapting is nothing more than using your professional skills and natural creativity in a different way. In some cases, adapting may simply mean taking an ordinary object and turning it into an adaptive device. For example, an elastic wrap may be used to assist with gripping free weights or to secure feet or hands to a bicycle or an arm ergometer.
- When creating a program with your client, keep in mind that people with the same disability can differ greatly in their levels of abilities. That's why it's important to be clear about the person's abilities, limitations and exercise preferences. Does he or she feel fatigued while exercising? Maybe he or she is working too hard. Work together to find a comfortable level. Do certain movements cause pain or discomfort? Stop, and try to perform the exercise differently.
- It's important to keep the lines of communication open. A person beginning a physical fitness program may not know what to expect. He or she may feel self-conscious about exercising, or concerned about getting hurt. He or she will look to you for assistance, guidance and reassurance.
- Additionally you may want to ask your new participant if he or she would like a buddy. Some people feel more at ease when a supportive, friendly person is there for encouragement and assistance.
Actually, you are describing the way that I've adjusted exercises for women who are pregnant, or for people with heart problems or arthritis. Can you give me specific examples of ways to adjust exercises for other types of physical disabilities?
Programs for people with disabilities should improve flexibility, strength and endurance, all of which are necessary to perform activities of daily living (ADL), such as getting out of bed, transferring (i.e., the act of getting into and out of a wheelchair), dressing and grooming, and showering and bathing. When a person has a disability, being physically fit can help him or her perform ADLs more easily.
Tips for Modifying Exercises....
The following list is not exhaustive, but it highlights activities that may be more appropriate for people with disabilities. It will give you some general ideas of where to start making individual modifications.
Also, guidelines for modifying exercises for specific disabling conditions and for monitoring the intensity of aerobic activities can be found in the books or from the organizations listed in this brochure.
- People with contracture (permanent muscular shortening due to a chronic spasm or fibrosis; or muscle imbalance due to paralysis) most often need to work on muscle flexibility before beginning a strengthening program, since their abilities are limited by reduced range of motion. Before beginning, it's helpful to know that certain positions can affect individuals differently. For some people, lying on the back will relax certain muscles, while for others, lying on the stomach will relax them. Work together to find the most effective method.
- The muscles involved in transferring and for balance are particularly important to an individual who uses a wheelchair. Wheeling and repeated transfers often result in uneven muscular development. A balanced, strength training program and stretching of the shoulder muscles can help relieve muscle spasms and prevent injury. People who use wheelchairs should work muscles that counter-balance the anterior muscles used for moving and transferring.>
- Strengthening and endurance exercises help an individual with paraplegia (paralysis of the lower extremities and, generally the trunk) to: avoid shoulder injury; improve performance in transfers; assist with weight control; preserve muscle mass; and, strengthen affected muscles.
- Spasticity (a state of increased muscular tone with exaggeration of the tendon reflexes) from cerebral palsy stroke, closed head injury or multiple sclerosis can contribute to muscle imbalance. It's important to stretch and strengthen the opposing muscles, being careful not to increase the abnormal muscle tone.
- For individuals with limited strength, such as those with multiple sclerosis, a buddy can provide resistance. In another strengthening technique, the individual is positioned on a weight bench, and his or her trunk and extremities are stabilized. A trunk stabilizing belt may be used. Any sign of skin sensitivity or breakdown should be monitored.
- Help the individual practice the rules of safe lifting: stretch before lifting; breathe normally when lifting; use smooth movements. That might mean using lighter weights. Lift slowly, 2 to 4 seconds per lift. Stay in the pain-free range. Avoid soreness. If the person is sore after lifting, use less weight, for fewer times, and less often.
- For people with quadriplegia (paralysis of the legs and arms), depending on the level of injury and the individual's voluntary control of the extremities, endurance activities can include arm bicycling and wheelchair training. Grip gloves or cuffs can help a person grasp handles of exercise equipment. Trunk stabilizing belts can be used on strength training or endurance equipment.
- For people with paraplegia, a variety of accessible endurance activities include arm bicycling wheelchair training rower-cycling and swimming.
- People with multiple sclerosis or lower body limitations may benefit from aerobic exercise performed while sitting or in a pool.
Many of these suggestions are applicable to all people, whether or not they have a disability. Everyone who exercises should warm up, cool down and be careful to not overwork joints and muscles.
You will pick up other ideas as you work with people with different disabilities. Additional examples for working with a person with a disability can be found in this brochure's list of resources.
By working with a person with a disability, you are helping him or her become fit for life! Helping people make physical activity an important part of their lifestyle takes time, courage, determination and imagination. By working together, you can help ensure it can be done!
For more ideas, check out the following organizations that can help physical activity and wellness program instructors adapt the fun for everyone!
"Conditioning with Physical Disabilities, Kevin F. Lockette and Ann M. Keyes, editors, in cooperation with The Rehabilitation Institute of Chicago. Available by contacting:
P.O. Box 5076
Champaign, Illinois 61825-5076
Fax: (217) 351-1549
ACSMs "Exercise Management for Persons with Chronic Diseases and Disabilities," Scott Wikgren, acquisitions editor. Available by contacting:
P.O. Box 5076
Champaign, Illinois 61825-5076
Fax: (217) 351-1549
"Fitness Programming and Physical Disability," Patricia D. Miller, editor. Available by contacting:
P.O. Box 5076
Champaign, Illinois 61825-5076
Fax: (217) 351-1549
Resources on Physical Activity and People with Disabilities
The National Center on Physical Activity and Disability
Department of Disability and Human Development
University of Illinois at Chicago
1640 W. Roosevelt Road
Chicago, IL 60608-6904
Voice and TDD: (800) 900-8086
Fax: (312) 355-4058
National Center on Accessibility
501 North Morton Street - Suite 109
Bloomington, IN 47404-3732
Voice: (812) 856-4422
TDD: (812) 856-4421
Fax: (812) 856-4480
New York State Department of Health
Disability and Health Program
150 Broadway, Suite 350
Albany, New York 12204
Voice: (518) 474-2018
Access to Recreation
Recreation and Exercise Equipment
8 Sandra Court
Newbury Park, CA 91320
Voice: (800) 634-4351
Fax: (805) 498-8186
American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD)
An alliance of five national associations six district associations, and a research consortium
which support healthy lifestyles through high quality programs
1900 Association Drive
Reston, Virginia 20191
American Council on Exercise (ACE) - America's Authority on Fitness
5820 Oberlin Drive, #102
San Diego, CA 92121
Voice: (619) 535-8979
The American Occupational Therapy Association, Inc. (AOTA)
4720 Montgomery Lane
P.O. Box 31220
Bethesda, MD 20824-1220
Voice: (301) 652-2682
TDD: (800) 377-8555
Fax: (301) 652-7711
American Physical Therapy Association (APTA)
1111 North Fairfax Street
Alexandria, VA 22314-1488
Voice: (703) 684-APTA (2782) or (800) 999-2782
TDD: (703) 683-6748
Fax: (703) 684-7343
Resources on Access and the Americans with Disabilities Act
Council for Better Business Bureaus Foundation
4200 Wilson Boulevard
Arlington, VA 22203
U.S. Department of Justice Office of the ADA
What We Do: Uphold Disability Rights
950 Pennsylvania Avenue, NW
Washington, DC 20530-0001
Voice (DOJ Main Switchboard): (202) 514-2000
Voice (ADA Information Line): (800) 514-0301
TTY (ADA Information Line): (800) 514-0383
Architectural and Transportation Barriers Compliance Board
Director, Office of Technical and Information Services
Suite 1000, 1331 F Street, NW.
Washington, DC 20004-1111
Voice: (202) 272-0080
TTY: (202) 272-0082
Fax: (202) 272-0081
U.S. Equal Employment Opportunity Commission (EEOC)
Americans with Disabilities Act - Business Connection
Voice: (800) 514-0301
TTY: (800) 514-0383
ADA Home Page - Information and Technical Assistance on the Americans with Disabilities Act
New York State Department of Health