· Healthy Schools Database. Mandates: The Legislature recognizes the importance of physical education in maintaining healthy children and urges California schools to. · 2. Methods. To shape a research agenda on physical activity among persons aging with mobility disabilities, we conducted a scoping review. A scoping review. PREVENTING CRIME: WHAT WORKS, WHAT DOESN'T, WHAT'S PROMISING 1. A REPORT TO THE UNITED STATES CONGRESS. Prepared for the National Institute of Justice. Physical Activity Among Persons Aging with Mobility Disabilities: Shaping a Research Agenda. Interventions can target individuals, either one- on- one or in group settings, to promote changes. Another intervention approach, however, is to change the built environment and create policies to make healthy choices, including active living, the default option (e. We briefly review current research on each of these areas. Individually Focused Physical Activity Interventions Maximizing mobility in older adults has been the focus of multiple intervention projects. ![]() Much of the focus has been on preventing mobility disability in otherwise healthy older adults (e. However, some interventions have been specifically developed to increase physical activity among those who have mobility disabilities. The research that has been done among older adults with chronic disease or low fitness has indicated that multicomponent programs (including endurance, strength, flexibility, and balance) focusing on physical activity only (versus multiple behavior targets such as activity, nutrition, and medication), building exercise slowly over time, and using behavior change principles (e. Effective physical activity programs among older adults target moderate intensity activities, are inexpensive, are convenient [8. For women, particularly, inclusion of a social component can be important [8. It is likely for older adults with mobility disability that these program characteristics are also important although there may be differences due to the higher rates of illness, pain, fatigue, and depression among those with mobility disabilities. Rimmer and colleagues conducted a review of exercise interventions specifically for individuals under age 6. MS and stroke were the most common conditions studied. The 3. 2 randomized controlled trials involved aerobic, strength, or combined exercise but no two trials offered the same dose across 1. The primary outcomes were functional, musculoskeletal, cardiorespiratory, mental, and metabolic health. Although many of the exercise trials showed positive benefits, the lack of replication and often small sample size makes conclusions difficult. The authors suggest that exercise interventions need to be developed that focus on groups with the same functional impairment or activity limitation (e. It can be difficult to evaluate whether exercise interventions result in increases in exercise. Motl's review of studies on MS and physical activity showed the largest effect sizes were for studies with supervised exercise and shorter duration programs [1. Petter et al.'s review on physical activity programs for CHD showed that exercise levels did not vary whether the program was home or hospital based [2. Several limitations of the rehabilitation research literature are (1) lack of measurement of physical activity and (2) use of time- limited structured programs such that the benefits likely end when the programs stop. Studies are needed that focus on improving lifestyle activity and participation in on- going exercise programs that can be maintained once research ends. ![]() Barriers to activity can be much higher than for populations without disabilities, stemming from both increased internal struggles (e. Strategies to improve self- efficacy for continuing to exercise as well as self- efficacy to overcome barriers to exercise (symptoms, social environment, and physical environment) may merit specific attention in trials to promote physical activity in people with MS and other mobility disabilities [1. Social support has been identified as an important component of adapting to chronic conditions [8. Pacing of activity may be important to promoting physical activity among persons aging with mobility disability. Brawley et al. noted that in one large intervention for knee osteoarthritis, those who exercised more often but for shorter durations per session had less pain and better ADL performance than those who did more exercise [8. This suggests that for persons with disabilities, doing shorter bouts of exercise regularly could be more beneficial than pushing oneself to do more at one time. Additionally, the physical activity guidelines state that activity can be accumulated with three 1. An important issue is assuring older participants of the safety of exercise. Older adults or those with mobility disability may not believe that exercise is safe for them or they may not consider activities they can do (e. Risk of falls and fear of falling need to be addressed via education and specific intervention targets. Additionally, falls prevention among people aging with mobility disabilities is important due to higher rates of falls among those with disabilities [1. Fall rates for those with disabilities may be twice the rate of community- dwelling older adults [1. A potential cause and consequence of falls is activity restriction which can lead to a decrease in quality of life [1. Physical activities consisting of balance training, strengthening exercises, and gait training are important elements of falls prevention programs. However, there are few falls prevention interventions geared towards those with mobility disabilities [1. Programs developed in the general aging population, such as Matter of Balance and Stepping On, could be tested to determine whether they are effective for persons with mobility disabilities [1. Some attempts at modifying fall prevention programs for populations with disability, such as stroke, have begun [1. A review of interventions to prevent falls in those aged ≥8. Evidence- based physical activity programs do exist for some populations of adults aging with mobility disability. The Enhance. Fitness program, for example, has been offered to adults over age 6. The program promotes social support for a healthier lifestyle and involves supervised moderate intensity aerobic exercise, strength training, and flexibility and balance training. Involvement in the program was found to decrease health care costs over the long term [1. Fit and Strong is an evidence- based program for people with arthritis consisting of 8 weeks of aerobic, flexibility, and resistance training exercises. Because maintenance of physical activity is a problem when structured programs end, Fit and Strong tested the use of a maintenance contract plan according to individual preferences and telephone contacts twice monthly for months 3 through 6 and monthly between months 7 and 1. This approach was shown to promote physical activity, decrease lower extremity pain, stiffness, improve function, and improve strength and aerobic capacity as well as decrease depression at 1. For those with arthritis, other evidence- based programs include the Arthritis Foundation Aquatic Program [1. People with Arthritis Can Exercise (PACE) [7. Walk with Ease [1. A problem is that participation in such structured programs has been noted to be low, around 1% of the target population in one instance [7. ![]() Several reasons why people may not attend such programs are lack of interest in group- based exercise programs, inability to access programs due to transportation and lack of knowledge the programs are offered in close proximity to ones' residence. Improving the reach of such programs and expanding them to include those with various types of mobility disability should be a target. The Chronic Disease Self- Management Program is an empirically supported program teaching self- confidence to manage chronic conditions for those with hypertension, arthritis, heart disease, stroke, lung disease, and diabetes [1. Exercise is one component of the program and has been shown to improve for those that participate. While those with mobility disabilities could be included in such programs, further translating this type of approach for those specifically with diverse types of mobility disabilities could be a promising strategy. Some studies have sought to provide cognitive- behavioral self- regulation skills to aid participants' transitions from rehabilitation to independent lifestyle activity [8. Programs comparing facility- based programs to home- based independent exercise programs have shown no difference in improvements in functional capacity, suggesting that a lifestyle, home- based approach can be as effective as facility- based treatments. Lifestyle physical activity programs, which incorporate routine activity as part of usual life, may be more acceptable to a larger population [1.
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