proactive sci toolkit finalfhsd-sciactioncanada-2019.sites.olt.ubc.ca/files/2019/12/... · 2019....
TRANSCRIPT
The ProACTIVE SCI Toolkit
APhysiotherapist’sGuidetoPromotingPhysicalActivitytoClientswhohave
SpinalCordInjuries
COPYRIGHT©UNIVERSITYOFBRITISHCOLUMBIA
ProjectLeads:Dr.JasminKMa,PhDUniversityofBritishColumbia,ICORD(InternationalCollaborationonRepairDiscoveries)
Dr.KathleenAMartinGinis,PhD,O.M.C.Reichwald FamilyUBCSouthern MedicalProgramChairinPreventive MedicineProfessor,DivisionofPhysicalMedicineandRehabilitation,DepartmentofMedicineProfessor,SchoolofHealthandExerciseSciencesDirector, ChronicDiseasePrevention Program,UBCSouthernMedical ProgramPrincipalInvestigator,ICORD (InternationalCollaborationonRepair Discoveries)
Dr.OrenCheifetz,PT,PhDHamiltonHealthSciences
Thisresourcewasdevelopedandreviewedbyanexpertpanelofphysiotherapists,communitymemberswithspinalcordinjury,anduniversityresearchers(lastupdated2018).
Thankyoutoallofthephysiotherapistsandparticipantswhocontributedtheirinvaluabletimeandknowledgetoinformthedevelopmentofthistoolkit.
ThisprojectwasfundedbytheOntarioNeurotramaFoundationandtheRickHansenInstitute.
ExpertPanelMembers:JaniceCenturione,PTCaroleChebaro,PTDr.KimberlyCoros,MD,FRCPC,Dip.SportMed.JenniferDuley,PTCyndyMcLean,MScHoongPhang,PT,MScSheriRobertsMattSaganRobertShaw,BPHERichVanderWalKyleWhaley,PT
ForquestionsorrecommendationsforupdatesonthetoolkitpleasecontactDr.JasminMa([email protected]) orDr.KathleenMartinGinis ([email protected])
ProacTive Toolkit Executive Summary
Ms. Jasmin Ma, PhD Student
Dr. Kathleen Martin Ginis, PhD
Dr. Oren Cheifetz, PT, PhD
ToolkitContributors
COPYRIGHT©UNIVERSITYOFBRITISHCOLUMBIA 1
Step2:AimforatleasttheSCIphysicalactivityguidelines
Step1:Tailoryourinterventionbydiscussingthe
followingquestionstounderstandyourclient’ssituation
Step3:Pickyourstrategies
TheOnePageCheatSheet
Educate1. Safety Pg.82. Philosophy Pg.103. BasicDefinitions Pg.114. TheSCIPhysicalActivityGuidelines Pg.125. BenefitsofPhysicalActivity Pg.136. BehaviourChangeTechniques Pg.147.AdditionalMaterials Pg.24
Link&Refer
TailoredPrescription
1. Finance&Transportation Pg.272. LocateLocalResources:Tips&Tricks Pg.283. LinktoFacilities&Resources:Examples Pg.294. Peer-to-PeerConnections Pg.315. OtherProfessionals,Supports,and
Organizations Pg.32
1. TheInterview Pg.342. ActivityIdeaLadder:EverydayActive,
AdaptedActivities,AdaptedSports Pg.373. BasicPhysicalActivityPrescription Pg.414. SamplePrograms Pg.435. AdaptingCommonExerciseEquipment Pg.46
Asaquickreferenceforpromotingphysicalactivity,followthesethreesteps.Therestofthetoolkitprovidesdetaileddescriptionsofeachofthesestrategies andhowtousethem.
1)Currentphysicalactivitylevels/readinessforchange:
2)Goals(howmuchphysicalactivityandwhatarethebenefitsthey’dliketogain):
3)Typesofphysicalactivitytheycurrentlyenjoydoing:
4)Availableresources(e.g.,equipment,gym,recreationcentres nearthem,funding):
5)Barrierstoaccomplishingtheirgoal:
6)Mutuallydiscussshorttermgoalsandstrategies(seethefollowinglinktodownloadalistofprintableresourcestohelp:https://drive.google.com/drive/folders/13tJaCoGqBIj3nwK3Mykqn6-UfiIe5p_w?usp=sharing)
Forfitnessbenefits:20minofmoderatetovigorousaerobicactivity,2x/week
ANDStrengthtraining2x/week
Forcardiometabolic healthbenefits:30minofmoderatetovigorousaerobicactivity,
3x/week
2
StepstoUsingthisGuide(Overview)
2.Gaugeyourclient’sinterestinphysicalactivity.
2a.MotivatedMoveforwardwithone,twoorallthreeofthefollowingkeystrategiesaccordingtoyourclient’ssituationandyourownpracticeandskillset.
2b.NotMotivatedIfyourclientisn’tinterestedinphysicalactivity,learnthereasonswhy.Thenmoveforwardwithone,twoorallthreeofthefollowingkeystrategiesaccordingtoyourclient’ssituationandyourpracticeandskillset.Ifyourclientbecomesmotivated,referto3a.
Note:Becausehyperlinksareconstantlychangingandnewinformationiscontinuallyemergingonline,we’veincludedsearchterms[underlinedandinsquarebrackets] forrecommendedwebsites,organizations,programsandconcepts.
Educate
TailoredPrescription
Link&Refer
1. Familiarizeyourselfwiththesafetyguidelinesandphilosophyforpromotingphysicalactivity.
3.Keystrategies
Educate:SafetyBenefits
ProblemSolving
TailoredPrescription:ActivityIdeaLadder
Link&Refer:Finance&TransportationPeer-to-PeerConnections
Pg.7
Pg.26
Pg.33
Pg.8Pg.13
Pg.19
Pg.26Pg.31
Pg.37
3
StepstoUsingthisGuide(Detailed)
Thiscanbeachievedbysimplyaskingthisquestion:
“Doyouhaveanyplanstostart(continue)beingactive?”
1. Familiarizeyourselfwiththesafetyguidelinesandphilosophyforpromotingphysicalactivity.
Philosophy
Beforebeginningaconsultationwithyourclienttopromotephysicalactivity,taketimetounderstandpre-exercisescreeningconditions,commonrisksforpeoplewithanSCIwhobeginanexerciseprogram,andthetoolkit’sphilosophyforpromotingphysicalactivity.
2.Gaugeyourclient’sinterestinphysicalactivity.
Safety
Motivated
v Actors:clientswhohavestartedexercisingorhavebeenexercisingforalongtime.
v Intenders:clientswhohavenotbeenexercisingbutwouldliketo.
NotMotivated
v Pre-Intenders:clientswhohavenotbeenexercisingandhavenointentiontodoso.
Motivationalinterviewingisbeyondthescopeofthistoolkit,butmaybeausefulstrategyforresolvingambivalencethroughaclient-centeredcounsellingapproach.Propertrainingrequiresmultiple,in-personsessionswithfeedbackfromatrainedcounsellor.Foraquickoverview/refresher,see:http://learning.bmj.com/learning/module-intro/.html?moduleId=10051582[BMJMotivationalInterviewinginBriefConsultations]
2a.Motivated
2b.NotMotivated
Pg.8 Pg.10
4
3a.MotivatedMoveforwardwithone,twoorallthreeofthefollowingkeystrategiesaccordingtoyourclient’ssituationandyourownpracticeandskillset.
Educate
TailoredPrescription
Link&Refer
3.Keystrategies
Educate:SafetyBenefits
ProblemSolving
TailoredPrescription:ActivityIdeaLadder
Link&Refer:FinanceandTransportationPeer-to-PeerConnections
Potentialreasons:• notunderstandingthebenefits ofphysicalactivity
• fear ofactivity(e.g.,triggeringautonomicdysreflexia)
• barriers tophysicalactivity• alackofconfidence toexercise
3b.NotMotivatedIfyourclientisn’tinterestedinPA,learnthereasonswhy.
Ifyourclientiswillingtoaddresstheseissuesorlearnmore,moveforwardwithone,twoorallthreeofthefollowingkeystrategiesaccordingtoyourclient’ssituationandyourownpracticeandskillset:
Benefits,Fear,Barriers
Barriers,Confidence
Barriers,Confidence
Ifyourclientidentifiesanyoftheabovepotentialreasonsfornotexercising,herearesomerecommendedkeystrategies:
Seethetableofcontentsanddecidewhichofthekeystrategiesaremostappropriatetostart,maintain,orimproveyourclient’sexerciseprogram.
ToAddress…StepstoUsingthisGuide(Detailed)
Pg.7
Pg.26
Pg.33
Pg.8Pg.13Pg.19
Pg.26Pg.31
Pg.375
TableofContents
Educate
1. Safety Pg.82. Philosophy Pg.103. BasicDefinitions Pg.114. TheSCIPhysicalActivityGuidelines Pg.125. BenefitsofPhysicalActivity Pg.136. BehaviourChangeTechniques Pg.14*AdditionalMaterials Pg.24
Link&Refer
TailoredPrescription
1. Finance&Transportation Pg.272. LocateLocalResources:Tips&Tricks Pg.283. LinktoFacilities&Resources:Examples Pg.304. Peer-to-PeerConnections Pg.315. OtherProfessionals,Supports,andOrganizations Pg.32
1. TheInterview Pg.342. ActivityIdeaLadder:EverydayActive,AdaptedActivities,AdaptedSports Pg.373. BasicPhysicalActivityPrescription Pg.414. SamplePrograms Pg.435. AdaptingCommonExerciseEquipment Pg.46
Teachyourclientthebasicwaysandbenefitsofbeingphysicallyactiveandprovidethemwiththetoolstostartandmaintainexerciseontheirown.
Linkyourclienttoresources,orrefertopeers,programsorotherprofessionalstohelpthemstartorcontinuephysicalactivity.
Useyourbackgroundasaphysiotherapist,alongwithsomenewtools,todesignphysicalactivityprogramsthataretailoredspecificallyforyourclientwithSCI.
Educate
TailoredPrescription
Link&Refer
Ifyouarealreadyfamiliarwiththecontent,quicklynavigatethetoolkitbycompletingTheInterview(Pg.35)withyourclientandchoosetheappropriateinterventionstrategy/ies below:
6
EducateOverview
Teachyourclientsthebasicsofbeingphysicallyactiveandprovidethemwithtoolstostartandmaintainanexerciseprogramontheirown.
SafetyLearningaboutthecommonrisksofexerciseforpeoplewithSCIwillhelpyourclientspreventinjuryandfeelmoreconfidentthatriskscanbemitigated.1
Becomecomfortablewiththebasicsofphysicalactivity,specifically:
• Basicdefinitions:definingphysicalactivityandthekeytermsusedtoprescribeexercise
• TheSCIPhysicalActivityGuidelines:evidence-basedrecommendationsforminimumlevelsofphysicalactivitynecessaryforpeoplewithSCItoexperiencefitnessbenefits
• BenefitsofPhysicalActivity:research-supportedpositiveoutcomesfromparticipatinginphysicalactivityexperiencedbypeoplewithSCI
ABCsofPhysicalactivity
StrategiesthathavebeenshowntochangephysicalactivitybehaviourinpeoplewithSCI,including:
• actionplanning• SMARTgoalsetting• problemsolving• prompts&cues• gradedtasks
4 BehaviourChangeTechniques
• follow-up• self-monitoring• commitment• reward
LivedExperience/EducationalVideosBo
nus Utilizevideosfeaturingexpertsintheexercisefieldandthose
withlivedexperience.
PhilosophyMakeyourphysicalactivitypromotionstrategyeffectivebybasingitonkeyguidingprinciplesdevelopedbyphysiotherapists,peoplewithSCI,andbehaviourchangespecialists.
2
3
7
EducateSafety
WerecommendthatpeoplewithSCIcheckwithaphysicianbeforestartingaphysicalactivityprogram.Ifyou’reunsurewhetheraphysicianneedstobeconsultedbeforeyourclientstartsanexerciseprogram,usethePAR-Q+guidelines(backofthisguide)toinformyourdecision.
Tofindamedicaldoctorwhomightbeappropriateandqualifiedtoassessaclientpriortoexerciseparticipation,contactCASEM[CanadianAcademyofSportandExerciseMedicine] orCAPMR[CanadianAssociationofPhysicalMedicine&Rehabilitation].
Safetyshouldbeconsideredforallclients.Understandingandteachingcommonsafetyconcernscanhelptopreventinjuryforyourclients,andallowthemtofeelmoreconfidentthatriskscanbemitigated.Belowarealistofcommonsafetyissuesandstrategiestomitigaterisk.
PAR-Q+
OveruseInjury Shouldersandwristsareparticularlysusceptibletooveruse,butoveruseinjuriescanalsohappeninotherareasofthebody.Whenprescribingexerciseprograms,don’tforgettheimportanceofupperbodyfunctionforeverydaylifeandactivitiesforclientswhohaveanSCI.
Ø Progressslowly:aimforalittlemusclesoreness,notintensepain.Ø Varyexercises.Ø Prescriberestdays.
Pressureulcers People withSCIarevulnerabletopressureulcersorpressuresores—damagetotheskinand underlying tissue,whichistypicallycausedbysittingorlyingononepartofthebodyfortoolongoracombinationofpressureandshearingforces.
Ø Encourageshiftingbodyweightevery10to15minutes.Ø Recommendequippingwheelchairwithahigher qualitycushionto
betterrelievepressure.Ø Formoreinformationonpressureulcermanagement,seewww.onf.org
[ONFPressureUlcerGuide].
TemperatureDysregulation
Sweatingmaybeinhibitedbelowthelevelofaclient’sinjuryandimpairtheirabilitytoregulatetheirtemperature.
Ø Have clientscooldownwithawaterbottle,spraybottle,orcoldwettowelwhenexercisingoutdoorsintheheat.
Ø Submersinghandsorfeetin coldwaterorusingicevestscancoolcoretemperature
Ø Whenindoors,useafan(andaspraybottleforbetter results).
Pg.47
8
AutonomicDysreflexia(AD)
ADisasuddenandverylargeincreaseinbloodpressurewhichisoftenaccompaniedbysevereheadaches.KnowthesignsofAD (e.g.,severeheadache,feelingsofanxiety,profusesweatingand/orflushingabovethelevelofinjury,blurredvision).
Ø Emptying thebladderbeforeexercisecanhelppreventAD.Ø IfyouthinkyourclientisexperiencingAD,keepthemsittingup.Ø Dealwithanysuspectedcauses(e.g., kinkedcatheter,tightclothing,full
bladder).Ø Askiftheclienthasmedicationtomanagetheirbloodpressure.Ø Ifyoudealwiththesuspectedcausebutsymptomspersist,getmedical
assistance(i.e.ifnoimprovementinfiveminutes,seekaphysician;safestoptionmaybetheERifyouhavenoaccesstoblood pressure monitoring).
Ø FormoretrainingonAD,takethefreeonlinecourseatwww.abcofad.jibc.ca [JIBCABCofADinspinalcordinjury].
OrthostaticHypotension
Orthostatichypotensionisadangerousdropinbloodpressure.The30-20-10ruleisusedtodetermineorthostatichypotension. Whenaclientmovesfromlyingpositiontoanuprightposture(e.g.,sittingor standing)andexperiences anincreaseinheartratebymorethan30beatsperminute,adecreaseinsystolicbloodpressureof20mmHg,oradecreaseindiastolic bloodpressure of10mmHg(oranycombinationofthese),orthostatichypotensionshouldbesuspected.Othersymptoms mayincludelightheadedness,dizziness,nausea,andfatigue. Typically, individualswithtetraplegiaareatagreaterriskthanindividualswithparaplegia.
Ø Lietheclientbackdownuntilsymptomssubside.You can alsoelevatetheclient’sfeetandapplypressuretotheabdomen.
Fracture Afracture,orbreakinthebone,istypicallytheresultoftrauma,overuse,ordecreasedbonemineraldensity (osteoporosis). Fracturesaremorecommon inlimbsaffectedbyparalysis.
Ø Thosewhoexperienceseveremusclespasmsandhaveosteoporosisshouldtakeprecautionssuchasengaginginlowerimpactexercisetopreventfracturesfromoccurring.
Spasticity Spasticity, orhighmuscletone, canbeasignofpainandcanbeworsenedbymedicalissuessuchasskinbreakdownorinfection.
Ø Certainexercisesmightexacerbatespasticity—assess onacase-by-casebasis.Ifspasticitycontinuestoworsen,avoidtheproblematicexercise.
Ø Doingawarmupandstretchingmayhelpalleviatespasticity.
Sunburn Sunburn isdamagetotheskinasaresultofexposuretothesun’sultravioletrays.
Ø Useofsunscreen,shade,orlightcoloured andlightweightclothingtoprotectskinfromthesunisimportantforeveryonewhoexercisesoutside,butespeciallyforthosewithnoorlimitedsensationintheskin.
EducateSafety
9
GuidelinesataGlance
SCIActionCanada,inconjunctionwiththeRickHansenInstitute,hasdevelopedthePhysicalActivityGuidelinesforAdultswithSpinalCordInjury.AdultswithSCIshouldengageinatleast:
Forfitnessbenefits:20minofmoderatetovigorousaerobicactivity,2x/weekAND
Strengthtraining2x/week
Forcardiometabolic healthbenefits:30minofmoderatetovigorousaerobicactivity,3x/week
SmallSteps
InstillaCultureofPhysicalActivityasPartofEverydayLife
TailortotheIndividual
Ø TheSCIPhysicalActivityGuidelinesaretheminimumamountofactivityrequiredtoobtainfitnessbenefits(althoughotherbenefitsmaybeachievedatlowerdoses).However,noteveryoneisreadytomeetthoseguidelines.
Ø Somewillbereadytosetgoalsformeetingtheguidelinesorevenexceedingthem.Otherswillneedtostartwithmoremodestgoals(e.g.,doingrange-of-motionexerciseswhilewatchingTV)andworkuptomeetingtheguidelines.Tailoryourapproachbasedonyourclient’ssituation.
Ø Physicalactivityisimportantforreducingtheriskofprevalentchronicdiseases.Butit’salsocriticaltoyourclients’qualityoflife.Expertscontinuallyemphasizetheimportanceofconnectingphysicalactivitytoimprovementsineverydayfunction.
Ø Forexample,youcouldexplaintoyourclientshowaparticularexercisecanhelpmaketoilettransferseasier,orspellouthowbuildingstrengthandendurancewillallowthemtoplaylongerwiththeirkids.
Ø Youradviceismuchmoreeffectiveandmeaningfulwhenyouconsidertheenvironment,functionallevel,personality,barriers,familysituation,andmotivationofyourclients.Bepreparedtochallengeyourclientsifthey’rewillingandeagertointroducephysicalactivityintotheirlives.Youmayhavetotakesmaller,moremodeststepsifthey’renotfullyconfident.
Ø Integrateyourclientsintocommunitycentresifthey’reinterestedinexercisinginasettingwithavarietyofindividuals,orreferthemspecificallytoadaptedprogrammingifthat’stheirpreferenceorcomfortlevel.There’snosuchthingasablanketstrategy;eachclientisunique.
EducatePhilosophy
10
PhysicalActivityThefocusofthistoolkitextendsoutsideofrehabilitativeexercisestothebroadercategoryofphysicalactivity.Inaccordancewithup-to-dateliteratureandresearch,thetypesofphysicalactivityrecommendedtopromotetoclientsinordertohavethemexperiencefitnessbenefitsareleisuretimephysicalactivityandwheeling/activetransportation.Ø AleisuretimephysicalactivityissomethingthataclientCHOOSEStodointheirfreetime(e.g.,
goingtothegym,playingsports,takingthedogforawalk).Ø Wheeling/activetransportationcanbeencouragedasanalternativetodrivingortakingpublic
transittoadestination(e.g.,wheelingtoworkorthegrocerystore).
AerobicExerciseAerobicexercise,commonlyreferredtoascardio,involvesanactivitythattypicallyincreasesheartrateandbreathing(e.g.,wheeling,basketball,dancing).
Strength/ResistanceExerciseThistypeofexercisemakesuseofresistancetoimprovemuscularstrengthandfunction(e.g.,liftingweights,usingresistancebands,usingbodyweightexercises).
IntensityIntensityreferstohowhardtheindividualisworking.BelowareintensitydescriptionsthathavebeendeterminedtobeappropriateforclientswhohaveanSCI:
Mild Moderate Vigorous
InGeneral This includesphysicalactivitiesthatrequireclientstodoverylightwork.Theyshouldfeellikethey’reworking alittlebit,butoverall,theyshouldn’tfindthemselvesworkingtoohard.
This includesphysicalactivitiesthatrequiresomephysicaleffort.Clientsshouldfeellikethey’reworkingsomewhathardbutcankeepgoingforalongtime.
This includesphysicalactivitiesthatrequirea lotofphysicaleffort.Clientsshouldfeellikethey’reworkingreallyhard(almostattheirmaximum)andcanonlydotheactivityforashorttimebeforegettingtired.Theseactivitiescanbeexhausting.
BreathingandHeartRate
Thesestaynormalorareonlyalittlebitelevatedthannormal.
Breathing isharderandheartrateisfasterthannormal,butnottotheextreme.
Breathing isfairly hard,andbotharemuchfasterthannormal.
Muscles Muscles areloose, warmed-upandrelaxed;theyfeelnormaltemperatureoralittlebitwarmerandnottiredatall.
Muscles feelpumped andworked.They’rewarmerthannormalandstarttogettiredafterawhile.
Muscles burn, aretightandtense, feelalotwarmer thannormal,andfeeltiredquickly.
Skin Skin isnormal temperatureoronlyalittlebitwarmer,andnotsweaty.
Skin isa littlebitwarmer thannormal,andmightbealittlesweaty.
Skin ismuch warmerthannormalandmightbesweaty.
Mind Clientsmightfeelveryalert, butthere’snoeffectonconcentration.
Clients requiresomeconcentration tocomplete.
Clients require alotofconcentration(almost full)tocomplete.
EducatePhysicalActivityBasicDefinitions
11
ForFITNESSbenefits,aimfor:20minutesofmoderatetovigorousintensityaerobicactivity(e.g.,wheeling,armcycling,sports,
swimming)atleast2timesperweekAND
3setsof8-10repetitionsofstrengthtrainingexercises(e.g.freeweights,elasticresistancebands,cablepulleys,weightmachines)foreachmajorfunctioning
musclegroup,2timesperweek.
ForCARDIOMETABOLICHEALTHbenefits,aimfor:30minutesofmoderateto
vigorousintensityaerobicactivityatleast3timesperweek
Moderatemeanssomewhathard,andyoufeellikeyoucouldcontinueforalongtime.Duringtheactivity,youareabletotalk,but
notsingasong.
Vigorousisreallyhard;youfeellikeyoucanonlycontinueforashorttimebeforegettingtired.Youwillnotbeabletosaymorethanafewwordswithoutpausingforabreath.
STRENGTHENINGACTIVITYYoushouldfeelquitechallenged(withouthurtingyourself)bytheendofthethree
setsandeighttotenrepetitions.Takeaonetotwominuterestbreakbetweeneachset.Workeachmusclegrouponalternatedays.
EducateTheSCIPhysicalActivityGuidelines
These guidelines were developed by an international group led by Prof Kathleen Martin Ginis (University of British Columbia, Canada) and Prof Victoria Goosey-Tolfrey (Loughborough University, UK).
FitnessFor cardiorespiratory fitness and muscle strength benefits, adults with SCI should engage in at least:
20 minutes of moderate to vigorous intensity aerobic exercise 2 times a
week
3 sets of strength-training exercises for each major functioning muscle group, at a moderate to vigorous intensity
2
+
times a week
Cardiometabolic healthFor cardiometabolic health benefits, adults with SCI are suggested to engage in at least:
30 minutes of moderate to vigorous intensity aerobic exercise 3 times a
week
QuickVersionforExplainingtheGuidelinestoYourClients:(Formoredetail,see[scientificexerciseguidelinesforadultswithspinal
cordinjuryatSCIActionCanada.ca)
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Followingtheguidelinescanhelpimproveyourclient’sfitnessandstrength.Whenchoosingwhichbenefitstoemphasizetoyourclient,considerwhat’simportanttothem.Forexample,isyourclientseekingtoimprovetheirhealth,ormaintaintheirfunctionalindependence?Somebenefitsyourclientmayexpect(butarenotlimitedto):
EverydayBenefits• betterenduranceforwheelinglongerdistances• easiertransfersinandoutofawheelchair�• enhancedself-careandmobility�• betteroverallhealthandqualityoflife• moreenergy�• moresocialinteractionopportunities• improvedabilitytoplaywithchildren• moretimespentwithfamilywhenactivitiesaredonetogether
HealthBenefits• reducedcholesterolandfatsintheblood,whichcanlowertheriskofdevelopingseveralchronicdiseases
• lesspain• lowerriskofstress• lowerriskofdepression• improvedabilitytoregulatebloodglucose,decreasingriskfortypeiidiabetes
• bettersleepquality
EducateBenefitsofPhysicalActivity
13
Ifyourclientwantstobeginaphysicalactivityprogram,orhasbeenexercisingbutneedssomehelpreachingtheirgoals,considerthefollowingbehaviouralstrategiesthatmayhelpthemtransformtheirintentionsintoaction.
Notethatthesestrategiesnotonlyapplywhenpromotinganactivelifestyle,butcanalsobeusedtohelpyourclientsadheretotheirrehabilitativeexercises.
EachofthesetechniqueshavebeensupportedintheliteratureasmethodstoimprovephysicalactivityspecificallyinpeoplewhohaveanSCI.
ProblemSolving
SMARTGoalSetting
ActionPlanning
Prompts/Cues
GradedTasks
Follow-Up/Monitoring
RewardCommitment
Self-Monitoring
EducateBehaviourChangeTechniques:Overview
14
SMARTGoalsCreategoalsthatare:
ExampleofaSMARTgoal:
“Iwillgoforamoderatetovigorousintensitywheelofatleast20minutesduration,twiceperweek,
everyweek,foronemonth.”
WhythisagoodexampleofaSMARTgoal:
ü Specific:Thetypeofexercise(wheeling)iswell-defined.ü Measurable:Youandyourclientcaneasilykeeptrackofwhetherthegoalisbeing
met(twotimesperweek,atleast20minutes,everyweek).ü Attainable/Realistic:Thegoalisrealisticallyattainable.Whatconstitutes“realistic”
willvaryfrompersontoperson.Revieweachindividualclient’sexercisehistoryandcurrentleveloffitnessinordertosetappropriate,realisticgoals.
ü Time-Based:Thegoalhasanachievementenddate(onemonth).
EducateBehaviourChangeTechniques:SMARTGoals
15
ActionPlanning
Haveyourclientmakeadetailed,day-by-dayactionplanfortheirphysicalactivityatthebeginningofeachweek.Itshouldincludetheactivitytype,location,timeandduration,andexerciseintensity.Belowisanexampleofanactionplan.
Belowisanexampleofablankactionplanthatyoucanusewithyourclients.
EducateBehaviourChangeTechniques:Planning
16
Havingyourclientmonitortheirownprogressisimportantforpreparingthemtoindependentlymanagetheirphysicalactivityprogram.Encourageyourclientstowritedowntheactivitythey’vedoneattheendofeachday(orcheckoffwhethertheyfollowedtheiractionplanifthey’vemadeone).Distributethesecalendarstohelpyourclientsself-monitor.
Forclientswhoprefertorecordactivitiesindetail:
Forclientswhopreferasimplemonitoringapproach:
Goal
EducateBehaviourChangeTechniques:Self-Monitoring
Pleaserecordtheduration,intensity,andtypeofanyphysicalactivitythatyoudideachday.Havefun!
17
Followingupandmonitoringyourclientscanmakeyourclientsmoreaccountabletotheirgoal.Itcanbedoneinadditiontoself- monitoringandcanbeachievedinmanyways:
Monitoryourclient’sprogressinachievingtheirgoals.(seeGoalSetting)
Monitorhowwellyourclient’sactionplanisworkingforthem.(seePlanning)
Providefeedbackandencouragementonclients’progress.
Follow-upwithyourclientpost-discharge—evenaquickemailorphonecallcanbemeaningful.
Providesuggestionstohelpclientsovercomeobstacles.(seeProblemSolving)
Goal
EducateBehaviourChangeTechniques:Follow-up
Physicalactivitylogscanbehelpfultokeeptrackofyourclient’sprogress.Here’sasamplecalendarforyourclienttorecordandsharewithyouthedaystheywereactive:
Pleaserecordtheduration,intensity,andtypeofanyphysicalactivitythatyoudideachday.Iwillcheckonyourprogressatyournextvisit.Havefun!
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Identifyyourclient’sperceivedbarrierstoparticipatinginphysicalactivityandaccomplishinggoals,anddiscusspotentialsolutions.Belowareafewexamplesofcommonbarriersandpotentialsolutionsyoucanrecommendtoyourclient:
NoTimeØ Makeanactionplan.Ø Spendmoretimewithfamilyandfriendsbyexercisingwiththem.Ø Useactivetransportationandcountitaspartofyourexercisefortheday(e.g.,
wheeltowork).
PhysicalBarriersØ Ifpainisabarrier,exercisemayactuallybeeffectiveinreducingpain.Ø Startingexercisecanbedifficultwhenyoufeelfatigued,butit’sworthitintheend.
Oftenyou’llfeelmoreenergizedafteraworkout.Ø Becreativetomaximizeallabilities(seeAdaptingCommonExerciseEquipment).
LackofSupportorAccessØ Findanexercisepartner.Ø Connectwithyourcommunityrecreationcentreormunicipalrecreation
departmenttolearnaboutoptions.Ø MakegooduseofresourcessuchastheCanadianWheelchairSportAssociation’s
BridgingtheGapProgram,ActiveLivingAlliance,andtheCanadianParalympicCommitteeportal(SeeLinktoFacilities&Resources:Examples).
Ø Inpoorweather,tryexercisingwithavideo—forexample,theActiveHomesvideosontheSCIActionCanadawebsite.
“ICan’t.”Ø Startwithwhatyouknowandbuildyourskills.Workwhatworks,andfocuson
whatyoucando.Ø Takeatourofafacilitythatoffersanactivitythatinterestsyou.Ø Ifequipmentistooexpensivetopurchaseonyourown,theremaybecommunity-
basedprogramsandfacilitiesthathaveadaptedequipmentavailableforyoutouse(seeLocateLocalResources:TipsandTricks,andFinance&Transportation).
EducateBehaviourChangeTechniques:ProblemSolving
19
Settasksandgoalsthatareeasilyachievable,andthenincreasetheirdifficulty.
Tailoring/AdaptingSampleProgramTailoredPrescription
ActivityIdeaLadder
Why?Settingtasksandgoalsthataremoreachievablehelpsbuildyourclients’confidenceandincreasestheirlikelihoodtomaintaintheirexerciseprogram.
EducateBehaviourChangeTechniques:GradedTasks
Forsome,meetingtheguidelinesmaynotbeanappropriatefirstgoal.Forideasonhowtogradethetypesofactivitiesyourclientcanstrivetodobasedonwhatgoalisappropriateforthem,see:
Pg 37
20
Useenvironmentalorsocialstimulitohelptriggeraplannedbehaviour.Belowareafewexamplesofusefulpromptsandcuesyoucanrecommend:
Behaviour Prompt/Cue
Goforawheeltobreakuptheworkday
Programremindersintophone
Goforaswimafterwork Place gogglesbesidecomputer
Exercisefirstthinginthemorning
Set gymclothesbesidebed
Goforawheelaftergettingreadyinthemorning
Putastickynoteonthebathroommirror
Ensure yougetdailyexercise Havesomeonetext youtoaskifyou’veexercisedbeforetheendoftheday
Decreaselongperiodsoftimeworking atadeskwithoutmoving
Settimerson yourphoneorcomputertoremindyoutomoveeveryhourorso
Meetthe guidelinesforexercise
Keepacalendarbyyourdeskwith thedaysyouwanttoexercisecircled
Goforaworkoutafterlunch Packgymclothesunderlunchbag
Goforabikerideafterreading
Putastickynote reminderonapageacouplechaptersahead
EducateBehaviourChangeTechniques:Prompts&Cues
21
Haveyourclientsignacommitmentcontractormakeaverbalpromisetoachievetheirgoals.(SeeGoalSettingformakingSMARTgoals.)
Belowisablankcommitmentcontract:
Iamcommittedtoachievingthefollowinggoal:
Name_____________________________________________________
Signature__________________________________________________
Date______________________________________________________
EducateBehaviourChangeTechniques:Commitment
22
Rewardscanbeusedtomotivateyourclientstoengageinphysicalactivityandreachtheirgoals.Theserewardsmaybehelpfulwhenaclientisstartinganexerciseprogram,butrememberthatallclientsshouldbeencouragedtoultimatelyunderstandthattherealpayoffsforexercisingareenjoyment,fun,satisfaction,andsignificantandlong-lastinghealthbenefits.
Examplesofrewards:
Ifyourclientachievesaphysicalactivitygoal,youcouldsuggesttheyrewardthemselveswith:
• ahotbath• amanicure• relaxingandwatchingafavouriteTVshow• verbalencouragement• newexercisegear• adinnerouting• ahealthysmoothie
EducateBehaviourChangeTechniques:Reward
23
TherearemanyvideosavailableonlinethatfeaturephysicalactivityforpeoplewithanSCI.Someofferinspiringexerciseideas,informationontheSCI-specificbenefitsofexercise,anddetailsonadaptivesports.Othersprovideinformationonrelatedtopics(e.g.,sociallife,caregiving,andfinances).Thesevideosfeatureexpertsinthefieldandthosewithlivedexperience.Hereareafewexamples:
[NorthwestRegionalSpinalCordInjurySystem:SCIForumVideos]http://sci.washington.edu/info/forums/reports/universal_fitness.asp#
[FacingDisabilityVideos]http://www.facingdisability.com/videos/
[ActiveHomes:HomeStrengthTrainingGuideforPeoplewithSCI]http://sciactioncanada.ca/paraplegia-strength-training-videoshttp://sciactioncanada.ca/tetraplegia-strength-training-videos
[NationalCenteronHealth,PhysicalActivityandDisabilityVideos]http://www.nchpad.org/Videos
[SpinalCordInjuryResearchEvidence]https://scireproject.com
EducateAdditionalMaterials:ImportantInformationHubs
24
TheBasics:• Eachindividualhashisorherownspecificneedsforseatingdependingonthe
leveloflesionandlifestyle.• Properseatingshouldfollowthenaturalcontoursofthebody,providing
posturalsupportandincreasedfunctionalityasmuchaspossibletoenhancetheoverallqualityoflife.
WhyProperSeatingisImportant:• Preventionofmuscleimbalanceandcontracturefromprolongedimproper
posture• Properredistributionofpressure• Protectionofskinintegritybyminimizingunnecessaryshearforces• Providecomfortandreducepain• Helpmaintaineyecontact,increaseself-esteemandconfidence
WhatYouCanDo:1)AskQuestions:Doescomfort,stability,shearing,fatigue,orotherissuesrelatedtoyourchairaffectyourday-to-dayliving?
2)Refertoaseatingspecialist:Haveaproperassessmentdonebyaqualifiedtherapistorseatingandmobilityspecialist.
3)FollowUp:Provideongoingassessmentandmakeadjustmentsorreferralsasneeded.
Wanttolearnmore?[Posturalassessmentandseatingsystems- SpinalOutreachTeam]https://www.health.qld.gov.au/__data/assets/pdf_file/0019/423433/seating.pdf[RehabilitationEngineeringandAssistiveTechnologySocietyofNorthAmerica-ExpertPositionPapers]http://www.resna.org/knowledge-center/position-papers-and-provision-guidesWatchthisvideofortipsforchoosingtherightwheelchair[NRSCISTipsforChoosingtheRightWheelchair]:http://sci.washington.edu/info/forums/reports/wheelchair_choosing.aspDon’thaveanOT?https://www.find-an-ot.ca
EducateAdditionalMaterials:Seating
25
Tohelpyourclientsstartandcontinuephysicalactivity,linkthemtoresources,orreferthemtopeers,programsandotherprofessionals.
Rememberthatlackoftransportationandfinancesaretwoofthemostcommonlycitedbarrierstoparticipationinphysicalactivity.Refertootherprofessionalsandorganizationstohelpremovethesebarriers.
1
Researchanddevelopstrategiestoquicklylocatelocalresources,programsandfacilitiessuitableforyourclients.Connectwiththerecreationsectorforassistancewithyourclients’transitionfromtheclinicintothecommunity.
2
ExamplesofFacilitiesandResources
Learnaboutthekeyfacilitiestoreferclientstoineachprovince,andkeyresourcesthatcanbedistributedtoyourclients.
3
Finance&Transportation
Linkyourclientswithotherpeersforinvaluableinsightsgainedfromthelivedexperience.4 Peer-to-Peer
Connections
Establishconnectionsandnetworkswithotherprofessionals,supports,andorganizationsforamorecomprehensivephysicalactivitypromotionstrategy.
5OtherProfessionals,
Supports,andOrganizations
Shareyourresearchandknowledgeofexerciseprograms,resources,andotherinformationwithyourcolleagues;learnfromtheirknowledge.Bo
nus DiscussionCommunityto
ShareExercisesandResources
TipsandTrickstoLocateLocalResourcesand
Facilities
Link&ReferOverview&Checklist
26
Twoofthemostcommonbarrierstoparticipatinginphysicalactivityarelackofaccesstotransportationandfinances.Findingstrategiestoovercomethesebarriersmayrequiresomeinternetresearch,aphonecallortwo,andperhapsmakingyourclient’sfamilymembers,occupationaltherapist,orotherhealthprofessionalsawareofthebarrierssotheycanplayaroleinfindingsolutions.Asyouworktosetyourclientupforsuccess,consideringthefollowingconsiderationsandresources:
TransportationConsiderations:• accessibletransportationserviceswithassistance,taxis,parking• accessiblepublictransportationoptions(low-floorbuses,accessiblesubway/trainstops• parkingpermits• personalvehicleadaptations
Organizationsthatmaybeabletoprovideorfinanceequipmenttosupporttoyourclients:• MarchofDimes• BridgingtheGap• Forkids:[EasterSeals] and[CanadianTireJumpstart]
Organizationsoragenciesthatmaybeabletooffersupportandadvice:• provincialSCIorganizations(e.g.,SCIOntario,SCIPEI,CanadianParaplegicAssociation
Manitoba,SCIBC)[SeeExamplesofFacilities/ResourcestoConnecttoFacilities]• provincialministriesoftransportation• Foracompilationofdifferentfundingagenciessee[AdvancedMobilityAlternative
FundingAgencies]
Tailoring/AdaptingSampleProgram
TailoredPrescription:AdaptedSports
Link&Refer:Peer-to-PeerConnections
Formoreadviceonreducingcostsforsportsequipmentsee:
Forlivedexperienceadviceandtipsonnavigatingtransportationandfinancebarrierssee:
Tailoring/AdaptingSampleProgram
TailoredPrescription:EverydayActive
AdaptingCommonExerciseEquipment
Forideasonwhatyourclientcandoathomewhentransportationisunavailable,see:
Link&ReferFinance&Transportation
Pg.40
Pg.31
Pg.38
Pg.46
27
Youcansetyourclientsupwiththebestofintentionswhentheyleavetheclinic,butifthere'snowheretogotoexercise,it’sgoingtobedifficultforthemtoactontheirintentions.Herearetwosuggestionstohelpensureyourclientsareconnectedwithresources/facilities:
Notethat,ifyourclientlivesinaruralarea,itmaybedifficulttolocateaccessiblelocalresources.Ifthisisthecase,searchforlocalprogramsandfacilitiesavailabletothegeneralpublicandmakeaquickphonecalltoseeifthey’rewheelchairaccessibleandhaveprogramsorservicesgearedtowardmeetingyourclient’sneeds.
Ifyou’relocatedinalargercity,theseresourcesmaybehelpful:
Familiarizeyourselfwiththelocalaccessibleexerciseoptionswithinthecommunityandreferyourclientstotheseoptions.
ConductyourownsearchSearchtermsonGooglecaninclude:1) [Yourtownorregion]2) [Accessible/inclusive/spinalcordinjury/SCI/adapted/wheelchair]3) [Sport/exercise/programs/physicalactivity/facility]
Ifyouwanttotakeitonestepfurther,connectwithprogramsandfacilitiesthatofferadaptedfitnessopportunities.Seektheirassistanceonhowtosmoothyourclients’transitionfromrehabtothecommunity.Forexample,uponaclient’sdischarge,contactafacilityyou’veestablishedarelationshipwith,andthefacilitycanfollowupwiththeclientfromthatpointon.Makingthisconnectioncanmakeforasmoothertransition,withtheresultbeingawinforyou,yourclient,andthefacility.However,besuretogiveyourclientsalistofoptionssothechoiceisultimatelytheirs.
Establishconnectionswiththerecreationsector
[CanadianWheelchairSportAssociationPrograms]:www.cwsa.ca/programs
[CanadianParalympicCommitteeFindaClub]:www.paralympic.ca
[PhysicalActivity,ActiveLiving,andSportResourceCatalogueforCanadiansLivingwithPhysicalDisability]:www.cdpp.ca
[BridgingtheGapCanadaWheelchairSports]:www.btgcanada.ca
Findlocalaccessibleoptions
Link&ReferLocateLocalFacilitiesandResources:Tips&Tricks
28
NationalSCIActionCanadaCanadianParalympicCommitteeBridgingtheGapCanada
CanadianWheelchairSportAssociationSCICanada
•PhysicalActivityResearchCentre(Vancouver)•InternationalCollaborationonRepairDiscoveries(ICORD)•RickHansenInstitute(RHI)•SpinalCordInjuryBC•GFStrongRehabilitationCentre(Vancouver)
•SpinalCordInjuryAlberta•SteadwardCentreWheelchairSportsAlberta•UltimateWheelchairSportsFoundation
SpinalCordInjurySaskatchewan
CanadianParaplegicAssociationManitoba
•SpinalCordInjuryOntario•ParaSportOntario•OntarioWheelchairSportsAssociation•MacWheelers(Hamilton)•RevvedUp(Kingston)•PowerCord(St.Catherine’s)•Lyndhurst(Toronto)•WalkitOff(Newmarket)•VarietyVillage(Toronto)•AbilitiesCentre(Whitby)•Cruisers(Mississauga)
MoelleÉpinièreetMotricitéQuébec(MEMO- Qc)
AbilityNewBrunswick
TheCanadianParaplegicAssociationofNovaScotia
SpinalCordInjuryPrinceEdwardIsland
SpinalCordInjuryNewfoundlandandLabrador
Link&ReferLinktoFacilitiesandResources:Examples
29
Foracomprehensiveandquickhandoutthatincludesinformationonsafety,thebasicsofphysicalactivity,adaptiveactivities,andtipsonhowtomakeaplantoincludephysicalactivityasaregularpartofyourclient’slife,downloadthe[SCIGetFitToolkit]:www.sciactioncanada.ca
Foracomprehensiveguideonsafety,stability,adaptiveequipment,accessibility,exerciseprecautions,andafulloverviewofthecomponentsoffitnessincludingcardiovascular,strengthandflexibilityforwheelchairusers,seethe[NationalCenteronHealth,PhysicalActivityandDisabilityDiscoverAccessibleFitness] resource:http://www.nchpad.org/discoverfitness/index.htmlYoucanalsovisittheNCHPADwebsitefornutritioninformation:[NCHPADlifeonwheels].
Link&ReferLinktoFacilitiesandResources:Examples
30
ExamplesofWaystoConnectPeers
1) Gettingapeer-to-peerinteractionstartedcouldbeassimpleasaskingyourclientthequestion, “Wouldyoubeinterestedinconnectingwithapeer?”
2) Encourageyourclienttotalktootherswithadisabilityormeetotherpeersthroughgroupexerciseclasses.Thiscouldopenthedoortoexcellentexperientialknowledgeaboutphysicalactivity—insidertipsaboutwheretogo,adaptivestrategies,overcominghurdles,andavoidingsafetyandhealthissues.
3) Accompanyandintroduceyourclienttocoachesormembersofalocaladaptedfacilityorprogram.
4) Inviteachampionormentortoengagewithyourclient.
Notethatthecontextandreadinessoftheclientshouldbeconsideredbeforeinvitingthemtoengagewithapeer.
PeerMentoringProgramsIfyou’reunawareofanypeersforyourclientstoconnectwithlocally,theseorganizationsofferpeermentoringprograms,regularpeereventsandanextensivedatabasethatmakeiteasiertofindanidealpeermatch:
[FacingDisabilityPeerCounselling]:www.facingdisability.com
[ConnecTra SocietyPeerSupport]:http://www.connectra.org
ProvincialSCIOrganizations:[PeerSupport:SCIBC,CanadianParaplegicAssociationManitoba,SCIOntario,MoelleÉpinièreetMotricitéQuébec,AbilityNewBrunswick,CanadianParaplegicAssociationNovaScotia,SCIPrinceEdwardIsland,SCINewfoundlandandLabrador]
RobexperiencedaC5/C6SCIasaresultofadivingaccidentin2011.Priortohisinjury,Robwasthelocaltennisproandownedhisowntenniscompany.Hetaughtwheelchairtennisbeforehisinjury,buthadneverinstructedsomeonewithquadriplegiaandlimitedhandfunction.Inrehab,RobmetGary,anSCIOntariopeermentorwhohadbeenusingawheelchairforeightyearsandregularlyplayedwheelchairtennis.GaryinvitedRobtoplayagameandshowedRobhowhecouldtapehishandtohisracquet.Today,RobisaworldclasstennisathleteandshareshisknowledgeandexperiencewithotherpeoplewithSCIaroundtheworldwhoareinterestedinplayingthegame.Thisisjustoneexampleofhowasimplepeer-to-peerconnectioncanresultinthesharingofpricelessfirsthandexperienceandperhapsevenbeaturningpointinaclient’sdesiretoliveanactivelifestyle.
Link&ReferPeer-to-PeerConnections
31
Helpingyourclientadoptaphysicallyactivelifestyleoftenrequiresateam,justasrehabilitationforyourclientpost-injuryrequiresateam(e.g.,doctors,occupationaltherapists,respiratorytherapists,etc.).Developingandmaintaininganetworkofpotentialteammembersisagreatfirststep.Yournetworkcanincludeotherhealthcareprovidersandsupportworkers,otherphysiotherapists,andcommunityorganizations.Establishingtheseconnectionscanbeassimpleasreachingoutwithacall,sendinganintroductoryemail,orconnectinginperson.Threekeywaystoengagewithyournetworkareto:
Advocate
Collaborate
Learn
Workwithfacilitiesandprogramstocreateabetterunderstandingoftheneedsofyourclientandotherswithmobilitydisabilities.Forexample,challengerecreationandexercisefacilitiestobecomemoreaccessible,andlobbyforprogramstobecomemoreaffordable.
Workwithotherhealthcareproviders,supportworkers,programs,andyourclient’sfamilytoimprovecareintheclinic,community,andthehome.Forexample,reachouttoyourclient’sfamilyandsupportnetworkandworkcollectivelytohelpachieveyourclient’sgoals,negotiateacoordinatedprocesstomoveclientsfromtheclinictocommunity-basedprograms,andrelayknowledgeofyourclient’sprogress,preferences,andgoalstotheiroccupationaltherapistorpersonalsupportworker,whocanhelpyourclientcontinueandmaintainanactivelifestyleinthecommunityandthehome.
Seekadvicefromcentres, physiotherapists,orotherhealthcareproviders(e.g.recreationtherapists)whohaveexperienceworkingwithpeoplewithSCI.Askifthey’rewillingtosharetheirresources.
ExampleofMemberstoIncludeinYourNetwork
Healthcare&SupportProviders Other Physiotherapists Organizations
Rehabandpersonalsupportworkers
Privateneuroclinics Physiotherapy schools
Kinesiologists,personaltrainers GFStrong CollegeofKinesiologists
Familymembers/caregivers BlussonSpinalCord Centre Recreationcentres
Recreationtherapists TorontoRehab(Lyndhurst) CollegeofPhysiotherapists
Physiatrists Hamilton HealthSciencesSpineUnit
CanadianPhysiotherapyAssociation
Link&ReferOtherProfessionals,SupportsandOrganizations
32
Designexerciseprescriptionstailoredspecificallyforyourclient.
TheInterviewAsktherightquestionstodetermineyourclient’smotivation,goals,andpreferencestolaythefoundationforatailoredandeffectivephysicalactivityprogram.
1
Determinethelevelofactivitythat’srightforyourclient.Theactivitiesbelow,whichhaveincreasinglevelsofcommitmentandorganization,canbeusedasaguidetoorganizeactivityoptionsbasedonyourclient’sreadiness.
3. AdaptedSports:Foryourclientswhoareinterestedincompetitionandarewillingtoseekmoreorganizedformsofactivity.
2. AccessibleActivities:Typicallyrequiregreatercommitmentandorganizationthaneverydayactiveactivities,butmaynotrequirecommitmenttoateamororganization.
1. EverydayActive:Flexible,easy,andagoodstartingpointfornewexercisersorevenclientswhoarealreadyactive,butshortontimetodotheirtypicalworkout.
2 ActivityIdeaLadder
AdaptingCommonExercise
Equipment
Basicsteps,tips,andresourcestohelpyoudesignatailoredphysicalactivityprescriptionforyourclient.
BasicPhysicalActivity
Prescription
Alistofadaptedequipmentandideasformodifyingexistingormainstreamequipment.
Exampleprogramsfortheathlete,recreationalexerciser,andthenon-exerciser.SamplePrograms
3
4
5
TailoredPrescriptionOverviewandChecklist
33
TailoredPrescriptionTheInterview:Worksheet
InitialInterviewSessionName:Date:
1)Currentphysicalactivitylevels/readinessforchange:
2)Goals(howmuchphysicalactivityandwhatarethebenefitsthey’dliketogain):
3)Typesofphysicalactivitytheycurrentlyenjoydoing:
4)Availableresources(e.g.,equipment,gym,recreationcentres nearthem,funding):
5)Barrierstoaccomplishingtheirgoal:
6)Mutuallydiscussshorttermgoalsandstrategies(orseePg.16foralternativegoalsettingandactionplanningformats):
Option1 Option2 Option 3
Activity
When
Where
Howlong
Howoften34
1)Gaugeyourclient’scurrentphysicalactivitylevelsandreadinessfor
change
3)Learnwhatyourclientenjoysdoing
2)Identifyyourclient’sgoals
• Doyoucurrentlyplayasportorhaveahistoryofsportparticipation?
• Haveyoubeenexercisingregularlyduringthepastsixmonths?
• Wouldyouliketobeginexercisingorcontinueexercising?
• Whatsortofgoalsareyouworkingtowardsinyourhomeoryourdailylife?
• Isthereanythingthatyouhavedifficultydoingthatyou’dliketobeabletodobetterorwithgreaterindependence?
• Howmuchphysicalactivitywouldyouliketoseeyourselfdoingaweek?
• Whatsortsofactivitieshaveyoudoneinthepast,beforeandafteryourinjury?
• Whatsortsofactivitieswouldyouliketotryrightnow?
Herearesomesamplequestionstoaskyourclienttohelpyoumoveforwardwithatailoredphysicalactivityplan:
TailoredPrescriptionTheInterview
4)Understandwhatresourcesyourclienthasavailabletothem
6)Developaphysicalactivitygoalasateam
5)Identifyyourclient’sbarriers
• Doyouhaveanyexerciseequipmentathome?
• Isthereagymthatyouknowofthatisaccessibleoristhereagyminyourneighbourhoodthatwecouldinquireabouttheiraccessibility?
• Doyouhaveanyonetohelpyouexerciseorhelpkeepyouontrack?
• Canyouthinkofanythingthatyoucouldforeseegettinginthewayofyourprogram?
• Arethereanyobstaclesthathavecomeupinthepastthathavepreventedyoufrombeingphysicallyactive?
• Whatdoyouthinkisareasonablegoalforhowmuchexerciseyou’lldoinaweek
• Basedonwhatyoutoldme,does__x/weekforabout__minuteseachsessionseemlikeareasonablegoal?
35
Herearethedetailedstepstotailoringyourexerciseprescriptionbygettinganin-depthpictureofyourclient’ssituation(refertotheworksheetandsamplequestionsonPg.34):
1) Gaugeyourclient’scurrentphysicalactivitylevelsandreadinessforchange
Askyourclienthowmuchphysicalactivitytheyarecurrentlydoing(ifany).Understandtheirstageofmotivation(pre-intender,intender,actor)v Actors:Clientswhohavestartedexerciseorhavebeenexercisingforalongtimev Intenders:Clientswhohavenotbeenexercisingbutwouldliketov Pre-Intenders:Clientswhohavenotbeenexercisingandhavenointentiontodoso.Inthiscase,
understandwhythey’renotinterestedinbeingphysicallyactive.Youmayconsiderthefollowingresourcestoaddresspotentialbarrierstowantingtoexercise:
2)Ifyourclientisanactororintender,identifyyourclient’sgoals.
Educateyourclientonthephysicalactivityguidelines(Pg.12)andidentify:1) Howoftenandhowmuchphysicalactivityyourclientwouldliketodoaweek.2) Whatsortofbenefitstheywouldliketoseefrombeingphysicallyactive(e.g.transferring
independently,playingandbeingmoreinvolvedwiththeirkids).Linkinghowexercisecanhelpthemaccomplisheverydaylifegoalsmaybemoremeaningfulforsomeclients.
3)Learnwhatyourclientenjoysdoing
Physicalactivityparticipationismorelikelytobemaintainedwhentheactivityisenjoyable.Trialanderrormaybenecessarytofindtheactivities,sports,andmodalitiesthatappealtoyourclient.
4)Understandwhatresourcesyourclienthasavailabletothem
Askwhatequipment,facilities,andhelptheyhaveavailabletofacilitatetheirexercise.Forexample,whetherthereareappropriategyms,park,tracksnearby,equipmentathome,potentialexercisebuddiesorexerciseassistantsavailabletothem.
5)Identifyyourclient’sbarriers
Identifywhethertheyforeseeanybarrierstoparticipatinginphysicalactivitysuchastransportation,confidence,accesstofacilities,pain,knowledge,etc.
6)Developanactionplanasateam
Takingalltheinformationgathered,decideuponanactionplantogether(Pg.16).Ifappropriate,proceedtodevelopingatailoredexerciseprescription.
TailoredPrescriptionTheInterview
• SafetyPg.8• BenefitsPg.13• FinanceandTransportationPg.27
• LinktoFacilities/Resources:ExamplesPg.29• Peer-to-PeerConnectionsPg.31• ActivityIdeaLadderPg.37
36
SmallStepsApproach:
Thedifferenttypesofactivitiesonthisactivityladderrequireanincreaseincommitmentandorganizationasyouclimbtheladder.Notallstepsoftheladderneedtobetaken.Theladderissimplyaguidetohelporganizeactivitiesbasedonyourclient’sneeds.
EverydayActive
AccessibleActivities
AdaptedSports
Tailoring/AdaptingSampleProgram
1
3
2
Ensureyourclienthasbeenclearedforactivities.Ifyou’reunsure,refertothesafetysection,PAR-Q,ACSMguidelines,orcontactyourclient’sphysician.
TailoredPrescriptionActivityIdeaLadder
37
Walkorwheelto:• school• work• runerrandsto:
o grocerystoreo banko conveniencestoreo postofficeo pharmacy
Resistancebandandrangeofmotionexercises(canbedonewhilewatchingTV,doingcomputerwork,orreading):
• ankleflexion/dorsiflexion• squeezeobjectforgrip• bicepcurls• kneeraises• legextension• hipadduction/abduction• leanforwardandbackwardforcorestrength• leansidetosideforcorestrength(clientswithlowtrunkactivationcansupport
themselvesbyholdingthewheeloppositethedirectionleaning)
Everydayactivities:• standing• calfraisesatthesinkwhiledoingdishes• takingthedogoutforawalkorroll• playingwithyourkids• parkingfurtherawayfromyourdestinationandwalkingorwheelingtherestofthe
way• wheelingorwalkingatthemall,anindoortrack,oranarenaduringbadweather• holdingwalkingorwheelingmeetings
Theseactivitiesaremeanttobeflexible,easy,andagoodstartingpointfornewexercisersorevenexperiencedexerciserswhoareshortontimetodotheirtypicalworkoutroutine.Manyoftheseactivitieshavetheaddedbenefitofbeingabletobedoneathome.
TailoredPrescriptionActivityIdeaLadder:EverydayActive
38
AerobicActivities:• wheelforfunandendurance• cycleusingahandcycleorstationarybike• armergometer(armbike)• swim(withassistanceifneeded)• followalongwithanexercisevideo• playrecreationalsports• standingframeexercises• dance• curling• bocce
StrengtheningActivities:• resistancebands• liftweights(clientswithoutweightscanusecans,bottles,orotherhouseholditems)• usecablepulleys• bodyweightexercises• Yoga,PilatesorTaiChi
LOOKINGFORMORESTRENGTH-TRAININGIDEAS?CheckouttheActiveHomesresourcemanualsandinstructionalvideosontheSCIActionCanadawebsite.[ActiveHomesSCIActionCanada]:www.sciactioncanada.ca
Theseactivitiesaretypicallyhigherinintensityandmaybringgreaterfitnessandhealthbenefitsthaneverydayactiveactivities,butmaynotrequirecommitmenttoateamororganization.
Lookingforsomethingoutsideofthebox?Tryhighintensityintervaltraining.Ifyourclientdoesn’tenjoydoingcontinuousexercise(e.g.,cyclinganarmergometeratmoderateintensityfor20minutes),highintensityintervaltraining(HIIT)maybeanalternative.HIITconsistsofperiodsofhighintensityexercise,interspersedwithperiodsofrestorlowintensity.
WhilemoreSCI-specificresearchisneededtotestthebenefitsofthistypeoftraining,someclientsreportthistypeofactivitycanbeengaging,helpmaintainadherencewhenpainorfatiguearebarrierstoexercise,andbecompletedinashorterperiodoftime.SomeexamplesofHIITprotocolsthathavebeenstudiedinpeoplewithSCIinclude:
• 60secondsofmoderatetovigorousintensity,90secondsactiverest,for8sets• fourminutesatvigorousintensity,threeminutesactiverest,withincreasesinsetsas
appropriate• fourminutesmoderateintensity,oneminutevigorousactivity,withfivesets
Tailorthenumberofsetsandintensitybasedontheindividual’sleveloffitness.
TailoredPrescriptionActivityIdeaLadder:AccessibleActivities
39
Gettingyourclientsinvolvedinsport:Connectthemwithpeersinvolvedinsport,whocancreateenthusiasmandeducate:
• See[Peer-to-PeerConnections]• The[CanadianWheelchairSportsAssociation] canpersonallylinkyourclientto
wheelchairrugbyorothersportprogramsacrossCanada:www.cwsa.ca
Researchwhichlocaladaptedsportsareavailableinyourarea:• See[TipsandTricksforLocatingLocalResources]• [BridgingtheGapCanada’s‘HaveaGoDays’] areanopportunitytotrywheelchairsport
inafunandsupportiveenvironment:www.btgcanada.ca• Trythe[CanadianParalympicCommitteeFindaClub] function:www.paralympic.ca
Fundingforequipment:• [BridgingtheGapCanadaWheelchairLoans] canconnectyourclientwithprovincial
coordinatorswhocanoftensubsidizerentalfeesforsportwheelchairs:www.btgcanada.ca
• [ParaSport OntarioEquipmentRental] canarrangevarioussportequipmentrentals:www.parasportontario.ca
• [MarchofDimesAssistiveDevicesProgram] canhelpprovidefundingforequipment:www.marchofdimes.ca
TypicallyRequireSpecializedEquipment• fencing• powerlifting• Nordicandalpineskiing• waterskiing• cycling• sledgehockey• sailing• rugby(murderball)• horsebackriding• rockclimbing• hiking• canoeing• surfing• kayaking• rowing
CanBeLowCost
• tabletennis• athletics*• swimming• basketball*• boccia• curling• bowling• dance• golf*• boxing• martialarts• softball• tennis*• sittingvolleyball*canrequirespecialtychair
Theseactivitiesareforyourclientwhomightbelookingforcompetitionandiswillingtoseekmoreorganizedformsofactivity.
TailoredPrescriptionActivityIdeaLadder:AdaptedSports
40
Afterconductingtheinterviewanddeterminingphysicalactivitiesthatareinterestingandappropriateforyourclient,aphysicalactivityprescriptioncanbecreated.Aim tohaveyourclientatleastmeettheSCIphysicalactivityguidelines (fitnessbenefits:2x20minutesofmoderatetovigorousphysicalactivity/wk ANDstrengthtraining2x/wk,cardiometabolic healthbenefits:3x30minutesofmoderatetovigorousphysicalactivity/wk).However,noteveryclientwillbereadytomeettheguidelines.Tailor theexercisegoaltoyourclienttoensureit’sattainable.There’snoblanketstrategyfordesigninganexerciseprescription;yourapproachmaybedifferentforeachclient.Seethefollowingresourcesformorehelp:
Foraquickandeasywaytobuildexerciseprogramsonline,see:
Thiswebsiteiscontinuallyupdatedandbasedonthebestavailableevidence.Withmorethan1,000strengthandflexibilityexercises,youcaneasilybuildaprogramappropriateforaclientwithSCI(orotherdisabilities).Youcansearchforexercisesbydifferentcategoriesincludingcondition,exercisetype,bodypart,equipmentavailable,andage.Eachexercisehasanaccompanyingillustration,alongwithinstructions,goalsandprecautions,allwrittenintwoformats—oneappropriatefortheclient,theotherforthephysiotherapist.
Forsampleprogramsandfreeonlinefitnessandnutritiontraining,see:
TheNationalCenteronHealth,PhysicalActivityandDisability(NCHPAD)offersmanyresourcesforpeoplewithphysicaldisabilities,includingvideos,weeklyhighintensitytrainingprograms[NCHPADChampion’sRx],and14weeksoffreeonline,individualizedphysicalactivityandnutritioncoachingsessions[NCHPAD14WeekstoaHealthierYou].
PhysiotherapyExercises.com
Educate:SMARTGoalSetting
Educate:ActionPlanning
Tailoring:SampleProgram
NCHPAD.org
TailoredPrescriptionBasicPhysicalActivityPrescription
41
ExercisePrescription
1. Workwhatworks.Don’tgetboggeddownbyfunctionallimitations.Instead,focusonwhatyourclientcando,andprogressfromthere.
2. Thisisyourwheelhouse,soprescribephysicalactivitytoextendbeyondtypicalrehabexercises.
3. Safetycomesfirst,butdon’tbeafraidtochallengeyourclientifthey’rereadyandwilling.
4. Bemindfulofpreventingoveruseinjuriestotheupperbody(e.g.,shoulder,elbows,andwrists).Damagetojointsandmusclesintheupperbodycanseverelylimitaclient’sindependencewhenitcomestotransferringandwheeling.
5. Yourclientwheelsthroughouttheday,workingthepushmotionregularly.Incorporateposturalexercises(e.g.,scapularretractions)andemphasizepullingmovements.
6. Ifyourclienthasspasticity,focusonantagonistmovements.
7. Circuittraining(i.e.aseriesofresistanceexercisesinterspersedwithbriefaerobicexercise)isaneffectivewaytoincreasefitnessforpeoplewithSCI.
12QuickTips&TricksoftheTrade
Equipment
1. Ifgripassistanceglovesorstrapsareunavailable,usetensorbandagestoprovidegripassistance.
2. Considerwhichexercisesrequiretheuseofgripassistanceandgroupthoseexercisestogethertosavetimeandavoidtakinggripassistanceglovesonandoff.
3. Trytouseasfewtransfersaspossible(e.g.,doallexercisesthatrequiretransferringtoaplinthtogether).
4. Wedgeweightsbetweenthefloorandthewheeltokeepthewheelchairinplace.
5. Useelasticresistancebandsorstrapsaroundthelegstoavoidexcessiveabductionwhileusingequipmentsuchasarecumbentbike,oraroundthechesttostabilizethecore.
6. Withresistancebands,exercisecanbedoneanywhere.Theyareaninexpensive,easilytransportable,andcanbeusedathome,ontheplaneorbus,inthecar,etc.
TailoredPrescriptionBasicPhysicalActivityPrescription
42
Tailoring/AdaptingSampleProgram
Andreabecameparaplegicafterdevelopingtransversemyelitis,aneurologicalconditionthataffectsthespinalcord,attheageof12.Today,she’saworld-classwaterskierandenjoysbeingcompetitivewithherpartner inallaspectsoftheirlives.She’sbeenexercisingforalongtimeandenjoyschallengingherself,butshegetsboredeasilywithherworkoutsandneedsvariety.Andrealivesainacitywithanexcellentadaptedgymfacility.Hergoalsareweightlossandgeneralconditioning.Here’sasampleofAndrea’stypicalworkoutthatshedoesononeofherthreedaysatthegym(sometimesincompetitionwithherpartner):
Client's Name: Date
Duration of Training: 20-Jun
Check
XExercises Instructions Equip. Lbs SxR
Arm Ergometer 30s hard, 30s active rest, repeat 5 times Arm Erg
Int/ Ext Rotation Pulley 10/7.5 lbs 3x10
Single Arm Seated Row Single arm, try to use core to stabilize, otherwise stabilize with opposite hand on wheel Pulley 10lbs 3x10
Med Ball Figure 8's Med Ball 6lbs 3x10
Vita Glide 5 minutes continuous Arm Erg
Lat Pull Down Pulley 70lbs 3x10
Cross Body Pull Pulley 12.5 lbs 3x10
Med Ball Overhead Rotations Med Ball 8lbs 3x10
Arm Ergometer 20 s hard, 10 s active rest, repeat 8 times Arm Erg
Shoulder Abduction Free Weight 5lbs 3x10
Knee Raise and Leg Extension MAKE SURE SHE DOES THEM! :) Ankle Weights 3lbs 3x10
Ab Crunch Pulley 37.5 lbs 3x10
KINGSTON REVVED UP - WORK-OUT TRAININGSt. Mary's of the Lake Hosptial and Queen's Kinesiology Building
WARM-UP: Aerobic- NuStep- 5-10 min
Day 1
COOL-DOWN: Cardio- Wheelchair treadmill or arm ergometer, her choice
Special InstructionsShaded exercises are to be done in circuit
Andrea1 hour
TailoredPrescriptionSampleProgram:Athlete
43
MarneyhasaT5completespinalcordinjury.Sheenjoysspendingtimewithherdog,Dude,woodworking,andsocializing.Hergoalistokeepmovingandmaintainherindependencesothatshecandotheactivitiesthatsheenjoys.Marney likestogotothegym,butpreferstohavevarietyinheractivities.Here’sasampleofMarney’stypicalactivityschedulefortheweek:
Tailoring/AdaptingSampleProgram
TailoredPrescriptionSampleProgram:RecreationalExerciser
Sun Mon Tues Wed Thurs Fri Sat
Activity Walk thedog
Resistancetraining
Skillstrainingwith herdog
Spinclass
Where Trail Gym Park Gym
When 9am 2pm 2pm 10am
Howlong 30min. 30min. 20min. 30min.
Intensity Mild Moderate Mild Moderateto
Vigorous
44
Tailoring/AdaptingSampleProgram
Anyonewhodoesn’ttakepartinanyphysicalactivitymayhaveanumberofbarrierspreventingthemfromexercising.Ifclientsarewillingtoworkwithyoutoidentifyandaddressthesebarriers,youcanstructureaprogramthatcanaccommodatetheirsituation.Forexample,clientsmaytellyouthatthey’dliketoexercisebutfinditdifficulttofindtransportationandgetoutofthehomewithoutassistance.Ortheymaynothavemuchexerciseexperienceandlacktheabilitytoexerciseforanythinglongerthanafewminutes.Here’sasampleprogramthatcanhelpbegintoremovethesebarriersbyprescribingeasy-to-startexercisesthatcanbedoneathome.
IfwatchingTV,dothreesetsof:• 10bicepcurlswitharesistanceband• 10kneeraises• 10bodyweightliftsoffthechair
EverySaturdaymorning,putonanexercisevideoandfollowalong.Startbydoing10minutesofthevideo,andthenaddingacoupleminuteseachtime.
Progresswillbereviewedduringthenextvisit.
Signature:_______________________
ExercisePrescription
ClientName:_________NextVisit:____________
TailoredPrescriptionSampleProgram:Non-Exerciser
45
Iftraditionalexerciseequipmentisnotsuitableoravailable,herearesomealternatives:
Tailoring/AdaptingSampleProgram
Weights• cans• large/smallbottles(addliquidformoreweight)• bodyweight• resistancebands[e.g.www.treadmillfactory.ca 14piecepowerpack]
StretchingAids• resistanceband• towel• wall• cane
CommonAdaptedExerciseEquipment• gripaids• tensors(fortensoringhandforgripassistance)• wristweights• wheelchairpushgloves• medicineballs(ifithashandles,canutilizetensorsforgripassistance)• pulleys/cables(cantensorinhandoruseagripaid)• freeweights(utilizetensorforgripassistance)
SpecialtyEquipment• boxinggloves• armergometer(armbike)• VitaGlide• NuStep• rickshaw• wheelchairtreadmill• functionalelectricalstimulation(FES)• motorizedrecumbentbike• seatedelliptical• bodyweightsupportedtreadmill• bodyweightsupportedtreadmill• Lite-gait• passiverangeofmotionequipment(e.g.Motomed)
TailoredPrescriptionAdaptingCommonExerciseEquipment
46
ReprintedwithpermissionfromthePAR-Q+Collaboration(www.eparmedx.com)andtheauthorsofthePAR-Q+(Dr.DarrenWarburton,Dr.NormanGledhill,Dr.VeronicaJamnik,Dr.RoyShephard,andDr.ShannonBredin) 47
1. Do you have Arthritis, Osteoporosis, or Back Problems?
1a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments)
1b. Do you have joint problems causing pain, a recent fracture or fracture caused by osteoporosis or cancer, displaced vertebra (e.g., spondylolisthesis), and/or spondylolysis/pars defect (a crack in the bony ring on the back of the spinal column)?
1c. Have you had steroid injections or taken steroid tablets regularly for more than 3 months?
If the above condition(s) is/are present, answer questions 1a-1c If NO go to question 2
2. Do you have Cancer of any kind?If the above condition(s) is/are present, answer questions 2a-2b
3. Do you have a Heart or Cardiovascular Condition? This includes Coronary Artery Disease, Heart Failure, Diagnosed Abnormality of Heart Rhythm
If the above condition(s) is/are present, answer questions 3a-3d
If the above condition(s) is/are present, answer questions 5a-5e5. Do you have any Metabolic Conditions? This includes Type 1 Diabetes, Type 2 Diabetes, Pre-Diabetes
If NO go to question 3
If NO go to question 4
If NO go to question 6
4. Do you have High Blood Pressure? If the above condition(s) is/are present, answer questions 4a-4b
4a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments)
4b. Do you have a resting blood pressure equal to or greater than 160/90 mmHg with or without medication? (Answer YES if you do not know your resting blood pressure)
If NO go to question 5
2a. Does your cancer diagnosis include any of the following types: lung/bronchogenic, multiple myeloma (cancer of plasma cells), head, and neck?
2b. Are you currently receiving cancer therapy (such as chemotheraphy or radiotherapy)?
3a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments)
3b. Do you have an irregular heart beat that requires medical management? (e.g., atrial fibrillation, premature ventricular contraction)
3c. Do you have chronic heart failure?
3d. Do you have diagnosed coronary artery (cardiovascular) disease and have not participated in regular physical activity in the last 2 months?
5a. Do you often have difficulty controlling your blood sugar levels with foods, medications, or other physician- prescribed therapies?
5b. Do you often suffer from signs and symptoms of low blood sugar (hypoglycemia) following exercise and/or during activities of daily living? Signs of hypoglycemia may include shakiness, nervousness, unusual irritability, abnormal sweating, dizziness or light-headedness, mental confusion, difficulty speaking, weakness, or sleepiness.
5c. Do you have any signs or symptoms of diabetes complications such as heart or vascular disease and/or complications affecting your eyes, kidneys, OR the sensation in your toes and feet?
5d. Do you have other metabolic conditions (such as current pregnancy-related diabetes, chronic kidney disease, or liver problems)?
5e. Are you planning to engage in what for you is unusually high (or vigorous) intensity exercise in the near future?
2015 PAR-Q+YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
FOLLOW-UP QUESTIONS ABOUT YOUR MEDICAL CONDITION(S)
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
Copyright © 2015 PAR-Q+ Collaboration 2 / 401-01-2015
ReprintedwithpermissionfromthePAR-Q+Collaboration(www.eparmedx.com)andtheauthorsofthePAR-Q+(Dr.DarrenWarburton,Dr.NormanGledhill,Dr.VeronicaJamnik,Dr.RoyShephard,andDr.ShannonBredin) 48
If the above condition(s) is/are present, answer questions 7a-7d
If the above condition(s) is/are present, answer questions 8a-8c
If the above condition(s) is/are present, answer questions 9a-9c
If you have other medical conditions, answer questions 10a-10c
If NO go to question 8
If NO go to question 9
If NO go to question 10
If NO read the Page 4 recommendations
2015 PAR-Q+
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
Copyright © 2015 PAR-Q+ Collaboration 3 / 4
GO to Page 4 for recommendations about your current medical condition(s) and sign the PARTICIPANT DECLARATION.
7. Do you have a Respiratory Disease? This includes Chronic Obstructive Pulmonary Disease, Asthma, Pulmonary High Blood Pressure
7a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments)
7b. Has your doctor ever said your blood oxygen level is low at rest or during exercise and/or that you require supplemental oxygen therapy?
7c. If asthmatic, do you currently have symptoms of chest tightness, wheezing, laboured breathing, consistent cough (more than 2 days/week), or have you used your rescue medication more than twice in the last week?
7d. Has your doctor ever said you have high blood pressure in the blood vessels of your lungs?
8. Do you have a Spinal Cord Injury? This includes Tetraplegia and Paraplegia
8a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments)
8b. Do you commonly exhibit low resting blood pressure significant enough to cause dizziness, light-headedness, and/or fainting?
8c. Has your physician indicated that you exhibit sudden bouts of high blood pressure (known as Autonomic Dysreflexia)?
9. Have you had a Stroke? This includes Transient Ischemic Attack (TIA) or Cerebrovascular Event
9a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments)
9b. Do you have any impairment in walking or mobility?
9c. Have you experienced a stroke or impairment in nerves or muscles in the past 6 months?
10. Do you have any other medical condition not listed above or do you have two or more medical conditions?
10a. Have you experienced a blackout, fainted, or lost consciousness as a result of a head injury within the last 12 months OR have you had a diagnosed concussion within the last 12 months?
10b. Do you have a medical condition that is not listed (such as epilepsy, neurological conditions, kidney problems)?
10c. Do you currently live with two or more medical conditions? PLEASE LIST YOUR MEDICAL CONDITION(S) AND ANY RELATED MEDICATIONS HERE:
01-01-2015
6. Do you have any Mental Health Problems or Learning Difficulties? This includes Alzheimer’s, Dementia, Depression, Anxiety Disorder, Eating Disorder, Psychotic Disorder, Intellectual Disability, Down Syndrome
If the above condition(s) is/are present, answer questions 6a-6b If NO go to question 7
6a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments)
6b. Do you ALSO have back problems affecting nerves or muscles?
YES NO
YES NO
49
ReprintedwithpermissionfromthePAR-Q+Collaboration(www.eparmedx.com)andtheauthorsofthePAR-Q+(Dr.DarrenWarburton,Dr.NormanGledhill,Dr.VeronicaJamnik,Dr.RoyShephard,andDr.ShannonBredin) 50
Tailoring/AdaptingSampleProgramReferences
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followingspinalcordinjury.ArchivesofPhysicalMedicineandRehabilitation,90(4),682–695.http://doi.org/10.1016/j.apmr.2008.10.017.ALatimer-Cheung,A.E.,Arbour-Nicitopoulos,K.P.,Brawley,L.R.,Gray,C.,JustineWilson,A.,Prapavessis,H.,…MartinGinis,K.A.(2013).Developingphysicalactivityinterventionsforadultswithspinalcordinjury.Part2:Motivationalcounselingandpeer-mediatedinterventionsforpeopleintendingtobeactive.RehabilitationPsychology,58(3),307–15.http://doi.org/10.1037/a0032816Latimer,A.E.,MartinGinis,K.A.,&Arbour,K.P.(2006).Theefficacyofanimplementationintentioninterventionforpromotingphysicalactivityamongindividualswithspinalcordinjury:Arandomizedcontrolledtrial.RehabilitationPsychology,51(4),273–280.http://doi.org/10.1037/0090-5550.51.4.273Letts,L.,MartinGinis,K.A.,Faulkner,G.,Colquhoun,H.,Levac,D.,&Gorczynski,P.(2011).Preferredmethodsandmessengersfordeliveringphysicalactivityinformationtopeoplewithspinalcordinjury:afocusgroupstudy.RehabilitationPsychology,56(2),128–137.http://doi.org/10.1037/a0023624Ma,J.K.,&MartinGinis,K.A.(2018).Ameta-analysisofphysicalactivityinterventionsinpeoplewithphysicaldisabilities:Content,characteristics,andeffectsonbehaviour.PsychologyofSport&Exercise.http://doi.org/10.1016/j.psychsport.2018.01.006MartinGinis,K.A.,Arbour-Nicitopoulos,K.P.,Latimer,A.E.,Buchholz,A.C.,Bray,S.R.,Craven,B.C.,…Wolfe,D.L.(2010).Leisuretimephysicalactivityinapopulation-basedsampleofpeoplewithspinalcordinjurypartII:Activitytypes,intensities,anddurations.ArchivesofPhysicalMedicineandRehabilitation,91(5),729–733.http://doi.org/10.1016/j.apmr.2009.12.028MartinGinis,K.A.,Hicks,A.L.,Latimer,A.E.,Warburton,D.E.R.,Bourne,C.,Ditor,D.S.,…Wolfe,D.L.(2011).Thedevelopmentofevidence-informedphysicalactivityguidelinesforadultswithspinalcordinjury.SpinalCord,49(11),1088–1096.http://doi.org/10.1038/sc.2011.63MartinGinis,K.A.,Ma,J.K.,Latimer-Cheung,A.E.,&Rimmer,J.(2016).Asystematicreviewofreviewarticlesaddressingfactorsrelatedtophysicalactivityparticipationamongchildrenandadultswithphysicaldisabilities.HealthPsychologyReview,7199(June),1–31.http://doi.org/10.1080/17437199.2016.1198240MartinGinis,K.A.,Phang,S.H.,Latimer,A.E.,&Arbour-Nicitopoulos,K.P.(2012).Reliabilityandvaliditytestsoftheleisuretimephysicalactivityquestionnaireforpeoplewithspinalcordinjury.ArchivesofPhysicalMedicineandRehabilitation,93(4),677–682.http://doi.org/10.1016/j.apmr.2011.11.005MartinGinis,K.A.,Tomasone,J.R.,Latimer-Cheung,A.E.,Arbour-Nicitopoulos,K.P.,Bassett-Gunter,R.L.,&Wolfe,D.L.(2013).Developingphysicalactivityinterventionsforadultswithspinalcordinjury.Part1:acomparisonofsocialcognitionsacrossactors,intenders,andnonintenders.RehabilitationPsychology,58(3),299–306.http://doi.org/10.1037/a0032815MartinGinis,K.A.,vanderScheer,J.W.,Latimer-Cheung,A.E.,Barrow,A.,Bourne,C.,Carruthers,P.,...&Hayes,K.C.(2018).Evidence-basedscientificexerciseguidelinesforadultswithspinalcordinjury:anupdateandanewguideline. Spinalcord, 56(4),308.Michie,S.,Abraham,C.,Whittington,C.,McAteer,J.,&Gupta,S.(2009).Effectivetechniquesinhealthyeatingandphysicalactivityinterventions:Ameta-regression.HealthPsychology,28(6),690–701.http://doi.org/10.1037/a0016136
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