Blog post written by: Donna B Bainbridge, PT, EdD, ATC; James Michael Gleason, PT, MS; and Victoria S T Tilley, PT, GCS

People with intellectual disability are at risk for poorer health and earlier death than the general population. People with intellectual disability may have more difficulty understanding advertisements and media messages intended to enhance or promote health, and they often depend on family or caregivers to provide support and guidance in daily decision making. Many people with intellectual disability are underemployed or unemployed with limited financial resources, especially discretionary income to allow them to participate in recreational and physical activity programs. Many coaches and volunteers who work with sports teams in local communities may be reluctant to include children, youth, and adults with disabilities, or do not have the knowledge to teach sports-related skills to those who have difficulty learning or need extra time to learn or practice basic skills. As a result, people with intellectual disability may not have access to the many programs available to the nondisabled population that are extremely important to staying active and avoiding many chronic health conditions such as cardiovascular disease, diabetes, overweight, and other health problems. 

In response to these needs, physical therapists (PTs) have become important contributors to the Special Olympics Healthy Athletes screening and other healthy lifestyle initiatives. In 2000, a fitness screening protocol called FUNFitness was developed by the American Physical Therapy Association (APTA) in collaboration with Special Olympics to evaluate flexibility, strength, balance, and aerobic fitness in Special Olympics athletes. FUNfitness volunteers have screened over 160,000 Special Olympics athletes, collected data on physical performance, and provided individual instruction and referrals to physicians and to physical therapists as needed as a result of these screenings. The screening tests reveal that most Special Olympics athletes with intellectual disabilities have limitations in flexibility and poor balance skills. Much also needs to be done to improve their athletic skills, promote better daily function and health, prevent falls, and enlist more health care providers to provide needed services. Special Olympics has trained thousands of PTs and PT students to conduct the screenings and provide meaningful information and advice to athletes. FUNfitness has developed close collaborative ties with APTA in the United States and has developed a network through the World Confederation for Physical Therapy to expand these discussions and efforts globally .

These screening efforts have become a routine part of Special Olympics activities in many states and in countries around the globe. In addition, FUNfitness has developed a range of fitness materials and protocols for Special Olympics coaches to use for promotion of fitness with their athletes. Currently, FUNfitness and Special Olympics programs are developing and pilot testing a variety of community-based year-round fitness programs for athletes, such as the Special Olympics Get Fit for Sport designed for the Presidential Active Lifestyle Award, or PALA+. These resources will be posted on the Get Fit for Sport Special Olympics webpage so that Special Olympics programs, families, and physical therapists can use them to encourage individual and group fitness activities.

People with intellectual disabilities need access to knowledgeable health and fitness resources and to practitioners who can provide information and programs that are barrier free, can be easily understood, and encourage participation in physical activity and fitness. PTs are ideally suited to help make this happen. We challenge PTs to become more involved in their communities and to include people with intellectual disability who are frequently underserved by health promotion efforts. 

What is your experience with working with people with intellectual disability? How can we promote improved fitness and physical activity for this population?

On January 24, 2013, the Office for Civil Rights (OCR) issued a Dear Colleague Letter clarifying school's obligations under the Rehabilitation Act of 1973 to provide extracurricular athletic opportunities for students with disabilites. The guidance creates a clear roadmap for how schools can integrate students with disabilities into mainstream athletic programs and create adapted programs for students with disabilities.

"OCR's guidance is a landmark moment for individuals with disabilities, as it sends a loud message to educational institutions that students with disabilities must be provided opportunities for physical activity and sports equal to those afforded to students without disabilities," said Terri Lakowski, policy chair of the Inclusive Fitness Coalition (IFC) and nationally recognized sports policy advocate.

You may have seen this announcement in the media or through your organization, but what does it all mean and how will this impact extracurricular athletics?

The road towards victory for student athletes with disabilities was relentless. The letter released by the OCR came after ten years of advocacy to level the playing field in school-based athletic programs. The release of the Dear Colleague letter is merely further guidance on what should already be happening for students with disabilities, based on section 504 of the Rehabilitation Act of 1973. The purpose is to clarify school's responsibilities under the law; it does not provide any additional legislation. Similar to Title IX, which paved the way for women to have equal opportunities in sports, the updated guidance will hopefully provide a similar effect for student athletes with disabilities.

Above: Wheelchair athelete Tatyana McFadden, front, races in her first high school track meet alongside able-bodied runners, April 2006 in Rockville, MD. Photo courtesy of (Chris Gardner/AP)

Why are these guidelines important? The benefits of providing ALL students with opportunities for exercise and sports participation goes beyond justice and individual opportunity. There is a major epidemic of obesity among our youth and even more so among youth with disabilities.

"Inclusion in athletics is how children learn from each other, build social skills and optimize their growth and development. The OCR guidance is a clear indication that athletics is an extremely important part of our educational system and that youth and young adults with disabilities must be afforded the same opportunities as their non-disabled peers," said James Rimmer, Ph.D., who co-chairs the IFC and directs the National Center on Health, Physical Activity and Disability. "This should be part of a national strategy to lower obesity rates, which are disproportionately higher among youth with disabilities compared to their non-disabled peers." By providing equal access in extracurricular activities for students with disabilities, maybe we can begin to break down the common barriers to physical activity, and create a new culture of inclusion in our schools and communities.

To ensure equal opportunity does not mean a fundamental alteration to the program, but simply providing a reasonable modification to allow the student athletes with a disability to participate alongside their peers. The Dear Colleague Letter document outlines what constitutes a reasonable modification. One example is to provide a visual cue at the start of high school track races, simultaneously wtih the starter pistol sound, to be inclusive of students with hearing impairments. Another example of a reasonable modification is to allow an individual born with only one hand to be allowed to finish a swim race with a "onehand touch" as opposed to the "two-hand touch" finish rule for certain strokes. As you can see, inclusion can be a reality in all aspects of physical activity. The message is simple: Prevent Obesity, Be Inclusive.

The IFC, led by the Lakeshore Foundation in partnership with the American College of Sports Medicine, comprises over 200 organizations representing a cross-section of disability rights, sports, health/fitness, and civil rights communities. Recognizing the barriers that continue to limit opportunities for physical activity for individuals with disabilities in the school setting, the IFC works to expand opportunities for physical activity, exercise and athletics for individuals with disabilities. For more information, please visit www.incfit.org and www.lakeshore.org.

The True Meaning of Sedentary

The start of a new year sparks considerable conversation on losing weight, exercising more, and eating a healthier diet. While these are great stepping stones to leading a healthier lifestyle, they may not be enough to ward off chronic health conditions and mortality. Recent research findings are revealing that sitting too much during the day can be detrimental to an individual's health regardless of whether or not they meet the Physical Activity Guidelines for Americans. Today's society is consumed with advanced technology and a focus on convenience, which ultimately contributes to sedentary lifestyles among Americans. Fortunately, this sedentary lifestyle can be counteracted by adding in more movement throughout the day.

Health of People with Disabilities

There are approximately 54 million Americans with some type of disability. This amounts to about 20% of the population. Many consider health and disability and oxymoron, but in fact, persons with disabilities can lead healthy, active lifestyles when given the appropriate inclusive environment to succeed. The rate of obesity is far greater for both children and adults with disabilities than for the general population. 56% of people with disabilities do not engage in any leisure time physical activity, and 87% of people with disabilities experience at least one secondary condition. Self-reported health status is classified as poor in 37% of persons with disabilities compared to 8% in persons without disabilities. Physical inactivity and sedentary behavior is a national epidemic, but noticed more particularly in persons with disabilities due to few health professionals promoting regular physical activity for persons with disabilities, and a lack of community and health promotion programs inclusive of persons with disabilities. In order to develop a healthy, inclusive community, health messaging must include persons with disabilities. Below are strategies for creating an action plan to combat sedentary behavior and physical inactivity for everyone by adding movement in to the daily routine.

An Action Plan for Everyone

Simple adjustments to the daily routine can help make activity a default versus just an option. Get going and move more for an overall better health status.

In the workplace

1. If you are able to, try actively communiting to work by riding a bike or walking/wheeling. Inclusive communities that utilize Complete Streets are a win-win for everyone!
   
2. Make sure to always have a bottle of water at your desk. This will put you one step closer to achieving your recommended daily amount of water intake and will force you to have to get up to go to the bathroom.
3. Try walking/wheeling meetings instead of seated ones. The activity might just spark some new found creativity!
4. Utilize your lunch break for physical activity. Cut your lunch break in half so the other half can be filled with some kind of exercise. Midday activity helps you to wake up your brain, and may help to avoid that 2:00 p.m. burnout. Physical activity options include starting a walking club with coworkers or going to your local gym for a midday group fitness class.
5. Pace around your office while on a conference call.
6. Instead of emailing a co-worker, get up from your desk and converse in person.

In daily life

1. A pedometer is a great tool to monitor physical activity throughout the day. Achieving 10,000 steps may not be appropriate for everyone, so wear your pedometer to track movement on day one to achieve a baseline, and aim to increase that baseline each day.
2. Pets are great life companions and assets to your health. Take Fido for a walk daily to fit in some extra activity.
3. There is no shame in having a favorite television show, but try moving around the house or cleaning up while watching. You can also do simple exercises during commercial breaks, such as crunches, squats, or push-ups.
4. Almost any chore can be turned into a heart-pumping activity. Turn on some upbeat music and get working.
5. Take advantage of family time together on the weekends, and find a park to play in, a fun race to enter, or simply take a stroll or bike ride around the neighborhood together.

The Big Picture

Aside from the Physical Activity Guidelines for Americans recommended amount of physical activity per week, it is imperative that individuals simply move more throughout the day to reduce sedentary behavior and its associated health detriments. The Physical Activity Pyramid is a great way to start assessing daily movement levels in all individuals. Looking at physical activity in these categories makes it seem more attainable and included as a factor in every person's life. Now take a stand for a better health by moving more and getting active!