"If you always put limits on everything you do, physical or anything else, it will spread into your work and into your life. There are no limits. There are only plateaus, and you must not stay there, you must go beyond them." - Bruce Lee

As important as it is for health and fitness professionals to know what limitations an individual may have in terms of creating appropriate activities, especially for safety and medical considerations, it's also important to consider what that individual CAN do, and what they can do in context with their environment. The social model of disability has taught us that systemic barriers, negative attitudes and exclusion by society (whether purposely or not) are the main contributing factors in disabling people, not the disability itself.

The International Classification of Functioning, Disability, and Health, or ICF, is a comprehensive framework used by the World Health Organization (WHO) for describing and measuring health and disability at both the individual and population levels. This framework is used to assess the relationship among an individual's function, activities, and participation while also considering these in the context of the environmental and personal factors that influence an individual's overall health. 

The ICF puts the idea of 'health' and 'disability' in a new light and recognizes that any person can experience peaks and valleys in health, and therefore any person is prone to experiencing some kind of disability. It shifts the focus from what caused a disability to the impact that it has on the person. In addition, ICF considers the social aspects of disability and does not see disability as a medical condition. By including these contextual factors, the ICF helps us to assess the impact of the environment on the person's functioning, and therefore possibly assess potential "limitations" a bit differently.

The health domain and health-related domain contained in the ICF are described fromt he perspective of the body, the individual, and society in two basic categories: (1) Body Functions and Structures (system level); and (2) Activities and Participation (person level and person-environment interaction). The ICF can be used as a tool in exercise physiology to conduct a needs assessment or as an outcome evaluation. It allows the fitness professional to identify the barriers and facilitators that affect the health of the client with the disability and then find or create modifications for the specific individual in order to facilitate participation in an activity. The ICF emphasizes function, NOT the health condition, and categorizes the situation, NOT the person. Here is an example.

Do you see the ICF as having application in your field?

Reference: http://www.who.int/classifications/icf/en

One of the objectives for Healthy People 2020 isReduce the proportion of adults who engage in no leisure-time physical activity to “increase the proportion of people with disabilities who report having access to health and wellness programs”. According to the U.S. Department of Labor, more than 20 million families in the U.S. have at least 1 member with a disability, and in one out of every 5 households in the U.S., a family is caring for a child that has unique health care needs.  Barriers to physical activity in people with disabilities within the United States and many other countries throughout the developing world have contributed to significant public health problems confronting our society today. Some benefits of physical activity include increased cardiac and pulmonary function, improved ability to perform activities of daily living, protection against development of chronic diseases, decreased anxiety and depression, enhanced feeling of well-being, weight control, lowered cholesterol and blood pressure. 

There is a strong call to action for public health officials to implement evidence-based physical activity interventions that are inclusive of people of all abilities.  Due to the many barriers individuals with disabilities face in their physical activity efforts, it is important for us to come up with creative delivery methods for these interventions and opportunities for being physically active.  With the popularity of social networking sites, viral video, and other technology, one way that the National Center on Physical Activity and Disability is attempting to address this is through a video contest entitled, “How do you get enough?”

Being physically active is good for everybody. This is especially true for people with disabilities who tend to participate in less physical activity, carry excess weight and have higher rates of chronic heart disease and other health conditions.  The intention of this video contest is to illustrate to society that people with disabilities do live healthy active lifestyles as well as share various ways to get physical activity for individuals with disabilities and activity limitations. This video contest will be promoted through social networking sites such as Facebook and Twitter, and video sharing sites such as Youtube.

With two billion views on YouTube per day, this largely untapped market place of adults with disabilities and parents of children with disabilities can make a huge impact by showing the world how people with disabilities get their physical activity. Also, with the increase of cameras and cell phones with video capabilities, many people without expensive camera equipment and editing expertise are able to create these hugely popular videos without much effort. Whether it’s indoor or outdoor, recreational or competitive, solo or team, easy or intensive, we (and the rest of the world) are looking how people with a wide variety of abilities (whether successfully or unsuccessfully) get enough activity in a 1-10 minute video clip!  For more information, please see the contest rules at http://www.ncpad.org/newsletter/newsletter.php?letter=123&section=1593.  For a sample video please visit http://www.youtube.com/watch?v=9AGgD9rFdsA.

How are you using the Healthy People 2020 objectives to increase physical activity?  How do you work with clients and your community to encourage persons with disabilities go get enough activity?

Social determinants of health are social factors which can contribute to our health.  We may not always take into consideration that factors such as income, social support, stress, social exclusion, neighborhood environments and education can have a profound impact on health.  Additionally, one social determinant can actually lead to another and in many cases often does. For example, if you are unemployed, you are more likely to live in poor conditions and lack transportation. In this situation a person may not have the resources to go to a doctor for a medical issue, purchase healthy food, or engage in physical activity.  For more information on social determinants of health,                    visit the CDC Web site.

 Research has shown that healthcare alone cannot counteract the effects of these factors on health.  Interventions and programming, both on the local and more global level, are needed that target these social factors.  These interventions must be inclusive of all populations, including people with disabilities whose health can often have an even greater likelihood of being affected by these determinants.

Creating or adapting your interventions and programs in order to make them more inclusive of everyone is a process, and possibly an intimidating one.   However, simply having the right attitude is a huge step in the right direction.  If you are willing and open to creating modifications to accommodate even one person so he or she can benefit from your program, then you are on your way to being more inclusive.  Here are some suggestions:

• Worksite health promotion programs must be inclusive and consider appropriate modifications for current (or future) employees with disabilities.  Maybe you don’t have any employees with disabilities now, but one day you may.   Plus, your current employees are aging, increasing the likelihood of age-related activity limitations.  Encouraging healthy behaviors now for people of all abilities can possibly help avoid or delay these limitations or secondary conditions AND improve worker productivity and/or attendance.
• By including the caregiver or other support provider within a program, you can help not only with the success of the individual with a disability but also increase your success rate twofold!
• It may be the case that someone can’t get to your facility to participate in a program, whether its because of transportation or another issue.   When this occurs, try to find ways to make your program, or even pieces of it, accessible from a remote location, whether online or through another method.
• Maybe you don’t have any idea of how to get started, nor do you feel you have the time or resources to make the necessary changes up front in order to make your program more inclusive.  You have to start somewhere, right?  So, start by making sure your marketing materials and targeted audiences are diverse and that you make it known that anyone is invited to participate.  You can then make the changes individually as those people sign up.  Ask the individual what type of accommodations he or she may need in order to benefit from your program, and go from there.
• Any other suggestions???  Please share!