"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

Research published in the British scientific journal Age and Ageing found that older adults are highly knowledgeable about the health benefits of physical activity, yet many remain inactive due to the many barriers to participation. This article examines these barriers and suggests ways in which you and your organization can reduce or eliminate their impact on the physical activity levels of older adults.

1. Lack of interest (by far the #1 factor)

Prior to starting a program, have your older customer examine all their options. Would they prefer taking a class or going solo? Are they a morning or night person? Does indoor fitness appeal to them, or would they prefer to play outside? Could they dedicate large blocks of time to physical activity or could they fit only shorter, more frequent intervals into their schedule? What are their real world goals?

Young or old, people tend to enjoy things that interest them, that help them reach a goal or that is fun and social. By simply asking what they like to do you can break this barrier down one program at a time.

2. Shortness of breath

Shortness of breath can be due to a variety of health issues. It can also be that they are simply out of shape. Meet with their  healthcare provider to see whether you'll need to consider any special modifications before starting an exercise program. If necessary, get clearance to begin a program. Educate members that there are ways to address issues to improve their quality of life.

3. Joint pain

According to the Arthritis Foundation, regular, moderate exercise offers a whole host of benefits to people with arthritis. By exercising, your member can reduce joint pain and stiffness, build strong muscle around the joints, and increase flexibility and endurance.

4. Perceived lack of fitness

Education is the key here. Ensure that your members know they can start slowly, i.e. with 5-10-minute walks in the morning, at lunchtime and after dinner. With their resistance training, start them with only a couple of exercises and build up. DO NOT OVERWORK them or you will never see them again. Set long-term goals and show them how they will build their fitness level or workout over time.

5. Lack of energy

In many cases, this barrier is reversible and can be due to a low fitness level. It could also be from the interaction of multiple prescription drugs. The first step to a solution is to establish why they are lacking energy, then explain how being active will actually give them more energy. For many it can even reduce the number of expensive drugs they take.

6. Doubting that exercise can lengthen life

Ask your older customers about their quality of life. Are they able to do the things they want to do? Explain how exercise can improve their quality of life, no matter how long they live. What exercise will offer them is the ability to age on their own terms.

How are you reducing barriers that limit participation levels among your older customers?

Do you think it’s easy for adults to meet the Physical Activity Guidelines for Americans? Even though we’re in a profession dedicated to promoting health and well-being, do you often struggle to personally meet the Guidelines? I know I do. As professionals dedicated to helping others increase their physical activity, I think it’s important for us to acknowledge the challenges we might face ourselves and share those things that have worked for us in hopes of inspiring others to meet the Guidelines.

Here are some of the things that have worked for me: There are hand weights and elastic bands next to my desk at work. There’s a pair of walking shoes ready to go by the door. I have a few exercise posters just inside my top desk drawer. These few changes to my environment have helped me come closer to meeting the Guidelines. I often pick up the weights or bands and do a series of exercises while on conference calls, in between checking emails, or before starting an administrative task. The walking shoes often come on when I see that I have 10 to 15 minutes before my next appointment. A quick walk or a few flights of stairs gets my heart pumping, and also allows me to focus on the next meeting. I do all these things in my street clothes, no need for changing or showering.

My office does some interesting health promotions, all with the intent of getting staff more active. By taking part, I’ve done a lot of things I wouldn’t have normally tried such as: taking a yoga class, assisting in a volunteer project helping an elderly neighbor (shoveling snow off a roof), participating in a corporate triathlon relay, and recording my monthly steps. This variety of activities really helps me meet the Guidelines. The variety is actually kind of fun. My company’s not trying to get all of us into yoga, or running, or counting our steps…they’re just trying to get us active in something, this week and next week, and the week after. 

Supportive friends and relationships also help me meet the Guidelines. Instead of getting grief or mockery from co-workers who may see me doing arm curls, or see some perspiration (sometime even sweat) on my face, I get compliments about doing something healthy. When I ask for others to join me on the quick walk around the block, I actually get a few who say “yes.” When I ask for help in meeting one of the company’s health activities, my co-workers understand the importance, and lend support. 

I believe changes to your environment, choosing a variety of activities, and getting support from friends and colleagues is integral in helping most of us and our clients meet the Guidelines. So even though I sometimes struggle meeting the Guidelines, I’m finding ways to help me be active.

What environmental changes have you recommended to others to help them reach greater levels of physical activity? 

What variety of activities have you incorporated to promote more activity? 

How have you created or cultivated supportive friends and relationships for your clients?