Physical activity participation among older adults with diabetes: Applying the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) Guidelines

To describe leisure participation in adolescents with congenital heart defects (CHD) and identify factors associated with intensity of participation. Eighty adolescents with CHD were recruited (39 males, 41 females; mean age [SD] 15y 8mo [1y 8mo] range 11y 5mo-19y 11mo) of whom 78 completed the Children's Assessment of Participation and Enjoyment (CAPE) outcome measure of leisure participation. The measure has five subscales: recreational, active-physical, social, skill-based, and self-improvement. Associations between the CAPE and age, sex, and development were examined. Motor ability (Movement Assessment Battery for Children, Second Edition), cognition (Leiter International Performance Scale-Revised), behavior (Strengths and Difficulties Questionnaire), and motivation (Dimensions of Mastery Questionnaire) were assessed. Participants exhibited impaired motor (43.5%), behavioral (23.7%), and cognitive (29.9%) development. The most intense participation was in social (mean [SD] 3.3 [0.99]) and recreational (2.9 [0.80]) activity types on the CAPE. Male sex (p<0.05) and younger age were associated with greater physical activity (<15y: 1.87; ≥15y: 1.31, p<0.05). Greater engagement in social activities was related to better cognition (r=0.28, p<0.05), higher motor function (r=0.30-0.36, p<0.01), and fewer behavioral difficulties (r=-0.32 to -0.47, p<0.01). Cognitive ability (r=0.27, p<0.05), dexterity and aiming/catching (r=0.27-0.33, p<0.05), and behavior problems (r=0.38-0.49, p=0.001) were correlated with physical activity participation. Persistence in tasks, an aspect of motivation, correlated with physical (r=0.45, p<0.001) and social activity involvement (r=0.28, p<0.05). Ongoing developmental impairments in adolescents with CHD are associated with decreased active-physical and social engagement, putting them at risk of poor physical and mental health. Health promotion strategies should be considered. Adolescents with congenital heart defects (CHD) have limited engagement in active-physical leisure activities. Cognitive, motor, and behavioral impairments are associated with decreased participation in leisure in children with CHD. Female sex and older age are associated with less engagement in leisure. Mastery motivation correlates with participation, suggesting an avenue for intervention.

Purpose: This review aims to describe the factors that influence participation in physical activity (PA) in people with neuromusculoskeletal (NMS) conditions. Methods: A systematic search of six databases was conducted. Articles were included if the study qualitatively explored factors that influence participation in PA by individuals with a NMS condition. Fifteen peer-reviewed articles published between 2003 and 2013 were analysed for common themes and critically appraised. Results: Results were categorised using the International Classification of Functioning, Disability and Health framework. The most common demotivators reported for the three areas of functioning, body function and structures, activities and participation were lack of walking balance, muscle weakness, pain, stiffness, bladder and blower problems, depression, thermoregulation and fear of injury. Fluctuating symptoms and fatigue were mentioned as demotivators in all of the progressive conditions. Maintaining independence, function and weight, and the prevention of secondary conditions were the leading motivators reported in this domain. Most common environmental barriers include accessibility, costs, transport and insufficient information and knowledge from health professionals. Social support is a consistent determinate of PA and is reported as a facilitator in every study. The most common personal demotivators include lack of motivation, feelings of self-consciousness and embarrassment in public, anxiety, frustration and anger. Personal motivators include goal setting and achieving, enjoyment, feeling good, feeling “normal”, motivation and optimism, redefining self and escapism from everyday boundaries. Conclusions: Individuals with NMS conditions report complex common barriers, facilitators, demotivators and motivators to participation in PA. The way these factors influence participation in PA is unique to the individual; therefore, it is necessary to adopt an individually tailored approach when designing interventions.Implications for RehabilitationIndividuals with neuromusculoskeletal conditions report common factors that influence participation in physical activity.It is the characteristics, attitude and beliefs of an individual that determine the way in which these factors influence participation in physical activity.Health professionals should be guided by the International Classification of Functioning, Disability and Health framework when assessing individuals, as the model will ensure all major factors of interest with regard to disability and physical activity behaviour are considered.Interventions to promote participation in physical activity in people with neuromusculoskeletal conditions require an individual approach that facilitates the assessment and management of an individual’s barriers to physical activity.A multi-disciplinary approach may be required to address factors that influence participation in physical activity. Health professionals must be informed about other areas of expertise and draw on this when necessary.

Federal guidelines state that youth should participate in a variety of physical activity (PA) they find enjoyable. Little is known, however, about how variety and enjoyment are associated with PA participation among adolescents. Data came from the 2010 National Youth Physical Activity and Nutrition Survey, a nationally representative survey of adolescents. Path analysis was used to examine the association of a variety of self-reported PA, defined as the number of activities and activity types (ie, team sports/weightlifting, individual activities, and other competitive/recreational sports), on self-reported PA enjoyment and participation. The analysis also examined whether enjoyment mediates the association between a variety of PA and participation. Separate models were estimated for boys and girls. Number of activities was associated with increased PA enjoyment and participation. For boys and girls, team sports/weightlifting was associated with increased participation, and individual activities were indirectly associated with increased participation through enjoyment. For boys, team sports/weightlifting was indirectly related with participation. These findings suggest that participation in a variety of PA is associated with increased PA enjoyment and participation. Providing opportunities for adolescents to engage in a variety of activities might help them identify PA they enjoy and facilitate lifelong PA habits.

Participation in physical activity in persons with spinal cord injury: A comprehensive perspective and insights into gender differences

Public health guidelines to prevent spreading COVID-19 place older adults at risk of loneliness and social isolation. Evidence suggests that participation protects older adults from such detrimental outcomes, therefore we aimed to identify the factors associated with participation in life roles among older adults living in the community during the COVID-19 pandemic. We conducted a telesurvey on a random sample of community-dwelling older adults living in Hamilton, Ontario, Canada, between May and July 2020. Outcome measures included participation in life roles, physical function, physical activity, mobility, mental health, nutrition, and demographics. We conducted two multivariate regression analyses with the Late Life Disability Instrument’s (LLDI) frequency and limitations scales as the dependent variables. Candidate factors were organized by International Classification of Functioning, Disability, and Health (ICF) framework domains; personal factors, body functions and structures, activities, and environmental factors. A total of 272 older adults completed the telesurvey (mean age 78 ±7.3 yrs, 70% female). Age, using walking aids, driving status, household income, education, mental health, nutrition, physical function, and dwelling type explained 47.1% (p<0.001) of the variance observed in LLDI frequency scores. Using walking aids, driving status, receiving health assistance, mental health, and physical function explained 33.9% (p<0.001) of the variance observed in LLDI limitation scores. These findings highlight factors from multiple ICF domains that are associated with participation limitation and frequency among older adults during the pandemic. Our findings have implications for developing public health initiatives to mitigate the effects of the pandemic on the participation of older adults.

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Obesity in older adults increases the risks of diabetes, cardiovascular disease, cognitive decline, and depression. Physical activity has been established as an important strategy in lifestyle interventions for obese people. This study focused on the strategy for increasing participation in physical activity, which is called social support. Although the studies found that social support helps to motivate participation in physical activity of older adults, its beneficial effects for population with obesity are still few investigations. Therefore, this study focused on developing a social support-based physical activity program for obese older adults with cognitive impairment and hypothesized that it can increase level of physical activity and reduce severity of depression and cognitive decline in obese older adults with cognitive impairment. In this study, thirty-nine participants were divided into three groups consisting of 13 obese older adults, 13 obese older adults with cognitive impairment, and 13 obese older adults with cognitive impairment and receiving the physical activity program for 4 weeks. After that, the levels of physical activity, cognition, and depression were tested in all three groups. Results showed that social support-based physical activity decreased cognitive decline and severity of depression in obese older adults with cognitive impairment. Moreover, the level of physical activity in obese older adults with cognitive impairment and receiving the physical activity program was increased by increasing participation in leisure-time physical activity. Thus, it suggested that the social support-based physical activity exerted beneficial effects for obese older adults with cognitive impairment via increasing participation in leisure-time physical activity.

Identifying protective factors or effective prevention strategies for dementia would result in considerable benefits by prolonging quality of life and reducing social burden. Current data suggests that participation in physical leisure activities may lower the risk of dementia by improving cognitive reserves. The objective of this review was to determine the best available evidence in relation to physical leisure activities in preventing dementia among older adults. Types of studies Randomised controlled trials (RCTs) and other experimental designs were considered for inclusion into the review. In the absence of clinical trials, other study designs such as cohort, case controlled and cross-sectional were considered. Only articles published in the English language were included with no publication date restriction.Types of participants Participants of interest were adults aged 60 and older with or without a clinical diagnosis of dementia, living in the community or residential care setting.Types of intervention This review considered studies that evaluated the effectiveness of any physical leisure activity in the prevention of dementia. Physical activities included gardening, playing sports, exercises, sightseeing and any other activities that required active movement of the body.Types of outcome measures The review considered studies that indicated the presence or absence of dementia as determined by cognitive function tests, mental examination scores, DSM classification (Diagnostic and Statistical Manual of Mental Disorders), and other valid dementia diagnostic tools. A search for published and unpublished literature in the English language was conducted using all major electronic databases. There was no publication date restriction. A three-step search strategy was developed using MeSH terminology and keywords to ensure that all material relevant to the review was captured. The methodological quality of included studies was assessed by two reviewers, who appraised each study independently, using standardised Joanna Briggs Institute (JBI) critical appraisal tools. Data was extracted from the studies that were identified as meeting the criteria for methodological quality using the standard JBI data extraction tools. Due to the heterogeneity of populations and interventions, results are presented in narrative form. Seventeen longitudinal studies were included in the review. Studies were grouped by stage of adult life participation when interventions were undertaken i.e. early-middle adulthood and late life. The evidence regarding the relationship between participation in physical activities during midlife and later life and the prevention of dementia was equivocal. The majority of studies showed limited benefits in engaging in physical activities and results indicated that some activities might be more beneficial than others. IMPLICATIONS FOR RESEARCH.

BackgroundStudies examining associations of socio-eco-demographic characteristics with physical activity (PA) participation of older adults have produced inconsistent results. Perceived PA barriers may be a possible explanation for the mixed findings. Therefore, the purpose of this study was to examine the correlation of socio-eco-demographic (SED) characteristics with PA of older adults and the moderation effects of perceived barriers of PA.MethodsThree hundred eighty-four older adults (≥ 60 years old) were recruited from public places in six different cities. Questions regarding socio-eco-demographic characteristics, PA, and perceived PA barriers were asked, in-person, by two examiners. Ordinal logistic regression models examined the association of socio-eco-demographic characteristics with subjectively measured PA, and the interactive effects of subscales of perceived PA barriers and socio-eco-demographic variables for PA outcomes.ResultsSignificant main effects for PA outcomes were found for education and living status (P < 0.01) and college-educated individuals and those were living in their private houses reported higher PA. Also, 24 significant interactive effects of perceived PA barriers by socio-eco-demographic factors were found (P < 0.05). Significant moderation effects by all subscales of perceived PA barriers were observed for education and living status. The effect of age for the PA outcomes was moderated by “lack of time”, “fear of injury”, and “lack of skill”. Only “fear of injury” and “lack of time” moderated the effect of gender and marriage for outcome variable, respectively. The effect of employment was moderated by “lack of willpower”, “fear of injury”, “lack of skill” and “lack of resources”.ConclusionsNovel evidence revealed that there are moderations by perceived PA barriers for the effect of almost all socio-eco-demographic characteristics. These findings highlight a need to consider older adults’ perspectives and perceptions, when it comes to establish policies for PA participation.

To determine the predictors of magnitude of change in response to a participation-focused leisure-time physical activity intervention in children with cerebral palsy (CP) using the ParticiPAte CP protocol. We included 33 children (16 males, 17 females) aged 8 to 12years (mean age=10y, SD=1y 6mo) with CP with pre/postintervention data from a wait-list randomized trial. The hypothesized linear predictors of change in primary outcomes (Canadian Occupational Performance Measure [COPM]-performance and COPM-satisfaction, Belief in Goal Self-Competence Scale (BiGSS), and minutes per day moderate-to-vigorous physical activity [MVPA]) were: age; Gross Motor Function Classification System level; comorbid autism spectrum disorder (ASD); Goal Attainment Scaling T score; Problems in Schools Questionnaire; Physical Activity Climate Questionnaire; Motives for Physical Activities Measure-Revised; and stage of behaviour change. Multivariable models were selected using the Bayesian information criterion. Overcoming barriers to participation, age, and comorbid ASD explained 49% of the variance in change in COPM-performance. Being motivated by interest and/or enjoyment and age explained 32% of the variance in change in COPM-satisfaction. Being motivated by physical activity competence or appearance (extrinsic motivation) explained 24% of the variance in change in BiGSS. Parental autonomy supportiveness, overcoming barriers to participation, appearance motivation, and baseline MVPA explained 59% of the variance in change in MVPA. These findings support a behaviour paradigm for conceptualizing physical activity in children with CP. Children who met their treatment goals showed a greater increase in physical activity participation. Children who were more intrinsically motivated by physical activity at baseline improved more. Being older and having a comorbid diagnosis of autism spectrum disorder were associated with an attenuated effect of the therapy.

Physical activity (PA) participation is widely recognized as a critical component of health and development for disabled and non-disabled children. Emergent literature reflects a paradigm shift in the conceptualization of childhood PA as a multi-dimensional construct, encompassing aspects of physical performance, and self-perceived engagement. However, ambiguity remains around how participation as a health construct is integrated into PA research. The primary objective of the present mini-review is to critically examine current conceptual and methodological approaches to evaluating PA participation among disabled children. We conducted a systematic review of contemporary literature (published between 2000 and 2016). Seventeen articles met inclusion criteria, and their research approach was classified into guiding framework, definition of the key construct, and measurement used. The primary guiding framework was the international classification of functioning, disability and health. An explicit definition of PA participation was absent from all studies. Eight studies (47%) operationalized PA and participation as independent constructs. Measurements included traditional performance-based aspects of PA (frequency, duration, and intensity), and alternative participation measures (subjective perception of involvement, inclusion, or enjoyment). Approximately 64% of included articles were published in the past 2 years (2014–2016) indicating a rising interest in the topic of PA participation. Drawing from the broader discussion of participation in the literature, we offer a working definition of PA participation as it pertains to active, health-associated behaviors. Further description of alternative approaches to framing and measuring PA participation are offered to support effective assessment of health status among disabled children.

The emphasis on body image has increased over the past few decades, underscoring the importance of understanding factors associated with perceptions of body satisfaction and how body satisfaction is related to physical activity (PA) participation across all subgroups in the population. Little is known about satisfaction with body function and appearance in the older adult population. Purpose The purpose of this presentation is to examine sociodemographic, psychosocial and health-related correlates for body satisfaction in an adult population ages 50 and over from the Active for Life® (AFL) pilot year (n = 768). A secondary purpose is to explore relationships between body appearance satisfaction (BAS) and body function satisfaction (BFS) with PA while controlling for age, race, education, BMI, health rating and depressive symptoms. Methods AFL was established to learn how to deliver, sustain and evaluate evidence-based PA programs to mid-life and older adults through community organizations. Nine community grantees (in 12 geographical areas) implemented one of two evidence-based PA programs. Analyses for this presentation used baseline data from the AFL pilot year. Bivariate correlates for two dependent variables (BAS and BFS) were examined using correlation coefficients for continuous independent variables and ANOVAs for categorical independent variables; ANCOVAs were run to assess relationships between BAS and BFS with PA (MET-hrs/week of moderate-intensity PA from the CHAMPS) while controlling for sociodemographic, psychological and health-related correlates and geographical area. Results More positive BAS and BFS was associated with being female, younger age and better health ratings; lower BMI and depressive symptoms and higher levels of education and PA (all ps <0.05). In multivariate models, PA remained a significant correlate of BAS (p = 0.002) and BFS (p <0.0001) after adjusting for sex, age, race, education, BMI, health status, depressive symptoms and geographical area; the model explained 29.64% of the variance in BAS and 29.23% of the variance in BFS. Conclusions The results from this study demonstrate a significant relationship between PA and BAS and BFS in an older adult population even after adjusting for sociodemographic, psychological and demographic variables. These findings suggest the importance of PA in understanding older adults' perceptions of body satisfaction, both appearance and body function satisfaction. Programs aimed at increasing PA among older adults should consider the motivational impact of improved body appearance and physical function as desired outcomes. Funded by The Robert Wood Johnson Foundation.

For individuals with haemophilia, the benefits of many forms of physical activity outweigh their risks. Although activities with significant trauma risk should be avoided, persons who have haemophilia can participate in, enjoy and even excel in a variety of physical activities and sports. Both the National Hemophilia Foundation and the World Foundation of Hemophilia have produced documents to guide individuals with haemophilia and their healthcare professionals, coaches and parents in developing physical activity programmes and participation in sports. Physical activity guidelines for promoting health benefits exist worldwide and can be incorporated into individualized exercise programmes to ensure that a person with haemophilia is not only choosing appropriate activities, but also improving overall health and preparing the body to manage haemophilia better. Physiotherapy treatment is paramount in helping individuals prevent, manage and optimally recover from bleeds. Furthermore, the physical therapist, along with the haemophilia care team, can assist in preparing an individual to begin or progress to a physical activity programme that enhances fitness level, body composition and overall well-being. This article presents the unique role of the physiotherapist in facilitating safe participation in quality physical activity in the context of risks, benefits and activity recommendations. Participation in physical activity from an early age is ideal to facilitate the development of body awareness and capability and to foster the adoption of a physically active lifestyle; however, it is never too late to start. Consistent participation in quality physical activity beginning at any age is central to managing haemophilia and, equally important, to achieving overall health and well-being.

Physical Activity Measures in the Healthy Communities Study.

635 Understanding parent perceptions of healthy physical activity for their child with a chronic medical condition