Prioritizing challenges and solutions to the implementation of task-oriented community exercise programs for people with balance and mobility limitations

Abstract

Background: To increase access to safe exercise programs in the community for people balance and mobility limitations, physical therapists (PTs) at a rehabilitation hospital partnered with a municipal recreation provider to implement an evidence-based, low cost, task-oriented group exercise program called “Together in Movement and Exercise” (TIME). In this innovativemodel, PTs train and provide ongoing support tofitness instructors to deliver TIME in community centres. To obtain a comprehensive understanding of issues limiting widespread expansion of the TIME program, we held a one-day stakeholders meeting. Purpose: To identify and prioritize challenges and action plans to starting, expanding and sustaining the provision of community-based task-oriented exercise programs for ambulatory people with balance and mobility limitations through a healthcare-recreation partnership. Methods: At a 1-day meeting held in Toronto, Canada, participants in the same stakeholder group were seated together. During two activities, participants at each tablewere asked to discuss and identify top challenges to implementing the TIME program and 3–5 strategies to address them. In a post-meeting online survey, participants were asked to rate the priority of each strategy as: not a priority, low priority, medium priority, and high priority. A strategy designated as a high priority by at least 60% of survey respondents was classified as a priority. Results: Fifty-three individuals attended the meeting and 41 people completed the online questionnaire. The percentage of meeting vs survey participants by stakeholder group was: fitness instructors (21% vs 15%), recreation coordinators/managers (21% vs 32%), healthcare system coordinators/managers (17% vs 22%), healthcare professionals (19% vs 15%), researchers (8% vs 10%), TIME participants (8% vs 2%) and caregivers (8% vs 5%). The challenges and priority strategies included: challenge-1: insufficient funding to run the program; strategy: submit a proposal to your regional health authority to fund exercise programs in the region (74%); challenge-2: maintenance of program integrity; strategy: Consistent use of training materials (71%); challenge-3: sustaining the exercise programs over time; strategies: ongoing communication/collaboration between rehabilitation and recreation providers (88%), ongoing training of new fitness instructors (71%); challenge-4: marketing of the program; strategies: links with physicians and healthcare providers (67%), links with peer support groups or charities (64%), use of standardized marketing materials (62%); challenge-5: training of fitness instructors to have complex skill set; strategy: consulting with key people (PT trainers) as problems arise (68%); challenge-6: no access to recruit TIME participants directly from healthcare; strategy: form links between rehabilitation and recreation providers (88%); challenge-7: exercise program full, not open to new registrants; strategies: offer additional programs (69%), offer a maintenance program (62%). Conclusion(s): Physical therapists can play a central role in collaborating with other healthcare and recreation professionals to develop and sustain community exercise programs for people with balance and mobility limitations. Implications: Meeting output is expected to inform service provision, health policy, education, and research.