Community-based Exercise Program Research Articles

Individualized exercise and the health of the AYA cancer survivor population

Background + Hypothesis
 Adolescent and young adult cancer survivors (AYACS: ages 15-39) have an 84.5% five-year survival rate.(1) AYACS have a 10 times greater risk to develop cardiac disease compared to healthy peers.(2) This is in part due to their lower physical activity.(3) Structured exercise in adult cancer survivors improves strength, fatigue, VO2, and antioxidant levels and it decreases markers of cellular damage(4, 5). AYACS could benefit similarly, reducing long-term health effects. Although evidence suggests exercise is beneficial in older cancer survivors, this has not been demonstrated in AYACS. We hypothesized that a 12-week one-on-one multi-modal, community-based exercise program would improve AYACS outcomes compared to baseline or inactive AYACS. The current study hopes to demonstrate the feasability of an exercise intervention in a community setting within Indianapolis.
 Methods
 Six individuals were included in a feasibility trial for a larger pilot study of 374 participants. On day 1, baseline assessments were performed for experimental outcomes: body composition, strength, flexibility, VO2peak, balance, plasma biomarkers, PA, psychological health, health-related quality of life, and fatigue. Mini reassessments were performed at week 5, measuring strength and VO2peak with an estimated 1-rep maximum and 6-minute Walk Test respectively; in the larger pilot study participants will be reassessed at weeks 12 and 24. Participants train for 60 minutes (20 cardio, 30 weights, 10 stretching) 3 times a week for 12 weeks, one-on-one with a cancer exercise specialist.
 Results
 The average change in VO2peak was +25.3% and in strength was +17.5% (no statistical analysis). Adherence was 90.9%.
 Conclusion + Potential impact
 This trial suggests the feasibility of a pilot larger study. The greatest limitation was that the population sample was not within the AYACS age range. However, as the goal was to show feasibility rather than to prove efficacy, the sample gave useful information.
 Sources (1-5) 1. Anderson C, Smitherman AB, Nichols HB. Conditional relative survival among long-term survivors of adolescent and young adult cancers. Cancer. 2018;124(14):3037-43. 2. Armstrong GT, Kawashima T, Leisenring W, Stratton K, Stovall M, Hudson MM, et al. Aging and risk of severe, disabling, life-threatening, and fatal events in the childhood cancer survivor study. J Clin Oncol. 2014;32(12):1218-27. 3. Wu YP, Yi J, McClellan J, Kim J, Tian T, Grahmann B, et al. Barriers and Facilitators of Healthy Diet and Exercise Among Adolescent and Young Adult Cancer Survivors: Implications for Behavioral Interventions. J Adolesc Young Adult Oncol. 2015;4(4):184-91. 4. Repka CP, Hayward R. Oxidative Stress and Fitness Changes in Cancer Patients after Exercise Training. Med Sci Sports Exerc. 2016;48(4):607-14. 5. Repka CP, Hayward R. Effects of an Exercise Intervention on Cancer-Related Fatigue and Its Relationship to Markers of Oxidative Stress. Integr Cancer Ther. 2018;17(2):503-10.

Physical Activity Across the Cancer Journey: Experiences and Recommendations From People Living With and Beyond Cancer.

The majority of individuals living with and beyond cancer are not sufficiently active to achieve health benefits. The aim of this study was to explore individuals' experiences of physical activity (PA) behavior across the cancer journey and to ask individuals living with and beyond cancer to identify strategies to support habitual PA. An exploratory, descriptive, qualitative design was used. Purposive sampling methods were used to recruit individuals living with and beyond cancer who had been referred to, and/or participated in, a community-based exercise program or were attending a cancer support center. The focus group discussions were audio recorded, transcribed verbatim, and analyzed using a thematic analysis approach. Seven focus groups were conducted with 41 participants. Many individuals reported that regular PA provided a vehicle for recovery that created a sense of "self-power," defined as taking ownership and control of one's health to increase well-being. Barriers to PA participation included environmental-, patient-, and treatment-related challenges. Recommendations to support long-term adherence to PA included completion of fitness assessments at regular intervals and provision of a home exercise program. The benefits and barriers to PA participation for individuals diagnosed with cancers that were not represented may not have been identified. The strategies recommended to support habitual PA may be salient only to individuals whose cancer diagnoses were represented. Exercise is seen as a vehicle for recovery from cancer but long-term adherence for individuals is complex. The findings from this study can inform the development of exercise oncology rehabilitation programs and could support a greater likelihood of program success, thereby optimizing the health, well-being, and quality of life of survivors of cancer.

Implementation Characteristics of Community-Based Exercise Programs for Cancer Survivors

Implementation Characteristics of Community-Based Exercise Programs for Cancer Survivors

Community-based exercise for health promotion and secondary cancer prevention in Canada: protocol for a hybrid effectiveness-implementation study

IntroductionCancer care has expanded from a disease-focused, survival-oriented model to an approach that now considers how survivors can live well in the aftermath of intensive therapy, where they may deal...

Community-based exercise programs for cancer survivors: a scoping review of practice-based evidence.

Based on randomized controlled trials, exercise is an efficacious strategy to improve quality of life (QOL) among cancer survivors. However, the effectiveness of exercise programs to improve QOL in real-world settings is unknown, as are factors related to external validity. This hinders dissemination and scalability. This scoping review synthesized published research on community-based exercise programs for cancer survivors and reported on the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM). A systematic literature search identified community-based exercise programs for adult cancer survivors (1980-March 2018), that met the following inclusion criteria: at least one face-to-face exercise session, the primary aim of program evaluation (i.e., feasibility/effectiveness), and pre/post measure of QOL. Data were coded using the RE-AIM framework. The effect size was calculated for overall QOL. Electronic database search yielded 553 articles; 31 studies describing unique programs were included for review. All studies described at least one element of implementation and most (80.6%) reported a significant (p < .05) improvement in at least one subscale, or total QOL. Few studies reported on indicators of reach (16.1%), adoption (6.5%), individual (16.1%), or system-level maintenance (32.3%). Community-based exercise programs are effective for improving QOL in adult cancer survivors. Recommendations are provided to improve reporting across RE-AIM dimensions, which is an important step to enhance the scalability of programs and thus, the potential for exercise to be fully integrated into system-level standard care for cancer survivors. Community-based exercise programs are a resource to improve QOL for adult cancer survivors.

Implementation of a Community-Based Exercise Program for Parkinson Patients: Using Boxing as an Example.

Background:Persons with Parkinson’s disease (PD) benefit from continuous exercise through participation in community-based exercise programs. However, community programs often lack PD-specific knowledge needed to provide safe and adequately dosed exercise.Objective:To evaluate the acceptability and safety of a PD-specific boxing program in the community.Methods:We developed specific educational resources to facilitate the boxing instructors. We also organized an educational and practical workshop for patients (n = 26) and instructors (n = 10), and assessed: (a) participants’ satisfaction; (b) instructors’ appreciation of the educational resources; and (c) numbers of patients interested in participating in the boxing program. After 18 months, patients and instructors completed a questionnaire evaluating: (a) participants’ satisfaction; (b) adverse events; (c) facilitators and barriers; and (d) proportion of participants at follow-up.Results:Twenty-six persons with PD (62% men) and 10 boxing instructors participated in the workshop. 81% of patients and 80% of instructors were very satisfied. Instructors found the educational materials “very helpful” (60%) or “helpful” (40%). Patients expressed a clear interest (54%) or possible interest (46%) in the program. We initiated classes with 10 participants. At 18-months follow-up, the program consisted of four boxing sessions/week, led by three instructors, with 40 participants. Seventeen patients responded to the questionnaire at follow-up. Participants were “very satisfied” (53%), “satisfied” (35%) and neither satisfied nor unsatisfied (12%) with the program. Adverse effects were mild (e.g., muscle aches). Transportation and physical disability were the main barriers for participation.Conclusions:The boxing program was well-received, with increasing numbers of participants at 18 months. The educational resources can support boxing instructors participating in current and future boxing classes being delivered in the community.

Adaptive Physical Activity for Stroke: An Early-Stage Randomized Controlled Trial in the United States

Background. As stroke survival improves, there is an increasing need for effective, low-cost programs to reduce deconditioning and improve mobility. Objective. To conduct a phase II trial examining whether the community-based Italian Adaptive Physical Activity exercise program for stroke survivors (APA-Stroke) is safe, effective, and feasible in the United States. Methods. In this single-blind, randomized controlled trial, 76 stroke survivors with mild to moderate hemiparesis >6 months were randomized to either APA-Stroke (N = 43) or Sittercise (N = 33). APA-Stroke is a progressive group exercise regimen tailored to hemiparesis that includes walking, strength, and balance training. Sittercise, a seated, nonprogressive aerobic upper body general exercise program, served as the control. Both interventions were 1 hour, 3 times weekly, in 5 community locations, supervised by exercise instructors. Results. A total of 76 participants aged 63.9 ± 1.2 years, mean months poststroke 61.8 ± 9.3, were included. There were no serious adverse events; completion rates were 58% for APA-Stroke, 70% for Sittercise. APA-Stroke participants improved significantly in walking speed. Sample size was inadequate to demonstrate significant between-group differences. Financial and logistical feasibility of the program has been demonstrated. Ongoing APA classes have been offered to >200 participants in county Senior Centers since study completion. Conclusion. APA-Stroke shows great promise as a low-cost, feasible intervention. It significantly increased walking speed. Safety and feasibility in the US context are demonstrated. A pivotal clinical trial is required to determine whether APA-Stroke should be considered standard of care.

Implementing Cancer Exercise Rehabilitation: An Update on Recommendations for Clinical Practice

A growing body of research evidence supports the benefit of exercise for cancer survivors both during and after cancer treatment. The purpose of this paper is to provide an update on our previously published review in 2006 on the state of the evidence supporting exercise for survivors of cancer as well as guidelines for integrating exercise programming in the cancer clinical setting. First, we provide a brief overview on the benefits of exercise as well as preliminary evidence supporting the implementation of community-based exercise programs. Second, we summarize the principles and goals of exercise, and the identified barriers to exercise among cancer survivors. Finally, we propose an interdisciplinary model of care for integrating exercise programming into clinical care including guidelines for medical and pre-exercise screening, exercise testing and programming considerations.

Exercise Type And Intensity In Older Women: Preliminary Results Of Community-based Interventions On Functional Capacity

Exercise type and intensity in older women: Preliminary results of community-based interventions on functional capacity Gabriel de Souza Zanini, Vanessa Teixeira do Amaral, Gabriel Falcão, Emmanuel Gomes Ciolac São Paulo State University - UNESP, School of Sciences, Physical Education Department, Exercise and Chronic Disease Research Laboratory PURPOSE: To assess the effect of different community-based exercise interventions on functional capacity in older women. METHODS: 80 sedentary or insufficiently active older women (69.2 ± 7.9) were randomly assigned to perform a twice-weekly community-based moderate-intensity continuous aerobic training plus resistance training (MICT+RT)(N=28), high-intensity interval training plus resistance training (HIIT+RT)(N=24) or resistance training (RT)(N=28) programs. ,. Anthropometric (weight, height and BMI) and functional capacity (seat-and-reach, handgrip, sit-up, timed up-and-go (TUG), and 6-minute walking (6MW) tests) were assessed before and after 12 weeks of follow-up. RESULTS: Weight, BMI and seat-and-reach did not change significantly during follow-up in any group. Handgrip strength improved (P < 0.05) after MICT+RT and RT, but not after HIIT+RT. Sit-up, TUG and 6MW performance improved (P < 0.05) similarly between groups during follow-up (Table 1).Table 1: Functional capacity before and after follow-up.CONCLUSION: The present preliminary results suggest that community-based exercise programs are effective to improve functional capacity in older women, independent of their type and intensity. Table 1 Functional capacity before and after follow-up. MICT+RT: moderate-intensity continuous aerobic training plus resistance training group; HIIT+RT: high-intensity interval training plus resistance training group; RT: resistance training group; TUG: Timed up-and-go test; 6MW: six minute walking test; * P < 0.05.

Walking People - Aruku-hito, Community-based Group Exercise Program For Older Adults: Expanding The Reach

Walking People - Aruku-hito, Community-based Group Exercise Program For Older Adults: Expanding The Reach

Oral Creatine Supplementation On Physicaly Active Elderly Women Cognition Improvement

PURPOSE: The aim of this study was to verify if creatine supplementation in conjunction with a community-based exercise program improved cognition in elderly women. METHODS: Twenty elderly women were randomized into 2 groups: creatine (CRE, n=10, age = 71± 6 y; body mass = 67.4± 6.0 kg; height = 166±2 cm) or control (CON, n=10, age = 73±6 y; body mass = 67.4±5.7 kg; height = 164±4 cm). All subjects were active and did not use CM or pro-cognitive drugs before the experiment. CRE group received 2.0 g.kg body mass-1·d-1 of CM for 28 days. CON group received 2,0 g.kg body mass-1.day-1 of dextrosol. Community-based exercises (walking, dancing, calisthenics, stretching) were performed 3x a week with 1 h per session. Cognition was assessed using a battery of five tests: a Visual Reaction Time (VRT) test, a visual GO/NO GO reaction time (GNG) test; a Differentiation task test (DTT), an Eriksen flanker test (EFT), and a Corsi block test (CBT). Subjects completed a familiarization, taking the testing battery on two sessions over nonconsecutive days the week prior to the experiment. The week after familiarization, subjects completed the test battery and initiated supplementation (CRE or CON). After 28 days, they repeated the test battery. Chi-square tests were used to compare groups and sessions for DTT, EFT, and CBT. Repeated measures ANOVA were used to compare VRT and GNG. Significance level was set p≤ 0.05. RESULTS: Significant (p≤ 0.05) pre-post performance increases in GNG, EFT, and CBT were observed in CRE vs. CON (table 1). We did not find difference between moments or groups in VRT (p>0.05) nor DTT (p>0.05). Table 1 - Cognitive tests results *p ≤0.05 difference from other means according to ANOVA. Differing superscripts (a,b) indicate p ≤ 0.05 difference according to Chi-SquareTable 1: Cognitive tests results *p ≤0.05 difference from other means according to ANOVA. Differing superscripts (a,b) indicate p ≤ 0.05 difference according to Chi-SquareCONCLUSIONS: We conclude that 2g·kg-1·day-1 during 28 days of oral CM supplementation improved results in some cognitions tasks in elderly woman.

Physical Activity, Physical Function And Quality Of Life In Patients With Single And Multiple Chronic Diseases

PURPOSE: An estimated 50 million people in the Europe live with multi-morbidity (MM). Research has found that those with MM have a greater risk of physical function (PF) decline and poorer quality of life (QoL) than those with a single chronic disease (SCD). The aim of this study was to compare the physical activity (PA) levels and sedentary behavior (SB) in patients with MM and SCD and to investigate the association between PA and PF and QoL. METHODS: Subjects (n=229, 54.4% female, age (mean±SD) 62.2±11.1 yr) were recruited at induction to a community-based exercise program for chronic disease. Medical history was obtained from a referral letter provided by a healthcare professional. Subjects with a single diagnosis of a chronic disease, primarily including cardiovascular, respiratory disease, cancer, diabetes, were classified as SCD. Participants with ≥2 of these diagnoses were classified as MM. BMI and waist to hip ratio (WHR) were measured and calculated using standard procedures. Upper and lower body strength, flexibility and cardiorespiratory fitness were assessed using a hand-grip test, sit-to-stand test (STS), sit and reach test (SRT), and 6-min time trial (6MTT), respectively. PA and SB were recorded using an activPAL3 micro accelerometer. QoL was assessed using the EQ5D VAS. Independent sample T tests were used to compare MCD with SCD on measures of PA, SB, PF and QoL. General linear models were used to investigate the association between PA and SB and PF and QoL RESULTS: 102 (44.5%) participants were defined as MM. Participants with MM had higher waking SB (9.3 ± 1.8 vs 9.9 ± 1.9 hrs/d, p=.013),lower MVPA (0.3 ± 0.2 vs 0.4 ± 0.2 hrs/d, p=.001) and daily step count (6185 ± 3016 vs 7270 ± 3196 steps/d, p=.009) compared with SCD. MM had higher BMI (31.6 ± 7.3 vs 28.0 ± 5.3 kg/m2), (p=.000 for all). MM achieved significantly poorer results for the STS (23.8 ± 9.6 vs 21.2 ± 7.3 s, p=0.21) and 6MTT (453.3 ± 118.9 vs 514.4 ± 113.2 m, p=0.00). There were no differences between groups for WHR, SRT and QoL. MVPA was significantly related to weight, BMI, 6MTT,daily step count was related to STS, 6MTT and QoL and waking SB was related to WHR. CONCLUSIONS: Individuals with MM had greater SB and less PA than those with SCD. PF was poorer for individuals with MM. There were significant associations between PA with physical function and QoL in a CD population.

Pathology Classification And Exercise Adherence: A JTA Educational Approach To Providing Community-Based Exercise Programs

Pathology Classification And Exercise Adherence: A JTA Educational Approach To Providing Community-Based Exercise Programs

Advances in the Management of Peripheral Artery Disease.

This paper provides a concise update on the management of peripheral artery disease (PAD). PAD continues to denote a population at high risk for mortality but represents a threat for limb loss only when associated with foot ulcers, gangrene, or infections. Performing either angiogram or non-invasive testing for all patients with foot ulcers, gangrene, or foot infections will help increase the detection of PAD, and refined revascularization strategies may help optimize wound healing in this patient group. Structured exercise programs are becoming available to more patients with claudication as methods to improve adherence to community-based exercise programs will improve. Finally, ensuring more patients with PAD receive aspirin therapy and statins may improve long-term survival, while further research will help determine if adding newer antiplatelet or anticoagulant medications may reduce leg amputations in selected patients. Clinicians should have a low threshold to obtain an angiogram and to pursue revascularization in patients with foot ulcers, gangrene, or foot infections. In patients with claudication, clinicians should maximize the benefits derived from exercise therapy and medical management before offering percutaneous or surgical revascularization.

Predictors of cancer survivors’ response to a community-based exercise program

ObjectiveTo explore the degree to which sociodemographic (i.e., age, sex, ethnicity, weight status, vocational status, marital status), medical (i.e., stage of cancer, treatment status, comorbidity burden), functional (i.e., self-rated health, exercise capacity), cognitive (i.e., exercise self-efficacy beliefs), and behavioural (i.e., program adherence, extra-curricular exercise) factors predicted cancer-related fatigue and quality of life among 224 cancer survivors who participated in the community-based Wellspring Cancer Exercise Program (WCEP). DesignProspective, quasi-experimental single-group repeated measures design. MethodData on predictors and outcomes were collected using self-report and objective measures upon enrollment in the program (week 0), every 10 weeks until program completion (weeks 10, 20, 30), and at 16-weeks follow-up (46 weeks). Data were analyzed using multilevel modeling. ResultsIn general, participants who were working or transitioning to work, rated their health better, and had higher exercise self-efficacy beliefs had lower cancer-related fatigue, and those who rated their health better and had higher exercise self-efficacy beliefs had higher quality of life. Also, there was a significant interaction between time and exercise self-efficacy beliefs for cancer-related fatigue and quality of life such that greater improvements were observed among participants with higher exercise self-efficacy beliefs. ConclusionCancer survivors’ perceptions of their health and their ability to exercise should be fostered to ensure they respond positively to exercise programs in terms of cancer-related fatigue and quality of life.

Perceptions of peer-led learning among older adults in a community-based aquatic exercise program

ABSTRACTWhile aquatic exercises have been considered one of the most appropriate learning activities for older adult learners because they are safe and beneficial for health, limited evidence exists regarding how older adult learners perceive their learning environment and different learning strategies. Thus, our research explored older adults’ perceptions of peer-led aquatics classes. We interviewed 19 individuals who participated in aquatics exercise courses in a community recreation center in order to answer the following research questions: (a) How do older adults perceive a peer-led aquatics class? (b) How do older adult learners describe their interaction with their instructor and other learners in their learning environment? Using constant comparative analysis, we identified the participants’ perceptions of peer-led learning with regard to their perceived relationships in class, optimistic views on the peer-led learning concept, mixed and neutral attitudes, and professionalism of teaching. From our findings, we discussed empathic relationships, mixed perspectives derived from learners’ physical condition and personal value, and a lack of peer instructor training programs, especially in a senior fitness field. Findings have implications for senior fitness instructors and educators of older adults.

Fitness coordinators’ and fitness instructors’ perspectives on implementing a task-oriented community exercise program within a healthcare-recreation partnership for people with balance and mobility limitations: a qualitative study

Background: Healthcare organizations are partnering with recreation organizations to support the delivery of community-based exercise programs for people with balance and mobility limitations. The value and impact of support strategies provided by healthcare organizations, however, have not been examined.Objective: Study objectives were to explore fitness coordinators’ and fitness instructors’ experiences with implementing a task-oriented community-based exercise program for people with balance and mobility limitations within the context of a healthcare-recreation partnership.Methods: A qualitative descriptive study was conducted. Fitness coordinators and instructors involved with delivering a licensed, group, task-oriented community-based exercise program for people with balance and mobility limitations supported by a healthcare-recreation partnership were interviewed by telephone. Interviews were audio-recorded and transcribed verbatim. A thematic analysis was performed.Results: Eight fitness coordinators and 8 fitness instructors from 14 recreation centres were interviewed. Findings showed that healthcare-recreation partnerships help to optimize exercise program quality and safety through multiple strategies. Fitness coordinators and instructors still face challenges with program implementation at start-up and over time. Recommendations to address these challenges included increased training content related to adjusting exercises to accommodate participant abilities, 1–2 visits from a healthcare professional each program after initial program implementation, suggestions to increase exercise variety, and ongoing education.Conclusions: Findings clarify the role of healthcare organizations, ongoing challenges, and directions for improvement in this program delivery model.Implications for rehabilitationCommunity recreation centres can provide task-oriented exercise programs to help people with balance and mobility limitations safely engage in regular exerciseHealthcare organizations should provide specific supports to help increase the safety and quality of task-oriented exercise programs in recreation centresSupports include providing clear exercise guidelines, and a healthcare professional who trains fitness instructors, visits the program, answers questions between visits, promotes collaboration and information exchange between recreation centres, and provides ongoing education

AB104. 37. The effect of a community-based pre-operative exercise programme on health-related components of fitness and health-related quality of life in major surgical oncological patients: a pilot study

AB104. 37. The effect of a community-based pre-operative exercise programme on health-related components of fitness and health-related quality of life in major surgical oncological patients: a pilot study

Fitness and Quality of Life Outcomes of Cancer Survivor Participants in a Community Exercise Program

Exercise is recommended for cancer survivors, as it mitigates treatment side effects and improves overall wellness. Therefore, survivors attend community-based exercise programs and report positive results, but published evaluations of outcomes of these programs are scarce in the literature. The objective of this study is to validate the anecdotal reports of the physical fitness and quality of life benefits of the LIVESTRONG at the YMCA program. A retrospective analysis of deidentified data consisting of 17 program cohorts of the LIVESTRONG at the YMCA program (n = 88) was conducted. Statistically significant improvements were seen when compared to baseline in the physical fitness measures of the 6-minute walk, the chest and leg presses, the sit-and-reach test, and the one-leg stand test, as well as in the domains of the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29) Profile, a health-related quality of life questionnaire. These domains are physical function, anxiety, depression, fatigue, social role satisfaction, and pain. The anecdotal impression that participation in the LIVESTRONG at the YMCA program improves physical fitness and subjective quality of life perceptions was supported by statistical analysis of the subjective and objective pre- and postprogram measurements for this data set. Exercise in this cancer-specific community exercise program is likely to improve physical fitness and quality of life outcomes.

Experiences of people with stroke and multiple sclerosis and caregivers of a community exercise programme involving a healthcare-recreation partnership

Purpose: To explore perceptions of people with neurological conditions and their caregivers of the health benefits of a group, task-oriented community-based exercise programme incorporating a healthcare-recreation partnership.Materials and methods: Descriptive qualitative study. Individuals with balance and mobility deficits from a neurological condition, and their caregivers, were interviewed on completion of a group, task-oriented community-based exercise programme incorporating a healthcare-recreation partnership. A thematic analysis was performed.Results: Nine people post-stroke, and four people with multiple sclerosis (MS) (n = 13; 54% male) and 12 caregivers (83% spouses) participated. Two themes emerged. One theme indicated that the programme fosters diverse, interrelated health benefits. Participants described experiences of improved balance, strength, and confidence that translated to improved everyday functioning and social participation. Benefits were reinforced through repeated programme registration. A second theme indicated that caregivers experience challenges and diverse benefits related to the programme. Transportation and programme cost were primary challenges. Caregivers described emotional health benefits from assisting participants during classes and observing participants improvement over time.Conclusions: Group, task-oriented community-based exercise programmes incorporating a healthcare-recreation partnership may yield health benefits for exercise participants and caregivers. Results can guide programme evaluation, the nature and timing of education about such programmes, and efforts to address cost and transportation issues.Implications of rehabilitationStroke and multiple sclerosis commonly cause balance and mobility limitations that can result in physical inactivity and further deterioration in health.Group, task-oriented community-based exercise programmes in which rehabilitation professionals train and support fitness instructors to deliver the exercise programme in community centres may increase access to exercise participation for this group.Study results suggest by improving balance and mobility, these programmes help increase independence in activities of daily living and social and leisure participation, while improving caregiver mental health and decreasing the need for caregiver assistance.Rehabilitation professionals can use findings to inform patient education, and support programme implementation and referral.