ProacTive SCI Toolkit Finalfhsd-sciactioncanada-2019.sites.olt.ubc.ca/files/2019/12/... · 2019....

The ProACTIVE SCI Toolkit

APhysiotherapist’sGuidetoPromotingPhysicalActivitytoClientswhohave

SpinalCordInjuries

ProjectLeads:Dr.JasminKMa,PhDUniversityofBritishColumbia,ICORD(InternationalCollaborationonRepairDiscoveries)

Dr.KathleenAMartinGinis,PhD,O.M.C.Reichwald FamilyUBCSouthern MedicalProgramChairinPreventive MedicineProfessor,DivisionofPhysicalMedicineandRehabilitation,DepartmentofMedicineProfessor,SchoolofHealthandExerciseSciencesDirector, ChronicDiseasePrevention Program,UBCSouthernMedical ProgramPrincipalInvestigator,ICORD (InternationalCollaborationonRepair Discoveries)

Dr.OrenCheifetz,PT,PhDHamiltonHealthSciences

Thisresourcewasdevelopedandreviewedbyanexpertpanelofphysiotherapists,communitymemberswithspinalcordinjury,anduniversityresearchers(lastupdated2018).

Thankyoutoallofthephysiotherapistsandparticipantswhocontributedtheirinvaluabletimeandknowledgetoinformthedevelopmentofthistoolkit.

ThisprojectwasfundedbytheOntarioNeurotramaFoundationandtheRickHansenInstitute.

ExpertPanelMembers:JaniceCenturione,PTCaroleChebaro,PTDr.KimberlyCoros,MD,FRCPC,Dip.SportMed.JenniferDuley,PTCyndyMcLean,MScHoongPhang,PT,MScSheriRobertsMattSaganRobertShaw,BPHERichVanderWalKyleWhaley,PT

ForquestionsorrecommendationsforupdatesonthetoolkitpleasecontactDr.JasminMa(8jkm@queensu.ca) orDr.KathleenMartinGinis (Kathleen_Martin.Ginis@ubc.ca)

ProacTive Toolkit Executive Summary

Ms. Jasmin Ma, PhD Student

Dr. Kathleen Martin Ginis, PhD

Dr. Oren Cheifetz, PT, PhD

ToolkitContributors

Step2:AimforatleasttheSCIphysicalactivityguidelines

Step1:Tailoryourinterventionbydiscussingthe

followingquestionstounderstandyourclient’ssituation

Step3:Pickyourstrategies

TheOnePageCheatSheet

Educate1. Safety Pg.82. Philosophy Pg.103. BasicDefinitions Pg.114. TheSCIPhysicalActivityGuidelines Pg.125. BenefitsofPhysicalActivity Pg.136. BehaviourChangeTechniques Pg.147.AdditionalMaterials Pg.24

Link&Refer

TailoredPrescription

1. Finance&Transportation Pg.272. LocateLocalResources:Tips&Tricks Pg.283. LinktoFacilities&Resources:Examples Pg.294. Peer-to-PeerConnections Pg.315. OtherProfessionals,Supports,and

Organizations Pg.32

1. TheInterview Pg.342. ActivityIdeaLadder:EverydayActive,

AdaptedActivities,AdaptedSports Pg.373. BasicPhysicalActivityPrescription Pg.414. SamplePrograms Pg.435. AdaptingCommonExerciseEquipment Pg.46

Asaquickreferenceforpromotingphysicalactivity,followthesethreesteps.Therestofthetoolkitprovidesdetaileddescriptionsofeachofthesestrategies andhowtousethem.

1)Currentphysicalactivitylevels/readinessforchange:

2)Goals(howmuchphysicalactivityandwhatarethebenefitsthey’dliketogain):

3)Typesofphysicalactivitytheycurrentlyenjoydoing:

4)Availableresources(e.g.,equipment,gym,recreationcentres nearthem,funding):

5)Barrierstoaccomplishingtheirgoal:

6)Mutuallydiscussshorttermgoalsandstrategies(seethefollowinglinktodownloadalistofprintableresourcestohelp:https://drive.google.com/drive/folders/13tJaCoGqBIj3nwK3Mykqn6-UfiIe5p_w?usp=sharing)

Forfitnessbenefits:20minofmoderatetovigorousaerobicactivity,2x/week

ANDStrengthtraining2x/week

Forcardiometabolic healthbenefits:30minofmoderatetovigorousaerobicactivity,

3x/week

StepstoUsingthisGuide(Overview)

2.Gaugeyourclient’sinterestinphysicalactivity.

2a.MotivatedMoveforwardwithone,twoorallthreeofthefollowingkeystrategiesaccordingtoyourclient’ssituationandyourownpracticeandskillset.

2b.NotMotivatedIfyourclientisn’tinterestedinphysicalactivity,learnthereasonswhy.Thenmoveforwardwithone,twoorallthreeofthefollowingkeystrategiesaccordingtoyourclient’ssituationandyourpracticeandskillset.Ifyourclientbecomesmotivated,referto3a.

Note:Becausehyperlinksareconstantlychangingandnewinformationiscontinuallyemergingonline,we’veincludedsearchterms[underlinedandinsquarebrackets] forrecommendedwebsites,organizations,programsandconcepts.

Educate

Link&Refer

1. Familiarizeyourselfwiththesafetyguidelinesandphilosophyforpromotingphysicalactivity.

3.Keystrategies

Educate:SafetyBenefits

ProblemSolving

TailoredPrescription:ActivityIdeaLadder

Link&Refer:Finance&TransportationPeer-to-PeerConnections

Pg.8Pg.13

Pg.26Pg.31

StepstoUsingthisGuide(Detailed)

Thiscanbeachievedbysimplyaskingthisquestion:

“Doyouhaveanyplanstostart(continue)beingactive?”

1. Familiarizeyourselfwiththesafetyguidelinesandphilosophyforpromotingphysicalactivity.

Philosophy

Beforebeginningaconsultationwithyourclienttopromotephysicalactivity,taketimetounderstandpre-exercisescreeningconditions,commonrisksforpeoplewithanSCIwhobeginanexerciseprogram,andthetoolkit’sphilosophyforpromotingphysicalactivity.

2.Gaugeyourclient’sinterestinphysicalactivity.

Safety

Motivated

v Actors:clientswhohavestartedexercisingorhavebeenexercisingforalongtime.

v Intenders:clientswhohavenotbeenexercisingbutwouldliketo.

NotMotivated

v Pre-Intenders:clientswhohavenotbeenexercisingandhavenointentiontodoso.

Motivationalinterviewingisbeyondthescopeofthistoolkit,butmaybeausefulstrategyforresolvingambivalencethroughaclient-centeredcounsellingapproach.Propertrainingrequiresmultiple,in-personsessionswithfeedbackfromatrainedcounsellor.Foraquickoverview/refresher,see:http://learning.bmj.com/learning/module-intro/.html?moduleId=10051582[BMJMotivationalInterviewinginBriefConsultations]

2a.Motivated

2b.NotMotivated

Pg.8 Pg.10

3a.MotivatedMoveforwardwithone,twoorallthreeofthefollowingkeystrategiesaccordingtoyourclient’ssituationandyourownpracticeandskillset.

Educate

Link&Refer

3.Keystrategies

Educate:SafetyBenefits

ProblemSolving

TailoredPrescription:ActivityIdeaLadder

Link&Refer:FinanceandTransportationPeer-to-PeerConnections

Potentialreasons:• notunderstandingthebenefits ofphysicalactivity

• fear ofactivity(e.g.,triggeringautonomicdysreflexia)

• barriers tophysicalactivity• alackofconfidence toexercise

3b.NotMotivatedIfyourclientisn’tinterestedinPA,learnthereasonswhy.

Ifyourclientiswillingtoaddresstheseissuesorlearnmore,moveforwardwithone,twoorallthreeofthefollowingkeystrategiesaccordingtoyourclient’ssituationandyourownpracticeandskillset:

Benefits,Fear,Barriers

Barriers,Confidence

Ifyourclientidentifiesanyoftheabovepotentialreasonsfornotexercising,herearesomerecommendedkeystrategies:

Seethetableofcontentsanddecidewhichofthekeystrategiesaremostappropriatetostart,maintain,orimproveyourclient’sexerciseprogram.

ToAddress…StepstoUsingthisGuide(Detailed)

Pg.8Pg.13Pg.19

Pg.26Pg.31

Pg.375

TableofContents

Educate

1. Safety Pg.82. Philosophy Pg.103. BasicDefinitions Pg.114. TheSCIPhysicalActivityGuidelines Pg.125. BenefitsofPhysicalActivity Pg.136. BehaviourChangeTechniques Pg.14*AdditionalMaterials Pg.24

Link&Refer

1. Finance&Transportation Pg.272. LocateLocalResources:Tips&Tricks Pg.283. LinktoFacilities&Resources:Examples Pg.304. Peer-to-PeerConnections Pg.315. OtherProfessionals,Supports,andOrganizations Pg.32

1. TheInterview Pg.342. ActivityIdeaLadder:EverydayActive,AdaptedActivities,AdaptedSports Pg.373. BasicPhysicalActivityPrescription Pg.414. SamplePrograms Pg.435. AdaptingCommonExerciseEquipment Pg.46

Teachyourclientthebasicwaysandbenefitsofbeingphysicallyactiveandprovidethemwiththetoolstostartandmaintainexerciseontheirown.

Linkyourclienttoresources,orrefertopeers,programsorotherprofessionalstohelpthemstartorcontinuephysicalactivity.

Useyourbackgroundasaphysiotherapist,alongwithsomenewtools,todesignphysicalactivityprogramsthataretailoredspecificallyforyourclientwithSCI.

Educate

Link&Refer

Ifyouarealreadyfamiliarwiththecontent,quicklynavigatethetoolkitbycompletingTheInterview(Pg.35)withyourclientandchoosetheappropriateinterventionstrategy/ies below:

EducateOverview

Teachyourclientsthebasicsofbeingphysicallyactiveandprovidethemwithtoolstostartandmaintainanexerciseprogramontheirown.

SafetyLearningaboutthecommonrisksofexerciseforpeoplewithSCIwillhelpyourclientspreventinjuryandfeelmoreconfidentthatriskscanbemitigated.1

Becomecomfortablewiththebasicsofphysicalactivity,specifically:

• Basicdefinitions:definingphysicalactivityandthekeytermsusedtoprescribeexercise

• TheSCIPhysicalActivityGuidelines:evidence-basedrecommendationsforminimumlevelsofphysicalactivitynecessaryforpeoplewithSCItoexperiencefitnessbenefits

• BenefitsofPhysicalActivity:research-supportedpositiveoutcomesfromparticipatinginphysicalactivityexperiencedbypeoplewithSCI

ABCsofPhysicalactivity

StrategiesthathavebeenshowntochangephysicalactivitybehaviourinpeoplewithSCI,including:

• actionplanning• SMARTgoalsetting• problemsolving• prompts&cues• gradedtasks

4 BehaviourChangeTechniques

• follow-up• self-monitoring• commitment• reward

LivedExperience/EducationalVideosBo

nus Utilizevideosfeaturingexpertsintheexercisefieldandthose

withlivedexperience.

PhilosophyMakeyourphysicalactivitypromotionstrategyeffectivebybasingitonkeyguidingprinciplesdevelopedbyphysiotherapists,peoplewithSCI,andbehaviourchangespecialists.

EducateSafety

WerecommendthatpeoplewithSCIcheckwithaphysicianbeforestartingaphysicalactivityprogram.Ifyou’reunsurewhetheraphysicianneedstobeconsultedbeforeyourclientstartsanexerciseprogram,usethePAR-Q+guidelines(backofthisguide)toinformyourdecision.

Tofindamedicaldoctorwhomightbeappropriateandqualifiedtoassessaclientpriortoexerciseparticipation,contactCASEM[CanadianAcademyofSportandExerciseMedicine] orCAPMR[CanadianAssociationofPhysicalMedicine&Rehabilitation].

Safetyshouldbeconsideredforallclients.Understandingandteachingcommonsafetyconcernscanhelptopreventinjuryforyourclients,andallowthemtofeelmoreconfidentthatriskscanbemitigated.Belowarealistofcommonsafetyissuesandstrategiestomitigaterisk.

PAR-Q+

OveruseInjury Shouldersandwristsareparticularlysusceptibletooveruse,butoveruseinjuriescanalsohappeninotherareasofthebody.Whenprescribingexerciseprograms,don’tforgettheimportanceofupperbodyfunctionforeverydaylifeandactivitiesforclientswhohaveanSCI.

Ø Progressslowly:aimforalittlemusclesoreness,notintensepain.Ø Varyexercises.Ø Prescriberestdays.

Pressureulcers People withSCIarevulnerabletopressureulcersorpressuresores—damagetotheskinand underlying tissue,whichistypicallycausedbysittingorlyingononepartofthebodyfortoolongoracombinationofpressureandshearingforces.

Ø Encourageshiftingbodyweightevery10to15minutes.Ø Recommendequippingwheelchairwithahigher qualitycushionto

betterrelievepressure.Ø Formoreinformationonpressureulcermanagement,seewww.onf.org

[ONFPressureUlcerGuide].

TemperatureDysregulation

Sweatingmaybeinhibitedbelowthelevelofaclient’sinjuryandimpairtheirabilitytoregulatetheirtemperature.

Ø Have clientscooldownwithawaterbottle,spraybottle,orcoldwettowelwhenexercisingoutdoorsintheheat.

Ø Submersinghandsorfeetin coldwaterorusingicevestscancoolcoretemperature

Ø Whenindoors,useafan(andaspraybottleforbetter results).

AutonomicDysreflexia(AD)

ADisasuddenandverylargeincreaseinbloodpressurewhichisoftenaccompaniedbysevereheadaches.KnowthesignsofAD (e.g.,severeheadache,feelingsofanxiety,profusesweatingand/orflushingabovethelevelofinjury,blurredvision).

Ø Emptying thebladderbeforeexercisecanhelppreventAD.Ø IfyouthinkyourclientisexperiencingAD,keepthemsittingup.Ø Dealwithanysuspectedcauses(e.g., kinkedcatheter,tightclothing,full

bladder).Ø Askiftheclienthasmedicationtomanagetheirbloodpressure.Ø Ifyoudealwiththesuspectedcausebutsymptomspersist,getmedical

assistance(i.e.ifnoimprovementinfiveminutes,seekaphysician;safestoptionmaybetheERifyouhavenoaccesstoblood pressure monitoring).

Ø FormoretrainingonAD,takethefreeonlinecourseatwww.abcofad.jibc.ca [JIBCABCofADinspinalcordinjury].

OrthostaticHypotension

Orthostatichypotensionisadangerousdropinbloodpressure.The30-20-10ruleisusedtodetermineorthostatichypotension. Whenaclientmovesfromlyingpositiontoanuprightposture(e.g.,sittingor standing)andexperiences anincreaseinheartratebymorethan30beatsperminute,adecreaseinsystolicbloodpressureof20mmHg,oradecreaseindiastolic bloodpressure of10mmHg(oranycombinationofthese),orthostatichypotensionshouldbesuspected.Othersymptoms mayincludelightheadedness,dizziness,nausea,andfatigue. Typically, individualswithtetraplegiaareatagreaterriskthanindividualswithparaplegia.

Ø Lietheclientbackdownuntilsymptomssubside.You can alsoelevatetheclient’sfeetandapplypressuretotheabdomen.

Fracture Afracture,orbreakinthebone,istypicallytheresultoftrauma,overuse,ordecreasedbonemineraldensity (osteoporosis). Fracturesaremorecommon inlimbsaffectedbyparalysis.

Ø Thosewhoexperienceseveremusclespasmsandhaveosteoporosisshouldtakeprecautionssuchasengaginginlowerimpactexercisetopreventfracturesfromoccurring.

Spasticity Spasticity, orhighmuscletone, canbeasignofpainandcanbeworsenedbymedicalissuessuchasskinbreakdownorinfection.

Ø Certainexercisesmightexacerbatespasticity—assess onacase-by-casebasis.Ifspasticitycontinuestoworsen,avoidtheproblematicexercise.

Ø Doingawarmupandstretchingmayhelpalleviatespasticity.

Sunburn Sunburn isdamagetotheskinasaresultofexposuretothesun’sultravioletrays.

Ø Useofsunscreen,shade,orlightcoloured andlightweightclothingtoprotectskinfromthesunisimportantforeveryonewhoexercisesoutside,butespeciallyforthosewithnoorlimitedsensationintheskin.

EducateSafety

GuidelinesataGlance

SCIActionCanada,inconjunctionwiththeRickHansenInstitute,hasdevelopedthePhysicalActivityGuidelinesforAdultswithSpinalCordInjury.AdultswithSCIshouldengageinatleast:

Forfitnessbenefits:20minofmoderatetovigorousaerobicactivity,2x/weekAND

Strengthtraining2x/week

Forcardiometabolic healthbenefits:30minofmoderatetovigorousaerobicactivity,3x/week

SmallSteps

InstillaCultureofPhysicalActivityasPartofEverydayLife

TailortotheIndividual

Ø TheSCIPhysicalActivityGuidelinesaretheminimumamountofactivityrequiredtoobtainfitnessbenefits(althoughotherbenefitsmaybeachievedatlowerdoses).However,noteveryoneisreadytomeetthoseguidelines.

Ø Somewillbereadytosetgoalsformeetingtheguidelinesorevenexceedingthem.Otherswillneedtostartwithmoremodestgoals(e.g.,doingrange-of-motionexerciseswhilewatchingTV)andworkuptomeetingtheguidelines.Tailoryourapproachbasedonyourclient’ssituation.

Ø Physicalactivityisimportantforreducingtheriskofprevalentchronicdiseases.Butit’salsocriticaltoyourclients’qualityoflife.Expertscontinuallyemphasizetheimportanceofconnectingphysicalactivitytoimprovementsineverydayfunction.

Ø Forexample,youcouldexplaintoyourclientshowaparticularexercisecanhelpmaketoilettransferseasier,orspellouthowbuildingstrengthandendurancewillallowthemtoplaylongerwiththeirkids.

Ø Youradviceismuchmoreeffectiveandmeaningfulwhenyouconsidertheenvironment,functionallevel,personality,barriers,familysituation,andmotivationofyourclients.Bepreparedtochallengeyourclientsifthey’rewillingandeagertointroducephysicalactivityintotheirlives.Youmayhavetotakesmaller,moremodeststepsifthey’renotfullyconfident.

Ø Integrateyourclientsintocommunitycentresifthey’reinterestedinexercisinginasettingwithavarietyofindividuals,orreferthemspecificallytoadaptedprogrammingifthat’stheirpreferenceorcomfortlevel.There’snosuchthingasablanketstrategy;eachclientisunique.

EducatePhilosophy

PhysicalActivityThefocusofthistoolkitextendsoutsideofrehabilitativeexercisestothebroadercategoryofphysicalactivity.Inaccordancewithup-to-dateliteratureandresearch,thetypesofphysicalactivityrecommendedtopromotetoclientsinordertohavethemexperiencefitnessbenefitsareleisuretimephysicalactivityandwheeling/activetransportation.Ø AleisuretimephysicalactivityissomethingthataclientCHOOSEStodointheirfreetime(e.g.,

goingtothegym,playingsports,takingthedogforawalk).Ø Wheeling/activetransportationcanbeencouragedasanalternativetodrivingortakingpublic

transittoadestination(e.g.,wheelingtoworkorthegrocerystore).

AerobicExerciseAerobicexercise,commonlyreferredtoascardio,involvesanactivitythattypicallyincreasesheartrateandbreathing(e.g.,wheeling,basketball,dancing).

Strength/ResistanceExerciseThistypeofexercisemakesuseofresistancetoimprovemuscularstrengthandfunction(e.g.,liftingweights,usingresistancebands,usingbodyweightexercises).

IntensityIntensityreferstohowhardtheindividualisworking.BelowareintensitydescriptionsthathavebeendeterminedtobeappropriateforclientswhohaveanSCI:

Mild Moderate Vigorous

InGeneral This includesphysicalactivitiesthatrequireclientstodoverylightwork.Theyshouldfeellikethey’reworking alittlebit,butoverall,theyshouldn’tfindthemselvesworkingtoohard.

This includesphysicalactivitiesthatrequiresomephysicaleffort.Clientsshouldfeellikethey’reworkingsomewhathardbutcankeepgoingforalongtime.

This includesphysicalactivitiesthatrequirea lotofphysicaleffort.Clientsshouldfeellikethey’reworkingreallyhard(almostattheirmaximum)andcanonlydotheactivityforashorttimebeforegettingtired.Theseactivitiescanbeexhausting.

BreathingandHeartRate

Thesestaynormalorareonlyalittlebitelevatedthannormal.

Breathing isharderandheartrateisfasterthannormal,butnottotheextreme.

Breathing isfairly hard,andbotharemuchfasterthannormal.

Muscles Muscles areloose, warmed-upandrelaxed;theyfeelnormaltemperatureoralittlebitwarmerandnottiredatall.

Muscles feelpumped andworked.They’rewarmerthannormalandstarttogettiredafterawhile.

Muscles burn, aretightandtense, feelalotwarmer thannormal,andfeeltiredquickly.

Skin Skin isnormal temperatureoronlyalittlebitwarmer,andnotsweaty.

Skin isa littlebitwarmer thannormal,andmightbealittlesweaty.

Skin ismuch warmerthannormalandmightbesweaty.

Mind Clientsmightfeelveryalert, butthere’snoeffectonconcentration.

Clients requiresomeconcentration tocomplete.

Clients require alotofconcentration(almost full)tocomplete.

EducatePhysicalActivityBasicDefinitions

ForFITNESSbenefits,aimfor:20minutesofmoderatetovigorousintensityaerobicactivity(e.g.,wheeling,armcycling,sports,

swimming)atleast2timesperweekAND

3setsof8-10repetitionsofstrengthtrainingexercises(e.g.freeweights,elasticresistancebands,cablepulleys,weightmachines)foreachmajorfunctioning

musclegroup,2timesperweek.

ForCARDIOMETABOLICHEALTHbenefits,aimfor:30minutesofmoderateto

vigorousintensityaerobicactivityatleast3timesperweek

Moderatemeanssomewhathard,andyoufeellikeyoucouldcontinueforalongtime.Duringtheactivity,youareabletotalk,but

notsingasong.

Vigorousisreallyhard;youfeellikeyoucanonlycontinueforashorttimebeforegettingtired.Youwillnotbeabletosaymorethanafewwordswithoutpausingforabreath.

STRENGTHENINGACTIVITYYoushouldfeelquitechallenged(withouthurtingyourself)bytheendofthethree

setsandeighttotenrepetitions.Takeaonetotwominuterestbreakbetweeneachset.Workeachmusclegrouponalternatedays.

EducateTheSCIPhysicalActivityGuidelines

These guidelines were developed by an international group led by Prof Kathleen Martin Ginis (University of British Columbia, Canada) and Prof Victoria Goosey-Tolfrey (Loughborough University, UK).

FitnessFor cardiorespiratory fitness and muscle strength benefits, adults with SCI should engage in at least:

20 minutes of moderate to vigorous intensity aerobic exercise 2 times a

3 sets of strength-training exercises for each major functioning muscle group, at a moderate to vigorous intensity

times a week

Cardiometabolic healthFor cardiometabolic health benefits, adults with SCI are suggested to engage in at least:

30 minutes of moderate to vigorous intensity aerobic exercise 3 times a

QuickVersionforExplainingtheGuidelinestoYourClients:(Formoredetail,see[scientificexerciseguidelinesforadultswithspinal

cordinjuryatSCIActionCanada.ca)

Followingtheguidelinescanhelpimproveyourclient’sfitnessandstrength.Whenchoosingwhichbenefitstoemphasizetoyourclient,considerwhat’simportanttothem.Forexample,isyourclientseekingtoimprovetheirhealth,ormaintaintheirfunctionalindependence?Somebenefitsyourclientmayexpect(butarenotlimitedto):

EverydayBenefits• betterenduranceforwheelinglongerdistances• easiertransfersinandoutofawheelchair�• enhancedself-careandmobility�• betteroverallhealthandqualityoflife• moreenergy�• moresocialinteractionopportunities• improvedabilitytoplaywithchildren• moretimespentwithfamilywhenactivitiesaredonetogether

HealthBenefits• reducedcholesterolandfatsintheblood,whichcanlowertheriskofdevelopingseveralchronicdiseases

• lesspain• lowerriskofstress• lowerriskofdepression• improvedabilitytoregulatebloodglucose,decreasingriskfortypeiidiabetes

• bettersleepquality

EducateBenefitsofPhysicalActivity

Ifyourclientwantstobeginaphysicalactivityprogram,orhasbeenexercisingbutneedssomehelpreachingtheirgoals,considerthefollowingbehaviouralstrategiesthatmayhelpthemtransformtheirintentionsintoaction.

Notethatthesestrategiesnotonlyapplywhenpromotinganactivelifestyle,butcanalsobeusedtohelpyourclientsadheretotheirrehabilitativeexercises.

EachofthesetechniqueshavebeensupportedintheliteratureasmethodstoimprovephysicalactivityspecificallyinpeoplewhohaveanSCI.

ProblemSolving

SMARTGoalSetting

ActionPlanning

Prompts/Cues

GradedTasks

Follow-Up/Monitoring

RewardCommitment

Self-Monitoring

EducateBehaviourChangeTechniques:Overview

SMARTGoalsCreategoalsthatare:

ExampleofaSMARTgoal:

“Iwillgoforamoderatetovigorousintensitywheelofatleast20minutesduration,twiceperweek,

everyweek,foronemonth.”

WhythisagoodexampleofaSMARTgoal:

ü Specific:Thetypeofexercise(wheeling)iswell-defined.ü Measurable:Youandyourclientcaneasilykeeptrackofwhetherthegoalisbeing

met(twotimesperweek,atleast20minutes,everyweek).ü Attainable/Realistic:Thegoalisrealisticallyattainable.Whatconstitutes“realistic”

willvaryfrompersontoperson.Revieweachindividualclient’sexercisehistoryandcurrentleveloffitnessinordertosetappropriate,realisticgoals.

ü Time-Based:Thegoalhasanachievementenddate(onemonth).

EducateBehaviourChangeTechniques:SMARTGoals

ActionPlanning

Haveyourclientmakeadetailed,day-by-dayactionplanfortheirphysicalactivityatthebeginningofeachweek.Itshouldincludetheactivitytype,location,timeandduration,andexerciseintensity.Belowisanexampleofanactionplan.

Belowisanexampleofablankactionplanthatyoucanusewithyourclients.

EducateBehaviourChangeTechniques:Planning

Havingyourclientmonitortheirownprogressisimportantforpreparingthemtoindependentlymanagetheirphysicalactivityprogram.Encourageyourclientstowritedowntheactivitythey’vedoneattheendofeachday(orcheckoffwhethertheyfollowedtheiractionplanifthey’vemadeone).Distributethesecalendarstohelpyourclientsself-monitor.

Forclientswhoprefertorecordactivitiesindetail:

Forclientswhopreferasimplemonitoringapproach:

EducateBehaviourChangeTechniques:Self-Monitoring

Pleaserecordtheduration,intensity,andtypeofanyphysicalactivitythatyoudideachday.Havefun!

Followingupandmonitoringyourclientscanmakeyourclientsmoreaccountabletotheirgoal.Itcanbedoneinadditiontoself- monitoringandcanbeachievedinmanyways:

Monitoryourclient’sprogressinachievingtheirgoals.(seeGoalSetting)

Monitorhowwellyourclient’sactionplanisworkingforthem.(seePlanning)

Providefeedbackandencouragementonclients’progress.

Follow-upwithyourclientpost-discharge—evenaquickemailorphonecallcanbemeaningful.

Providesuggestionstohelpclientsovercomeobstacles.(seeProblemSolving)

EducateBehaviourChangeTechniques:Follow-up

Physicalactivitylogscanbehelpfultokeeptrackofyourclient’sprogress.Here’sasamplecalendarforyourclienttorecordandsharewithyouthedaystheywereactive:

Pleaserecordtheduration,intensity,andtypeofanyphysicalactivitythatyoudideachday.Iwillcheckonyourprogressatyournextvisit.Havefun!

Identifyyourclient’sperceivedbarrierstoparticipatinginphysicalactivityandaccomplishinggoals,anddiscusspotentialsolutions.Belowareafewexamplesofcommonbarriersandpotentialsolutionsyoucanrecommendtoyourclient:

NoTimeØ Makeanactionplan.Ø Spendmoretimewithfamilyandfriendsbyexercisingwiththem.Ø Useactivetransportationandcountitaspartofyourexercisefortheday(e.g.,

wheeltowork).

PhysicalBarriersØ Ifpainisabarrier,exercisemayactuallybeeffectiveinreducingpain.Ø Startingexercisecanbedifficultwhenyoufeelfatigued,butit’sworthitintheend.

Oftenyou’llfeelmoreenergizedafteraworkout.Ø Becreativetomaximizeallabilities(seeAdaptingCommonExerciseEquipment).

LackofSupportorAccessØ Findanexercisepartner.Ø Connectwithyourcommunityrecreationcentreormunicipalrecreation

departmenttolearnaboutoptions.Ø MakegooduseofresourcessuchastheCanadianWheelchairSportAssociation’s

BridgingtheGapProgram,ActiveLivingAlliance,andtheCanadianParalympicCommitteeportal(SeeLinktoFacilities&Resources:Examples).

Ø Inpoorweather,tryexercisingwithavideo—forexample,theActiveHomesvideosontheSCIActionCanadawebsite.

“ICan’t.”Ø Startwithwhatyouknowandbuildyourskills.Workwhatworks,andfocuson

whatyoucando.Ø Takeatourofafacilitythatoffersanactivitythatinterestsyou.Ø Ifequipmentistooexpensivetopurchaseonyourown,theremaybecommunity-

basedprogramsandfacilitiesthathaveadaptedequipmentavailableforyoutouse(seeLocateLocalResources:TipsandTricks,andFinance&Transportation).

EducateBehaviourChangeTechniques:ProblemSolving

Settasksandgoalsthatareeasilyachievable,andthenincreasetheirdifficulty.

Tailoring/AdaptingSampleProgramTailoredPrescription

ActivityIdeaLadder

Why?Settingtasksandgoalsthataremoreachievablehelpsbuildyourclients’confidenceandincreasestheirlikelihoodtomaintaintheirexerciseprogram.

EducateBehaviourChangeTechniques:GradedTasks

Forsome,meetingtheguidelinesmaynotbeanappropriatefirstgoal.Forideasonhowtogradethetypesofactivitiesyourclientcanstrivetodobasedonwhatgoalisappropriateforthem,see:

Useenvironmentalorsocialstimulitohelptriggeraplannedbehaviour.Belowareafewexamplesofusefulpromptsandcuesyoucanrecommend:

Behaviour Prompt/Cue

Goforawheeltobreakuptheworkday

Programremindersintophone

Goforaswimafterwork Place gogglesbesidecomputer

Exercisefirstthinginthemorning

Set gymclothesbesidebed

Goforawheelaftergettingreadyinthemorning

Putastickynoteonthebathroommirror

Ensure yougetdailyexercise Havesomeonetext youtoaskifyou’veexercisedbeforetheendoftheday

Decreaselongperiodsoftimeworking atadeskwithoutmoving

Settimerson yourphoneorcomputertoremindyoutomoveeveryhourorso

Meetthe guidelinesforexercise

Keepacalendarbyyourdeskwith thedaysyouwanttoexercisecircled

Goforaworkoutafterlunch Packgymclothesunderlunchbag

Goforabikerideafterreading

Putastickynote reminderonapageacouplechaptersahead

EducateBehaviourChangeTechniques:Prompts&Cues

Haveyourclientsignacommitmentcontractormakeaverbalpromisetoachievetheirgoals.(SeeGoalSettingformakingSMARTgoals.)

Belowisablankcommitmentcontract:

Iamcommittedtoachievingthefollowinggoal:

Name_____________________________________________________

Signature__________________________________________________

Date______________________________________________________

EducateBehaviourChangeTechniques:Commitment

Rewardscanbeusedtomotivateyourclientstoengageinphysicalactivityandreachtheirgoals.Theserewardsmaybehelpfulwhenaclientisstartinganexerciseprogram,butrememberthatallclientsshouldbeencouragedtoultimatelyunderstandthattherealpayoffsforexercisingareenjoyment,fun,satisfaction,andsignificantandlong-lastinghealthbenefits.

Examplesofrewards:

Ifyourclientachievesaphysicalactivitygoal,youcouldsuggesttheyrewardthemselveswith:

• ahotbath• amanicure• relaxingandwatchingafavouriteTVshow• verbalencouragement• newexercisegear• adinnerouting• ahealthysmoothie

EducateBehaviourChangeTechniques:Reward

TherearemanyvideosavailableonlinethatfeaturephysicalactivityforpeoplewithanSCI.Someofferinspiringexerciseideas,informationontheSCI-specificbenefitsofexercise,anddetailsonadaptivesports.Othersprovideinformationonrelatedtopics(e.g.,sociallife,caregiving,andfinances).Thesevideosfeatureexpertsinthefieldandthosewithlivedexperience.Hereareafewexamples:

[NorthwestRegionalSpinalCordInjurySystem:SCIForumVideos]http://sci.washington.edu/info/forums/reports/universal_fitness.asp#

[FacingDisabilityVideos]http://www.facingdisability.com/videos/

[ActiveHomes:HomeStrengthTrainingGuideforPeoplewithSCI]http://sciactioncanada.ca/paraplegia-strength-training-videoshttp://sciactioncanada.ca/tetraplegia-strength-training-videos

[NationalCenteronHealth,PhysicalActivityandDisabilityVideos]http://www.nchpad.org/Videos

[SpinalCordInjuryResearchEvidence]https://scireproject.com

EducateAdditionalMaterials:ImportantInformationHubs

TheBasics:• Eachindividualhashisorherownspecificneedsforseatingdependingonthe

leveloflesionandlifestyle.• Properseatingshouldfollowthenaturalcontoursofthebody,providing

posturalsupportandincreasedfunctionalityasmuchaspossibletoenhancetheoverallqualityoflife.

WhyProperSeatingisImportant:• Preventionofmuscleimbalanceandcontracturefromprolongedimproper

posture• Properredistributionofpressure• Protectionofskinintegritybyminimizingunnecessaryshearforces• Providecomfortandreducepain• Helpmaintaineyecontact,increaseself-esteemandconfidence

WhatYouCanDo:1)AskQuestions:Doescomfort,stability,shearing,fatigue,orotherissuesrelatedtoyourchairaffectyourday-to-dayliving?

2)Refertoaseatingspecialist:Haveaproperassessmentdonebyaqualifiedtherapistorseatingandmobilityspecialist.

3)FollowUp:Provideongoingassessmentandmakeadjustmentsorreferralsasneeded.

Wanttolearnmore?[Posturalassessmentandseatingsystems- SpinalOutreachTeam]https://www.health.qld.gov.au/__data/assets/pdf_file/0019/423433/seating.pdf[RehabilitationEngineeringandAssistiveTechnologySocietyofNorthAmerica-ExpertPositionPapers]http://www.resna.org/knowledge-center/position-papers-and-provision-guidesWatchthisvideofortipsforchoosingtherightwheelchair[NRSCISTipsforChoosingtheRightWheelchair]:http://sci.washington.edu/info/forums/reports/wheelchair_choosing.aspDon’thaveanOT?https://www.find-an-ot.ca

EducateAdditionalMaterials:Seating

Tohelpyourclientsstartandcontinuephysicalactivity,linkthemtoresources,orreferthemtopeers,programsandotherprofessionals.

Rememberthatlackoftransportationandfinancesaretwoofthemostcommonlycitedbarrierstoparticipationinphysicalactivity.Refertootherprofessionalsandorganizationstohelpremovethesebarriers.

Researchanddevelopstrategiestoquicklylocatelocalresources,programsandfacilitiessuitableforyourclients.Connectwiththerecreationsectorforassistancewithyourclients’transitionfromtheclinicintothecommunity.

ExamplesofFacilitiesandResources

Learnaboutthekeyfacilitiestoreferclientstoineachprovince,andkeyresourcesthatcanbedistributedtoyourclients.

Finance&Transportation

Linkyourclientswithotherpeersforinvaluableinsightsgainedfromthelivedexperience.4 Peer-to-Peer

Connections

Establishconnectionsandnetworkswithotherprofessionals,supports,andorganizationsforamorecomprehensivephysicalactivitypromotionstrategy.

5OtherProfessionals,

Supports,andOrganizations

Shareyourresearchandknowledgeofexerciseprograms,resources,andotherinformationwithyourcolleagues;learnfromtheirknowledge.Bo

nus DiscussionCommunityto

ShareExercisesandResources

TipsandTrickstoLocateLocalResourcesand

Facilities

Link&ReferOverview&Checklist

Twoofthemostcommonbarrierstoparticipatinginphysicalactivityarelackofaccesstotransportationandfinances.Findingstrategiestoovercomethesebarriersmayrequiresomeinternetresearch,aphonecallortwo,andperhapsmakingyourclient’sfamilymembers,occupationaltherapist,orotherhealthprofessionalsawareofthebarrierssotheycanplayaroleinfindingsolutions.Asyouworktosetyourclientupforsuccess,consideringthefollowingconsiderationsandresources:

TransportationConsiderations:• accessibletransportationserviceswithassistance,taxis,parking• accessiblepublictransportationoptions(low-floorbuses,accessiblesubway/trainstops• parkingpermits• personalvehicleadaptations

Organizationsthatmaybeabletoprovideorfinanceequipmenttosupporttoyourclients:• MarchofDimes• BridgingtheGap• Forkids:[EasterSeals] and[CanadianTireJumpstart]

Organizationsoragenciesthatmaybeabletooffersupportandadvice:• provincialSCIorganizations(e.g.,SCIOntario,SCIPEI,CanadianParaplegicAssociation

Manitoba,SCIBC)[SeeExamplesofFacilities/ResourcestoConnecttoFacilities]• provincialministriesoftransportation• Foracompilationofdifferentfundingagenciessee[AdvancedMobilityAlternative

FundingAgencies]

Tailoring/AdaptingSampleProgram

TailoredPrescription:AdaptedSports

Link&Refer:Peer-to-PeerConnections

Formoreadviceonreducingcostsforsportsequipmentsee:

Forlivedexperienceadviceandtipsonnavigatingtransportationandfinancebarrierssee:

TailoredPrescription:EverydayActive

AdaptingCommonExerciseEquipment

Forideasonwhatyourclientcandoathomewhentransportationisunavailable,see:

Link&ReferFinance&Transportation

Youcansetyourclientsupwiththebestofintentionswhentheyleavetheclinic,butifthere'snowheretogotoexercise,it’sgoingtobedifficultforthemtoactontheirintentions.Herearetwosuggestionstohelpensureyourclientsareconnectedwithresources/facilities:

Notethat,ifyourclientlivesinaruralarea,itmaybedifficulttolocateaccessiblelocalresources.Ifthisisthecase,searchforlocalprogramsandfacilitiesavailabletothegeneralpublicandmakeaquickphonecalltoseeifthey’rewheelchairaccessibleandhaveprogramsorservicesgearedtowardmeetingyourclient’sneeds.

Ifyou’relocatedinalargercity,theseresourcesmaybehelpful:

Familiarizeyourselfwiththelocalaccessibleexerciseoptionswithinthecommunityandreferyourclientstotheseoptions.

ConductyourownsearchSearchtermsonGooglecaninclude:1) [Yourtownorregion]2) [Accessible/inclusive/spinalcordinjury/SCI/adapted/wheelchair]3) [Sport/exercise/programs/physicalactivity/facility]

Ifyouwanttotakeitonestepfurther,connectwithprogramsandfacilitiesthatofferadaptedfitnessopportunities.Seektheirassistanceonhowtosmoothyourclients’transitionfromrehabtothecommunity.Forexample,uponaclient’sdischarge,contactafacilityyou’veestablishedarelationshipwith,andthefacilitycanfollowupwiththeclientfromthatpointon.Makingthisconnectioncanmakeforasmoothertransition,withtheresultbeingawinforyou,yourclient,andthefacility.However,besuretogiveyourclientsalistofoptionssothechoiceisultimatelytheirs.

Establishconnectionswiththerecreationsector

[CanadianWheelchairSportAssociationPrograms]:www.cwsa.ca/programs

[CanadianParalympicCommitteeFindaClub]:www.paralympic.ca

[PhysicalActivity,ActiveLiving,andSportResourceCatalogueforCanadiansLivingwithPhysicalDisability]:www.cdpp.ca

[BridgingtheGapCanadaWheelchairSports]:www.btgcanada.ca

Findlocalaccessibleoptions

Link&ReferLocateLocalFacilitiesandResources:Tips&Tricks

NationalSCIActionCanadaCanadianParalympicCommitteeBridgingtheGapCanada

CanadianWheelchairSportAssociationSCICanada

•PhysicalActivityResearchCentre(Vancouver)•InternationalCollaborationonRepairDiscoveries(ICORD)•RickHansenInstitute(RHI)•SpinalCordInjuryBC•GFStrongRehabilitationCentre(Vancouver)

•SpinalCordInjuryAlberta•SteadwardCentreWheelchairSportsAlberta•UltimateWheelchairSportsFoundation

SpinalCordInjurySaskatchewan

CanadianParaplegicAssociationManitoba

•SpinalCordInjuryOntario•ParaSportOntario•OntarioWheelchairSportsAssociation•MacWheelers(Hamilton)•RevvedUp(Kingston)•PowerCord(St.Catherine’s)•Lyndhurst(Toronto)•WalkitOff(Newmarket)•VarietyVillage(Toronto)•AbilitiesCentre(Whitby)•Cruisers(Mississauga)

MoelleÉpinièreetMotricitéQuébec(MEMO- Qc)

AbilityNewBrunswick

TheCanadianParaplegicAssociationofNovaScotia

SpinalCordInjuryPrinceEdwardIsland

SpinalCordInjuryNewfoundlandandLabrador

Link&ReferLinktoFacilitiesandResources:Examples

Foracomprehensiveandquickhandoutthatincludesinformationonsafety,thebasicsofphysicalactivity,adaptiveactivities,andtipsonhowtomakeaplantoincludephysicalactivityasaregularpartofyourclient’slife,downloadthe[SCIGetFitToolkit]:www.sciactioncanada.ca

Foracomprehensiveguideonsafety,stability,adaptiveequipment,accessibility,exerciseprecautions,andafulloverviewofthecomponentsoffitnessincludingcardiovascular,strengthandflexibilityforwheelchairusers,seethe[NationalCenteronHealth,PhysicalActivityandDisabilityDiscoverAccessibleFitness] resource:http://www.nchpad.org/discoverfitness/index.htmlYoucanalsovisittheNCHPADwebsitefornutritioninformation:[NCHPADlifeonwheels].

Link&ReferLinktoFacilitiesandResources:Examples

ExamplesofWaystoConnectPeers

1) Gettingapeer-to-peerinteractionstartedcouldbeassimpleasaskingyourclientthequestion, “Wouldyoubeinterestedinconnectingwithapeer?”

2) Encourageyourclienttotalktootherswithadisabilityormeetotherpeersthroughgroupexerciseclasses.Thiscouldopenthedoortoexcellentexperientialknowledgeaboutphysicalactivity—insidertipsaboutwheretogo,adaptivestrategies,overcominghurdles,andavoidingsafetyandhealthissues.

3) Accompanyandintroduceyourclienttocoachesormembersofalocaladaptedfacilityorprogram.

4) Inviteachampionormentortoengagewithyourclient.

Notethatthecontextandreadinessoftheclientshouldbeconsideredbeforeinvitingthemtoengagewithapeer.

PeerMentoringProgramsIfyou’reunawareofanypeersforyourclientstoconnectwithlocally,theseorganizationsofferpeermentoringprograms,regularpeereventsandanextensivedatabasethatmakeiteasiertofindanidealpeermatch:

[FacingDisabilityPeerCounselling]:www.facingdisability.com

[ConnecTra SocietyPeerSupport]:http://www.connectra.org

ProvincialSCIOrganizations:[PeerSupport:SCIBC,CanadianParaplegicAssociationManitoba,SCIOntario,MoelleÉpinièreetMotricitéQuébec,AbilityNewBrunswick,CanadianParaplegicAssociationNovaScotia,SCIPrinceEdwardIsland,SCINewfoundlandandLabrador]

RobexperiencedaC5/C6SCIasaresultofadivingaccidentin2011.Priortohisinjury,Robwasthelocaltennisproandownedhisowntenniscompany.Hetaughtwheelchairtennisbeforehisinjury,buthadneverinstructedsomeonewithquadriplegiaandlimitedhandfunction.Inrehab,RobmetGary,anSCIOntariopeermentorwhohadbeenusingawheelchairforeightyearsandregularlyplayedwheelchairtennis.GaryinvitedRobtoplayagameandshowedRobhowhecouldtapehishandtohisracquet.Today,RobisaworldclasstennisathleteandshareshisknowledgeandexperiencewithotherpeoplewithSCIaroundtheworldwhoareinterestedinplayingthegame.Thisisjustoneexampleofhowasimplepeer-to-peerconnectioncanresultinthesharingofpricelessfirsthandexperienceandperhapsevenbeaturningpointinaclient’sdesiretoliveanactivelifestyle.

Link&ReferPeer-to-PeerConnections

Helpingyourclientadoptaphysicallyactivelifestyleoftenrequiresateam,justasrehabilitationforyourclientpost-injuryrequiresateam(e.g.,doctors,occupationaltherapists,respiratorytherapists,etc.).Developingandmaintaininganetworkofpotentialteammembersisagreatfirststep.Yournetworkcanincludeotherhealthcareprovidersandsupportworkers,otherphysiotherapists,andcommunityorganizations.Establishingtheseconnectionscanbeassimpleasreachingoutwithacall,sendinganintroductoryemail,orconnectinginperson.Threekeywaystoengagewithyournetworkareto:

Advocate

Collaborate

Workwithfacilitiesandprogramstocreateabetterunderstandingoftheneedsofyourclientandotherswithmobilitydisabilities.Forexample,challengerecreationandexercisefacilitiestobecomemoreaccessible,andlobbyforprogramstobecomemoreaffordable.

Workwithotherhealthcareproviders,supportworkers,programs,andyourclient’sfamilytoimprovecareintheclinic,community,andthehome.Forexample,reachouttoyourclient’sfamilyandsupportnetworkandworkcollectivelytohelpachieveyourclient’sgoals,negotiateacoordinatedprocesstomoveclientsfromtheclinictocommunity-basedprograms,andrelayknowledgeofyourclient’sprogress,preferences,andgoalstotheiroccupationaltherapistorpersonalsupportworker,whocanhelpyourclientcontinueandmaintainanactivelifestyleinthecommunityandthehome.

Seekadvicefromcentres, physiotherapists,orotherhealthcareproviders(e.g.recreationtherapists)whohaveexperienceworkingwithpeoplewithSCI.Askifthey’rewillingtosharetheirresources.

ExampleofMemberstoIncludeinYourNetwork

Healthcare&SupportProviders Other Physiotherapists Organizations

Rehabandpersonalsupportworkers

Privateneuroclinics Physiotherapy schools

Kinesiologists,personaltrainers GFStrong CollegeofKinesiologists

Familymembers/caregivers BlussonSpinalCord Centre Recreationcentres

Recreationtherapists TorontoRehab(Lyndhurst) CollegeofPhysiotherapists

Physiatrists Hamilton HealthSciencesSpineUnit

CanadianPhysiotherapyAssociation

Link&ReferOtherProfessionals,SupportsandOrganizations

Designexerciseprescriptionstailoredspecificallyforyourclient.

TheInterviewAsktherightquestionstodetermineyourclient’smotivation,goals,andpreferencestolaythefoundationforatailoredandeffectivephysicalactivityprogram.

Determinethelevelofactivitythat’srightforyourclient.Theactivitiesbelow,whichhaveincreasinglevelsofcommitmentandorganization,canbeusedasaguidetoorganizeactivityoptionsbasedonyourclient’sreadiness.

3. AdaptedSports:Foryourclientswhoareinterestedincompetitionandarewillingtoseekmoreorganizedformsofactivity.

2. AccessibleActivities:Typicallyrequiregreatercommitmentandorganizationthaneverydayactiveactivities,butmaynotrequirecommitmenttoateamororganization.

1. EverydayActive:Flexible,easy,andagoodstartingpointfornewexercisersorevenclientswhoarealreadyactive,butshortontimetodotheirtypicalworkout.

2 ActivityIdeaLadder

AdaptingCommonExercise

Equipment

Basicsteps,tips,andresourcestohelpyoudesignatailoredphysicalactivityprescriptionforyourclient.

BasicPhysicalActivity

Prescription

Alistofadaptedequipmentandideasformodifyingexistingormainstreamequipment.

Exampleprogramsfortheathlete,recreationalexerciser,andthenon-exerciser.SamplePrograms

TailoredPrescriptionOverviewandChecklist

TailoredPrescriptionTheInterview:Worksheet

InitialInterviewSessionName:Date:

1)Currentphysicalactivitylevels/readinessforchange:

2)Goals(howmuchphysicalactivityandwhatarethebenefitsthey’dliketogain):

3)Typesofphysicalactivitytheycurrentlyenjoydoing:

4)Availableresources(e.g.,equipment,gym,recreationcentres nearthem,funding):

5)Barrierstoaccomplishingtheirgoal:

6)Mutuallydiscussshorttermgoalsandstrategies(orseePg.16foralternativegoalsettingandactionplanningformats):

Option1 Option2 Option 3

Activity

Howlong

Howoften34

1)Gaugeyourclient’scurrentphysicalactivitylevelsandreadinessfor

change

3)Learnwhatyourclientenjoysdoing

2)Identifyyourclient’sgoals

• Doyoucurrentlyplayasportorhaveahistoryofsportparticipation?

• Haveyoubeenexercisingregularlyduringthepastsixmonths?

• Wouldyouliketobeginexercisingorcontinueexercising?

• Whatsortofgoalsareyouworkingtowardsinyourhomeoryourdailylife?

• Isthereanythingthatyouhavedifficultydoingthatyou’dliketobeabletodobetterorwithgreaterindependence?

• Howmuchphysicalactivitywouldyouliketoseeyourselfdoingaweek?

• Whatsortsofactivitieshaveyoudoneinthepast,beforeandafteryourinjury?

• Whatsortsofactivitieswouldyouliketotryrightnow?

Herearesomesamplequestionstoaskyourclienttohelpyoumoveforwardwithatailoredphysicalactivityplan:

TailoredPrescriptionTheInterview

4)Understandwhatresourcesyourclienthasavailabletothem

6)Developaphysicalactivitygoalasateam

5)Identifyyourclient’sbarriers

• Doyouhaveanyexerciseequipmentathome?

• Isthereagymthatyouknowofthatisaccessibleoristhereagyminyourneighbourhoodthatwecouldinquireabouttheiraccessibility?

• Doyouhaveanyonetohelpyouexerciseorhelpkeepyouontrack?

• Canyouthinkofanythingthatyoucouldforeseegettinginthewayofyourprogram?

• Arethereanyobstaclesthathavecomeupinthepastthathavepreventedyoufrombeingphysicallyactive?

• Whatdoyouthinkisareasonablegoalforhowmuchexerciseyou’lldoinaweek

• Basedonwhatyoutoldme,does__x/weekforabout__minuteseachsessionseemlikeareasonablegoal?

Herearethedetailedstepstotailoringyourexerciseprescriptionbygettinganin-depthpictureofyourclient’ssituation(refertotheworksheetandsamplequestionsonPg.34):

1) Gaugeyourclient’scurrentphysicalactivitylevelsandreadinessforchange

Askyourclienthowmuchphysicalactivitytheyarecurrentlydoing(ifany).Understandtheirstageofmotivation(pre-intender,intender,actor)v Actors:Clientswhohavestartedexerciseorhavebeenexercisingforalongtimev Intenders:Clientswhohavenotbeenexercisingbutwouldliketov Pre-Intenders:Clientswhohavenotbeenexercisingandhavenointentiontodoso.Inthiscase,

understandwhythey’renotinterestedinbeingphysicallyactive.Youmayconsiderthefollowingresourcestoaddresspotentialbarrierstowantingtoexercise:

2)Ifyourclientisanactororintender,identifyyourclient’sgoals.

Educateyourclientonthephysicalactivityguidelines(Pg.12)andidentify:1) Howoftenandhowmuchphysicalactivityyourclientwouldliketodoaweek.2) Whatsortofbenefitstheywouldliketoseefrombeingphysicallyactive(e.g.transferring

independently,playingandbeingmoreinvolvedwiththeirkids).Linkinghowexercisecanhelpthemaccomplisheverydaylifegoalsmaybemoremeaningfulforsomeclients.

3)Learnwhatyourclientenjoysdoing

Physicalactivityparticipationismorelikelytobemaintainedwhentheactivityisenjoyable.Trialanderrormaybenecessarytofindtheactivities,sports,andmodalitiesthatappealtoyourclient.

4)Understandwhatresourcesyourclienthasavailabletothem

Askwhatequipment,facilities,andhelptheyhaveavailabletofacilitatetheirexercise.Forexample,whetherthereareappropriategyms,park,tracksnearby,equipmentathome,potentialexercisebuddiesorexerciseassistantsavailabletothem.

5)Identifyyourclient’sbarriers

Identifywhethertheyforeseeanybarrierstoparticipatinginphysicalactivitysuchastransportation,confidence,accesstofacilities,pain,knowledge,etc.

6)Developanactionplanasateam

Takingalltheinformationgathered,decideuponanactionplantogether(Pg.16).Ifappropriate,proceedtodevelopingatailoredexerciseprescription.

TailoredPrescriptionTheInterview

• SafetyPg.8• BenefitsPg.13• FinanceandTransportationPg.27

• LinktoFacilities/Resources:ExamplesPg.29• Peer-to-PeerConnectionsPg.31• ActivityIdeaLadderPg.37

SmallStepsApproach:

Thedifferenttypesofactivitiesonthisactivityladderrequireanincreaseincommitmentandorganizationasyouclimbtheladder.Notallstepsoftheladderneedtobetaken.Theladderissimplyaguidetohelporganizeactivitiesbasedonyourclient’sneeds.

EverydayActive

AccessibleActivities

AdaptedSports

Ensureyourclienthasbeenclearedforactivities.Ifyou’reunsure,refertothesafetysection,PAR-Q,ACSMguidelines,orcontactyourclient’sphysician.

TailoredPrescriptionActivityIdeaLadder

Walkorwheelto:• school• work• runerrandsto:

o grocerystoreo banko conveniencestoreo postofficeo pharmacy

Resistancebandandrangeofmotionexercises(canbedonewhilewatchingTV,doingcomputerwork,orreading):

• ankleflexion/dorsiflexion• squeezeobjectforgrip• bicepcurls• kneeraises• legextension• hipadduction/abduction• leanforwardandbackwardforcorestrength• leansidetosideforcorestrength(clientswithlowtrunkactivationcansupport

themselvesbyholdingthewheeloppositethedirectionleaning)

Everydayactivities:• standing• calfraisesatthesinkwhiledoingdishes• takingthedogoutforawalkorroll• playingwithyourkids• parkingfurtherawayfromyourdestinationandwalkingorwheelingtherestofthe

way• wheelingorwalkingatthemall,anindoortrack,oranarenaduringbadweather• holdingwalkingorwheelingmeetings

Theseactivitiesaremeanttobeflexible,easy,andagoodstartingpointfornewexercisersorevenexperiencedexerciserswhoareshortontimetodotheirtypicalworkoutroutine.Manyoftheseactivitieshavetheaddedbenefitofbeingabletobedoneathome.

TailoredPrescriptionActivityIdeaLadder:EverydayActive

AerobicActivities:• wheelforfunandendurance• cycleusingahandcycleorstationarybike• armergometer(armbike)• swim(withassistanceifneeded)• followalongwithanexercisevideo• playrecreationalsports• standingframeexercises• dance• curling• bocce

StrengtheningActivities:• resistancebands• liftweights(clientswithoutweightscanusecans,bottles,orotherhouseholditems)• usecablepulleys• bodyweightexercises• Yoga,PilatesorTaiChi

LOOKINGFORMORESTRENGTH-TRAININGIDEAS?CheckouttheActiveHomesresourcemanualsandinstructionalvideosontheSCIActionCanadawebsite.[ActiveHomesSCIActionCanada]:www.sciactioncanada.ca

Theseactivitiesaretypicallyhigherinintensityandmaybringgreaterfitnessandhealthbenefitsthaneverydayactiveactivities,butmaynotrequirecommitmenttoateamororganization.

Lookingforsomethingoutsideofthebox?Tryhighintensityintervaltraining.Ifyourclientdoesn’tenjoydoingcontinuousexercise(e.g.,cyclinganarmergometeratmoderateintensityfor20minutes),highintensityintervaltraining(HIIT)maybeanalternative.HIITconsistsofperiodsofhighintensityexercise,interspersedwithperiodsofrestorlowintensity.

WhilemoreSCI-specificresearchisneededtotestthebenefitsofthistypeoftraining,someclientsreportthistypeofactivitycanbeengaging,helpmaintainadherencewhenpainorfatiguearebarrierstoexercise,andbecompletedinashorterperiodoftime.SomeexamplesofHIITprotocolsthathavebeenstudiedinpeoplewithSCIinclude:

• 60secondsofmoderatetovigorousintensity,90secondsactiverest,for8sets• fourminutesatvigorousintensity,threeminutesactiverest,withincreasesinsetsas

appropriate• fourminutesmoderateintensity,oneminutevigorousactivity,withfivesets

Tailorthenumberofsetsandintensitybasedontheindividual’sleveloffitness.

TailoredPrescriptionActivityIdeaLadder:AccessibleActivities

Gettingyourclientsinvolvedinsport:Connectthemwithpeersinvolvedinsport,whocancreateenthusiasmandeducate:

• See[Peer-to-PeerConnections]• The[CanadianWheelchairSportsAssociation] canpersonallylinkyourclientto

wheelchairrugbyorothersportprogramsacrossCanada:www.cwsa.ca

Researchwhichlocaladaptedsportsareavailableinyourarea:• See[TipsandTricksforLocatingLocalResources]• [BridgingtheGapCanada’s‘HaveaGoDays’] areanopportunitytotrywheelchairsport

inafunandsupportiveenvironment:www.btgcanada.ca• Trythe[CanadianParalympicCommitteeFindaClub] function:www.paralympic.ca

Fundingforequipment:• [BridgingtheGapCanadaWheelchairLoans] canconnectyourclientwithprovincial

coordinatorswhocanoftensubsidizerentalfeesforsportwheelchairs:www.btgcanada.ca

• [ParaSport OntarioEquipmentRental] canarrangevarioussportequipmentrentals:www.parasportontario.ca

• [MarchofDimesAssistiveDevicesProgram] canhelpprovidefundingforequipment:www.marchofdimes.ca

TypicallyRequireSpecializedEquipment• fencing• powerlifting• Nordicandalpineskiing• waterskiing• cycling• sledgehockey• sailing• rugby(murderball)• horsebackriding• rockclimbing• hiking• canoeing• surfing• kayaking• rowing

CanBeLowCost

• tabletennis• athletics*• swimming• basketball*• boccia• curling• bowling• dance• golf*• boxing• martialarts• softball• tennis*• sittingvolleyball*canrequirespecialtychair

Theseactivitiesareforyourclientwhomightbelookingforcompetitionandiswillingtoseekmoreorganizedformsofactivity.

TailoredPrescriptionActivityIdeaLadder:AdaptedSports

Afterconductingtheinterviewanddeterminingphysicalactivitiesthatareinterestingandappropriateforyourclient,aphysicalactivityprescriptioncanbecreated.Aim tohaveyourclientatleastmeettheSCIphysicalactivityguidelines (fitnessbenefits:2x20minutesofmoderatetovigorousphysicalactivity/wk ANDstrengthtraining2x/wk,cardiometabolic healthbenefits:3x30minutesofmoderatetovigorousphysicalactivity/wk).However,noteveryclientwillbereadytomeettheguidelines.Tailor theexercisegoaltoyourclienttoensureit’sattainable.There’snoblanketstrategyfordesigninganexerciseprescription;yourapproachmaybedifferentforeachclient.Seethefollowingresourcesformorehelp:

Foraquickandeasywaytobuildexerciseprogramsonline,see:

Thiswebsiteiscontinuallyupdatedandbasedonthebestavailableevidence.Withmorethan1,000strengthandflexibilityexercises,youcaneasilybuildaprogramappropriateforaclientwithSCI(orotherdisabilities).Youcansearchforexercisesbydifferentcategoriesincludingcondition,exercisetype,bodypart,equipmentavailable,andage.Eachexercisehasanaccompanyingillustration,alongwithinstructions,goalsandprecautions,allwrittenintwoformats—oneappropriatefortheclient,theotherforthephysiotherapist.

Forsampleprogramsandfreeonlinefitnessandnutritiontraining,see:

TheNationalCenteronHealth,PhysicalActivityandDisability(NCHPAD)offersmanyresourcesforpeoplewithphysicaldisabilities,includingvideos,weeklyhighintensitytrainingprograms[NCHPADChampion’sRx],and14weeksoffreeonline,individualizedphysicalactivityandnutritioncoachingsessions[NCHPAD14WeekstoaHealthierYou].

PhysiotherapyExercises.com

Educate:SMARTGoalSetting

Educate:ActionPlanning

Tailoring:SampleProgram

NCHPAD.org

TailoredPrescriptionBasicPhysicalActivityPrescription

ExercisePrescription

1. Workwhatworks.Don’tgetboggeddownbyfunctionallimitations.Instead,focusonwhatyourclientcando,andprogressfromthere.

2. Thisisyourwheelhouse,soprescribephysicalactivitytoextendbeyondtypicalrehabexercises.

3. Safetycomesfirst,butdon’tbeafraidtochallengeyourclientifthey’rereadyandwilling.

4. Bemindfulofpreventingoveruseinjuriestotheupperbody(e.g.,shoulder,elbows,andwrists).Damagetojointsandmusclesintheupperbodycanseverelylimitaclient’sindependencewhenitcomestotransferringandwheeling.

5. Yourclientwheelsthroughouttheday,workingthepushmotionregularly.Incorporateposturalexercises(e.g.,scapularretractions)andemphasizepullingmovements.

6. Ifyourclienthasspasticity,focusonantagonistmovements.

7. Circuittraining(i.e.aseriesofresistanceexercisesinterspersedwithbriefaerobicexercise)isaneffectivewaytoincreasefitnessforpeoplewithSCI.

12QuickTips&TricksoftheTrade

Equipment

1. Ifgripassistanceglovesorstrapsareunavailable,usetensorbandagestoprovidegripassistance.

2. Considerwhichexercisesrequiretheuseofgripassistanceandgroupthoseexercisestogethertosavetimeandavoidtakinggripassistanceglovesonandoff.

3. Trytouseasfewtransfersaspossible(e.g.,doallexercisesthatrequiretransferringtoaplinthtogether).

4. Wedgeweightsbetweenthefloorandthewheeltokeepthewheelchairinplace.

5. Useelasticresistancebandsorstrapsaroundthelegstoavoidexcessiveabductionwhileusingequipmentsuchasarecumbentbike,oraroundthechesttostabilizethecore.

6. Withresistancebands,exercisecanbedoneanywhere.Theyareaninexpensive,easilytransportable,andcanbeusedathome,ontheplaneorbus,inthecar,etc.

TailoredPrescriptionBasicPhysicalActivityPrescription

Andreabecameparaplegicafterdevelopingtransversemyelitis,aneurologicalconditionthataffectsthespinalcord,attheageof12.Today,she’saworld-classwaterskierandenjoysbeingcompetitivewithherpartner inallaspectsoftheirlives.She’sbeenexercisingforalongtimeandenjoyschallengingherself,butshegetsboredeasilywithherworkoutsandneedsvariety.Andrealivesainacitywithanexcellentadaptedgymfacility.Hergoalsareweightlossandgeneralconditioning.Here’sasampleofAndrea’stypicalworkoutthatshedoesononeofherthreedaysatthegym(sometimesincompetitionwithherpartner):

Client's Name: Date

Duration of Training: 20-Jun

XExercises Instructions Equip. Lbs SxR

Arm Ergometer 30s hard, 30s active rest, repeat 5 times Arm Erg

Int/ Ext Rotation Pulley 10/7.5 lbs 3x10

Single Arm Seated Row Single arm, try to use core to stabilize, otherwise stabilize with opposite hand on wheel Pulley 10lbs 3x10

Med Ball Figure 8's Med Ball 6lbs 3x10

Vita Glide 5 minutes continuous Arm Erg

Lat Pull Down Pulley 70lbs 3x10

Cross Body Pull Pulley 12.5 lbs 3x10

Med Ball Overhead Rotations Med Ball 8lbs 3x10

Arm Ergometer 20 s hard, 10 s active rest, repeat 8 times Arm Erg

Shoulder Abduction Free Weight 5lbs 3x10

Knee Raise and Leg Extension MAKE SURE SHE DOES THEM! :) Ankle Weights 3lbs 3x10

Ab Crunch Pulley 37.5 lbs 3x10

KINGSTON REVVED UP - WORK-OUT TRAININGSt. Mary's of the Lake Hosptial and Queen's Kinesiology Building

WARM-UP: Aerobic- NuStep- 5-10 min

COOL-DOWN: Cardio- Wheelchair treadmill or arm ergometer, her choice

Special InstructionsShaded exercises are to be done in circuit

Andrea1 hour

TailoredPrescriptionSampleProgram:Athlete

MarneyhasaT5completespinalcordinjury.Sheenjoysspendingtimewithherdog,Dude,woodworking,andsocializing.Hergoalistokeepmovingandmaintainherindependencesothatshecandotheactivitiesthatsheenjoys.Marney likestogotothegym,butpreferstohavevarietyinheractivities.Here’sasampleofMarney’stypicalactivityschedulefortheweek:

TailoredPrescriptionSampleProgram:RecreationalExerciser

Sun Mon Tues Wed Thurs Fri Sat

Activity Walk thedog

Resistancetraining

Skillstrainingwith herdog

Spinclass

Where Trail Gym Park Gym

When 9am 2pm 2pm 10am

Howlong 30min. 30min. 20min. 30min.

Intensity Mild Moderate Mild Moderateto

Vigorous

Anyonewhodoesn’ttakepartinanyphysicalactivitymayhaveanumberofbarrierspreventingthemfromexercising.Ifclientsarewillingtoworkwithyoutoidentifyandaddressthesebarriers,youcanstructureaprogramthatcanaccommodatetheirsituation.Forexample,clientsmaytellyouthatthey’dliketoexercisebutfinditdifficulttofindtransportationandgetoutofthehomewithoutassistance.Ortheymaynothavemuchexerciseexperienceandlacktheabilitytoexerciseforanythinglongerthanafewminutes.Here’sasampleprogramthatcanhelpbegintoremovethesebarriersbyprescribingeasy-to-startexercisesthatcanbedoneathome.

IfwatchingTV,dothreesetsof:• 10bicepcurlswitharesistanceband• 10kneeraises• 10bodyweightliftsoffthechair

EverySaturdaymorning,putonanexercisevideoandfollowalong.Startbydoing10minutesofthevideo,andthenaddingacoupleminuteseachtime.

Progresswillbereviewedduringthenextvisit.

Signature:_______________________

ExercisePrescription

ClientName:_________NextVisit:____________

TailoredPrescriptionSampleProgram:Non-Exerciser

Iftraditionalexerciseequipmentisnotsuitableoravailable,herearesomealternatives:

Weights• cans• large/smallbottles(addliquidformoreweight)• bodyweight• resistancebands[e.g.www.treadmillfactory.ca 14piecepowerpack]

StretchingAids• resistanceband• towel• wall• cane

CommonAdaptedExerciseEquipment• gripaids• tensors(fortensoringhandforgripassistance)• wristweights• wheelchairpushgloves• medicineballs(ifithashandles,canutilizetensorsforgripassistance)• pulleys/cables(cantensorinhandoruseagripaid)• freeweights(utilizetensorforgripassistance)

SpecialtyEquipment• boxinggloves• armergometer(armbike)• VitaGlide• NuStep• rickshaw• wheelchairtreadmill• functionalelectricalstimulation(FES)• motorizedrecumbentbike• seatedelliptical• bodyweightsupportedtreadmill• bodyweightsupportedtreadmill• Lite-gait• passiverangeofmotionequipment(e.g.Motomed)

TailoredPrescriptionAdaptingCommonExerciseEquipment

ReprintedwithpermissionfromthePAR-Q+Collaboration(www.eparmedx.com)andtheauthorsofthePAR-Q+(Dr.DarrenWarburton,Dr.NormanGledhill,Dr.VeronicaJamnik,Dr.RoyShephard,andDr.ShannonBredin) 47

1. Do you have Arthritis, Osteoporosis, or Back Problems?

1a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments)

1b. Do you have joint problems causing pain, a recent fracture or fracture caused by osteoporosis or cancer, displaced vertebra (e.g., spondylolisthesis), and/or spondylolysis/pars defect (a crack in the bony ring on the back of the spinal column)?

1c. Have you had steroid injections or taken steroid tablets regularly for more than 3 months?

If the above condition(s) is/are present, answer questions 1a-1c If NO go to question 2

2. Do you have Cancer of any kind?If the above condition(s) is/are present, answer questions 2a-2b

3. Do you have a Heart or Cardiovascular Condition? This includes Coronary Artery Disease, Heart Failure, Diagnosed Abnormality of Heart Rhythm

If the above condition(s) is/are present, answer questions 3a-3d

If the above condition(s) is/are present, answer questions 5a-5e5. Do you have any Metabolic Conditions? This includes Type 1 Diabetes, Type 2 Diabetes, Pre-Diabetes

If NO go to question 3

4. Do you have High Blood Pressure? If the above condition(s) is/are present, answer questions 4a-4b

4b. Do you have a resting blood pressure equal to or greater than 160/90 mmHg with or without medication? (Answer YES if you do not know your resting blood pressure)

2a. Does your cancer diagnosis include any of the following types: lung/bronchogenic, multiple myeloma (cancer of plasma cells), head, and neck?

2b. Are you currently receiving cancer therapy (such as chemotheraphy or radiotherapy)?

3b. Do you have an irregular heart beat that requires medical management? (e.g., atrial fibrillation, premature ventricular contraction)

3c. Do you have chronic heart failure?

3d. Do you have diagnosed coronary artery (cardiovascular) disease and have not participated in regular physical activity in the last 2 months?

5a. Do you often have difficulty controlling your blood sugar levels with foods, medications, or other physician- prescribed therapies?

5b. Do you often suffer from signs and symptoms of low blood sugar (hypoglycemia) following exercise and/or during activities of daily living? Signs of hypoglycemia may include shakiness, nervousness, unusual irritability, abnormal sweating, dizziness or light-headedness, mental confusion, difficulty speaking, weakness, or sleepiness.

5c. Do you have any signs or symptoms of diabetes complications such as heart or vascular disease and/or complications affecting your eyes, kidneys, OR the sensation in your toes and feet?

5d. Do you have other metabolic conditions (such as current pregnancy-related diabetes, chronic kidney disease, or liver problems)?

5e. Are you planning to engage in what for you is unusually high (or vigorous) intensity exercise in the near future?

2015 PAR-Q+YES NO

YES NO

FOLLOW-UP QUESTIONS ABOUT YOUR MEDICAL CONDITION(S)

YES NO

If the above condition(s) is/are present, answer questions 7a-7d

If the above condition(s) is/are present, answer questions 8a-8c

If the above condition(s) is/are present, answer questions 9a-9c

If you have other medical conditions, answer questions 10a-10c

If NO read the Page 4 recommendations

2015 PAR-Q+

YES NO

GO to Page 4 for recommendations about your current medical condition(s) and sign the PARTICIPANT DECLARATION.

7. Do you have a Respiratory Disease? This includes Chronic Obstructive Pulmonary Disease, Asthma, Pulmonary High Blood Pressure

7b. Has your doctor ever said your blood oxygen level is low at rest or during exercise and/or that you require supplemental oxygen therapy?

7c. If asthmatic, do you currently have symptoms of chest tightness, wheezing, laboured breathing, consistent cough (more than 2 days/week), or have you used your rescue medication more than twice in the last week?

7d. Has your doctor ever said you have high blood pressure in the blood vessels of your lungs?

8. Do you have a Spinal Cord Injury? This includes Tetraplegia and Paraplegia

8b. Do you commonly exhibit low resting blood pressure significant enough to cause dizziness, light-headedness, and/or fainting?

8c. Has your physician indicated that you exhibit sudden bouts of high blood pressure (known as Autonomic Dysreflexia)?

9. Have you had a Stroke? This includes Transient Ischemic Attack (TIA) or Cerebrovascular Event

9b. Do you have any impairment in walking or mobility?

9c. Have you experienced a stroke or impairment in nerves or muscles in the past 6 months?

10. Do you have any other medical condition not listed above or do you have two or more medical conditions?

10a. Have you experienced a blackout, fainted, or lost consciousness as a result of a head injury within the last 12 months OR have you had a diagnosed concussion within the last 12 months?

10b. Do you have a medical condition that is not listed (such as epilepsy, neurological conditions, kidney problems)?

10c. Do you currently live with two or more medical conditions? PLEASE LIST YOUR MEDICAL CONDITION(S) AND ANY RELATED MEDICATIONS HERE:

01-01-2015

6. Do you have any Mental Health Problems or Learning Difficulties? This includes Alzheimer’s, Dementia, Depression, Anxiety Disorder, Eating Disorder, Psychotic Disorder, Intellectual Disability, Down Syndrome

If the above condition(s) is/are present, answer questions 6a-6b If NO go to question 7

6b. Do you ALSO have back problems affecting nerves or muscles?

YES NO

Tailoring/AdaptingSampleProgramReferences

Arbour-Nicitopoulos,K.P.,MartinGinis,K.A.,&Latimer,A.E.(2009).Planning,leisure-timephysicalactivity,andcopingself-efficacyinpersonswithspinalcordinjury:Arandomizedcontrolledtrial.ArchivesofPhysicalMedicineandRehabilitation,90(12),2003–2011.http://doi.org/10.1016/j.apmr.2009.06.019Astorino,T.A.,&Thum,J.S.(2016).Intervaltrainingelicitshigherenjoymentversusmoderateexerciseinpersonswithspinalcordinjury.TheJournalofSpinalCordMedicine.http://doi.org/10.1080/10790268.2016.1235754Bouchard,C.,&Shephard,R.J.(1994).Physicalactivity,fitness,andhealth:themodelandkeyconcepts.InPhysicalActivity,Fitness,andHealth:InternationalProceedingsandConsensusStatement (pp.77–88).Brawley,L.R.,Arbour-nicitopoulos,K.P.,&MartinGinis,K.A.(2013).Developingphysicalactivityinterventionsforadultswithspinalcordinjury.Part3:Apilotfeasibilitystudyofaninterventiontoincreaseself-managedphysicalactivity,58(3),316–321.http://doi.org/10.1037/a0032814Brurok,B.,Helgerud,J.,Karlsen,T.,Leivseth,G.,&Hoff,J.(2011).Effectofaerobichigh-intensityhybridtrainingonstrokevolumeandpeakoxygenconsumptioninmenwithspinalcordinjury.AmericanJournalofPhysicalMedicine&Rehabilitation,90(5),407–414.http://doi.org/10.1097/PHM.0b013e31820f960fFaulkner,G.,Gorczynski,P.,Arbour,K.,Letts,L.,Wolfe,D.,&MartinGinis,K.(2010).Messengersandmethodsofdisseminatinghealthinformationamongindividualswithspinalcordinjury:Ascopingreview.HandbookofSpinalCordInjuries,(416),349–374.Froehlich-Grobe,K.,Lee,J.,Aaronson,L.,Nary,D.E.,Washburn,R.A.,&Little,T.D.(2014).Exerciseforeveryone :Arandomizedcontrolledtrialofprojectworkoutonwheelsinpromotingexerciseamongwheelchairusers.ArchivesofPhysicalMedicineandRehabilitation,95(1),20–28.http://doi.org/10.1016/j.apmr.2013.07.006Froehlich-Grobe,K.,&White,G.W.(2004).Promotingphysicalactivityamongwomenwithmobilityimpairments:Arandomizedcontrolledtrialtoassessahome- andcommunity-basedintervention.ArchivesofPhysicalMedicineandRehabilitation,85(4),640–648.http://doi.org/10.1016/j.apmr.2003.07.012Hasnan,N.,Engkasan,J.,Husain,R.,&Davis,G.(2013).High- intensityvirtual- realityarmplusFES- legintervaltraininginindividualswithspinalcordinjury.BiomedicalTechnology,58.http://doi.org/10.1515/bmt-2013-40Hicks,A.L.,MartinGinis,K.A.,Pelletier,C.A.,Ditor,D.S.,Foulon,B.,&Wolfe,D.L.(2011).Theeffectsofexercisetrainingonphysicalcapacity,strength,bodycompositionandfunctionalperformanceamongadultswithspinalcordinjury:asystematicreview.SpinalCord,49(11),1103–1127.http://doi.org/10.1038/sc.2011.62Kosma,M.,Cardinal,B.J.,&McCubbin,J.A.(2005).Apilotstudyofaweb-basedphysicalactivitymotivationalprogramforadultswithphysicaldisabilities.DisabilityandRehabilitation,27(23),1435–1442.http://doi.org/10.1080/09638280500242713Krassioukov,A.,Eng,J.J.,&Warburton,D.E.(2009).Asystematicreviewofthemanagementoforthostatichypotensionafterspinalcordinjury.ArchivesofPhysicalMedicineandRehabilitation,90(5),876–885.http://doi.org/10.1016/j.apmr.2009.01.009Krassioukov,A.,Warburton,D.E.,Teasell,R.,Eng,J.J.,&TheSCIREResearchTeam.(2009).Asystematicreviewofthemanagementofautonomicdysreflexia followingspinalcordinjury.ArchivesofPhysicalMedicineandRehabilitation,90(4),682–695.http://doi.org/10.1016/j.apmr.2008.10.017.ALatimer-Cheung,A.E.,Arbour-Nicitopoulos,K.P.,Brawley,L.R.,Gray,C.,JustineWilson,A.,Prapavessis,H.,…MartinGinis,K.A.(2013).Developingphysicalactivityinterventionsforadultswithspinalcordinjury.Part2:Motivationalcounselingandpeer-mediatedinterventionsforpeopleintendingtobeactive.RehabilitationPsychology,58(3),307–15.http://doi.org/10.1037/a0032816Latimer,A.E.,MartinGinis,K.A.,&Arbour,K.P.(2006).Theefficacyofanimplementationintentioninterventionforpromotingphysicalactivityamongindividualswithspinalcordinjury:Arandomizedcontrolledtrial.RehabilitationPsychology,51(4),273–280.http://doi.org/10.1037/0090-5550.51.4.273Letts,L.,MartinGinis,K.A.,Faulkner,G.,Colquhoun,H.,Levac,D.,&Gorczynski,P.(2011).Preferredmethodsandmessengersfordeliveringphysicalactivityinformationtopeoplewithspinalcordinjury:afocusgroupstudy.RehabilitationPsychology,56(2),128–137.http://doi.org/10.1037/a0023624Ma,J.K.,&MartinGinis,K.A.(2018).Ameta-analysisofphysicalactivityinterventionsinpeoplewithphysicaldisabilities:Content,characteristics,andeffectsonbehaviour.PsychologyofSport&Exercise.http://doi.org/10.1016/j.psychsport.2018.01.006MartinGinis,K.A.,Arbour-Nicitopoulos,K.P.,Latimer,A.E.,Buchholz,A.C.,Bray,S.R.,Craven,B.C.,…Wolfe,D.L.(2010).Leisuretimephysicalactivityinapopulation-basedsampleofpeoplewithspinalcordinjurypartII:Activitytypes,intensities,anddurations.ArchivesofPhysicalMedicineandRehabilitation,91(5),729–733.http://doi.org/10.1016/j.apmr.2009.12.028MartinGinis,K.A.,Hicks,A.L.,Latimer,A.E.,Warburton,D.E.R.,Bourne,C.,Ditor,D.S.,…Wolfe,D.L.(2011).Thedevelopmentofevidence-informedphysicalactivityguidelinesforadultswithspinalcordinjury.SpinalCord,49(11),1088–1096.http://doi.org/10.1038/sc.2011.63MartinGinis,K.A.,Ma,J.K.,Latimer-Cheung,A.E.,&Rimmer,J.(2016).Asystematicreviewofreviewarticlesaddressingfactorsrelatedtophysicalactivityparticipationamongchildrenandadultswithphysicaldisabilities.HealthPsychologyReview,7199(June),1–31.http://doi.org/10.1080/17437199.2016.1198240MartinGinis,K.A.,Phang,S.H.,Latimer,A.E.,&Arbour-Nicitopoulos,K.P.(2012).Reliabilityandvaliditytestsoftheleisuretimephysicalactivityquestionnaireforpeoplewithspinalcordinjury.ArchivesofPhysicalMedicineandRehabilitation,93(4),677–682.http://doi.org/10.1016/j.apmr.2011.11.005MartinGinis,K.A.,Tomasone,J.R.,Latimer-Cheung,A.E.,Arbour-Nicitopoulos,K.P.,Bassett-Gunter,R.L.,&Wolfe,D.L.(2013).Developingphysicalactivityinterventionsforadultswithspinalcordinjury.Part1:acomparisonofsocialcognitionsacrossactors,intenders,andnonintenders.RehabilitationPsychology,58(3),299–306.http://doi.org/10.1037/a0032815MartinGinis,K.A.,vanderScheer,J.W.,Latimer-Cheung,A.E.,Barrow,A.,Bourne,C.,Carruthers,P.,...&Hayes,K.C.(2018).Evidence-basedscientificexerciseguidelinesforadultswithspinalcordinjury:anupdateandanewguideline. Spinalcord, 56(4),308.Michie,S.,Abraham,C.,Whittington,C.,McAteer,J.,&Gupta,S.(2009).Effectivetechniquesinhealthyeatingandphysicalactivityinterventions:Ameta-regression.HealthPsychology,28(6),690–701.http://doi.org/10.1037/a0016136

Tailoring/AdaptingSampleProgramReferences

Michie,S.,Richardson,M.,Johnston,M.,Abraham,C.,Francis,J.,Hardeman,W.,…Wood,C.E.(2013).Thebehaviorchangetechniquetaxonomy(v1)of93hierarchicallyclusteredtechniques:Buildinganinternationalconsensusforthereportingofbehaviorchangeinterventions.AnnalsofBehavioralMedicine,46(1),81–95.http://doi.org/10.1007/s12160-013-9486-6Pelletier,C.A.,Latimer-cheung,A.E.,Warburton,D.E.,&Hicks,A.L.(2014).Directreferralandphysicalactivitycounsellingupondischargefromspinalcordinjuryrehabilitation,52(5),392–395.http://doi.org/10.1038/sc.2014.16Riebe,D.,Franklin,B.A.,Thompson,P.D.,Garber,C.E.,Whitfield,G.P.,Magal,M.,&Pescatello,L.S.(2015).UpdatingACSM’srecommendationsforexercisepreparticipation healthscreening.Medicine&ScienceinSports&Exercise,2473–2479.http://doi.org/10.1249/MSS.0000000000000664Rimmer,J.H.,&Henley,K.Y.(2013).Buildingthecrossroadbetweeninpatient/outpatientrehabilitationandlifelongcommunity-basedfitnessforpeoplewithneurologicdisability.JournalofNeurologicPhysicalTherapy :JNPT,37(2),72–7.http://doi.org/10.1097/NPT.0b013e318291bbf6Scelza,W.M.,Kalpakjian,C.Z.,Zemper,E.D.,&Tate,D.G.(2005).Perceivedbarrierstoexerciseinpeoplewithspinalcordinjury.AmericanJournalofPhysicalMedicine&Rehabilitation,84(8),576–583.http://doi.org/10.1097/01.phm.0000171172.96290.67Schwarzer,R.(2008).Modelinghealthbehaviorchange:Howtopredictandmodifytheadoptionandmaintenanceofhealthbehaviors.AppliedPsychology,57(1),1–29.http://doi.org/10.1111/j.1464-0597.2007.00325.xSchwarzer,R.,Lippke,S.,&Luszczynska,A.(2011).Mechanismsofhealthbehaviorchangeinpersonswithchronicillnessordisability:theHealthActionProcessApproach(HAPA).RehabilitationPsychology,56(3),161–70.http://doi.org/10.1037/a0024509Shirley,D.,vanderPloeg,H.P.,&Bauman,A.E.(2010).Physicalactivitypromotioninthephysicaltherapysetting:Perspectivesfrompractitionersandstudents.PhysicalTherapy,90(9),1311–22.http://doi.org/10.2522/ptj.20090383TheSCIREResearchTeam.SpinalCordInjuryResearchEvidence.Retrievedfromscireproject.comTomasone,J.R.,Flood,S.M.,Ma,J.K.,Scime,N.V,Burke,S.M.,Sleeth,L.,…TheSCIREResearchTeam.(2018).Physicalactivityself-managementinterventionsforadultswithspinalcordinjury:Part1–Asystematicreviewoftheuseandeffectivenessofbehavior changetechniques.PsychologyofSport&Exercise.http://doi.org/10.1016/j.psychsport.2018.01.012Tordi,N.,&Dugue,B.(2001).Intervaltrainingprogramonawheelchairergometerforparaplegicsubjects.SpinalCord,39,532–537.http://doi.org/10.1038/sj.sc.3101206vanderPloeg,H.P.,Streppel,K.R.M.,vanderBeek,A.J.,ven derWoude,L.H.V,Vollenbroek-hutten,M.M.R.,vanHarten,W.H.,&vanMechelen,W.(2007).Successfullyimprovingphysicalactivitybehaviorafterrehabilitation.AmericanJournalofHealthPromotion,21(3),153–159.Vincent,K.,&AmericanCollegeofSportsMedicine.(2013).ResistanceExerciseforPersonswithSpinalCordInjury.Warms,C.A.,Belza,B.L.,Whitney,J.D.,Mitchell,P.H.,&Stiens,S.A.(2004).Lifestylephysicalactivityforindividualswithspinalcordinjury:apilotstudy.AmericanJournalofHealthPromotion,18(4),288–291.

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