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Physical Activity Module

Current Practice: Physical Activity Programming for Individuals with SCI The majority of E-Scan participating sites (i.e., 83.3%—10/12) report having a fitness centre (See Figure 3.0) that offers specialized or adapted fitness services. These fitness services primarily serve those living in the community, as 75% (9/12) provide fitness services to outpatients; whereas fewer - 58.3% (7/12) - offer similar services to SCI inpatients. One-third - 33% (4/12) - of the adapted fitness programs are provided offsite and external to the organization. The best model for physical activity service delivery is through interdisciplinary care. However, this model is not used in current SCI fitness facilities. Of the 10 sites with facilities, nine different provider types are reported, often with a single provider group providing service in isolation. The most prevalent physical activity-related provider types are “fitness specialists” (4/10), physiotherapists (3/10) and physiotherapy assistants (3/10). Nurses, therapeutic recreation specialists and therapy assistants are each reported as providing service in two centres; and one centre reports service delivery from occupational therapists (OTs), physiatrists or rehabilitation therapists (Figure 3.0). Fitness specialists included kinesiologists, YMCA fitness instructors and a wellness exercise therapist. Figure 3.0 Histogram showing the number and variety of fitnes provider types acros fitnes centres. A model illustrating the spectrum of physical activity services currently offered by rehabilitation and fitness professionals, in Canada, is shown in Figure 4.0. Traditionally, exercise or physical activity prescription is developed by considering the individual’s history and a formal exercise assessment. The physical activity prescription is then based on the F.I.T. principle, which specifies the frequency (how often), intensity (how much and how hard), and time (how long) one should spend doing a particular physical activity. The type or choice of exercise modality is then matched to consumer abilities, preference, fiscal resources and fitness goals. Monitoring/reassessment is conducted to inform exercise progression, facilitate goal modification and to identify and/or resolve adverse effects. Health promotion programming focused on enhancing and maintaining physical activity participation (lifestyle modification) follows a similar pattern, although may involve additional activities. Figure 4.0 includes some activities that are consistent with this paradigm. The focus of assessment, within a health promotion context, typically involves identification of preferences, barriers and resources in order to set realistic goals, and to develop an action plan. Counselling can assist with action plan development, building of self-efficacy to facilitate self-regulation of physical activity behaviours, or “coping planning” to overcome barriers. Self-monitoring is essential to ensure continued participation and appropriate modification of goals and action plans, over time. The role of physical activity in preventing secondary complications and maintaining health and wellness, in individuals with SCI, is well established, and acknowledged by a majority of rehab service providers. As a result, several fitness centres at, or affiliated with, local SCI rehabilitation sites have developed over the last 10–20 years to address SCI client needs. However, current Canadian models of physical activity service delivery are biased toward outpatients with SCI, and typically offered by a single healthcare provider. This pattern of service delivery appears historical, having been derived from a lack of designated funding, rather than from optimal models of service delivery. Despite the widespread acknowledgement of “exercise is medicine”, the majority of programs are run on a fee-for-service basis, with the goal of making them revenue neutral. Several of the fitness centres were developed with the goal of enabling individuals to transition into community-based services, but care providers note that this remains a challenge for a variety of reasons (including environmental barriers), as rural or remote communities are not generally well served by community-based, physical activity organizations. 168 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


Physical Activity Module
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