A Model Health Promotion Program for People with Disabilities in the Supportive Transitional Setting
The Center on Health Promotion Research for Persons with Disabilities (CHP) was established in 1997 with a grant from the Centers for Disease Control and Prevention, Division of Human Development and Disability, to develop a comprehensive health promotion program for persons with disabilities. The project consists of a 12-week intervention that is comprised of exercise sessions, nutritional training, cooking classes, and peer support groups. The intervention takes place on the campus of a large university in the United States.
The goal of the exercise program is to have each participant engage in regular physical activity for 30 to 60 minutes a day. The exercise program consists of the following activities: cardiovascular endurance, muscle strength and endurance, and flexibility. During the first two weeks of the program, participants are trained in using the equipment. Individual goals are developed for each participant to insure that they are exercising within their comfort zone and are achieving a training effect. In cases where the participant is having difficulty using a piece of equipment, certain adaptations are made to allow for successful use. For example, some individuals are not tall enough to comfortably reach the pedals on a stationary bike. Wooden foot lifts were constructed with velcro straps to allow individuals to be able to reach the pedals. While clients with stroke were performing leg lifts on the strength equipment, the weakened or paralyzed leg would not stay in alignment with the non-involved leg. An elastic band was designed to keep both legs in alignment during the lift. Some clients are advised not to use certain exercise machines because of marked elevations in blood pressure or because a certain movement may cause joint pain. These low-tech adaptations often make the difference in whether or not a person can access a certain piece of equipment successfully.
Exercise sessions are supervised by an exercise professional who has some training in disability and physical activity and several volunteers. Each volunteer works with one to three participants. Participants wear a heart rate monitor for the entire cardiovascular workout to assure that they are exercising safely. Participants are taught how to measure their own rating of perceived exertion (RPE), use the equipment safely, and understand the warning signs for when to stop exercising.
Nutrition classes and cooking instruction occur immediately after the exercise session. The class is directed by a registered dietitian. The nutrition component consists of short modules on healthy eating, food preparation, an examination of old eating routines, food labels, shopping tips, and restaurants and special occasions. The participants learn how to cook healthy meals and discuss ways to alter their eating habits. Much of the hour is spent trying new foods and occasionally cooking a healthy meal.
During the first week of the program, participants are asked to keep a food diary for three consecutive days. After the dietitian analyzes each participant's food intake, specific long-term goals (12-16 weeks) and short-term objectives (2-4 weeks) are developed for each participant. Some of the goals include losing weight, eating more fruits and vegetables, lowering cholesterol levels or blood sugar, and consuming less meat.
3. Health Education Module
The Health Education module offers participants new ways to conceptualize changes that have occurred in their lives related to their their disability (e.g., greater weakness and fatigue, increased social isolation). The concept of wellness as related to coping is emphasized throughout the program. A central aspect of the wellness perspective is the mind-body connection: one's general health is related to the interaction between the person, their thoughts, and the outside environment.
In order to help participants understand the positive effect they could have on preventing secondary conditions by altering their lifestyle, group discussions center around modifying various health behaviors (e.g., lowering cholesterol, increasing physical activity, reducing body weight, managing stress). Different examples of healthy coping behaviors are provided to the group with substantial audience participation. Relaxation exercises as a stress management technique are introduced during the first few weeks of the program and are practiced regularly during the health education class.
One of the most challenging aspects of the program has been helping participants develop new ways of coping with stressful events or situations. For many of the group members, stress appears related to changes in relationships with friends or family members or from a recent setback related to their disability. Although the individual group members have been able to quickly identify sources of stress, it is often difficult for them to alter their thinking about how to cope with these events. This has been an area where feedback and support from their peers has been essential in facilitating positive change.
A primary goal of the health education module is to encourage participants to manage their own health when they return to the Community Setting. Participants are provided with the names and addresses of exercise facilities in their neighborhood and in some instances are transported to these facilities by staff to acclimate them to the new environment. One motivational technique that has been found to be helpful in keeping participants engaged in a healthy lifestyle after they leave the program is to facilitate peer relationships. Many participants establish new friendships during the program and continue these relationship after the program ends. This helps to decrease social isolation and keep participants connected to their community.
4. Results of CHP Program
Through this carefully designed and structured health promotion intervention, participants made substantial gains on both physiological and psychological health outcomes, subsequently lowering the magnitude and incidence of various secondary conditions. In particular, the participants improved their physical fitness levels (e.g., strength, cardiovascular fitness) and noted that they had more energy and vigor and were able to do more household activities at the end of the program. In the area of nutritional training, the groups increased their knowledge of how to cook healthy meals on a fixed budget. To allow for greater adherence to a healthier diet, food items that were culturally sensitive were recommended. Nutritional knowledge also increased and participants reported consuming less fat and cholesterol at the end of the study. As a result of healthier eating patterns and increased physical activity levels, total cholesterol and low-density lipoprotein cholesterol (LDL-C) were significantly reduced. In the area of health education, participants who reported being depressed and socially isolated prior to the intervention had a significant reduction in depression and social isolation and improved on several quality of life measures (i.e., satisfaction with life).