Encouraging Participation in Exercise for Individuals with Mobility Impairments: Development of the CHEC-FIT

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Encouraging Participation in Exercise for
Individuals with Mobility Impairments
Development of the CHEC-FIT

• Danica Steinle, MSOT 08
• Washington University School of Medicine
• Department of Occupational Therapy
• April, 2008

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Funding

• This project was funded by a grant from the
• Missouri Foundation For Health

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Background Wellness

• In 2003, 53 of adults with disabilities lacked
  physical activity or lead a sedentary lifestyle
  compared to 34 of adults without disabilities
  (CDC, 2006).
• Improve physical characteristics (Guttman, 1976
  Shepard, 1991 Wahman, Gabriele Richard, 2006).
  
• Improved psychological benefits such as higher
  acceptance of disability, higher
  self-esteem/efficacy, and sense of life control
  (Guttman, 1976 Rejeski, Focht, 2002 Wahman,
  Gabriele, Richard, 2006).

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Quotes on the Benefits of Exercise

• I can go up and down stairs to the basement
  without any problem (increase endurance), can go
  outside and get mail (when weather is good)
  without problem.
• I have better endurance I don't suffer from
  fatigue as easily
• I feel that my balance and leg strength are
  better and I do notice a difference in everything
  I do especially with cooking and cleaning around
  the house. My endurance is somewhat better
• It has become easier to transfer myself.

Chang, 2006
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Background Environment

• In 2002, 48 of the disabled population reported
  encountering barriers to access of local health
  facilities and wellness programs (CDC, 2006).
• Environmental factors play an important role in
  determining individuals with mobility impairments
  rate of participation (Rimmer, Riley, Wang,
  Rauworth, Jurkowski, 2004 Kirchner, Gerber,
  Smith, 2007)

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Purpose of the Study

• To develop a measurement tool for assessing the
  environmental receptivity specific to inside
  fitness facilities to help acknowledge
  supports/barriers that play a role in exercise
  participation by individuals with mobility
  impairments.

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Aims of the Study

• Develop an instrument that can be used by allied
  health professionals, community health planners,
  and exercise participants to assess the
  environmental barriers that affect participation
  in exercise within fitness facilities
• Test the CHEC-FIT for inter-rater reliability
• Examine the relationship between the CHEC-FIT and
  AIMFREE scores

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Measurement Tools

• Although a few valid and reliable environmental
  measures exist each has there own limitations
  when assessing accessibility of fitness
  facilities
• ADA Accessibility Guidelines for Buildings and
  Facilities (ADAAG)
• Accessibility Instruments measuring Fitness and
  Recreation Environments (AIMFREE) by Rimmer
• Community Health Environment Checklist (CHEC) by
  Stark

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CHEC

• Major Domains

• Entering building
• Using the building
• Using restrooms
• Amenities

• Features

• 22 Features captured from subjective data by
  individuals with mobility impairments
• Scored dichotomously (yes N/A 1 No 0)

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CHEC-FIT

• The Community Health Environment Checklist
  Fitness Facilities (CHEC-FIT), is a user friendly
  measurement tool that can be used to objectively
  assess the aspects of the physical environment
  within fitness facilities that are important to
  persons with mobility impairments.

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CHEC-FIT Domains

• Main Fitness Area
• Lighting, Staffing, etc.
• Participation in Exercise
• Strength Aerobic Equipment, Swimming Pool, etc.
• Locker Rooms
• Lockers, Showers, etc.
• Miscellaneous
• Fees, Daycare, Transportation Route, etc.

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Methods

• The CHEC-FIT was developed using a multi-step
  method divided into four phases.
• Phase 1 Retrospective quantitative study
• Phase 2 Item development
• Phase 3 Scoring
• Phase 4 Psychometric testing

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Phase 1 Retrospective Study

• The Missouri Foundation For Health (MFH)
  sponsored study entitled Exercise Programs and
  Health Promotion for Unserved and Underserved
  People with Mobility Impairments was used to
  gather retrospective data on why individuals with
  mobility impairments do not exercise as much as
  they want to exercise
• Cannot afford membership
• Cannot afford special equipment
• Fitness facilities are not accessible

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Phase 2 Item Development

• Using a two-step approach both objective and
  subjective data was gathered to identify
  environmental features of interest for the
  measure
• Environmental Influences on Exercise
  Questionnaire (EIEQ)
• Key Informant Interviews

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Phase 2 Item Development Results

• EIEQ

• Key Informants

• General Accessibility Features (wide doorways,
  etc.)
• Caregiver or Support availability
• Day Care

• Affordable Membership
• Specialized Equipment
• Respectable Staff
• Staff Support
• Temperature Inside the Building
• Wide Spaces
• Accessible Showers Locker Rooms
• Located near Public Transportation Route

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Phase 2 Item Development Results

• 4 Domains

• 54 Items

• Main Fitness Area
• Participating in Exercise
• Staffing
• Strength Equipment
• Aerobic Equipment
• Exercise Classroom
• Swimming Pool
• Locker Room
• Miscellaneous

• 13 items
• 28 Items
• 1 Item
• 7 Items
• 4 Items
• 5 Items
• 11 Items
• 9 Items
• 4 Items

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Domain Main Fitness Area

• Are all entrances to the fitness area accessible?
• Is the floor surface smooth and easy to walk or
  roll over?
• Is the floor surface free from clutter and
  debris?

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Domain Participation in Exercise

• Can an individual in a wheelchair use some of the
  strength equipment (aerobic equipment) from the
  wheelchair without transferring?
• Are gloves, wraps, hooks available to use for
  griping handle bars on both weight and aerobic
  equipment for individuals whom do not have grip
  strength?

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Domain Participation in Exercise

• Does at least one of each type of strength
  equipment (aerobic equipment) or machine have
  clear floor space and served by an accessible
  route?

Access Board, 1999
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Domain Locker Room

• Is an accessible bench or seating near by the
  accessible lockers?

Access Board, 1999
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Domain Miscellaneous

• Is the fitness facility located near a public
  transportation route?
• Does a sliding fee, discount or scholarship
  program exist to help with membership fees for
  individuals with disabilities?

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Phases 3 4 Scoring and Testing

• Scoring completed by a focus group of nine
  individuals with mobility impairments

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Phases 4 Testing

• Testing a team of three raters individually
  assessed 10 fitness facilities using the CHEC-FIT
  to establish inter-rater reliability. Each
  CHEC-FIT took approximately 20 minutes to
  complete.

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Findings

• According to Portney and Watkins,
• a score of .75 indicates good reliability.
• CHEC-FIT Intraclass Correlation (ICC) .99

1
.75
.90
0
SPSS 16.0
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Findings
Pearsons Correlation
Overall Scores .737
Equipment Scores .628
Swimming Pool Scores .866
Locker Room Scores .686
Significant at .05 level Significant at .01
level
SPSS 16.0
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Accessing the Data
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(No Transcript)
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Limitations

• Scoring system only reflects true receptivity and
  not amenities
• Raters were all OT students, whom have been
  educated about accessibility features and were
  familiar with the original CHEC
• Small sample size used to correlate CHEC-FIT and
  AIMFREE scores
• Instrument is specific for individuals with
  mobility limitations

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Future Research

• Further psychometric testing comparing the
  CHEC-FIT to AIMFREE scores
• Placing individuals with mobility limitations in
  the specific sites and further compare direct
  subjective data to objective data gathered by the
  CHEC-FIT

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Implications for OT

• Therapists need to play an important role in
  promoting physical activity among individuals
  with mobility impairments and to promote
  exercising within fitness facilities
• Measuring fitness facilities for accessibility
• Educate clients
• Educate fitness professionals
• Reassess fitness facilities

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With Much Appreciation

• Gray Lab Dr. David Gray, Kerri Morgan, Dr. Holly
  Hollingsworth
• Dr. Susan Stark and Emily Somerville
• EMC Staff Sue, Jess and Melissa
• CHEC-ers Hillarie and Erin
• Parents
• Focus Group Participants