Using Technology to Promote Physical Activity Among Individuals with Cognitive Disabilities

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Using Technology to Promote Physical Activity
Among Individuals with Cognitive Disabilities

• James H. Rimmer, Ph.D., Professor
• Department of Disability and Human Development
• University of Illinois at Chicago
• Director, National Center on Physical Activity
  and Disability
• Coleman Institute Conference
• October 16, 2008
• Boulder, Colorado

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Presentation Overview

• Important health concerns related to people with
  cognitive disabilities.
• Conceptual RD Model (RAMP) for promoting
  physical activity.
• --Electronic Personalized Exercise Program
  (Project E-PEP)
• Technology to customize health promotion.

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What is the Urgency of Health Promotion Programs
for People with Cognitive Disabilities?

• Secondary conditions reported among people with
  varying types of cognitive disabilities
• Loneliness
• Social isolation
• Obesity
• Depression
• Pain
• Fatigue
• High Allostatic load

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Loneliness

• Lonely individuals tend to exhibit negative
  intrapersonal traits like pessimism (Davis,
  Hanson, Edson, Ziegler, 1992 Ernst Cacioppo,
  1999).
• Loneliness was found to be negatively correlated
  with happiness (Booth, Bartlett, Bohnsock,
  1992) and life satisfaction (Riggio, Watring,
  Throckmorton, 1993).
• Loneliness has been linked to such maladies as
  depression, hostility, alcoholism, poor
  self-concept, and psychosomatic illnesses
  (McWhirter, 1990).

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Prevalence of Obesity among US Adults with ID
(Rimmer Yamaki, MRDD Res. Rev 20061222-27)
General Population Obesity 32.2
of Obesity
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International Research on Obesity Prevalence in
Persons with I/DD
C.A. Melville et al. 2007
Simila and Niskanen (1991)
Males without ID
Finland
Males with ID
Australia
Stewart et al. (1994)
Females without ID
Moore et al. (2004)
Australia
Females with ID
Hove (2004)
Norway
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RecTech/NCPAD Conceptual Framework The RAMP As a
Metaphor for Building a RD Agenda
Sustainable Lifestyle Change
Improve Physiological and Psychological Health
and Function
Promote Adherence
Increase Participation
Provide Access
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Project PEP Physician-Referred Physical Activity
and Nutrition Support System for Overweight
Adults with Disabilities

• James H. Rimmer, Ph.D., Principal Investigator
• Valerie Lawson, M.S., Project Coordinator
• Ben Gerber, M.D., Co-Principal Investigator
• Paul Heckerling, M.D., Co-Principal Investigator
• CDC Grant R04/CCU523275
• 2003-2006

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PEP Study Design
Awareness
Low Support
Randomization
High Support
6 months
6 months
Post- intervention
baseline
Follow-up
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Body Mass Index (BMI) by Group Significant Time
effect (p.001) and Group x Time effect (p
lt.001)
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Hospital Admissions (plt.05) and Outpatient Visits
Within 12 Months by Group
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PEP-II Tailored Support System for Overweight
Adults with Disabilities

• James H. Rimmer, Ph.D., Principal Investigator
• Gillian Goodfriend, M.S., Project Coordinator
• Ben Gerber, M.D., Co-Principal Investigator
• Paul Heckerling, M.D., Co-Principal Investigator
• CDC Grant R01/DD000134
• 2006-2009

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PEP Intervention Model
Needs Assessment

• Current activity level
• Self-Efficacy
• Functional Ability
• Preferences individually and culturally based

• Barriers to PA Nutrition
• Health Status
• Readiness to Change

Personalized Physical Activity and Nutrition
Program

• Realistic goals
• Individualized communication
• Equipment adaptation
• Personal buddy
• Family support and exercise participation

• Performance feedback
• Positive focus
• Dynamic design
• Reinforcement strategies

Increasing likelihood of initiation
Long-Term support
Increased physical activity? Healthier eating
behavior? Improved health status ?

• Link to Community Resources
• YMCA local fitness facilities
• Social support group
• Physical activity networking

YES
NO
Increased adherence, QOL improved proximal
distal health outcomes
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RecTech/NCPAD RD Model Employing New and
Emerging Technologies
Sustainable Lifestyle Change
Improve Physiological and Psychological Health
and Function
Promote Adherence
Increase Participation
Provide Access
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Level I Access

• Remote assessment technologies and real-time
  solutions to access the built environment

Provide Access
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Community Assessment AIMFREE on PDA Accessibility
Instruments Measuring Fitness and Recreation
Environments

• Dynamic computerized assessment provides the
  advantage of completing the survey while touring
  the environment being assessed.

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The CAT Process
Typical Pattern of Responses
Increased Difficulty

• Score is calculated and the next best item is
  selected based on item difficulty

Middle Difficulty
/- 1 Std. Error
Decreased Difficulty
Correct
Incorrect
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Remote Assessment The Future
Solutions wizard matches items for specific
access issues with possible solutions from the
cumulative knowledge base and sends them to the
team.
Computerized adaptive testing (CAT) and
integrated smart tools assure a valid survey with
a minimum number of items
Items without a good match
Or items for which the team feels the existing
solutions are not adequate or appropriate.
Ubiquitous broadband allows survey teams to
access Web application from anywhere.
Review by the TRT with report sent to survey team
and facility
New solutions get added to the solutions
knowledge base
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Working Towards a National Solutions Database
MT
ND
OR
NY
MI
IA
IL
CA
VA
KS
NC
NCPAD provides information resources and
technical assistance to the 16 State
Implementation Projects in the area of physical
activity for people with disabilities
Validated evidence based practice and effective
health promotion strategies for increasing
physical activity are fed back to NCPAD
AR
SC
NCPAD actively promotes adoption of evidence
based physical activity programs for people with
disabilities to all States
FL
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Level II Participation

• Smart tailoring and data mining to optimize
  programs in the shortest amount of time

Increase Participation
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The PEP Tailored Communication Approach
Coach provides tailored communication support via
phone and/or email
Realistic nutrition and activity goals are set
Variety and choice are emphasized to promote
sustained interest
Participant and coach create an initial plan
Participant and coach revise plan as needed
Referrals come from rehab, health and wellness
providers
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Level III Adherence

• How can technology facilitate and motivate people
  to exercise on a regular basis? 
• Four Cardinal Rules of Adherence
• Interactive
• Immersive
• Engaging
• Effective

Promote Adherence
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Level IV Health Function

• Self-management instruction and support
• Monitoring compliance and effectiveness of
  interventions

Improve Health and Function
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Smart Devices for Monitoring Body Functions
What it monitors Acceleration (Motion) Galvanic
Skin Response (GSR) Skin Temperature Heat
Flux Heart Beats What we derive (today) Total
Energy Expenditure Physical Activity
Duration Number of Steps Sleep Efficiency Contexts
Sleep, lying down, sedentary, driving,
ambulation, biking, other exercise
Timestamp Button
2-axis Accelerometer (inside)
Heart Beat Receiver Board (inside)
Machine Learning
Heat Flux Sensor
Near-Body Ambient Temperature Sensor
GSR Sensors
Skin Temperature
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RecTech (www.rectech.org)
Beneficial Designs
RERC RecTech is supported through a grant from
the National Institute on Disability and
Rehabilitation Research
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Special Thanks