Research articlePhysical activity participation among persons with disabilities: Barriers and facilitators
Introduction
D espite the volume of evidence indicating the benefits of regular physical activity for health and functioning, people with disabilities are far less likely to engage in physically active lifestyles than are people without disabilities.1, 2, 3, 4, 5, 6, 7, 8 According to the Healthy People 2010 report, 56% of adults with disabilities do not engage in any leisure-time physical activity compared to 36% among adults without disability.8 Promoting moderate levels of physical activity among people with disabilities is an important goal for public health and public policy, as regular physical activity improves well-being and contributes to the prevention or delay of chronic disease.9
Little is known about why the majority of people with disabilities fail to integrate regular physical activity into their lifestyle. It has been suggested that an understanding of potential barriers and facilitators that affect participation by people with disabilities could provide important information necessary for developing interventions that have a greater likelihood of success.10, 11, 12, 13 Unfortunately, published literature on barriers and facilitators associated with participation in physical activity among people with disabilities is limited.14, 15, 16
Historically, accessibility to public spaces has limited the opportunity for people with disabilities to engage in social and recreational activities.17 One study on access to environmental settings among adult wheelchair users, including recreational and leisure facilities, reported that many people who use wheelchairs were unable to gain access to these facilities because of such barriers as bad weather or climate, no curb cuts or blocked curb cuts, limited strength or fitness, inaccessible doors and bathrooms, no parking, poor travel surfaces, obstructed travel, personal illness, no ramps or ramps too steep, and wheelchair problems.15 Rimmer et al.16 reported a large number of barriers to physical activity among African-American women with physical disabilities. Barriers included lack of transportation, inability to pay for a fitness membership, lack of knowledge on where or how to exercise, and lack of understanding on the importance of exercise in improving their condition or health.
Title III of the Americans with Disabilities Act (ADA) addresses the issue of accessibility by establishing public and commercial facility standards for people with disabilities.18 (The ADA is a federal law passed in 1990 to protect the rights of people with disabilities.) Yet, emerging research indicates that access to fitness and recreation facilities is still a major barrier to physical activity for persons with disabilities. Studies conducted in the Kansas City metropolitan area,19 Topeka, Kansas,20 and western Oregon21 using an accessibility survey that consisted of items taken from the ADA guidelines and tailored to fitness centers found that none of the assessed physical activity sites were 100% compliant with the ADA.19, 20 Only 8% of exercise equipment areas, 55% of drinking fountains, and 37% of the customer service desks in facilities surveyed in western Oregon were accessible to persons with disabilities.21 Similarly, one study involving individuals with arthritis that utilized a survey designed to assess barriers and facilitators related to participation in exercise reported inaccessibility of exercise programs due to lack of transportation and accessible exercise facilities.22
To date, there has never been a systematic review of barriers/facilitators associated with participation in physical activity among people with disabilities. Likewise, there is no information available on barriers and facilitators to physical activity participation reported by professionals who work in fields related to physical activity environments that involve structural or program development (i.e., architects, city managers, fitness and recreation professionals). Additional research on personal and environmental barriers and facilitators is needed to build an infrastructure for future program development and appropriate facility and community design that will enhance participation among people with disabilities. The purpose of this study was to identify barriers and facilitators associated with physical activity participation as perceived by people with disabilities, and professionals who have a direct or indirect influence on accessibility of physical activity and recreation facilities and programs for people with disabilities.
Section snippets
Participants
Focus groups were conducted in ten regions across the United States in 2001 to 2002 involving individuals with disabilities and professionals. Participants were recruited through the ten regional offices of the Disability and Business Instructional Technology Assistance Centers (DBITACs), which are federally funded centers designed to provide technical assistance to businesses and persons with disabilities regarding the ADA. The focus groups were conducted in the following cities: Atlanta,
Results and discussion
The results of this qualitative study found that there were a number of personal and environmental barriers and facilitators related to access and participation reported by both people with disabilities and professionals affiliated with fitness and recreation facility design and/or program development (city planners and park district managers, fitness and recreation professionals, architects). These barriers and facilitators were grouped into ten major categories that are defined in Table 2.
Conclusion
It is clear from the many and diverse responses provided by the four sets of focus group participants that access to physical activity venues by people with disabilities is a complex, multifaceted issue. Moreover, access can be viewed from the perspective of the person with the disability or the professional who works in the facility or has some association with its structure and design. These perceptions could potentially be quite different in terms of whether a facility is considered
Acknowledgements
This work was supported, in part, by the Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Division of Human Development and Disability (R04CCR514155), and the National Institute on Disability and Rehabilitation Research (H133E020715). We are grateful to Robin Jones for her assistance in organizing the data-collection procedures with the Disability and Business Instructional Technology Assistance Centers.
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