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PCPFS Research Digests

Physical Activity & Fitness for Persons with Disabilities

A Paradigm Shift

An article related to fitness and activity for persons with disabilities can give rise

to many different questions. Some readers might ask, "What good would it do

for people to exercise who are already disabled?" People with disabilities might

think, "Exercise will use up my energy before I get the things done I really need

to do on a daily basis" or "I'm afraid I could aggravate my condition like making

my joints stiff or more painful." Owners of exercise facilities and administrators

of public facilities have often surmised, "What if they fall and injure themselves?

We may be liable."

Historically, the approach to physical activity for people with disabilities has

been couched in medical rationale and focused on rehabilitation. Whereas

physical education (physical training) has been a part of school curriculum for

nearly 100 years, the original orientation was to supplement what was being

done in the medical arena, i.e. rehabilitation. The paradigm was based on the

medical model and one of isolation and segregation. Rimmer defines

rehabilitation as:

"the restoration and/or maintenance of physical function, which

allows an individual to perform activities of daily living without

incurring high levels of stress or fatigue. These activities include but

are not limited to, ambulating, dressing and undressing, transferring

from a wheelchair to a bed or commode, carrying or lifting common

items such as groceries or laundry, reaching for objects above the

head, rising from a chair and walking up and down stairs."(1994,p.

2)

This definition of rehabilitation does not account for physical activity for the joy

of it as in play, exercise to improve or maintain fitness or activity required in

employment. The new paradigm of healthy, active lifestyles for people with

disabilities is one of inclusion and integration. Whereas much of what people do

in rehabilitation contributes to physical fitness, activities designed and engaged

in for the express purpose of improving physical fitness goes well beyond

rehabilitation. Today, adapted physical education programs in the schools include

games, sports, rhythms and aquatics suited to the individual needs, capacities

and limitations of students with disabilities-a welcome change over the medical

gymnastics of the turn of the century.

Originally used in 1985 (Casperson and others) and reiterated in 1995 by Pate

and colleagues in a recommendation from CDC, physical fitness is "a set of

attributes that people have or achieve that relates to the ability to perform

physical activity (Pate and others, 1995)." The implication of this definition over
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others in the past is that it takes into consideration ALL activities of daily living

including the physical demands of employment, deliberate structured activity

done expressly to maintain or improve fitness, normal ambulation, play, sport

and domestic chores. Unlike previous definitions, research findings over the past

several decades have modulated the view that to be of value for improving

physical fitness, activity had to be vigorous. In fact, A Report of the Surgeon

General: Physical Activity and Health (1996) brings together findings that

indicate that physical activity need not be strenuous to provide health benefits.

Thus, the old paradigm of providing rehabilitation and practice on activities of

daily living as the sole sum and substance of physical activity for people with

disabilities has been replaced. The model for fitness development today includes

play, sport, physical demands of employment involving large and small muscles

and daily chores for people with disabilities and able-bodied people alike.

Persons with disabilities have demanded this shift and research supports it.

Benefits of Activity/Fitness for People with Disabilities

The statements at the opening of this digest are common misunderstandings

held by people on the topic of exercise and fitness for persons with disabilities.

The fact of the matter is: individuals with disabilities, for the most part, can gain

very similar benefits from physical activity and the accrued physical fitness as

people without disabilities.

People with disabilities can enhance the functioning and health of their heart,

lungs, muscles and bones in most cases through regular physical activity.

Flexibility, mobility and coordination can be improved, lessening the negative

effects of some conditions or slowing the progression of others. Besides,

participation in physical activity can be fun and provide a chance to meet people

and make new friends. Since physical activity contributes to the maintenance of

health, by exercising, people actually build stamina that makes the demands of

daily living easier thus leaving extra energy at the end of the day for additional

social activities. While there may be some minor discomfort by anyone at the

beginning of a physical activity program after being sedentary, there is no

evidence that appropriate activity, done correctly will aggravate most conditions.

It is important to know how one's body responds to different conditions and to

plan activities accordingly.

Some people with disabilities hesitate to be active for fear of falling. Anyone can

fall and activity actually improves balance and coordination to the extent that

injury is less likely among people who exercise on a daily basis. People or

entities who own facilities where activity programs are conducted are no more

liable for injuries to people with disabilities than they are for injuries sustained

by any other consumer given that the facilities and equipment are properly

maintained and appropriate instruction and supervision are provided.

Challenges to Becoming Physically Active

People with disabilities have many challenges impeding their progress that have

to be overcome or circumvented. These challenges vary depending on the

disability, but here are a few of them:

Attitudinal and architectural barriers still exist and require a great deal of

energy to overcome. Architectural barriers alone require considerably more

energy expenditure over that required by people without disabilities for

ambulating up ramps or going around the building to an accessible

entrance (Miller and others, 1984).

Most people with disabilities live very sedentary lifestyles and therefore

have weight problems and other (secondary) health concerns.

Inefficient movement patterns and poor body alignment increases the

amount of energy required to do normal tasks. Fatigue results from this

inefficiency leaving the person too tired for leisure-time activities, reduces
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job efficiency and decreases the overall quality of life (Shephard, 1990).

Mechanical efficiency and energy levels are negatively effected by:

reduced sensory input as in deafness and blindness, spasticity and

abnormal reflex activity, use of prostheses and aids like crutches and by

loss of functional muscle mass as occurs in paralysis (Skrotsky, 1983;

Kobberling and others, 1989; Fischer & Gullickson, 1978; and Wells &

Hooker, 1990).

Depression often accompanies a disability from accident or disease, but

can be ameliorated by regular physical activity (ACSM, 1995).

People with learning disabilities and mental retardation are more likely to

be employed in jobs requiring physical labor and thus need higher levels

of fitness than those in more sedentary job roles (Beasley, 1982).

Physical appearance is an important element in being socially accepted in

an exercise setting for anyone. People with disabilities need to look as

good as possible and follow good hygiene practices in order to obtain

social acceptance (Sherrill, 1998). Physical activity settings can be very

social and "putting the best self forward" is an important goal.

Effects of Disabilities on Health-Related Fitness Components

As mentioned earlier, people with disabilities can attain health benefits from

exercise in much the same way as people without disabilities. There are

individual considerations that must be made relative to some specific conditions,

but in general-everyone can improve his/her level of fitness.

Cardiovascular Fitness

The ability to sustain prolonged activity that elevates the heart rate and benefits

the heart and lungs is different for everyone. The previous statement is the

definition of aerobic capacity, sometimes called cardiorespiratory endurance.

Ordinarily, the benefits of increased aerobic activity include decreased resting

heart rate, decreased resting blood pressure, more efficient heart function,

improved circulation, increased muscular endurance, increased bone density and

mass, increased elasticity of the skin and decreased % of body fat with a

parallel increase in lean tissue. People with cardiovascular disease may not

experience some of the responses described above because of the medication

they take keeping blood pressure and cardiac functioning controlled. Impaired

circulation as seen in people with diabetes may not improve as dramatically as

in people without diabetes. Individuals with brittle bone disease (osteogenesis

imperfecta) may not be able to exercise vigorously using any high impact

activity such as jogging to gain the health benefit of increased bone mass, due

to the fragility of the bones under stress. Swimming or cycling, however, may

be possibilities for use by these people. In all cases, a physician should be

consulted regarding the intensity and frequency of exercise and the effects one

can expect based on the condition.

The Surgeon General of the United States (1996) has reported that adults

should exercise 20-30 minutes most days, but at least three days each week.

The modification of that recommendation for children is 30-60 minutes in

developmentally appropriate activity that is meaningful for the child (COPEC,

1998). Remember, all types of physical activity can be considered, so even if

done in shorter sessions such as wheeling the wheelchair down to the corner for

lunch, transferring from the wheelchair into the car and then playing 20 minutes

of wheelchair basketball after work-there will be greater benefits gained than if

these lifestyle behaviors were not developed at all.

When heart rate formulas are used to establish appropriate intensity of activity,

modifications can be made. Individuals with high level spinal cord injuries should

subtract 20-40 beats from 220 before subtracting age to adjust for the changes

in the autonomic nervous system from the injury to the spine (Shephard, 1990).

Persons with Down syndrome often do not reach their THR due to lack of
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motivation or understanding of the concepts involved. They may also be limited

by lower cardiac output resulting from damaged heart valves. Individuals with

prosthetics or progressive neuromuscular disorders such as multiple sclerosis

may fatigue easily and thus may not reach the THR. They should be carefully

monitored in order to avoid exhaustion. Persons with quadriplegia are unlikely to

be able to sustain a maximal heart rate higher than 120-130 bpm because of

impairment to the sympathetic nervous system. For these people, rating of

perceived exertion (RPE) is the best indicator of intensity of the exercise

(Rimmer, 1998). A method used frequently for people with disabilities is RPERating of Perceived Exertion (Borg, 1982). Some people with disabilities and

others who cannot meet the heart rate level because of fatigue, difficulty in

monitoring HR or restrictions caused by cardiac medication, do better with RPE.

Muscular Strength

The term "muscular strength" is generally accepted to mean increased capacity

to move weight and results from muscular development. Muscular development

occurs as a result of using free weights, variable resistance equipment,

isokinetics or isometrics. Athletes have been using strength development

techniques for years to enhance sport performance. Only recently the summary

of health benefits have been brought together through the Surgeon General's

Report (1996). Health benefits such as increased physical function, increased

independence in daily living activities and fewer medical complications have been

documented for older adults and people with disabilities (Stone, 1988).

Resistance training additionally contributes to increased heart muscle thickness,

decreased resting heart rate, greater stroke volume (amount of blood pumped

with each beat), more efficient heart muscle, increased circulation, increased

muscle mass (lean body tissue), increased bone density and decreased body fat.

Performance benefits include: slower heart rate during activity; increased

coordination, accuracy, precision and balance; increased self-esteem; easier

performance of activities of daily living (ADL); increased ease of propulsion;

decrease or elimination of pressure sores; decreased injury from overuse;

greater joint stability and decreased risks of cardiovascular disease.

There are some special considerations for resistance training by people with

disabilities. Safety is, of course, a primary factor with anyone using weight

training as a form of exercise. It is even more critical for individuals with

disabilities who may have poor posture, limited range of motion in joints or

problems with joint stability. All who lift weights using a barbell should use a

spotter. People with problems of joint stability or managing the barbell should

definitely use a spotter.

Muscle development should be balanced. Exercise both sides of the joint when

using weights. People who use wheelchairs should develop the musculature that

counter-balances the anterior muscles used for daily ambulation. Spasticity from

cerebral palsy, stroke, a closed head injury or multiple sclerosis can also cause

muscle imbalance. Stretch and strengthen the opposing muscles being careful

not to increase abnormal muscle tone.

A person's coordination, control and strength should determine whether he or

she should use machines or free weights. While machines move in only a

predetermined path, they tend to be safer. Free weights can provide a wider

range of resistance, since they can be obtained in less than 1 pound up through

hundreds, in many increments. They do, however, require balance and control

of the weight, a good grip or special gloves to keep the weight in the hand and

the availability of equipment in increments that are appropriate for any given

person.

Free weights can also be used in different ways such as in gravity-reduced

exercise training. This technique, described by Lockette & Keyes (1994), utilizes

gravity to reduce the effects of gravity of the weight and exercising limb by

doing the exercise in a position in which gravity aids the movement. Another
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method used with individuals with very limited strength as in multiple sclerosis,

is manual resistance. This method, often used in a rehabilitation setting, calls for

another person to provide the resistance. It, of course, cannot be calibrated like

free weights or a weight machine, but working with the same person all the

time is beneficial in that they can tell when they are giving more resistance than

previously. Positioning and strapping is also useful for stabilizing the trunk and

extremities to assure an aligned, secure and stabile position for performing

exercises (Lockette & Keyes, 1994, p. 19). This technique is very useful for

persons with amputations who lack the counter-balancing effect of the missing

extremities. A wide strap (29+) should be used so as not to cut the skin . Any

sign of skin sensitivity or breakdown should be monitored. Resistance training

for individuals with cerebral palsy can be very useful when strengthening the

muscles that oppose spasticity. Not only can it increase strength, but the

abnormal muscle tone in the spastic muscles can be decreased achieving better

balance between the two muscle groups.

Research has shown that for some neuromuscular conditions such as muscular

dystrophy, strength training can be beneficial in maintaining strength and

cardiorespiratory function if: 1) the degree of weakness is not severe, 2) the

rate or progression of the disease is relatively slow, 3) consideration is given to

the individual's total daily activity demands and 4) the rate of increasing the

intensity of the exercise is slow and supervised (Lockette & Keyes, 1994).

Strength training should be approached very cautiously and only after medical

consultation for individuals who have conditions that directly effect the muscle.

Such conditions are muscular dystrophy, neurological conditions such as multiple

sclerosis, polio or other progressive, degenerative diseases that result in gradual

loss of muscle mass.

The development of muscular strength is considerably important for individuals

who use wheelchairs or other assistive devices. Miller and others (1984)

reported that circumventing architectural barriers requires up to 15 times the

energy expenditure for persons with disabilities when compared with persons

without disabilities. People with mental retardation usually have very poor

muscle tone and muscular strength. Furthermore, the work environment for

many people with mental retardation is likely to demand greater physical

exertion requiring muscular strength.

Flexibility

The ability to move a body part around a joint is one of the most critical

elements in keeping people moving independently. As implied earlier, one of the

main benefits of flexibility is improved movement proficiency. In addition,

flexibility means increased range of motion, reduced muscle soreness, improved

posture, reduced musculoskeletal injuries, increased relaxation, reduced

neuromuscular tension and controlled spasticity. Being able to tie ones own

shoes, reach a plate on a shelf overhead or bend down to pick up a dropped

spoon means so much to the independence of every one of us. Exercising for

flexibility is an imperative component of any exercise program, especially for

those whose disabilities are severe. Joints that do not move, including those in

the spine, eventually become rigid and inflexible and the quality of life

diminishes measurably.

Stretching and bending exercises are ones that can be done several times a day

and should be if one is sedentary. Flexibility exercises should be done at the

beginning and ending of any exercise period. The length of the stretch

determines the intensity of flexibility exercises. For example, when seated with

one leg straight and the other flexed, the stretch is toward the foot of the

straight leg. If, at first, only the knee is reached, the reach should be a little

closer to the toes with each subsequent attempt until the toes are reached. It

may take several weeks. The amount of time to hold the stretch varies with a

goal of 10 seconds for warm-up and longer for warm-down. Muscles that are

spastic should be stretched for a longer period of time, possibly 20-30 seconds
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until the muscle is relaxed. If spasms, abnormal muscle tone or nonfunctional

primitive reflexes result from either stretching or resistance training, the

exercise should be discontinued and re-evaluated.

Caution should be exercised if the condition is one that would be aggravated by

stretching. Medical advice should be sought before including stretching exercises

in a program to learn how this component can be included and whether or not it

should be. Exercise programs should be re-evaluated on a regular basis as one's

condition changes. The exercise program must be geared to the person with

disabilities and his or her needs at any point in time, not shaping the person to

fit the program (Lockette & Keyes, 1994).

Some special techniques utilized in both rehabilitation and athletics include

passive and active range of motion and proprioceptive neuromuscular facilitation

(PNF). This technique may be used in instances in which the person is unable to

achieve the full range of motion themselves due to contractures or abnormal

muscle tone around the joint. These techniques should only be used at the

direction of medical personnel and by a trained assistant.

Body Composition

The last element effecting physical fitness is body composition. This is the

relationship between lean and fat tissue in the body, usually expressed in terms

of percentage of body fat. This is compared with body density that gives a

measurement of lean body tissue and bone. Regardless of the way one looks at

body composition or the means for measuring it, the goal is to have a balance

between body fat and lean tissue to support healthy living as identified in

research findings.

Whereas, the desirable thing to do with the other three components of fitness is

to increase them, with body fat the goal is often, but not always, to decrease it

to healthy levels in people with disabilities. Disadvantages of having excess body

fat include greater risk of atherosclerosis, hypertension and increased stress on

the heart and lungs. The increased body weight that often accompanies

increased body fat also places severe strain on joints, adversely effects posture,

decreases self-esteem and can affect interpersonal relationships. These

drawbacks of obesity are no different for people with disabilities than for people

without disabilities.

While all types of disabilities do not directly affect body composition, some play

a significant role in at least influencing if not determining body composition. For

example, wheelchair users with paraplegia tend to experience a decrease in lean

tissue due to muscular atrophy and an increase in connective tissue, lipids and

water (Shephard, 1990). Most research supports the notion that there is an

inverse relationship between body fat and the degree of mental retardation for

people living in the community. That is, the lower the IQ, the higher the

percentage of body fat. This relationship reverses itself, however, for people

with severe mental retardation residing in institutions. The body composition of

other types of disabilities has been sparsely studied. A Canadian study of blind

children found males to be slightly lower in body fat than peers and both sexes

slightly lower in lean body mass (Canadian Fitness Survey, 1983). This was quite

the opposite of findings in a New Zealand study in which both sexes were found

to have twice the subcutaneous body fat as their peers. When testing deaf

children ages 10-17, Winnick & Short (1985) found that they had increasing

percentages of fat when compared with children who hear, the more hearing

loss they had. For both sensory disorders, speculation is that these findings may

relate more to social factors such as opportunity to participate, rather than

having any direct cause-effect relationship with the disability.

Several techniques for measuring adiposity have been used successfully with

populations of people with disabilities. The most popular methods are:

underwater weighing, height-weight tables, body mass index and skinfold
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thickness. The nature of the condition may dictate which technique will be most

accurate. For example, individuals with severe contractures from cerebral palsy

may not be accurately compared with height-weight tables, but underwater

weighing can be used successfully. People with spinal cord injuries may have

significant muscle atrophy in the lower extremities, so the site selection for

measuring skinfold thickness would be critical with this population. For extremely

obese individuals, height-weight tables are recommended since skin fold calipers

may not be large enough.

Promoting Physical Activity and Fitness Programs

Every community can provide opportunities for people with disabilities to enjoy

the same privileges of activity as other citizens if administrators of recreation

and park programs, YMCA and YWCA directors, scout leaders and other civicminded citizens would simply look around when they themselves are out being

active. Are there programs available for participants in wheelchairs? Are families

encouraged to bring their children who have disabilities to family programs? Are

the environments and facilities designed for activity available and accessible to

people with disabilities? Are there safe, accessible and attractive trails for

bicycles, pedestrians and wheelchairs?

When a community is planning to develop or modify facilities for activity, people

with disabilities should be involved before programs are implemented. No one

sees the obstacles to access like someone in a wheelchair who cannot reach the

restroom door, get their chair under the drinking fountain or wheel up a grade

to reach the outdoor education classroom. Health care providers should also be

as supportive of physical activity for individuals with disabilities as they are with

anyone else, encouraging them to incorporate regular activity into their daily

lives. Most importantly, schools should provide high quality, preferably daily

physical education for grades K-12 that is accessible to students with

disabilities. This is where children develop their lifestyle behaviors and learn

skills that serve them throughout the lifespan.

Moving to Inclusion

In 1975, Public Law 94-142, The Education for All Handicapped Children Act was

signed into law. Reauthorized in 1990 and again in 1997 as Part B of PL 101-

476, the Individuals with Disabilities Education Act (IDEA), these laws provide

free, appropriate public education, including physical education to all students

with disabilities through age 21. One aspect of the laws that is most challenging

to implement is the concept of "least restrictive environment (LRE)." Through

this language (LRE), lawmakers advocated placing students with disabilities into

learning environments along with their peers who are without disabilities, to the

greatest extent possible. Adults tend to be more assertive than children and

thus, have been left to make their own way to be included in work, exercise and

other settings.

One of the main barriers for inclusion has been peoples' attitudes. The first

recommendation to program personnel for including individuals with disabilities

in physical activity, fitness and sport programs is to have a positive attitude. If

program leaders do not want to include people with disabilities, if they have

negative stereotypes about the performance capabilities or are fearful they will

injure the persons with disabilities, the effort will most surely fail. Leaders and

teachers should learn as much as they can about persons with disabilities such

as:

their medical and health problems,

activities they should not do, such as tumbling for individuals with atlantoaxial-instability,

current level of motor performance and fitness,

goals or objectives the person has for him or herself,

goals defined in programs such as individualized educational programs
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(IEP) or vocational rehabilitation,

unique learning and communication styles,

behavioral concerns,

special interests and strengths of the person.

Activity leaders such as physical educators, recreation personnel, parents,

coaches or aides should ask to be involved in helping to plan the goals for a

person who wants to learn to be more physically active. Whether in a school

setting, worksite program or local fitness center, the best way to include

individuals with disabilities is to get to know them well. Learn as much as

possible about the person's interests, goals, ABILITIES as well as their

disabilities. Include the person with disabilities in the program planning; they

have ideas, too, on how to get their needs met.

Use peers to assist the individual with disabilities to the extent needed. This is

not to say that another member of the fitness club should spend their entire

aerobics class assisting the person with disabilities, but on occasion there may

be a need to demonstrate a step, modify a movement or spend extra practice

time in order for the routine to be learned. Some individuals with disabilities

may not learn as fast as their peers, so expect to spend extra time or enlist

peers. In most cases, especially in the schools, if the educator thinks he/she

needs extra support to help the student have a meaningful learning experience,

then he or she should ask for it and expect to get it. If the student has a

trained assistant during other parts of the day and in other classes, and the

physical educator believes it would be beneficial to have one in physical

education, then an aide should be provided.

Visit other programs the individual is in or similar activity programs. If other

professionals are spending time with the individual, find out what techniques

work and which do not. Observe the person in another setting if possible to

observe the nature of interaction with other program leaders. Try to replicate

the successful styles. Be ready to change styles and techniques to accommodate

individuals' unique learning needs. Individuals who are mentally retarded, for

example, may benefit more from demonstrations, whereas persons who are

blind, might profit more from having the teacher "walk them through" the

motions or provide instructions in Braille or large print.

There are also professional organizations that may provide advice and

recommend professionals in your region who would be willing to assist with

problems encountered by people with disabilities trying to access activity

programs. There is a listing of such organizations below.

What about Sport?

Certainly sport has become an integral part of the physical activity milieu that

has opened up dramatically to people with disabilities in the past 30 years.

Evolution of Special Olympics International has gone from a day-camp in the

back yard of Eunice Kennedy and Sargent Shriver in 1963 and the first

competition in Chicago's Soldier Field in 1968 with 1,000 athletes with mental

retardation to similar summer games held in New Haven, Connecticut in 1995

hosting 7,000 athletes. Today over 1 million athletes participate in Special

Olympics programs in over 150 countries around the world. In 1988 the

International Olympic Committee signed an historic agreement officially

recognizing Special Olympics (SOI, 1997).

Many organizations exist that promote sport for people with physical disabilities.

The history of most goes back to the International Stoke Mandeville Wheelchair

Sports Federation initiating sport for people in wheelchairs as early as World

War II. Since that time multiple groups have organized which facilitate sport for

people with specific disabilities as well as bringing many disability groups

together such as the International Coordinating Committee of the World Sports

Organizations for the Disabled (ICC). Although the ICC was in existence a mere
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8 years, it accomplished one feat-it got the attention of the International

Olympic Committee. In 1985 a meeting with IOC president Juan Antonio

Samaranch resulted in the agreement to use the alternate terminology for their

games of Paralympics. Surprisingly, the root-para-comes from the Latin meaning

"attached to" rather than referring to paraplegia. So from that time to the

present, the Paralympics have been attached to the Olympic Games and hosted

in the same city (DePawu & Gavron, 1995). The names and addresses of a few

sport governing organizations are listed below.

Professional

Organizations

American Association for Active Lifestyles and Fitness

(ask about a contact in your state)

1900 Association Drive

Reston, VA 20191

(800) 213-7193

http://www.aahperd.org/aaalf/aaalf.html

American College of Sports

Medicine PO Box 1440

Indianapolis, IN 46206-1440

(317) 637-9200

http://www.acsm.org

American Council on Exercise (IDEA)

5820 Oberlin Dr., #102

San Diego, CA 92121

(619) 535-8979

http://www.acefitness.org

American Occupational Therapy

Association 4720 Montgomery Lane,

PO Box 31220

Bethesda, MD 31220

(301) 652-6611

http://www.aota.org/

American Physical Therapy Association

1111 North Fairfax Street

Alexandria, VA 22314

(703) 706-3201

http://www.apta.org/

American Therapeutic Recreation

Association 2308 L Street, NW

Washington, DC 20037-1415

(202) 298-0417

http://www.atra-tr.org/

National Recreation and Parks Association

22377 Belmont Ridge Road

Ashburn, VA 20148-4501

(703) 858-0784

http://www.nrpa.org/

Selected Disability Sport Governing

Organizations

President's Council on Physical Fitness and Sport

Hubert Humphrey Building

200 Independence Ave., SW,

Room 731H

Washington, DC 20201-0004

http://www.indiana.edu

(for information on fitness testing)

Disabled Sports USA

451 Hungerford Dr., Suite 100

Rockville, MD 20850

http://www.nas.com/~dsusa/

Wheelchair Sports, USA

3595 E. Fountain Boulevard,

Suite L-1

Colorado Springs, CO 80910

http://www.wsusa.org/

Special Olympics International

13525 G Street, NW, Suite 500

Washington, DC 20005

http://www.specialolympics.org

United States Cerebral Palsy Athletic Association

200 Harrison Avenue

Newport, RI 02840

http://www.uscpaa.org/

Published quarterly by the

President's Council

on Physical Fitness

and Sports

Guest Author:

Dr. Janet A. Seaman,

 Executive Director

Co-Edited By:

Drs. Chuck Corbin

and Bob Pangrazi
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Washington, D.C. American Association for

Active Lifestyles and Fitness one

of six national associations

of AAHPERD

Arizona

State University

References

1. American College of Sports Medicine. (1991). Guidelines for exercise testing and prescription.

Philadelphia: Lea & Febiger.

2. American College of Sports Medicine. (1995). Guidelines for exercise testing and prescription

(5th ed.). Philadelphia: Lea & Febiger.

3. Beasely, C.R. (1982). Effects of a jogging program on cardiovascular fitness and work

performance of mentally retarded persons. American Journal of Mental Deficiency, 6, 609-613.

4. Borg, G.A. (1982). Psychophysical bases of perceived exertion. Medicine and Science in Sports

and Exercise, 14(5), 377-381.

5. Block, M.E. & Garcia, C. (1995). Including students with disabilities in physical education.

Reston, VA. American Alliance for Health, Physical Education, Recreation & Dance.

6. Canada Fitness Survey. (1983). Fitness and lifestyle in Canada. Ottawa, ON: Directorate of

Fitness and Amateur Sport.

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Other Resources

1. Active Living Alliance for Canadians with a Disability, (1995). Moving to Inclusion. Oxon Hill,

MD: AAHPERD Publications (800-321-0789).

2. Miller, P.D. Ed. (1995). Fitness Programming and Physical Disability. Champaign, IL: Human

Kinetics (800-747-4457).

3. Randazzo, D. & Corless, K. (1998). Activity for everyone: Children of all abilities in a regular

physical activity program. Oxon Hill, MD: AAHPERD Publications.

4. Seaman, J.A. Ed. (1995). Physical best and individuals with disabilities: A handbook for inclusion

in fitness testing. Reston, VA: AAHPERD Publications.

Physical Activity and Fitness Quote
PCPFS Research Digests

http://www.fitness.gov/publications/digests/digest_mar1999.html[12/3/2010 3:03:23 PM]

Individuals with disabilities, for the most part,

can gain very similar benefits from physical activity and the

accrued physical fitness as people without disabilities.

Dr. Janet A. Seaman, Executive Director American

Association for Active Lifestyles and Fitness (AAHPERD)

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