Experiences of people with stroke and multiple sclerosis and caregivers of a community exercise programme involving a healthcare-recreation partnership.

Purpose: To explore perceptions of people with neurological conditions and their caregivers of the health benefits of a group, task-oriented community-based exercise programme incorporating a healthcare-recreation partnership.Materials and methods: Descriptive qualitative study. Individuals with balance and mobility deficits from a neurological condition, and their caregivers, were interviewed on completion of a group, task-oriented community-based exercise programme incorporating a healthcare-recreation partnership. A thematic analysis was performed.Results: Nine people post-stroke, and four people with multiple sclerosis (MS) (n = 13; 54% male) and 12 caregivers (83% spouses) participated. Two themes emerged. One theme indicated that the programme fosters diverse, interrelated health benefits. Participants described experiences of improved balance, strength, and confidence that translated to improved everyday functioning and social participation. Benefits were reinforced through repeated programme registration. A second theme indicated that caregivers experience challenges and diverse benefits related to the programme. Transportation and programme cost were primary challenges. Caregivers described emotional health benefits from assisting participants during classes and observing participants improvement over time.Conclusions: Group, task-oriented community-based exercise programmes incorporating a healthcare-recreation partnership may yield health benefits for exercise participants and caregivers. Results can guide programme evaluation, the nature and timing of education about such programmes, and efforts to address cost and transportation issues.Implications of rehabilitationStroke and multiple sclerosis commonly cause balance and mobility limitations that can result in physical inactivity and further deterioration in health.Group, task-oriented community-based exercise programmes in which rehabilitation professionals train and support fitness instructors to deliver the exercise programme in community centres may increase access to exercise participation for this group.Study results suggest by improving balance and mobility, these programmes help increase independence in activities of daily living and social and leisure participation, while improving caregiver mental health and decreasing the need for caregiver assistance.Rehabilitation professionals can use findings to inform patient education, and support programme implementation and referral.

Considerations for expanding community exercise programs incorporating a healthcare-recreation partnership for people with balance and mobility limitations: a mixed methods evaluation.

OBJECTIVE: To increase access to safe and appropriate exercise for people with balance and mobility limitations, community organizations have partnered with healthcare providers to deliver an evidence-based, task-oriented group exercise program in community centers in Canada. We aimed to understand challenges and solutions to implementing this program model to inform plans for expansion. RESULTS: At a 1-day meeting, 53 stakeholders (healthcare/recreation personnel, program participants/caregivers, researchers) identified challenges to program implementation that were captured by seven themes: Resources to deliver the exercise class (e.g., difficulty finding instructors with the skills to work with people with mobility limitations); Program marketing (e.g., to foster healthcare referrals); Transportation (e.g., particularly from rural areas); Program access (e.g., program full); Maintaining program integrity; Sustaining partnerships (i.e., with healthcare partners); and Funding (e.g., to deliver program or register). Stakeholders prioritized solutions to form an action plan. A survey of individuals supervising 28 programs revealed that people with stroke, acquired brain injury, multiple sclerosis, and Parkinson's disease register at 95-100% of centers. The most prevalent issues with program fidelity across centers were not requiring a minimum level of walking ability (32%), class sizes exceeding 12 (21%), and instructor-to-participant ratios exceeding 1:4 (19%). Findings provide considerations for program expansion.

Characterising community exercise programmes delivered by fitness instructors for people with neurological conditions: a scoping review.

A scoping review was conducted to characterise evaluations of community-based exercise programmes (CBEPs) delivered by fitness instructors to people with neurological conditions. Literature published from 1946 to April 2014 in MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and the grey literature were searched. Search terms included community, programme, exercise, adult, brain disease and spinal cord disease. Two reviewers independently screened titles and abstracts for inclusion. One author reviewed full-text articles to evaluate eligibility. Studies were included if the study objective was to evaluate an exercise programme, the programme was community-based and delivered by fitness instructors, exercise participants were ≥18 years of age and had a neurological condition, and a full-text article was available and written in English. After reviewing 1785 titles and abstracts, 18 (1.01%) articles describing 15 studies were included in the review. One author completed data abstraction from the included studies. A second reviewer independently verified the extracted data for accuracy. Exercise programmes most commonly included people with stroke (47%) and Parkinson's disease (40%), incorporated a stand-alone (80%), multi-component (20%), group (67%), individual (20%) and combined format (13%), strength training (40%) and functional/task-oriented training (40%), reported a minimum walking requirement (67%), and involved a healthcare professional (HCP) with various roles (53%), including training (27%), advising and supporting (33%). The most commonly examined participant outcomes were health-related quality of life (60%) and functional balance (47%). More research is needed to develop CBEPs targeting individuals with low ambulatory function and multiple neurological conditions, to develop recommendations for the involvement of HCPs in CBEPs and document their involvement, and to evaluate system-level outcomes such as cost, healthcare utilisation and impact on caregivers. The findings support a number of considerations to guide future research into CBEPs delivered by fitness instructors for individuals with neurological conditions.