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

Abstract

ObjectiveTo 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.ResultsAt 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.Electronic supplementary materialThe online version of this article (10.1186/s13104-018-3313-x) contains supplementary material, which is available to authorized users.

Factors influencing implementation of aerobic exercise after stroke: a systematic review

“…The remaining sixteen studies in this review reported on the barriers and/or facilitators to participation in, or implementation of, an exercise intervention after stroke from the perspectives of staff. Examples of these interventions were 'exercise programme' [51], 'community-based exercise' [52,53], 'high intensity interval training' [54] and 'fitness programmes' [55] . These were included under this review's broad definition of aerobic exercise to avoid the possibility of excluding valuable data.…”

“…Staff included healthcare professionals [52,53,[58][59][60][61][62], physiotherapists [54,63,64] and fitness instructors [53,65], cardiac and stroke rehabilitation teams [66], exercise professionals [51,62] and others [53,[55][56][57]62]. The views of physiotherapists (n=909) were predominant with a lesser number of exercise professionals (n=114), medical staff (n=8) and nurses (=11) represented.…”

“…This is because use of standard exercise equipment may be challenging for some people after stroke depending on physical and cognitive abilities [65]. A suitable accessible physical space and appropriate environment were factors reported by exercise professionals and healthcare professionals [51,53].…”

“…The potential cost of providing necessary extra resources was also identified as a factor, for example, concerns of self-employed fitness instructors about the source of funding for training in stroke [51,65] and funds to sustain a community-based exercise programme [53].…”

Evaluation and facilitation of intervention fidelity in community exercise programs through an adaptation of the TIDier framework

“…Implementing community-based exercise programs remains challenging [9], with a lack of published information on how to provide local contextualisation while keeping fidelity to essential elements [10]. Developing methods to assist community-based organizations to uptake established exercise evidence to routine practice while maintaining fidelity may be the most helpful way to advance decision making in this area.…”