RIIL WEBCAST NO. 6 PHYSICAL ACTIVITY, MOTIVATION AND PEOPLE WITH DISABILITIES. >> RACHEL: GOOD AFTERNOON EVERYBODY OR SHOULD I SAY GOOD THANKSGIVING EVE. WELCOME TO THE WEBCAST ON PHYSICAL ACTIVITIES, MOTIVATION AND PEOPLE WITH DISABILITIES. I'M RACHEL KOSOY AT ILRU YOUR HOST FOR TODAY'S PROGRAM. I'D LIKE TO FIRST RECOGNIZE THE SPONSORS OF THIS PROGRAM AND REVIEW A COUPLE OF TECHNICAL DETAILS BEFORE WE BEGIN. FIRST I REALLY WOULD LIKE TO RECOGNIZE THAT TODAY'S ACTIVITY IS A RESULT OF AND FUNDED BY THE COMMITMENT OF NIDRR, THE NATIONAL INSTITUTE ON DISABILITY REHABILITATION AND RESEARCH. THEY'RE COMMITTED TO MAKING RESEARCH FINDINGS AVAILABLE TO EVERYBODY WHO HAS A STAKE IN THE RESEARCH FINDINGS. THIS SERIES OF WEBCASTS IS JOINTLY SPONSORED BY FOUR PROJECTS OF WHICH ILRU IS A PARTNER. AND THOSE FOUR PROJECTS ARE RIIL, THE RESEARCH INFORMATION FOR INDEPENDENT LIVING, WHICH IS A JOINT EFFORT OF THE RRTC ON INDEPENDENT LIVING AND ILRU. SECONDLY, THE RESEARCH TRAINING -- THE RESEARCH AND TRAINING CENTER ON INDEPENDENT LIVING AT THE UNIVERSITY OF KANSAS. THIRDLY, THE RRTC ON HEALTH AND WELLNESS, WHICH IS A PROJECT OF OREGON INSTITUTE ON DISABILITY AND DEVELOPMENT AT OREGON HEALTH AND SCIENCE UNIVERSITY. AND LAST, BUT NOT LEAST, THE RRTC ON MANAGED CARE AND DISABILITIES WHICH IS A PROJECT OF N. R. H. CENTER FOR HEALTH AND DISABILITY RESEARCH AND ILRU. JUST A COUPLE OF TECHNICAL THINGS TO GO OVER BEFORE WE GET STARTED. FIRST OF ALL, IF ANYBODY ENCOUNTERS ANY PROBLEMS DURING THE WEBCAST AND YOU WOULD LIKE TO CALL IN FOR TECHNICAL ASSISTANCE, THEN HERE IS A PHONE NUMBER WHERE YOU CAN REACH US: IT'S (713)-520-0232. THE SECOND THING IS IF DURING THE PROGRAM YOUR SCREEN AND YOUR SOUND FREEZES, THEN ALL YOU HAVE TO DO IS GO BACK AND LOOK ON THE REALPLAYER AND HIT THE PLAY BUTTON AGAIN. OKAY, IT SHOULD NOT HAPPEN, BUT WE'VE HEARD IT'S HAPPENED TO A COUPLE OF PEOPLE. SO DON'T PANIC, YOU JUST HAVE TO HIT THAT PLAY BUTTON AGAIN AND YOU'LL BE BACK IN BUSINESS. ANOTHER THING TO TELL YOU IS THAT THE PRESENTERS WILL BE TAKING QUESTIONS DURING THE WEBCAST AND IF YOU'D LIKE TO SUBMIT A QUESTION, YOU CAN SEND IT IN TO WEBCAST@ ILRU.ORG. THERE SHOULD BE A LINK ON YOUR E-MAIL MESSAGE AS WELL AS ON THE WEB PAGE HOW YOU LINKED TO THIS WEBCAST. THE PRESENTERS WILL ALSO BE REFERRING TO HANDOUTS WHICH ARE UP ON THE WEBSITE. SO YOU MIGHT WANT TO LOOK ON THE WEBSITE AND GO AHEAD AND DOWNLOAD THOSE IF YOU WANT TO REFER TO THEM DURING THE PRESENTATION. OKAY, NOW, LET'S GET TO THE MEAT OF WHY WE'RE HERE TOED. TODAY'S PRESENTATION IS ABOUT PHYSICAL ACTIVITY, MOTIVATION AND PEOPLE WITH DISABILITIES. AND I JUST WANT TO SAY THAT I THINK THIS IS A PERFECT TOPIC FOR TODAY BECAUSE I THINK WE DEFINITELY ARE ALL GOING TO NEED TO BE EXERCISING AFTER TOMORROW BECAUSE I'M ANTICIPATING EATING A LOT TOMORROW. SO I'M GOING TO BE LISTENING CAREFULLY FOR MOTIVATION FOR HOW TO EXERCISE AFTER TOMORROW. AND TODAY'S PRESENTATION IS PRESENTED BY THREE EXPERTS, AND ALL OF THEM ARE INVOLVED IN A NATIONAL STUDY ON PHYSICAL ACTIVITY BEHAVIOR CHANGE AND ADULTS WITH PHYSICAL DISABILITIES. AND THIS IS ACTUALLY A PROJECT OF THE RRTC ON HEALTH AND WELLNESS. SO THE THREE EXPERTS WE HAVE WITH US TODAY ARE DR. JEFF MCCUBBIN, HE IS APPROVE AND INTERIM DEAN AT THE COLLEGE OF HEALTH AND HUMAN PERFORMANCE OF OREGON STATE UNIVERSITY. WE ALSO HAVE WITH US DR. BRAD CARDINAL, ASSOCIATE PROFESSOR WITH THE DEPARTMENT OF EXERCISE AND SPORTS SCIENCE OF OREGON STATE UNIVERSITY. AND OUR LEAD PRESENTER TODAY IS MARIA KOSMA. SHE'S A GRADUATE RESEARCH AND TEACHING ASSISTANT AT THE DEPARTMENT OF EXERCISE AND SPORTS SCIENCE AT OREGON STATE UNIVERSITY. MS. KOSMA HAS ALONG CAREER OF TEACHING AND CONDUCTING RESEARCH AS WELL AS WRITING AND SPEAKING ABOUT PHYSICAL ACTIVITY AND PEOPLE WITH BOTH COGNITIVE DISABILITIES AND WITH PHYSICAL DISABILITIES. SHE HAS A MASTERS DEGREE IN ADAPTED PHYSICAL ACTIVITY AND IS A DOCTORAL CANDIDATE IN MOVEMENT STUDIES AND DISABILITIES. AND SHE'S DONE A LOT OF HER WORK IN HER NATIVE COUNTRY, GREECE, BUT WE ARE VERY LUCKY TO HAVE HER WITH US, AT LEAST FOR NOW. SO WITHOUT FURTHER ADO, I'M GOING TO TURN IT OVER TOU, MARIA. >> MARIA: HELLO, I'M MARIA AND I AM FROM GREECE AND I HOPE MY ACCENT WON'T BE AN OBSTACLE TO UNDERSTAND MY PRESENTATION. I WILL TRY TO SPEAK AS SLOWLY AS POSSIBLE. SO OUR TOPIC TODAY AS MENTIONED WILL BE MOTIVATING INDIVIDUALS WITH DISABILITIES TO BE PHYSICALLY ACTIVE. AND JUST A PRESENTATION OUTLINE. WE WILL REFER TO THE IMPORTANCE OF PHYSICAL ACTIVITY AND SO WE WILL PRESENT THE BENEFITS OF EXERCISE AND PHYSICAL ACTIVITY TOWARD CERTAIN DISABILITY POPULATIONS. WE WILL ALSO REFER TO PHYSICAL ACTIVITY CONCERNS IN ORDER TO INTRODUCE CERTAIN CONSIDERATIONS WHEN TRYING TO IDENTIFY WAYS TO INCREASE MOTIVATION. AND LASTLY, WE WILL REFER TO CERTAIN STRATEGIES TO INCREASE MOTIVATION. INCLUDE MOTIVATION TOWARD PHYSICIAN KAG ACTIVITY PAR PACING FOR PEOPLE WITH DISABILITIES IS A PUBLIC HEALTH PRIORITY SO IT IS VERY IMPORTANT FOR EVERYBODY TO BE ACTIVE. SO I WILL START WITH THE GENERAL BENEFITS OF PHYSICAL ACTIVITY. PHYSICAL ACTIVITY HAS BOTH PHYSIOLOGICAL AND PSYCHOLOGICAL BENEFITS. SOME OF THE PHYSIOLOGICAL BENEFITS COULD BE INCREASES OF CARDIOVASCULAR ENDURANCE WHICH IS MAXIMUM OXYGEN UPTAKE ON SUB MAXIMAL EXERCISE. INCREASES OF MUSCLE STRENGTH, MUSCLE ENDURANCE AND FLEXIBILITY. BEYOND THOSE BENEFITS, PHYSICAL ACTIVITY CAN CONTRIBUTE TO WEIGHT CONTROL, PREVENTION OF OBESITY AND OTHER HEALTH-RELATED CONDITIONS SUCH AS CARDIOVASCULAR DISEASES, DIABETES, COLON CANCER, HYPERTENSION, OSTEOPOROSIS, ARTHRITIS AND MANY, MANY OTHER DISORDERS. SO PHYSICAL ACTIVITY OR EXERCISE HAS MANY PHYSIOLOGICAL BENEFITS, BUT ALSO PSYCHOLOGICAL. FOR EXAMPLE, THROUGH EXERCISE, ANXIETY AND DEPRESSION CAN DECREASE. SO POSITIVE IMPROVEMENTS IN EMOTIONS AND SELF-ESTEEM AND SELF-CONFIDENCE OR CONFIDENCE ABOUT OUR PHYSICAL ACTIVITY SKILLS, OUR CONFIDENCE IN OUR BELIEF TO BE ACTIVE CAN ALL INCREASE THROUGH EXERCISE. NOW, I WILL MOVE TOWARD CERTAIN PHYSICAL ACTIVITY BENEFITS FOR SPECIFIC DISABILITY POPULATIONS. AND I JUST -- I WILL JUST SUMMARIZE FINDINGS FROM CERTAIN STUDIES, CURRENT STUDIES. ONE STUDY FROM 1999 REVEALED THAT WOMEN WITH SEVERAL PHYSICAL DISABILITIES COULD INCREASE SELF-CONTROL, PSYCHOLOGICAL IMPAIRMENT, PHYSICAL STRENGTH AND PERSONAL FREEDOM THROUGH EXERCISE. IN ADDITION, BODY/MIND FUNCTIONING COULD BE OPTIMIZED AND THOSE INDIVIDUALS COULD BE ABLE TO RECONSTRUCT THEIR SELF-IDENTITY BASED ON PERSONAL RATHER THAN SOCIETAL STANDARDS. SO THROUGH EXERCISE, THEY IDENTIFIED THEIR ROLES WITHIN SOCIETY. SOME WOMEN FROM DIFFERENT ETHNIC BACKGROUNDS TOOK -- ADOPTED A POLITICAL PERSPECTIVE THROUGH EXERCISE. SO THEY CHALLENGED GENDER ROLES, SEXUAL, RACIAL AND DISABILITIES STEREOTYPES INDICATING THAT SUCCESSFUL SPORTS PARTICIPATION IS NOT ONLY THE PROVINCE OF HIGH FUNCTIONING HETEROSEXUAL EUROPEAN-AMERICANS. EVERYBODY CAN BE SUCCESSFUL IN SPORTS, AND THEY PROVED THAT. THEY WERE WOMEN FROM DIFFERENT ETHNIC BACKGROUNDS SUCH AS AFRICAN AMERICAN AND FROM DIFFERENT SEXUAL ORIENTATIONS, AND THEY WERE VERY SUCCESSFUL AT SPORTS. PHYSICAL ACTIVITY HAS BEEN SUPPORTED TO INCREASE SELF-ESTEEM WHICH IS OUR BELIEF TO BE SUCCESSFUL IN SPORTS AND EXERCISE, AND ALSO INCREASE ATHLETIC IDENTITY FOR ADOLESCENT SWIMMERS WITH PHYSICAL DISABILITIES. SOME PEOPLE WITH DISABILITIES MIGHT EXPERIENCE SOCIAL PHYSIQUE ANXIETY, AND THIS IS A TYPE OF ANXIETY ABOUT THE WAY THE BODY LOOKS, SOME PEOPLE MIGHT HAVE NEGATIVE ATTITUDES -- NEGATIVE BODY IMAGE, MIGHT THINK THAT THEIR BODY IS NOT AS ATTRACTIVE AS THE SOCIETAL STANDARDS IMPOSE, SO IT HAS BEEN SUPPORTED THAT EXERCISE CAN REDUCE SOCIAL PHYSIQUE ANXIETY. AND IT CAN INCREASE PERCEIVED COMPETENCE, GOAL-SETTING BEHAVIORS, PERSISTENCE IN SPORTS AND EMPOWERED INDIVIDUALS WITH PHYSICAL DISABILITIES. BUT PHYSICAL ACTIVITIES HAS MANY BENEFITS ON OTHER DISABILITY POPULATIONS AS WELL. AND I WILL TURN TO THE PHYSICAL ACTIVITY BENEFITS FOR PEOPLE WITH DEVELOPMENTAL DISORDERS. IT HAS BEEN SUPPORTED THAT EXERCISE CAN INCREASE MUSCLE STRENGTH AND ENDURANCE, ENERGY LEVELS, VOCATIONAL FUNCTIONING AND IT CAN DECREASE ANXIETY FOR PEOPLE WITH INTELLECTUAL DISABILITIES. PARTICIPATION IN EXERCISE PROGRAMS CAN ALSO INCREASE TASKS AND ATTENTION TO TASK RELEVANT INFORMATION FOR ADOLESCENT WITH AUTISM. SO PEOPLE WITH AUTISM -- CHILDREN WITH AUTISM CAN FOCUS ON TASK-RELEVANT INFORMATION AND FOCUS THEIR ATTENTION TO PHYSICAL ACTIVITY TASKS WITHIN THE CLASSROOM, WITHIN PHYSICAL ACTIVITY CLASS. AND EXERCISE CAN HELP ON THAT. IN ADDITION, EXERCISE CAN HELP TO DIMINISH AND CONTROL INAPPROPRIATE BEHAVIORS SUCH AS STEREOTYPIC BEHAVIORS AMONG INDIVIDUALS WITH AUTISM AND INTELLECTUAL DISABILITIES. BUT EXERCISE HAS MANY BENEFITS FOR PEOPLE WITH DEPRESSION AS WELL. FOR EXAMPLE, AN EIGHT-WEEK RUNNING PROGRAM HAS BEEN SUPPORTED TO DECREASE DEPRESSION AND INCREASE PSYCHOLOGICAL WELL-BEING AMONG INDIVIDUALS WITH MAJOR DEPRESSIVE EPISODES. AN EXERCISE PROGRAM, FOR EXAMPLE A MUSCLE STRENGTH PROGRAM, CAN INCREASE MUSCLE STRENGTH. BY INCREASING MUSCLE STRENGTH, CERTAIN SELF-PERCEPTIONS CAN INCREASE, SUCH AS PHYSICAL SELF EFFICACY, THE BELIEF THAT SOMEONE CAN SUCCESSFULLY INCREASE MUSCLE STRENGTH, PHYSICAL COMPETENCE, THEIR CONFIDENCE ABOUT MUSCLE STRENGTH ABILITY, PHYSICAL ACCEPTANCE OR BODY ACCEPTANCE AND EVENTUALLY SELF-ESTEEM OR SELF-WORTH. BY INCREASING SELF-PERCEPTION, LEVELS OF DEPRESSION CAN DIMINISH AND POSITIVE MOOD CAN ELEVATE. SO PHYSICAL ACTIVITY HAS MANY PSYCHOLOGICAL BENEFITS AMONG PEOPLE WITH DEPRESSION. AS I SAID EARLY, I WILL REFER ALSO TO PHYSICAL ACTIVITY CONCERNS IN ORDER TO IDENTIFY THOSE CONSIDERATIONS WHEN TRYING TO DEVELOP MOTIVATIONAL PROGRAMS. FOR SOME INDIVIDUALS, FOR SOME DISABILITY POPULATIONS, FOR EXAMPLE FOR SOME PEOPLE WITH EATING DISORDERS SUCH AS ANOREXIA NERVOSA AND BULIMIA NERVOSA, EXCESSIVE EXERCISE CAN BE VERY DANGEROUS. THOSE PEOPLE BELIEVE THAT THEY ARE TOO FAT, THAT THEY ARE OVERWEIGHT, THEY HAVE THIS NEGATIVE BODY IMAGE THAT I TALKED BEFORE, AND SO THEY TRY TO EXCESSIVELY EXERCISE IN ORDER TO REMAIN SLENDER, BUT NOT NECESSARILY HEALTHY. SO IN THAT SENSE, EXERCISE IS NOT USED IN A HEALTHY WAY. IT IS NOT A HEALTHY BEHAVIOR, AND VIGOROUS EXERCISE WHICH LASTS FOR MANY, MANY HOURS CANNOT CONTRIBUTE TO ENJOYMENT AND FUN. ON THE CONTRARY, MOTIVATION AND JOY CAN DECREASE. AND OF COURSE THOSE NEGATIVE CONSEQUENCES OF EXCESSIVE EXERCISE CAN REVEAL AMONG DIFFERENT -- AMONG PEOPLE FROM DIFFERENT ETHNIC GROUPS. WOMEN, FOR EXAMPLE, AFRICAN AMERICAN WOMEN, WHITE WOMEN FROM DIFFERENT RELIGIOUS OR SEXUAL ORIENTATIONS MIGHT TRY TO EXCESSIVELY EXERCISE IN ORDER TO REMAIN SLENDER AND SO TO FIT BETTER IN THIS WESTERN EUROPEAN SOCIETY. AND SO TO AVOID FURTHER DISCRIMINATION. SO THEY USE THIS UNHEALTHY EXERCISE BEHAVIOR TO FIT BETTER INTO SOCIETY. AN ANALOGOUS PHENOMENON TO ANOREXIA IS MUSCLE DISMORE IF I A. PEOPLE TEND TO THINK THAT THEY ARE TOO THIN AND FRAIL, WHEREAS THEIR BODY SHAPE IS NORMAL AND MAY BE SUPER NORMAL. SO THEY THINK THAT THEY'RE TOO THIN AND THEY ENGAGE IN EXCESSIVE WEIGHT TRAINING AND MISUSE OF ANABOLIC STEROIDS IN ORDER TO INCREASE THEIR MUSCLE SIZE. SO THIS IS -- THIS AGAIN IS AN UNHEALTHY EXERCISE BEHAVIOR THAT SHOULD BE AVOIDED. AND THE PHENOMENON OF MUSCLE DYSMORPHIA CAN BE IDENTIFIED AMONG BOTH MEN AND WOMEN. NEGATIVE BODY IMAGES, CONCERN WITH THINNESS, CONCERNS WITH MUSCULARITY CAN REVEAL IN BOTH STANDARDS, MALE AND FEMALE. SO WHAT SHALL WE DO TO OVERCOME THOSE PHYSICAL ACTIVITY CONCERNS? WE AS PHYSICAL EDUCATORS, PHYSICAL ACTIVITY PROMOTERS, HEALTH EDUCATORS, WE SHOULD FOSTER THE IMPORTANCE OF PHYSICAL ACTIVITY FOR HEALTH AND NOT FOR BODY SIZE, NOT FOR BECOMING SLENDER, NOT FOR BECOMING MUSCULAR, BUT FOR BEING HEALTHY. MEDIA CAMPAIGNS SHOULD ENCOURAGE HEALTHY LIFESTYLES RATHER THAN MALADAPTIVE AND POTENTIALLY DANGEROUS BEHAVIORS. CERTAIN POLICY MAKERS SHOULD REENFORCE PROPER HEALTH AND PHYSICAL ACTIVITY EDUCATION WHICH SHOULD START IN KINDERGARTEN. BOYCOTT ADVERTISEMENTS AND PRODUCTS THAT PROMOTE UNHEALTHY IMAGES. JUST BRIEF INFORMATION ABOUT EUROPE, THE UNITED KINGDOM GOVERNMENT HAS ALREADY TAKEN ACTION TO BOYCOTT UNREALISTIC BODY IDEALS THAT MAY BE ADOPTED BY INDIVIDUALS VULNERABLE TO ANOREXIA NERVOSA. SO AFTER IDENTIFYING THOSE PHYSICAL ACTIVITY CONCERNS, AFTER FOSTERING THE IMPORTANCE OF EXERCISE AND PHYSICAL ACTIVITY FOR HEALTH, WE SHOULD CONSIDER THAT ONLY 23 PERCENT OF INDIVIDUALS WITH DISABILITIES ENGAGE IN REGULAR PHYSICAL ACTIVITY. AND THE QUESTION IS WHY? WHY SO FEW PEOPLE ENGAGE IN EXERCISE PROGRAMS? IN ANSWER TO THAT QUESTION, MIGHT BE DUE TO LOW MOTIVATION. PEOPLE MAY NOT BE MOTIVATED TO BE PHYSICALLY ACTIVE, BUT THIS LOW MOTIVATION MIGHT NOT BE A PERSONAL CHOICE, BUT IT MIGHT BE AN UNDESIRABLE OUTCOME INFLUENCED BY SOCIETAL AND CULTURAL CONSTRAINTS AND DISCRIMINATION. SO IF THE PEOPLE WITH DISABILITIES FOR EXAMPLE EXPERIENCE DISCRIMINATION, UNEQUAL OPPORTUNITIES, NEGATIVE ATTITUDES TOWARD PHYSICAL ACTIVITY PARTICIPATION, THEY MIGHT BE UNMOTIVATED TO ENGAGE IN ANY TYPE OF PHYSICAL ACTIVITY. SO LET'S PROVIDE CERTAIN -- LET'S PROPOSE CERTAIN STRATEGIES TO INCREASE MOTIVATION TOWARD PHYSICAL ACTIVITY. SO WE SHOULD ENCOURAGE LEISURE TYPE ACTIVITIES WHICH PROMOTES SUCCESSFUL EXPERIENCES. LEISURE TYPE ACTIVITIES ARE MEANINGFUL FOR THE INDIVIDUAL AND THEY ARE ENJOYABLE. INDIVIDUALS SHOULD SET SPECIFIC GOALS, REALISTIC GOALS FOR THEIR EXERCISE PROGRAM. INDIVIDUALS WITH DISABILITIES SHOULD HAVE REALISTIC GOALS, NOT TOO DIFFICULT, NOT TOO EASY, BUT SOMETHING THAT THEY CAN DO. SOMETHING WHICH IS APPROPRIATE AND MEANINGFUL. THEY SHOULD BE EDUCATED. THEY SHOULD BE INFORMED ABOUT THE BENEFITS AND RISKS OF PHYSICAL ACTIVITY. CERTAIN TECHNIQUES TO MANAGE STRESS AND SUCH TECHNIQUES CAN BE EXERCISE. THEY SHOULD FIND A WAY TO SET GOALS TO SOLVE ANY STRESSFUL SITUATION IN THEIR LIFE OR ANY CERTAIN PROBLEMS THAT MAY APPEAR IN THEIR PHYSICAL ACTIVITY OR EXERCISE PROGRAMS. THEY SHOULD TRY TO REEVALUATE THE BENEFITS AND COSTS OF PHYSICAL ACTIVITY. THEY SHOULD HAVE SOCIAL SUPPORT AND ENGAGE IN POSITIVE SELF-TALK. WE AS PHYSICAL EDUCATORS OR ADOPTED PHYSICAL EDUCATORS OR HEALTH EDUCATORS, WE SHOULD COMMUNICATE THE BARRIERS, PRECEDENCES AND CONSTRAINTS TOWARD PHYSICAL ACTIVITY PARTICIPATION. WHAT ARE THE BARRIERS OF INDIVIDUALS WITH DISABILITIES TO PARTICIPATE IN EXERCISE? WHAT ARE THE PRECEDENTS? AND KNOWING THOSE PRECEDENTS, WE CAN STRUCTURE PROGRAMS TO MEET THOSE PRECEDENTS AND TO OVERCOME THE BARRIERS. OTHER WAYS TO MOTIVATE PEOPLE TO BE ACTIVE IS TO PLAN CERTAIN LOCAL EVENTS. FOR EXAMPLE, A WALKING EVENT TO THE LOCAL ZOO OR TO THE AQUARIUM, ENCOURAGING FAMILY MEMBERS TO TAKE ACTION MIGHT BE VERY ENJOYABLE AND AVAILABLE TO EVERYONE. OTHER TYPE OF EVENTS, FOR EXAMPLE, HOSTING A WEEKEND EVENT SUCH AS BASKETBALL OR VOLLEYBALL GAMES WITHIN THE COMMUNITY. HOST GO OUT DOOR DANCING LESSONS OR POWER WALKING SEMINARS AS WELL AS INDOOR OR WORK SITE EVENTS CAN INCREASE OPPORTUNITIES FOR THE MOTIVATION TOWARD PHYSICAL ACTIVITY PARTICIPATION. BEYOND FOSTERING STRATEGIES TOWARDS MOTIVATION FOR (INAUDIBLE), WE SHOULD ALSO CONSIDER YOUTH. THE INCREASING PERCENTAGES OF YOUNG PEOPLE WHO ARE OVERWEIGHT HAVE LED TO THE DEVELOPMENT OF CERTAIN RECOMMENDATIONS AND STRATEGIES FOR PROMOTION OF AGE APPROPRIATE, MEANINGFUL ACTIVITIES. AGAIN, WE SHOULD BE AWARE OF THE BARRIERS TOWARD PHYSICAL ACTIVITY PARTICIPATION FOR YOUNG CHILDREN. PARENTS AND GUARDIANS SHOULD BE EDUCATED AND BECOME PHYSICAL ACTIVITY PROMOTERS FOR THEIR CHILDREN. MOST CHILDREN SHOULD HAVE QUALITY PHYSICAL EDUCATION, INCORPORATING BOTH EXTRACURRICULAR AND RECREATIONAL ACTIVITIES. THERE HAS TO BE ACCESSIBILITY AND EQUAL OPPORTUNITIES TO RECREATIONAL AND ORGANIZED ATHLETIC PROGRAMS. COACHES AND PROGRAM STAFF SHOULD BE WELL TRAINED. OTHER CONSIDERATIONS SHOULD BE FOSTERED SUCH AS CLOSE TO HOME BICYCLE AND WALKING PATHS, SIDEWALKS AND COMMUNITY FACILITIES WHICH PROMOTE PHYSICAL ACTIVITY PARTICIPATION. SO THE ENVIRONMENT SHOULD PROMOTE EXERCISE AND PHYSICAL ACTIVITY. AS PHYSICAL EDUCATORS, WE SHOULD REENFORCE CHALLENGING TASKS, NOT TOO DIFFICULT AS I SAID BEFORE, NOT TOO EASY GOALS, BUT CHALLENGING, SOMETHING THAT THE INDIVIDUAL CAN ENJOY AND CAN DO. WE SHOULD ALLOW SOME CONTROL TO YOUNGSTERS. WE SHOULD ASK THEM WHAT THEY LIKE AND WHAT THEY DON'T, AND WHAT ARE THE PHYSICAL ACTIVITIES THAT THEY PREFER. IN THAT WAY, WE CAN INCREASE MOTIVATION. AS PHYSICAL EDUCATORS, AGAIN, WE SHOULD HAVE POSITIVE ATTITUDES TOWARD TEACHING INDIVIDUALS WITH DISABILITIES. WE SHOULD HAVE POSITIVE ATTITUDES TOWARD INCLUDING INDIVIDUALS WITH DISABILITIES INTO INTEGRATED ENVIRONMENTS, GENERAL PHYSICAL CLASSES, IN ORDER TO INCREASE MOTIVATION AND DIMINISH DISCRIMINATION. SO LAST, BUT NOT LEAST, THE PHYSICAL ACTIVITY EXPERIENCES FOR THOSE INDIVIDUALS SHOULD OFFER FUN, ENJOYMENT AND EXCITEMENT. AND WE SHOULD DIMINISH ANXIETY IN ORDER TO INCREASE MOTIVATION. TO SUM UP AND CONCLUDE, PHYSICAL ACTIVITY AND EXERCISE IS VERY IMPORTANT FOR ALL INDIVIDUALS, PLUS INDIVIDUALS WITH DISABILITIES. WE SHOULD ALLOW CHOICES TO THOSE INDIVIDUALS FOR PHYSICAL ACTIVITY IN ORDER TO BE MOTIVATED TO PARTICIPATE IN FUTURE EXERCISE PROGRAMS. >> RACHEL: OKAY. >> MARIA: ARE THERE ANY QUESTIONS? >> RACHEL: WE HAVE A NUMBER HAVE QUESTIONS. I DECIDED TO HOLD THEM TO THE END. SO I THINK THAT WAS A LOT OF INFORMATION AND WE HAVE A RANGE HAVE QUESTIONS. LET'S JUST GET STARTED. ONE CAME IN. IT SAYS I HAVE A PHYSICAL DISABILITY. I CAN'T DO ALL THE REGULAR THINGS THAT ARE AT THE GYM AND ALSO I FEEL CONSPICUOUS THERE. WHAT OTHER OPTIONS DO I HAVE? AND THEN SORT OF A SECOND PART OF THE QUESTION IS IS THERE SOMEBODY OR A PROGRAM THAT CAN HELP ME FIGURE THIS OUT AND DO THE MOTIVATIONAL THINGS THAT YOU'VE BEEN TALKING ABOUT? >> MARIA: I WILL START ON THE SECOND PART OF THE QUESTION. AS I SAID, THE STRATEGIES THAT I OFFERED, THEY ARE WITHIN A CAMPAIGN WHICH IS IN THE WEBSITE. THIS PERSON CAN GO TO SURGEON'S GENERAL REPORT AND THESE STRATEGIES ARE PROVIDED FROM -- SOME OF THOSE STRATEGIES ARE PROVIDED SOME CDC CENTERS AND THERE IS A CAMPAIGN. AND THE TITLE OF IT IS PHYSICAL ACTIVITY SET, IT IS EVERYWHERE YOU GO. SO THIS CAMPAIGN TRIES TO INCORPORATE CERTAIN STRATEGIES TO INCREASE MOTIVATION TOWARDS PHYSICAL ACTIVITY PARTICIPATION. SO THIS PERSON CAN -- >> OKAY, WE HAVE A TECHNICAL. PLEASE HOLD ON. THE SERVER WENT DOWN. WE'LL HAVE TO RESTART. STAND BY, I'M RESTARTING. I'M HAVING TROUBLE REESTABLISHING CONTACT HERE. OKAY, GO AHEAD. >> RACHEL: SORRY, EVERYBODY FOR THE INTERRUPTION. >> JEFF: THIS IS JEFF MCCUBBIN. CAN YOU RESTATE THAT FIRST QUESTION AGAIN? I WAS TAKING NOTES AND I WANT TO MAKE SURE I HAD THE PERSON'S QUESTION CORRECT. >> RACHEL: YES, AND I'M ALSO GOING TO TACK ON -- AN ADDITIONAL QUESTION BECAUSE I THINK WHAT MARIA STARTED TO TALK ABOUT LEADS NICELY INTO THIS QUESTION AND MAYBE YOU GUYS CAN ADDRESS THEM ALTOGETHER. THAT FIRST QUESTION WAS I HAVE A PHYSICAL DISABILITY AND I CAN'T DO ALL THE REGULAR THINGS AT A GYM. ADDITIONALLY, THE PERSON SAYS THEY FEEL CONSPICUOUS THERE. THE CALLER WANTS TO KNOW WHAT OPTIONS DO I HAVE, AND THEN ADDITIONALLY, IS THERE SOMEONE OR A PROGRAM THAT CAN HELP ME FIGURE THIS OUT AND DO THE MOTIVATIONAL THINGS THAT YOU'RE TALKING ABOUT. AND THEN I'D LIKE TO GO AHEAD AND THROW OUT AN ADDITIONAL QUESTION BECAUSE I THINK YOU WERE BEGINNING TO ANSWER IT, MARIA. AND THAT IS THE IDEAS THAT YOU DESCRIBE ARE EXCELLENT. ARE YOU IMPLEMENTING THEM OR ARE THERE EDUCATION CAMPAIGNS WHICH ARE IMPLEMENTING THEM? AND ALONG THOSE LINES, IS THERE FUNDING AVAILABLE TO MAKE THESE IDEAS AND STRATEGIES A REALITY? >> LET ME SEE IF I CAN START WITH THE FIRST PART AND GIVE ME RECOMMENDATIONS. FOR THE INDIVIDUAL WHO SOUNDS LIKE HE OR SHE WANTS TO EXERCISE, BUT IT'S THE ENVIRONMENT THAT THEY GO INTO THAT MIGHT BE A PROBLEM. ONE RECOMMENDATION MIGHT BE TO TRY TO IDENTIFY ONE PERSON TO BE AN EXERCISE PARTNER FOR THAT INDIVIDUAL, THAT THEY CAN BRING WITH THEM A FRIEND, A COLLEAGUE, SOMEBODY THAT IS INTERESTED IN EXERCISE AS WELL, AND MAY BE LOOKING FOR A WORKOUT PARTNER. AND THAT MIGHT HELP FACILITATE MOVING AROUND THE GYM A LITTLE BIT EASIER, AND IT MIGHT ALSO HELP THAT PERSON FEEL CONNECTED TO SOMEBODY IN THAT PARTICULAR GYM. AND GOING TO A PARTICULAR STAFF PERSON AT THAT FACILITY AND SAYING I'M NOT FEELING COMFORTABLE HERE, I WOULD LIKE TO HAVE A WORKOUT PARTNER AND CAN YOU HELP IDENTIFY SOMEONE WHO MIGHT WANT TO WORK OUT WITH ME. A STAFF PERSON MIGHT BE ABLE TO KNOW SOMEBODY WHO HAS SKILLS AND INTERESTS IN PEOPLE WHO HAVE PHYSICAL DISABILITIES WHO MIGHT NOT BE IN THE GYM AT THE TIME THAT THEY TYPICALLY COME ANED COULD A RANGE TO PARTNER THAT PERSON. SO I THINK THAT IS A BETTER STRATEGY THAN HAVING SOMEBODY IDENTIFY A BUNCH OF EXERCISES THAT THEY MIGHT BE ABLE TO DO AT HOME. THERE IS AN ORGANIZATION NOW THAT HAS BEEN FUNDED RECENTLY BY THE CENTERS FOR DISEASE CONTROL THAT IS THE NATIONAL CLEARINGHOUSE OF PHYSICAL ACTIVITY FOR PERSONS WITH DISABILITIES. IT HAS AN ACRONYM THAT YOU COULD FIND ON THE WEB WHICH IS NCPAD.ORG. IT'S AT THE UNIVERSITY OF ILLINOIS-CHICAGO, AND THEY HAVE STAFF THAT CAN PROVIDE PARTICULAR DETAILS. SO IF THIS PERSON WHO CALLED IN, FOR INSTANCE, HAS A SPINAL CORD INJURY, HE OR SHE COULD ASK FOR SPECIFIC DETAILS ON HOW THEY MIGHT MOVE OR HOW THEY MIGHT DEVELOP AN EXERCISE PROGRAM FOR THEM AND THAT CLEARINGHOUSE CAN HELP TO PROVIDE SPECIFIC DETAILS TO THAT INDIVIDUAL. THE SECOND FOLLOW-UP QUESTION THAT I'LL FIRST TRY AND ASK DR. CARDINAL OR MARIA TO COME FORWARD WITH OTHER IDEAS, AND THAT IS AS IT RELATES TO HOW DO WE GET PROGRAMS LIKE THIS GOING IN OUR COMMUNITIES? ARE THERE WAYS TO FUND PROGRAMS LIKE THAT? AND I GUESS WITH MY INTEREST AND BACKGROUND, I WOULD HOPE THAT WE CAN IMPROVE THE PHYSICAL EDUCATION OPPORTUNITIES FOR OUR YOUNG CHILDREN WHO HAVE DISABILITIES IN THE SCHOOLS. AND THAT IS AN AREA THAT NEEDS TO BE A FIRST STEP IN TERMS OF MAKING SURE THAT COMMUNITY PHYSICAL ACTIVITY SPECIALISTS, IF YOU WILL, AND SPECIAL EDUCATORS AND THOSE WHO WORK IN THE REHAB COMMUNITY CAN WORK TOGETHER TO MAKE SURE THAT GOOD PROGRAMS ARE AVAILABLE IN THE SCHOOLS. BUT I THINK COMMUNITIES ARE STARTING TO CATCH ON. I WOULD LIKE TO HOPE SO AS THEY RESPOND TO MAKING ACCESSIBLE COMMUNITY-BASED PROGRAMS WITH THE AMERICANS WITH DISABILITIES ACT SO THAT MORE AND MORE FITNESS FACILITIES ARE RECOGNIZING THAT THEY HAVE RESPONSIBILITY AND AN UNDERSTANDING FOR THE NEEDS OF ALL PEOPLE AS IT RELATES TO PHYSICAL ACTIVITY. I THINK THERE IS A LONG WAY TO GO IN SOME COMMUNITIES, BUT PROGRESS HAS BEEN MADE IN CERTAIN PLACES. >> BRAD: THIS IS BRAD. I'M GOING TO ADD A COUPLE OF THINGS THAT WEREN'T HIGHLIGHTED THAT MIGHT BE UNIQUE. SO, ONE, IF THE PERSON WHO CALLED IN WITH THE QUESTION WAS NEAR A UNIVERSITY THAT HAS AN ADAPTED PHYSICAL ACTIVITY PROGRAM, OFTEN THEY COULD ENROLL IN A COURSE THERE WHICH WOULD ALLOW THEM PHYSICAL ACTIVITY OPPORTUNITIES AND SOME ONE ON ONE OR GROUP TANK WITH THAT UNIVERSITY'S PROGRAM. SO A LOT OF UNIVERSITIES DO HAVE ADAPTED PHYSICAL ACTIVITY PROGRAMS AVAILABLE. COMMUNITY COLLEGES AS WELL. THE SECOND THING I WOULD SAY IS THAT GO BACK TO A FUNDAMENTAL PRINCIPLE AND THAT IS THAT SOME PHYSICAL ACTIVITY IS BETTER THAN NO PHYSICAL ACTIVITY. SO IF THAT INDIVIDUAL CAN FIND OPPORTUNITIES NOT IN THE -- IF THEY'RE NOT AVAILABLE IN THE FITNESS CENTER, IT'S INACCESSIBLE, FINDING SOME ACCESS AND IF IT'S A HOME BASED PROGRAM, SO BE IT. THERE ARE SOME HOME-BASED PROGRAMS THAT WOULD BE AVAILABLE. SO I THINK THAT IT'S BETTER THAN NOTHING AT ALL. THOSE WOULD BE THE MAIN TWO THINGS THAT I GUESS I WOULD SAY THAT WITH REGARDS TO FUNDING OPPORTUNITIES, IN PART, THE PROGRAM THAT IS FUNDING US IS LOOKING AT SOME OF THESE VERY ISSUES AND SO THAT IS WITH NIDRR GROUP, U.S. DEPARTMENT OF ED, AND THEN CENTERS FOR DISEASE CONTROL AND PREVENTION WAS MENTIONED AND SOME LOCAL FOUNDATIONS OR REGIONAL FOUNDATIONS ALSO FUND WORK IN THIS AREA, AND THAT I'LL PASS THIS ONTO MARIA. >> MARIA: YEAH, AGAIN, WITH REGARD TO THE FIRST QUESTION, ANOTHER IDEA WOULD BE TO MODIFY THE ACTIVITIES. IF THIS IS POSSIBLE, AND IF THERE IS A TRAINED -- IF THE PHYSICAL EDUCATOR IS A GENERAL PHYSICAL EDUCATOR AND IF THERE IS ACCESSIBILITY TO A TRAINED PHYSICAL EDUCATOR WHO WORKS WITH PEOPLE WITH DISABILITIES OR TO AN ADAPTED PHYSICAL EDUCATOR, THAT WOULD BE ALSO USEFUL. TO ASK FOR HELP TO MODIFY THOSE ACTIVITIES, MAYBE AS DR. MCCUBBIN SAID, A HELPER, A FRIEND TO DO THOSE ACTIVITIES TOGETHER. AND WITH REGARD TO THE SECOND QUESTION, AGAIN, THIS CAMPAIGN IS AVAILABLE IN THE SURGEON'S GENERAL'S REPORT ON THE WEBSITE AND IT IS UNDER THE CENTERS FOR DISEASE CONTROL AND PREVENTION AND IT IS INDICATED WITH DETAILS HOW THE PERSON CAN APPLY THOSE STRATEGIES AND BE MOTIVATED TO BE ACTIVE. AND AGAIN, I DON'T KNOW IF CERTAIN -- I WOULD GUESS MANY COMMUNITIES AND MANY -- THERE MUST BE MANY COMMUNITIES WHO WOULD HAVE APPLIED THOSE STRATEGIES AND WOULD HAVE TRIED TO APPLY THIS CAMPAIGN. BUT I WOULDN'T KNOW FOR EACH SINGLE CITY WITHIN THE U.S. FOR SURE IN OREGON, HERE IN COMPANY VALLEYS THIS IS AVAILABLE. THERE ARE CERTAIN STRATEGIES FOR PEOPLE TO MAKE THEM ACCESSIBLE AND AVAILABLE TO INCREASE MOTIVATION. >> RACHEL: THOSE ARE SOME GREAT RESOURCES. WE HAVE A COUPLE OF MORE LEGAL QUESTIONS, AND I'LL GROUP THEM TOGETHER IF YOU GUYS CAN ADDRESS THESE. ONE IS, IS MY GYM REQUIRED TO ADAPT THEIR CLASSES FOR MY SPECIAL NEEDS? AND THEN A PARENT ALSO IS ASKING IF THEIR CHILD'S SCHOOL IS REQUIRED TO PROVIDE SOME SPECIAL PHYSICAL ACTIVITY, PHYSICAL EDUCATION CLASSES FOR HER CHILD WITH A DISABILITY? >> JEFF: THIS IS JEFF MCCUBBIN. I'LL TRY TO ANSWER EACH OF THOSE AND THEY ARE VERY GOOD QUESTIONS. WITH THE FIRST QUESTION IS MY GYM REQUIRED, AND I'M GOING TO BASE THIS ON IT IS A COMMUNITY BASED PROGRAM LIKE A YMCA OR EVEN A PRIVATE GYM THAT IS IN A COMMUNITY, THAT NOT ALL -- WHAT HAS TO BE REQUIRED IS THAT PEOPLE CAN'T BE DENIED ACCESS TO A PARTICULAR PROGRAM ON THE BASIS OF THE DISABILITY. SO IF THEY HAD -- IF A PERSON WANTED TO PARTICIPATE IN WEIGHTLIFTING AND ALL THE WEIGHTS WERE DOWNSTAIRS AT A LOWER LEVEL, THEN A FITNESS FACILITY WOULD NEED TO MAKE SURE THERE WERE SIMILAR WEIGHTS AVAILABLE ON THE GROUND FLOOR THAT MIGHT BE ACCESSIBLE. HOWEVER, THE REQUIREMENTS BY THE GYM IN TERMS OF ADMISSION FEES AND/OR MEMBERSHIP STRATEGIES IS CERTAINLY LEFT TO THAT PRIVATE OWNER TO STIPULATE, BUT THEY CAN'T DENY A PERSON WHO CAN CHOOSE TO BE A MEMBER OF THAT CLUB THE CAPACITY TO PARTICIPATE IN THE VARIOUS ELEMENTS OF THE CLUB. AND THAT CAN CREATE SOME ISSUES, BUT THE CLUB HAS TO TRY TO MAKE A REASONABLE ACCOMMODATION IN ORDER TO TRY TO FACILITATE THAT PERSON TO PARTICIPATE. AND THE REASONABLE NATURE OF THAT ACCOMMODATION, IT MIGHT NOT BE REASONABLE ACCORDING TO SOME TO HAVE TO PUT AN ELEVATOR IN NECESSARILY IF THEY COULD MOVE THE WEIGHTS TO THE GROUND LEVEL AND ALLOW THAT PERSON TO PARTICIPATE IN THOSE PROGRAMS. IT'S A LITTLE BIT LESS CLEAR TO ME, AND I CERTAINLY DON'T PRETEND TO BE A LEGAL ADVISOR, AT WHAT JUNCTURE DOES A FITNESS FACILITY HAVE TO RESPOND TO THE REQUESTS IF THE FACILITY IS A PRIVATE FACILITY IN A COMMUNITY. THE ISSUE IN THE SCHOOL, I'M A LITTLE BIT MORE COMFORTABLE WITH HAVING WATCHED THE DEVELOPMENT OF SPECIAL EDUCATION LAW IN THE LAST 15 OR 20 YEARS. DEPENDING UPON THE CHILD'S CAPACITY TO PARTICIPATE AND EACH STATE HAS A LITTLE BIT DIFFERENT REGULATIONS AS IT RELATES TO PHYSICAL EDUCATION, BUT IF PHYSICAL EDUCATION NEEDS TO BE AN ESSENTIAL PART OF THAT CHILD'S EDUCATIONAL DAY SUCH THAT THE TEAM OF TEACHERS INDICATE THAT, YES, THAT CHILD NEEDS TO PARTICIPATE IN A PHYSICAL EDUCATION PROGRAM, THAT PROGRAM NEEDS TO BE APPROPRIATE FOR THAT PARTICULAR CHILD. WHETHER IT HAS TO BE A SPECIAL PROGRAM DEPENDS ON WHETHER WHAT'S AVAILABLE FOR OTHER CHILDREN IN THAT CLASS OR IN THAT SCHOOL IS DEEMED APPROPRIATE. SO AS AN EXAMPLE, IF A CHILD WHO HAS SEVERE CEREBRAL PALSY IS SIX YEARS OF AGE AND THIS CHILD USES SOME FORM OF A POWER WHEELCHAIR TO MOVE THROUGH THE SCHOOL, THE LIKELIHOOD THAT THAT CHILD COULD ENGAGE IN MEANINGFUL PHYSICAL EDUCATION WITHOUT SIGNIFICANT ACCOMMODATIONS TO MEET THAT CHILD'S NEEDS IS PRETTY DOUBTFUL. AND IF THE TEAM FEELS THAT PHYSICAL EDUCATION IS IMPORTANT FOR THAT CHILD AND THE TEAM INCLUDES THE PARENT, THEN PHYSICAL EDUCATION WOULD NEED TO BE DESIGNED SPECIALLY TO MEET THAT CHILD'S NEEDS AND PHYSICAL EDUCATION IS PART OF WHAT IS KNOWN AS THE INDIVIDUAL'S WITH DISABILITIES EDUCATION ACT, IDEA. SO ALL EDUCATIONAL PROGRAMS, INCLUDING PHYSICAL EDUCATION, WHICH IS SPECIFICALLY STATED IN THAT LAW, NEEDS TO BE PROVIDED IN AN APPROPRIATE WAY FOR THAT CHILD. IT'S IMPOSSIBLE FOR ME TO JUDGE ON THE NATURE OF ONE CHILD AND IT DEPENDS ON WHAT'S AVAILABLE IN THE SCHOOLS; BUT WHAT UNFORTUNATELY HAPPENS IN TOO MANY SCHOOLS AROUND THE UNITED STATES IS THAT THEY DON'T MAKE SURE THAT THE PHYSICAL EDUCATION CLASS IS APPROPRIATE. THEY JUST INTEGRATE KIDS INTO THE REGULAR CLASS AND HOPE THAT THE KID GAINS SOMETHING VALUABLE BY THEIR PARTICIPATION IN PHYSICAL EDUCATION. AND THAT IS AN AREA THAT HAS CONTINUAL NEED FROM EAST COAST TO WES COAST AND NORTH TO SOUTH. IT'S A PROBLEM IN MANY DIFFERENT SCHOOLS BECAUSE IT'S NOT CLEARLY STATED; AND FRANKLY, THERE ARE NOT ENOUGH TEACHERS WITH TRAINING TO WORK WITH CHILDREN WITH DISABILITIES IN A PHYSICAL EDUCATION SETTING TO PROVIDE EFFECTIVE PROGRAMS THROUGHOUT. >> BRAD: THIS IS BRAD. IF I COULD ADD ONE THING ON THE FIRST PART OF THAT. THE FITNESS FACILITIES OR HEALTH CLUB'S RESPONSIBILITIES, THIS IS JUST TO ACKNOWLEDGE THAT IT IS DEFINITELY A PROBLEM. THERE WAS A STUDY DONE IN KANSAS CITY, MISSOURI, AND NONE OF THE CLUBS IN THAT AREA THAT WERE LOOKED AT WERE FULLY COMPLIANT WITH ADA GUIDELINES IN THAT AREA, AND WE INSTITUTED A STUDY HERE IN WESTERN OREGON, AND PRELIMINARY RESULTS IS ALL I CAN SHARE, BUT NO FACILITY OF THE 50 WE LOOKED AT WERE 100 PERCENT COMPLIANT. AND WHERE THE LAW BECOMES A BIG FACTOR IS IN A FACILITY'S RENOVATION, IF THE FACILITY IS BEING RENOVATED AND AN ARKT TEXT IS INVOLVED, THEN THE ARCHITECT DOES HAVE SOME LEGAL RESPONSIBILITY TO MODIFY THE FACILITY MAXIMIZING ACCOMMODATION WITH ADA COMPLIANCE REGULATIONS BEING ACCOUNTED FOR. BUT EXISTING FACILITIES MAY NOT MAKE THOSE ACCOMMODATIONS, MAY NOT HAVE MADE THOSE ACCOMMODATIONS. >> RACHEL: AND I'LL JUST -- I KNOW I'M THE QUESTION ASKER, BUT I'M GOING TO TAKE THE LIBERTY TO THROW IN AN ADDITIONAL RESOURCE, TOO. WHEN IT DOES COME TO GYMS, WHETHER THEY ARE PUBLIC OR PRIVATE, IT IS THE AMERICANS WITH DISABILITIES ACT WHICH GUIDES THE ACCESS ISSUES AND THAT THEY ARE DIFFERENT AS JEFF WAS SAYING BEFORE, THE GUIDELINES ARE A LITTLE BIT DIFFERENT IF YOU'RE TALKING ABOUT A CITY OR A COUNTY OR A LOCAL PROGRAM OR FACILITY VERSUS IF IT'S ONE OF THE COMMERCIAL GYMS, BUT FOR BOTH OF THEM, THEY CAN'T DENY ACCESS TO PEOPLE WITH DISABILITIES AND NEITHER ONE OF THEM IS ALLOWED TO CHARGE PEOPLE WITH DISABILITIES ANY SURCHARGE OR ANYTHING EXTRA OR INCREASE THEIR FEES OR THEIR MEMBERSHIP FEES OR SOMETHING BECAUSE THEY DO NEED SOME ACCOMMODATION. AND IF PEOPLE WHO ARE LISTENING DO HAVE ADDITIONAL QUESTIONS ABOUT THE AMERICANS WITH DISABILITIES ACT AND HOW IT APPLIES IN THESE ARENAS, YOU CAN CALL -- THERE IS AN 800 NUMBER. YOU CAN CALL FROM ANYWHERE IN THE COUNTRY AND YOU'LL BE CONNECTED TO YOUR REGIONAL ADA RESOURCE CENTER. AND THAT NUMBER IS 800-949-4232. OKAY, MOVING ON FROM THAT. WE HAVE ANOTHER QUESTION, SHIFTING GEARS, GUYS, ABOUT DEPRESSION. ACTUALLY THERE WERE A COUPLE OF QUESTIONS AND I THINK THAT WHAT PEOPLE ARE INTERESTED IN IS A LITTLE BIT MORE ABOUT HOW DOES EXERCISE COUNTER DEPRESSION? >> MARIA: OKAY, I WILL START WITH THE FIRST QUESTION, AND ACTUALLY THE TWO QUESTIONS ARE KIND OF TIED TOGETHER. CERTAIN HYPOTHESES HAVE BEEN PROPOSED ABOUT THE WAYS THAT EXERCISE HELPS PEOPLE WITH DEPRESSION. AND THE HYPOTHESES ARE DIVIDED INTO THE PSYCHOLOGICAL AND PHYSIOLOGICAL HYPOTHESES. AND IF WE START WITH THE PHYSIOLOGICAL HYPOTHESES, I WOULD REFER TO THOSE CHEMICALS, WHICH MEANS THAT WITH EXERCISE, DOPAMINE LEVELS AND OTHERS CAN INCREASE, AND WHAT THOSE CHEMICALS DO, BY INCREASING THE DOPAMINE LEVELS, THE PERSON FEELS BETTER AND THE PERSON FEELS IN MOOD, FEELS ENERGETIC AND ACTUALLY BY INCREASING DOPAMINE LEVELS, MOTIVATION ALSO INCREASES TO GET THE PERSON GOING. HOWEVER, THE PROBLEM IS THAT THEY CANNOT MEASURE THOSE CHANGES, THOSE CHEMICAL CHANGES IN THE BRAIN. THEY HAVE MEASURED THOSE CHEMICAL CHANGES INDUCED BY EXERCISE IN THE PER IDENTIFY CALIFORNIA SYSTEM, IN THE BLOOD PLASMA, BUT NOT IN THE BRAIN. SO WE DON'T ACTUALLY KNOW IF THOSE CHANGES DUE TO EXERCISE OCCUR IN THE BRAIN, AND SO THOSE SHIFTS IN MOOD AND MOTIVATION IS THE OUTCOME OF THOSE CHANGES WHICH ARE INDUCED BY EXERCISE. ANOTHER HYPOTHESIS IS THE THERMOGENIC HIGH POPTSDS SIS. WITH EXERCISE THE BODY TEMPERATURE INCREASES AND SO THOSE CHEMICALS AGAIN INCREASE. OPIATE LIKE CHEMICALS INCREASE AS WELL AND SO THE PERSON FEELS BETTER AND FEELS IN MOOD. SO THIS IS ONE WAY THAT EXERCISE CAN HELP PEOPLE WITH DEPRESSION BY INCREASING THOSE CHEMICALS, BY INCREASING THOSE NEURAL TRANSMITTERS AND SO THE PERSON IS CAPABLE OF DEALING WITH STRESSFUL SITUATIONS, AND THE PERSON IS MOTIVATED TO BE ACTIVE. THE OTHER HYPOTHESIS, THE OTHER WAY THAT EXERCISE CAN HELP PEOPLE WITH DEPRESSION IS THE PSYCHOLOGICAL HYPOTHESIS. AND WHAT DOES IT MEAN? THROUGH EXERCISE, AND I MENTIONED IN MY PRESENTATION BEFORE, THROUGH EXERCISE FOR EXAMPLE LET'S TAKE A MUSCLE STRENGTHENING PROGRAM. MUSCLE STRENGTH CAN INCREASE, SO AN EXERCISE PROGRAM CAN INCREASE MUSCLE STRENGTH. BY INCREASING MUSCLE STRENGTH, THE PERSON FEELS GOOD. THE PERSON'S SELF-EFFICACY, THE PERSON'S BELIEF TO INCREASE THEIR MUSCLE STRENGTH INCREASES. THE PERSON'S CONFIDENCE, PERCEIVED CONFIDENCE TO BE SUCCESSFUL IN MUSCLE STRENGTH PROGRAM IN MUSCLE STRENGTH EXERCISES AND TO GET GOING INCREASES. THE PERSON IS SATISFIED WITH HIS OR HER BODY, AND THE PERSON FEELS -- THE PERSON FEELS MEANINGFUL. AND BY THESE PSYCHOLOGICAL CHANGES, DEPRESSION DECREASES AND MOOD INCREASES. WE CAN REFER TO CERTAIN EXERCISE PROGRAMS. A FITNESS PROGRAM, A FITNESS PROGRAM CAN BOTH INCREASE THOSE CHEMICALS ON ONE HAND AND ON THE OTHER HAND, IT CAN INCREASE THOSE SELF-PERCEPTIONS TO DECREASE DEPRESSION. A MUSCLE STRENGTHENING PROGRAM AS I REFERRED BEFORE CAN INCREASE -- CAN OPTIMIZE FUNCTIONING, ESPECIALLY AMONG OLDER ADULTS AND SO DECREASE DEPRESSION AND INCREASE MOTIVATION. SO THIS IS THE WAY THAT EXERCISE CAN HELP PEOPLE WITH DEPRESSION TO BE MOTIVATED AND INCREASE THEIR MOOD. AND WE HAVE TO CONSIDER THAT WHATEVER THE PROGRAM IS, THE MAIN GOAL IS THE PERSON WILL BE ABLE TO MEET HIS NEEDS, HIS GOALS. IF THE GOAL IS TO INCREASE FITNESS, THE PROGRAM SHOULD BE CONSTRUCTED IN SUCH A WAY THAT FITNESS SHOULD INCREASE. THE PERSON NEEDS TO FEEL SUCCESSFUL THAT HIS OR HER GOAL HAS BEEN ACCOMPLISHED. WHATEVER THE GOAL IS, THE GOAL CAN BE JUST TO INCREASED THE FLEXIBILITY TO OPTIMIZE FUNCTIONING. WHATEVER THE GOAL, THE GOAL HAS TO BE MET. I DON'T KNOW IF BRAD WOULD LIKE TO -- >> BRAD: I THINK THAT'S GOOD. >> RACHEL: I THINK IT'S REALLY INTERESTING, TOO. IT'S INTERESTING TO HEAR THE PHYSICAL CHANGES AS WELL AS KIND OF THE PSYCHOLOGICAL CHANGES. I DON'T THINK -- I THINK THAT WE OFTEN HEAR ABOUT SOME OF THE CHEMICAL CHANGES THAT MIGHT BE HAPPENING, BUT YOU WERE ABLE TO PRESENT A LOT OF NEW INFORMATION I THINK FOR THE GENERAL PUBLIC. >> MARIA: THERE ARE SOME TECHNIQUES, IMAGING TECHNIQUES THAT THERE IS HOPE THAT THEY CAN MEASURE THOSE CHEMICAL CHANGES WITHIN THE BRAIN, BUT THIS HASN'T BEEN DONE YET. THOSE CHEMICAL CHANGES HAVE BEEN MEASURED IN THE PERIPHERAL SYSTEM ONLY. >> RACHEL: OKAY, WE HAVE A COUPLE OF OTHER QUESTIONS THAT ARE MORE SPECIFIC QUESTIONS. ONE REFERS TO SOMETHING YOU WERE TALKING ABOUT ON PAGE 3 OF THE HANDOUT WHERE YOU WERE TALKING ABOUT THE NEGATIVE CONSEQUENCES OF WESTERN CULTURE MESSAGES ON PEOPLE FROM DIFFERENT ETHNIC GROUPS. AND THE QUESTION IS ASKING WHETHER AFRICAN AMERICANS AND JEWISH WOMEN AND HOMOSEXUAL WOMEN, ARE THEY NATURALLY HEAVIER THAN WHITE WESTERN WOMEN? >> MARIA: THAT'S A GOOD QUESTION. IF I START WITH AFRICAN AMERICANS -- IT HAS BEEN SUPPORTED THAT THEY ARE NATURALLY HEAVIER, BUT THIS HAS TO DO WITH THEIR CULTURE. I MEAN, FOR THEM MAYBE INCREASING BODY FAT DECLARES WEALTH. SO IN THE WESTERN AMERICAN SOCIETY, THE OPPOSITE IDEAL OF THINNESS IS ONE THAT IS PROMOTED AND THIS IDEALIZATION OF THINNESS IS RELATED TO SUCK FEST AND POWER AND SEXUAL OR PHYSICAL ATTRACTIVENESS, BUT WITHIN THE AFRICAN AMERICAN WOMAN, THE IMPORTANCE MIGHT BE MOTHERHOOD. SO THERE ARE CULTURAL DIFFERENCES THERE. SO, YES, INDEED THERE MIGHT BE PROBLEMS WITH OBESITY AND DIABETES, BUT THE NEGATIVE BODY IMAGES THAT MIGHT APPEAR IN AN AFRICAN AMERICAN WOMAN MIGHT BE RELATED TO ACCULTUREIZATION, BEING IN THE WESTERN SOCIETY AND INFLUENCED BY THE FASHION SHOWS, HOLLYWOOD MOVIES AND MEDIA CAMPAIGNS PROVIDE. ABOUT THE JEWISH WOMAN OR HOMOSEXUAL WOMAN, I WOULD NOT RELATED THOSE PEOPLE TO CERTAIN BODY COMPOSITION MEASURES, BUT IT'S VERY PERSONAL, BUT WHAT I WOULD SAY WOULD BE THAT, FOR EXAMPLE, A JEWISH WOMAN OR A HOMOSEXUAL WOMAN MIGHT TRY TO BE SLENDER IN ORDER TO BETTER FIT INTO THE SOCIETY, BUT NOT NECESSARILY BECAUSE THIS WOMAN OR THIS MAN IS OBESE OR EXPERIENCING SOME OTHER PROBLEMS WITH -- MAYBE THIS PERSON CAN EXPERIENCE SOME PROBLEM WITH BODY IMAGE, BUT THIS PROBLEM IS COMING MAINLY FROM THE WESTERN SOCIETY, AND NOT FROM THE PERSON'S CULTURE. >> RACHEL: OKAY. >> JEFF: THIS IS JEFF MCCUBBIN. I APPRECIATE THE WAY MARIA TRIED TO ANSWER THAT QUESTION BECAUSE IT'S A DIFFICULT QUESTION TO ANSWER. I THINK ONE THING THAT WE DO KNOW ON THE BASIS OF HEALTH-RELATED INFORMATION THAT PEOPLE WITH AFRICAN AMERICAN DESCENT DO HAVE GREATER CONCERNS REGARDING OBESITY AND TYPE II DIABETES AND ARE AT HIGHER RISK FOR STROKE, AND THAT IS LIKELY A COMBINATION OF NOT BEING AS PHYSICALLY ACTIVE AS THEY MIGHT NEED TO BE AND, AGAIN, THAT MAY HAVE A CULTURAL INFLUENCE. I'M UNAWARE OF THE OTHER RELATED ISSUES. I THINK AS A SUBSET, THOUGH, WE KNOW THAT IN THE U.S., AND IT MAY BE A LACK OF ACCESS TO HEALTH CARE AND NOT ENOUGH ENCOURAGEMENT TO HAVE PEOPLE MONITOR THEIR WEIGHT AND THEIR OBESITY LEVELS AS ACCURATELY AS SOME INDIVIDUALS IN A MORE WESTERN SECT. >> MARIA: I WOULD LIKE TO SAY IF THE PERSON DOES NOT LIKE HIS OR HER BODY, IF THIS PERSON HAS THIS NEGATIVE BODY IMAGE BECAUSE OF THE WESTERN MESSAGES, BECAUSE OF THE MESSAGES PROVIDED BY THE WESTERN EUROPEAN AMERICAN SOCIETY, THEN THIS PERSON MIGHT ENGAGE IN EXCESSIVE EXERCISE IN UNHEALTHY EXERCISE BEHAVIOR, AND THIS IS -- THIS SHOULD BE A RED FLAG FOR US. WE SHOULD FOSTER EXERCISE FOR HEALTH, REGARDLESS OF THE BODY FAT. EXCESSIVE BODY FAT OF COURSE IS NOT GOOD, BUT WE SHOULD FOSTER EXERCISE FOR HEALTH, NOT EXCESSIVE EXERCISE BECAUSE WE LOOK DIFFERENT, BECAUSE WE MAY THINK WE ARE MORE OBESE THAN EUROPEAN AMERICAN WOMAN OR MAN. SO I DON'T KNOW IF WE KIND OF APPROACHED THIS QUESTION PROPERLY THERE. I HOPE WE DID. >> RACHEL: OKAY. I THINK SO. AND THIS NEXT QUESTION I THINK DOVE TAILS NICELY AND IT HAS TO DO WITH PEOPLE WHO, QUOTE, EXERCISE TOO MUCH. AND THE QUESTION IS DYSMORPHIA UNHEALTHY? >> MARIA: WHAT HAPPENS IS THE THAT PERSON FEELS THAT THEY ARE TOO FRAIL OR TOO THIN AND SO SPENDS EXCESSIVE AMOUNT OF TIME IN THE GYM TO EXERCISE, ESPECIALLY TO LIFT WEIGHTS. THIS PERSON MIGHT MISUSE ANABOLIC STEROIDS AND THIS OF COURSE IS UNHEALTHY BEHAVIORS. AND THE PERSON EXPERIENCES SOCIAL ALIENATION BECAUSE THEY SPEND SO MUCH TIME IN THE GYM AND DOES NOT HAVE ENOUGH TIME FOR HIS OR HER FRIENDS. SO I DON'T KNOW THAT HAVING THIS TENDENCY -- AGAIN, IT IS RELATED TO THE SELF-PERCEPTION. THE PERSON MIGHT BE PERFECTLY HEALTHY, MIGHT LOOK FINE, BUT THINKS THAT THIS PERSON IS TOO FRAIL, IS TOO SLENDER AND WANT TO INCREASE MUSCULARITY. THEY TRY TO CONTROL PROTEIN LEVELS AND EXCESSIVE WEIGHT TRAINING AND YES, IT IS BAD. >> BRAD: THIS IS BRAD. IF I COULD ADD, THE AMERICAN PSYCHIATRIC ASSOCIATION HAS NOT AGREED. THE SCIENTIFIC MANUAL OF THAT ORGANIZATION DOES NOT ACKNOWLEDGED MUSCLE DYSMORPHIA. AND BODY DYSMORPHIA IS A PERSON WHO BECOMES OBSESSED WITH DEVELOPING THEIR BODIES TO A SUPER NORMAL LEVEL. WHEN THEY LOOK IN THE MIRROR THEY DON'T SEE THAT THOUGH AND THEY START TO DO COMPROMISING BEHAVIORS THAT COMPROMISE THEIR HEALTH OR RELATIONSHIPS. AND AGAIN, WE'VE SEEN THIS IN SOME SMALLER SAMPLES, BUT WE -- AT LEAST AS A CLINICAL CRITERIA, WE DON'T KNOW EXACTLY WHAT THOSE ARE. AT THIS POINT WE JUST KNOW ABOUT THE POTENTIAL RELATIONSHIPS AND POTENTIAL OF THIS DISORDER, BUT NOT THE ACTUAL DISORDER. IT HASN'T BEEN STATISTICALLY DIAGNOSED YET. >> RACHEL: IT SOUNDS LIKE A LOT OF WHAT'S UNHEALTHY ABOUT IT IS ACTUALLY THE PSYCHOLOGICAL IMPLICATIONS RATHER THAN NECESSARILY HAVING TOO MUCH MUSCLE. >> JEFF: CORRECT, IT'S YOUR WILLINGNESS TO, FOR EXAMPLE, TAKE ANABOLIC STEROIDS OF UPWARDS OF 2,000 MILLIGRAMS OF AN ANABOLIC STEROID IS INJECTION FORMAT, FOR EXAMPLE, WHEN THE MEDICAL CRITERIA FOR THAT IS TO FACILITATE GROWTH AND MAYBE USE A 5 MILL I GRAM INJECTION. AND WE DO SEE PEOPLE DOING THESE EXTREME BEHAVIORS THAT ARE CERTAINLY HEALTH COMPROMISING SO THERE IS THE PHYSICAL SIDE OF IT, TOO, WHEN YOU GET INTO THE FARM ECOLOGICAL AID PART OF IT. >> MARIA: LOOKING AT THE DIET. THOSE PEOPLE TRY TO DECREASE THEIR FLUID LEVELS, SO THIS CAN LEAD TO DEHYDRATION. SO, YES, THERE ARE PHYSICAL CONSIDERATIONS AS WELL. >> JEFF: AND THIS IS JEFF. I GUESS MY IMPRESSION IS THAT -- AND I DON'T KNOW THE EXACT STATISTICS AND WOULD ASK MARIA OR BRAD TO ADD TO THIS. WHILE THERE ARE DISORDERS WHERE EXCESSIVE EXERCISE MAY BE A SYMPTOM FOR AN UNDERLYING PSYCHOLOGICAL DISORDER, A FAR MORE PREVALENT PROBLEM IN THE UNITED STATES IS THOSE WHO EXERCISE TOO LITTLE. SO IT'S A SEDENTARY NATURE OF CHOICES THAT CERTAIN SUB GROUPS MAKE AND THAT MAY INCLUDE PEOPLE WITH DISABILITIES THAT IS A VERY BIG CONCERN FOR US. HOW DO WE HELP TO FACILITATE THOSE WHO ARE OTHERWISE SEDENTARY TO CHOOSE TO BE MORE PHYSICALLY ACTIVE, NOT TO NECESSARILY MAKE ALL PEOPLE ATHLETIC OR PEOPLE WHO CHOOSE TO BE EXERCISING FREQUENTLY EACH DAY, BUT HOW DO WE GET PEOPLE TO BE MOVING MORE SO THAT THEY CAN MAINTAIN THEIR HEALTH FOR A LONGER PERIOD OF TIME? THAT IS A CRITICAL ISSUE FOR OUR POPULATION OR OUR CULTURE TO TRY TO ADDRESS. AND WE WANT TO BE PART OF THAT. >> RACHEL: OKAY, WE HAVE A COUPLE OF OTHER QUESTIONS. ONE IS SHIFTING GEARS A LITTLE BIT. THE QUESTION IS WHAT ROLE DOES OR CAN ASSISTIVE TECHNOLOGY PLAY IN MOTIVATING INDIVIDUALS WITH DISABILITIES TO BE MORE PHYSICALLY ACTIVE? >> MARIA: ONE THING THAT COMES IN MY MIND IS AGAIN WITH NEGATIVE BODY IMAGE, BY USING A CERTAIN BRACE DEVICE, THE PERSON CAN KIND OF HIDE HIS OR HER DISABILITY AND BE MORE ACCEPTED INTO THE SOCIETY AND FEEL BETTER AND BE MORE MOTIVATED TO BE ACTIVE. SO THE AESTHETIC PART OF IT -- OF COURSE THE MOST IMPORTANT THING IS THE FUNCTIONING PART OF IT THAT FACILITATES THE PERSON TO PARTICIPATE IN MANY, MANY PHYSICAL ACTIVITIES. EVEN A PERSON WITH AN AMPUTATION, FOR EXAMPLE. BEYOND THE FUNCTIONING PART, THE AESTHETIC PART CAN ALSO COME INTO PLAY AND SO THE PERSON FEELS BETTER, FEELS LIKE THEY LOOK LIKE THE OTHERS AND IS BETTER ACCEPTED WITHIN THE SOCIETY. >> THERE ARE A VARIETY OF FORMS OF ASSISTIVE TECHNOLOGY. I THINK MARIA IS RIGHT. IF WE LOOKED AT PROSTHETICS DESIGNED AS A FORM OF ASSISTIVE TECHNOLOGY, CERTAINLY THE IMPROVED CAPACITY OF PROSTHESIS TO FACILITATE MOTION AND TO HELP PEOPLE CONTINUE TO MOVE MORE INDEPENDENTLY IS WONDERFUL, BUT THERE ARE ALSO SOME TYPES OF ASSISTIVE TECHNOLOGY, COMPUTERIZATION THAT IN SOME WAYS MAY HAVE HELPED INCREASE OUR PROBLEM IN THE U.S. AS IT RELATES TO SEDENTARY LIFESTYLES. IF PEOPLE DON'T HAVE TO MOVE VERY FAR TO BRING EVERYTHING TO THEM, IT MIGHT INCREASE THE CHOICES THAT PEOPLE HAVE TO MAKE TO BE ACTIVE FROM A SEDENTARY POSITION. BUT I THINK MAYBE BRAD WOULD WANT TO COMMENT ON THE WAYS THAT WE CAN USE ASSISTIVE TECHNOLOGY TO MOTIVATE PEOPLE AND I THINK THAT'S ONE OF THE AREAS THAT WE'RE LOOKING AT NOW. >> BRAD: SO THIS IS BRAD, AND I'LL ECHO FIRST TO REENFORCE THE NOTION THAT ASSISTIVE TECHNOLOGY COULD BE QUITE DANGEROUS IN THE SENSE THAT AS WE BECOME MORE DEPENDENT ON THAT WE HAVE TO DO LESS PHYSICAL WORK WHICH IS -- WHICH MEANS WE DO LESS PHYSICAL ACTIVITY. SO TO TAKE THE POSITIVE SIDE OF THAT, IN THE FIRST STUDY THAT WE DID, WE WERE LOOKING AT A BEHAVIOR CHANGE MODEL, AND MAYBE THIS GOES BACK EVEN TO THE FIRST QUESTION ABOUT PROGRAMS TO HELP ENHANCE MOTIVATION, SO WE'VE BEEN TRYING TO IDENTIFY WHAT ARE SOME MOTIVATIONAL STRATEGIES THAT WE MIGHT BE ABLE TO EMPLOY TO HELP PEOPLE MOVE THROUGH A BEHAVIOR CHANGE PROCESS. AND IN THE SECOND STUDY, WHICH WE ARE IN THE PROCESS OF DEVELOPING AND HOPING TO GET UNDERWAY WITHIN THE YEAR, WE'LL BE TRYING TO IMPLEMENT SOME OF THESE MOTIVATIONAL PROGRAMS TO ASSIST PEOPLE, AND THAT WOULD BE DELIVERED -- ONE USE OF ASSISTIVE TECHNOLOGY TO DELIVER IT THROUGH A MECHANISM SUCH AS THIS WEBCAST OR SOME SORT OF SELF-HELP TIME PROGRAMS. THAT COULD BE A POTENTIAL POSITIVE WAY. >> RACHEL: GREAT. OKAY, I HAVE A QUESTION NOW FROM AN INDEPENDENT LIVING CENTER, AND THEIR QUESTION IS THAT THEIR CENTER RECENTLY WROTE A GRANT TO THE -- I BELIEVE THEY ARE REFERRING TO THE DEPARTMENT OF EDUCATION HERE, AND THE GRANT WAS TO DEVELOP AND OPEN A FITNESS CENTER FOR PEOPLE WITH DISABILITIES. AND WE WOULD OFFER WORKSHOPS ON BENEFITS TO NUTRITION, HEALTH FULL LIFESTYLES AND OTHER RELATED TOPICS SPECIFIC TO DIFFERENT DISABILITY GROUPS AND GENERAL FITNESS BENEFITS. WE WERE NOT AWARDED THE FUNDS. THE QUESTION IS HOW REALISTIC IS IT TO BELIEVE THAT THERE IS ANY FUNDING AVAILABLE FOR THIS VITAL ISSUE? AND I ALSO HAVE TO LET YOU KNOW THAT THERE IS A LITTLE P.S. ON THIS MESSAGE THAT SAYS THANK YOU FOR THIS ENLIGHTENING WEBCAST AND WE LOOK FORWARD TO HAEFRG FROM YOU. ANY INFORMATION WILL BE WELCOME. >> JEFF: I'LL TRY TO ANSWER THE FIRST PART. I GUESS YOU'RE ABSOLUTELY RIGHT. IT WOULD BE GREAT IF WE WOULD CREATE A BUNCH OF FACILITIES FOR COMMUNITIES AROUND THE U.S. THAT WOULD TARGET POPULATIONS WHERE THEY CAN COME ANED EXERCISE. AND THERE IS A NEGATIVE SIDE TO THAT AND I EXPECT IF THEY'RE SEEKING FUNDING FROM THE U.S. DEPARTMENT OF EDUCATION, ONE OF THE GOALS AND FRANKLY ONE THAT I BELIEVE IS A VERY GOOD GOAL IS TO TRY TO INTEGRATE PROGRAMS SUCH THAT THE PERSONS CAN DISABILITIES WOULD BE EXERCISING WITH OTHERS AND NOT NECESSARILY SEGREGATING THEM INTO THEIR OWN FACILITY. THAT MIGHT BE THE PERCEPTION OF THAT FUNDING AGENCY AND I KNOW THAT INDEPENDENT LIVING CENTER HASN'T BEEN SUCCESSFUL IN THEIR OWN COMMUNITIES AND GETTING THINGS TO INTEGRATE AND HOPEFULLY PRODUCE OPPORTUNITIES FOR EVERY ONE. I COULD OFFER THIS PERSON OR THIS AGENCY A MODEL THAT HAS BEEN SUCCESSFUL IN CANADA, AND THAT IS AT THE UNIVERSITY OF ALBERTA. THERE IS CURRENTLY A CENTER THERE CALLED THE BOB STEADWARD CENTER. AND YOU COULD WRITE THERE AND TELL HIM THAT PEOPLE FROM OREGON STATE SAID THEY SHOULD CONTACT HIM. IN THAT AREA, THEY HAVE A LARGE POPULATION BASE AND THEY HAVE HUNDREDS OF PEOPLE WHO COME TO THAT FACILITY ON THE UNIVERSITY CAMPUS ON A DAILY AND WEEKLY BASIS, AND THEY EVEN HAVE SATELLITE PROGRAMS THROUGHOUT THE CITY OF EDMONDTON WHO HAVE TRAINED STAFF HOV THE CAPACITY AND THE ABILITY TO DEVELOP PROGRAMS FOR PEOPLE WITH A VARIETY AND TYPES OF PHYSICAL DISABILITIES. SO THAT IS AN EXAMPLE OF A PROGRAM THAT HAS BEEN VERY SUCCESSFUL THAT HAS CHOSEN TO BE MORE OF A SEPARATE TYPE OF FACILITY, YET THEY HAVE DEVELOPED THIS PROGRAM IN CONJUNCTION WITH THE UNIVERSITY. THAT PROGRAM GETS SIGNIFICANT FUNDING FROM THE -- I CAN'T RECALL -- WHAT IS THAT, THE GOVERNMENT WITHIN ALBERTA, SO THAT THEY GET -- I'M SORRY, IT'S NATIONAL LEVEL FUNDING TARGETED SPECIFICALLY IN ALBERTA, CANADA, THAT THEY'RE ABLE TO BE SUCCESSFUL IN GETTING SUPPORT. KEEP THAT FACILITY RUNNING, BUT IT IS ALSO LINKED WITH OTHER RESEARCH PROJECTS AND ALSO LINKED TO THE UNIVERSITY ITSELF. SO THAT MAY BE A RECOMMENDED WAY FOR THE PEOPLE TO TRY TO SEEK FUNLDING TO SEE IF THEY CAN SOMEHOW PARTNER WITH A UNIVERSITY AND PARTNER WITH A PROGRAM THAT COULD BRING TALENT THERE AND TRAIN TALENT. ONE OF THE BIGGEST FAILINGS I THINK I HAVE FROM BEING IN THIS PROFESSION FOR THE LAST 20 YEARS IS THAT WE STILL ARE NOT PRODUCING ENOUGH QUALIFIED STUDENTS THROUGHOUT THE UNITED STATES THAT GO OUT AND EXERCISE WHERE THERE IS AN EXERCISE BACKGROUND OR IN PHYSICAL EDUCATION THAT TRULY HAVE THE SKILLS NECESSARY TO INCLUDE PEOPLE WITH DISABILITIES IN ALL PROGRAMS. AND WE NEED TO IMPROVE WHAT OUR UNIVERSITIES DO IN PREPARING TEACHERS AND OUR PROFESSIONALS BETTER TO BE MORE ABLE AND MORE WILLING TO DESIGN AND DEVELOP PROGRAMS FOR ALL INDIVIDUALS. >> RACHEL: OKAY, GREAT. AND I WILL FORWARD THIS E-MAIL TO YOU GUYS SO YOU CAN SEND HER THAT CONTACT INFORMATION. AND ADDITIONALLY, MAYBE WE CAN PUT IT UP -- WE'RE GOING TO FOLLOW UP THIS WEBCAST WITH AN ON LINE DISCUSSION BOARD. SO IF PEOPLE HAVE ADDITIONAL QUESTIONS OR WANT TO SHARE RESOURCES, THERE WILL BE A WAY TO DO THAT AND SHARE THE INFORMATION THAT WAY, TOO. OKAY, WE HAVE WHAT I THINK IS PROBABLY A GOOD CLOSING QUESTION. THIS IS FROM SOMEBODY WHO SAID IT'S BEEN A LONG TIME SINCE THEY HAVE EXERCISED AND THEY JUST DON'T KNOW HOW TO START. NOW, CAN YOU PLEASE, PLEASE JUST GIVE SOME TIPS FOR HOW TO GET MOTIVATED AND HOW TO GET STARTED AGAIN. >> MARIA: YES. WELL, START SLOWLY. YES, THIS PERSON CAN JUST START WALKING WITH FRIENDS, WITH FAMILY MEMBERS IN THE PARK, IN AN AQUARIUM, IN THE ZOO, ENJOYING THE WEATHER ENJOYING THE ENVIRONMENT. SO IT IS IMPORTANT FOR THE PERSON TO START SLOWLY. START WITH VERY BASIC STUFF LIKE A WALKING PROGRAM. THIS PERSON NEEDS TO CHECK WITH HIS OR HER PHYSICIAN IF THERE ARE ANY HEALTH CONSIDERATIONS. SO WHEN THIS PERSON STARTS TO INCREASE PHYSICAL ACTIVITY OR EXERCISE LEVELS, FOR EXAMPLE, A RUNNING PROGRAM OR AEROBIC PROGRAM, THAT IT IS SURE THAT THIS PERSON IS HEALTHY TO BEGIN TO START REGULAR EXERCISE PROGRAM, BUT IT IS IMPORTANT TO START SLOWLY. GO FOR A BIKE, START ENJOYING THE WEATHER AND ENJOYING TIME WITH FRIENDS. IN OREGON, IT'S RAINING. SO I DON'T KNOW IF BRAD WANTS TO ADD SOMETHING. >> BRAD: THIS IS BRAD AND I'M GOING TO OFFER SOME ADVICE TO THE -- SPECIFICALLY WHAT I'M GOING TO CALL TAILORED ADVICE. WITHOUT KNOWING TOO MUCH, I'M GOING TO SUGGEST THIS PERSON IS IN A BEHAVIOR CHANGE AREA CALLED PREPARATION. IT SOUNDS LIKE THEY'RE GETTING READY TO MAKE A COMMITMENT TO EXERCISE, AND SO ASSUMING THAT'S ESSENTIALLY THE PHYSICIAN'S APPROVAL IS THERE, THEN I WOULD SUGGEST TO THIS PERSON TO IDENTIFY AN ACTIVITY TYPE THAT THEY MIGHT ENJOY AND AN ACTIVITY GOAL THAT'S VERY PROCESSED FOCUSED. FOCUS ON JUST GOING THE BEHAVIOR. I'M GOING TO INCREASE MY BEHAVIOR BY FIVE MINUTES TODAY AND WITH A GRADUAL GOAL OF GETTING IT UP TO 30 MINUTES THAT CAN BE ACCUMULATED OVER THE BETTER PART OF A DAY AND IT CAN BE JUST MODERATE INTENSITY. IT DOESN'T HAVE TO BE VIGOROUS ACTIVITY AND I WOULD ALSO SUGGEST THAT EARLY ON THAT THEY HAVE AN ACTIVITY LOG THAT WHEREIN THEIR DAY MIGHT ACTIVITY BEST FIT IN? AND TO TRY TO COME UP WITH A VERY CONSISTENT TIME THAT THEY COULD REWARD THEMSELVES FOR JUST -- I'M GOING TO MAKE TIME TO EXERCISE WHEN I WAKE UP IN THE MORNING. THAT'S THE COMMITMENT AND THEY CAN REWARD THEMSELVES FOR THAT. AGAIN, FOCUSING ON THE PROCESS OF JUST DOING THAT BEHAVIOR ALONE AND ESTABLISHING A HABIT AND GETTING IT SCHEDULED IN. HAVING AN ALTERNATIVE THAT HERE IN OREGON IT IS RAINING TODAY, SO IF IT IS SOMEBODY WHO WAS GOING TO GO OUT AND DO A WHEELCHAIR ACTIVITY OUTSIDE, MAYBE THEY NEED TO HAVE A RAINY DAY ALTERNATIVE AND HAVE THAT IN MIND. AS THIS OCCURS, KEEP IN MIND FOR MOTIVATIONAL PURPOSES THAT THERE MAY BE SOME LAPSES THAT OCCURS OR YOU MISS AN OCCASIONAL SESSION AND DON'T BEAT YOURSELF UP FOR DOING THAT, BUT TRY TO LEARN FROM THAT AND GAIN SOME KNOWLEDGE AND INSIGHTS ABOUT YOURSELF AND WHAT SPECIFICALLY LIKE MAY HAVE CAUSED THAT. MAYBE YOU DON'T HAVE AN ALTERNATIVE AND IT IS RAINING AND YOU NEED TO THINK ABOUT HAVING AN ALTERNATIVE. OR MAYBE LIKE SOME PEOPLE SAY I DON'T FEEL LIKE DOING IT TODAY. TRY TO EXPLORE. WHY DON'T YOU FEEL LIKE DOING IT? MAYBE YOU EXERCISED TOO HARD LAST TIME AND YOU HAVE SOME SORENESS. THOSE ARE JUST A FEW STRATEGIES THAT I HOPE ARE SOMEWHAT SPECIFIC THAT MIGHT HELP THIS PARTICULAR PERSON. >> RACHEL: GREAT. OKAY. AND THIS IS MY QUESTION, I WANTED TO KNOW IF YOU GUYS CAN DESCRIBE A LITTLE BIT THE STUDY THAT YOU ARE WORKING ON RIGHT NOW AND SOME OF THE WORK THAT YOU GUYS ARE ENGAGED IN CURRENTLY AND MAYBE OFF OF THAT YOU CAN GIVE US A LITTLE TEASER AND LET US HAVE SOME SENSE OF INFORMATION OR RESEARCH RESULTS THAT WE CAN LOOK FORWARD TO DOWN THE LINE. >> BRAD: OKAY, THIS IS BRAD AGAIN. WE HAVE TWO STUDIES THAT HAVE BEEN FUNDED THROUGH NIDRR, AND THE FIRST STUDY WE'VE JUST FINISHED OUR DATA COLLECTION ON AND ARE JUST GETTING INTO LOOKING AT THE DATA IN THE LAST COUPLE OF DAYS ACTUALLY. WE HAD A NATIONAL REPRESENTATIVE SAMPLE. WE IDENTIFIED PEOPLE ACROSS A VARIETY OF BEHAVIOR CHANGE PATTERNS WITH REGARD TO PHYSICAL ACTIVITY IN THIS BEHAVIOR CHANGE CONTINUUM. PEOPLE RANGING FROM NOT EVEN THINK ABOUTING THE PROSPECT OF BEING PHYSICALLY ACTIVE. PEOPLE BEING PHYSICALLY ACTIVE FOR GREATER THAN SIX MONTHS AND EVERYTHING IN BETWEEN. AND FROM THESE PEOPLE, WE HAD A LARGE RESPONSE RATE, AGAIN, A NATIONALLY REPRESENTATIVE SAMPLE. WE HAD AN 82 PERCENT RESPONSE RATE FROM THIS GROUP. SO WE'RE VERY GRATEFUL FOR THAT AND WE HOPE TO LEARN A TREMENDOUS AMOUNT OF INFORMATION FROM THIS PARTICULAR POPULATION. THIS WILL INFORM US IN A SECOND STUDY WHICH WE'RE GEARING UP TO DO AND IN THE SECOND STUDY WHAT WE HOPE TO DO IS TO TAKE THE INFORMATION WE'VE LEARNED, USING THIS BEHAVIOR CHANGE CONTINUUM, AND TO ESTABLISH REASONABLE GOALS. SO SOMEBODY WHO IS NOT THINKING ABOUT BEING PHYSICALLY ACTIVE, THE MOST REASONABLE GOAL FOR THEM IS TO GET THEM TO THINK ABOUT BEING PHYSICALLY ACTIVE AND FOR SOME RUN WHO IS THINKING ABOUT IT, THE MOST REASONABLE GOAL IS TO GET THEM TO PREPARE TO BE ACTIVE AND FOR SOMEONE PREPARING TO BE ACTIVE TO COMMIT TO BE ACTIVE AND ONCE THEY COMMIT TO GET THEM TO STICK TO THE ACTIVITY AND THAT'S WHAT WE'RE GOING TO TRY TO DO IN THE SECOND STUDY. THAT'S ALL HYPOTHETICAL RIGHT NOW BUT I THINK WE'VE GOT A GOOD MODEL IN PLACE THAT WILL ALLOW THAT TO HAPPEN. AND THEN OF COURSE WE WANT TO STUDY THAT AND HOPEFULLY AGAIN GOING BACK TO THE VERY FIRST QUESTION, GET THAT UP ONTO -- GET THAT OUT TO THE PEOPLE WHO NEED IT THE MOST. >> RACHEL: GREAT. THAT'S A LOT TO LOOK FORWARD TO. AND I REALLY WANT TO THANK ALL THREE OF YOU. I THINK THIS WAS REALLY INTERESTSING AND VERY PRACTICAL, TOO, AND I THINK THAT YOU GUYS GAVE SOME REALLY GOOD INFORMATION THAT WAS HELPFUL FOR PEOPLE WHO ARE AT ALL DIFFERENT STAGES IN THE GAME. AND I'M SURE THAT THERE ARE SOME SHY PEOPLE OUT THERE WHO HAVEN'T ASKED THEIR QUESTIONS YET AND HOPEFULLY SOME OF YOUR QUESTIONS WERE ANSWERED THROUGH THE DISCUSSION THAT OTHER PEOPLE GENERATED. AND IF YOU DO HAVE ADDITIONAL QUESTIONS AFTER WE WRAP UP TODAY, YOU COULD CONTINUE TO E-MAIL THEM TO US AND WE'LL PASS THEM ON. OR YOU CAN POST THEM ONTO THE DISCUSSION BOARD AND A LINK TO THAT WILL BE PROVIDED ON THE WEBCAST PAGE. IF YOU GO BACK TO THE WEBCAST PAGE NEXT WEEK AFTER THANKSGIVING. I THINK THIS WAS HELPFUL INFORMATION AND REALLY IMPORTANT AT A TIME WHEN WE'RE ABOUT TO SIT AROUND AND VISIT A LOT AND EAT A LOT. SO THANK YOU. LET ME DO A QUICK WRAP UP AND THANK SOME ADDITIONAL FOLKS. FIRST OF ALL, AGAIN, I WANT TO REPEAT THAT WE REALLY DO WANT TO ACKNOWLEDGE AND THANK NIDRR, FOR FUNDING THIS REALLY IMPORTANT INITIATIVE, AND AGAIN, THE OTHER PARTNERS WHO COLLABORATED TO MAKE THIS POSSIBLE, THE RESEARCH INFORMATION FOR INDEPENDENT LIVING, THE RRTC ON INDEPENDENT LIVING AT UNIVERSITY OF KANSAS, THE RRTC ON HEALTH AND WELLNESS, AND THE RRTC ON MANAGED CARE AND DISABILITY. THIS PRESENTATION, THIS WEBCAST JUST LIKE THE THERE'S IN THIS SERIES WILL BE ARCHIVED. SO IF YOU WOULD LIKE TO SHARE IT WITH A FRIEND WHO WASN'T ABLE TO TUNE IN TODAY, OR IF YOU WANT TO LISTEN TO IT AGAIN, YOU CAN, AND IT WILL BE THERE AND THE TRANSCRIPT WILL BE AVAILABLE AS WELL. OUR NEXT WEBCAST IS GOING TO BE NEXT WEDNESDAY, NOVEMBER 28TH, AND IT IT IS A CONTINUATION OF THIS TOP ACHE IN AWARE, THAT WILL BE PRESENTED BY LAURIE POWERS. I HIGHLY RECOMMEND IT. I'VE HEARD BOTH OF THEM SPEAK AND I THINK IT WILL BE AS INTERESTING AS TODAY. AND FINALLY, I WANT TO ACKNOWLEDGE THE ILRU TEAM WHO WORKED TO MAKE THIS HAPPEN AND THAT INCLUDES ROB DICKEHUTH AND MARIE BRYANT, MARJ GORDON, SHARON FINNEY, DAWN HEINSOHN AND LAUREL RICHARDS. AND WE ALL HAVE BEEN WORKING REALLY HARD TO USE THIS NEW TECHNOLOGY TO MAKE THIS INFORMATION ACCESSIBLE TO EVERYBODY, AS MANY PEOPLE AS POSSIBLE. SO WE REALLY WOULD APPRECIATE YOUR FEEDBACK. IF YOU COULD PLEASE FILL OUT THE EVALUATION FORM WHICH YOU CAN ACCESS THROUGH A LINK ON THE WEBCAST PAGE. IT'S THERE WITH THE MATERIALS OR IT'S ALSO I THINK IN YOUR E-MAIL. AND AGAIN, THANK YOU VERY MUCH TO OUR PRESENTERS AND WE HOPE TO SEE YOU ALL OR HAVE YOU ALL TUNE IN NEXT WEEK ON WEDNESDAY AND HAVE A HAPPY THANKSGIVING EVERYBODY. BYE-BYE.