Exercise has shown promise for improving heath and function as well as for mitigating secondary conditions such as pain, fatigue, deconditioning, and obesity for people with disabilities (Rimmer & Shenoy, 2006). These secondary conditions can have a negative impact on health and health-related quality of life (HRQOL) of both children and adults with disabilities (e.g. Badia, et al., 2014; Grondhuis & Aman, 2014; Rimmer, et al., 2011). Many exercise interventions have been tested in disability populations such as stroke, Parkinson’s disease, schizophrenia, intellectual disability, and cerebral palsy, among others. Systematic reviews of these studies have generally found that exercise has positive effects on the functional abilities and HRQOL experienced by people with disabilities (e.g. Broderick, & Vancampfort, 2017; Desveaux et al., 2014; Dibble, Addison, & Papa, 2009; Ryan, et al., 2017; Wu, et al, 2017). Past research has also shown positive relationships between HRQOL and community participation for individuals with disabilities (Sundar, et al., 2016; White, et al., 2016), suggesting that exercise interventions could potentially improve both health-related quality of life and community participation among people with disabilities.
Despite the plethora of existing studies and the general findings that exercise has a positive effect on at least some aspects of HRQOL among people with disabilities, the level of evidence for the efficacy of exercise interventions among people with disabilities is not strong. These studies have relatively small sample sizes and less than optimal study designs. Many lack adequate measurement of key outcomes, and lack evidence of the sustainability of results over time (Broderick, & Vancampfort, 2017; Desveaux et al., 2014; Dibble, Addison, & Papa, 2009; Ryan, et al., 2017). There is a need to establish stronger evidence of the effectiveness of exercise interventions or programs for improving and sustaining health and HRQOL among people with disabilities, and to determine the extent to which improved HRQOL is related to improved community participation outcomes. It is also important to establish implementation feasibility for such interventions or programs in real-world environments in order to increase the likelihood of their successful implementation or adoption.
Badia, M., Riquelme, I., Orgaz, B., Acevedo, R., Longo, E., & Montoya, P. (2014). Pain, motor function and health-related quality of life in children with cerebral palsy as reported by their physiotherapists. BMC Pediatrics, 14:192.
Broderick, J., & Vancampfort, D. (2017). Yoga as part of a package of care versus standard care for schizophrenia. Cochrane Database of Systematic Reviews, Issue 9. Art. No.: CD012145. DOI: 10.1002/14651858.CD012145.pub2.
Desveaux, L., Beauchamp, M., Goldstein, R., & Brooks, D. (2014). Community-based exercise programs as a strategy to optimize function in chronic disease: A systematic review. Medical Care, 52, 3, 216-26.
Dibble, L. E., Addison, O., & Papa, E. (2009). The effects of exercise on balance in persons with Parkinson’s disease: A systematic review across the disability spectrum. Journal of Neurologic Physical Therapy, 33, 14-26.
Grondhuis, S. N., & Aman, M. G. (2014). Overweight and obesity in youth with developmental disabilities: A call to action. Journal of Intellectual Disability Research, 58 part 9, 787–99.
Rimmer, J. H., & Shenoy, S. S. (2006). Institute of Medicine’s Workshop on Disability in America: A New Look: Summary and Background Papers. Appendix L Impact of Exercise on Targeted Secondary Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11579.
Rimmer, J. H., Chen, M-D., & Hsieh, K. A. (2011). Conceptual model for identifying, preventing, and managing secondary conditions in people with disabilities. Physical Therapy, 91, 1728–39.
Ryan, J. M., Cassidy, E. E., Noorduyn, S. G., & O’Connell. N. E. (2017). Exercise interventions for cerebral palsy. Cochrane Database of Systematic Reviews, Issue 6. Art. No.: CD011660. DOI: 10.1002/14651858.CD011660.pub2.
Sundar, V., Brucker, D. L., Pollack, M. A., & Chang, H. (2016). Community and social participation among adults with mobility impairments: A mixed methods study. Disability and Health Journal, 9, 682-91
White, J., Magin, P., Attia, J., Sturm, J., McElduff, P., & Carter, G. (2016). Predictors of health-related quality of life in community-dwelling stroke survivors: A cohort study. Family Practice, 33, 4, 382–87
Wu P-L., Lee M., Huang T-T. (2017). Effectiveness of physical activity on patients with depression and Parkinson’s disease: A systematic review. PLoS ONE, 12, 7: e0181515. https://doi. org/10.1371/journal.pone.0181515
The Administrator of the Administration for Community Living establishes a priority on Exercise Interventions for People with Disabilities (Project). Under this priority, the Project must conduct research on the effect of an exercise intervention or program on the health and health-related quality of life and community participation outcomes of people with disabilities. When the research is complete and if the results provide evidence about the effectiveness of the exercise intervention, the Project must provide training, technical assistance, and knowledge translation activities to promote the uptake and adoption of the findings. In order to advance knowledge in this area, the Project must focus on an exercise intervention or program that has previous evidence of efficacy--rather than developing a new, untested intervention or program--and continue to build stronger evidence of its effectiveness and feasibility. The target population for the exercise intervention or program can be children or adults with any type of disability. The Project's activities must be designed and conducted in close collaboration with the target population of people with disabilities and other relevant stakeholders. To optimize future implementation or adoption of the intervention or program, the Project’s research activities must be conducted in a real-world setting where the exercise intervention or program is designed to be implemented as part of an existing service delivery system (e.g. healthcare facility, community center, school, etc.). The Project must conduct research activities at the "intervention efficacy" or "scale-up evaluation" stage, or some combination of these two stages. NIDILRR's research stages are defined in this section of the Funding Opportunity Announcement.
Of particular interest to NIDILRR and ACL under this funding opportunity announcement is research on exercise interventions to address obesity among children and youth with disabilities. However, we do not give an application that addresses this topic a preference over other applications.
Under this priority, the Project must be designed to contribute to the following outcomes:
1. Evidence of effectiveness of an exercise intervention or program that has been shown in previous research to improve health-related quality of life for people with disabilities. The Project must contribute to this outcome by conducting high quality and rigorous research activities to establish stronger evidence than is currently available.
2. Evidence of the feasibility of the exercise intervention or program for implementation in a real-world setting in which it is designed to be implemented. The Project must contribute to this outcome by conducting the Center’s research activities in collaboration with members of the target population, representative organizations from the intended setting, and other relevant stakeholders who will be crucial to the successful implementation of the intervention or program.
3. Increased awareness of, and use of the evidence generated under paragraphs a and b among key stakeholders. The Project must contribute to this outcome by developing and implementing a knowledge translation plan that includes dissemination, training, and technical assistance as appropriate.
Definitions -- Stages of Research
Exploration and discovery means the stage of research that generates hypotheses or theories through new and refined analyses of data, producing observational findings and creating other sources of research-based information. This research stage may include identifying or describing the barriers to and facilitators of improved outcomes of individuals with disabilities, as well as identifying or describing existing practices, programs, or policies that are associated with important aspects of the lives of individuals with disabilities. Results achieved under this stage of research may inform the development of interventions or lead to evaluations of interventions or policies. The results of the exploration and discovery stage of research may also be used to inform decisions or priorities;
Intervention development means the stage of research that focuses on generating and testing interventions that have the potential to improve outcomes for individuals with disabilities. Intervention development involves determining the active components of possible interventions, developing measures that would be required to illustrate outcomes, specifying target populations, conducting field tests, and assessing the feasibility of conducting a well-designed intervention study. Results from this stage of research may be used to inform the design of a study to test the efficacy of an intervention;
Intervention efficacy means the stage of research during which a project evaluates and tests whether an intervention is feasible, practical, and has the potential to yield positive outcomes for individuals with disabilities. Efficacy research may assess the strength of the relationships between an intervention and disabilities. Efficacy research may assess the strength of the relationships between an intervention and outcomes, and may identify factors or individual characteristics that affect the relationship between the intervention and outcomes. Efficacy research can inform decisions about whether there is sufficient evidence to support “scaling-up” an intervention to other sites and contexts. This stage of research may include assessing the training needed for wide-scale implementation of the intervention, and approaches to evaluation of the intervention in real-world applications; and
Scale-up evaluation means the stage of research during which a project analyzes whether an intervention is effective in producing improved outcomes for individuals with disabilities when implemented in a real-world setting. During this stage of research, a project tests the outcomes of an evidence-based intervention in different settings. The project examines the challenges to successful replication of the intervention, and the circumstances and activities that contribute to successful adoption of the intervention in real-world settings. This stage of research may also include well-designed studies of an intervention that has been widely adopted in practice, but lacks a sufficient evidence base to demonstrate its effectiveness.