Policy

The risk: All individuals need health care and a good health regimen to stay well and actively participate in the community. According to the Centers for Disease Control and Prevention (CDC), there are many health implications for being overweight. Among the increased risks are: greater risk of hypertension, Type 2 diabetes, coronary heart disease, stroke, some cancers, high cholesterol, osteoarthritis, asthma, and other respiratory problems. For an individual with a disability, understanding how to prevent illness and manage these secondary health conditions is an important part of healthy living.

Physical Activity Benefits: Physical activity at all ages reduces risks of heart disease, high blood pressure, and diabetes. Physically active children, including children with disabilities, are more likely to thrive academically and socially. Physically active children also learn how to incorporate safe and healthy activities into their lives. For adults, physical activity can reduce the risks of secondary health conditions and pain as well as depression.

In 2008 the U.S. Department of Health and Human Services (HHS) published the 2008 Physical Activity Guidelines for Americans to provide information and guidance on the types and amounts of physical activity that provide substantial health benefits for all Americans aged 6 years and older. The report recognizes that one of the most important steps any individual can take to achieve better health is becoming physically active.

Key Guidelines for Individuals with Disabilities:

• Adults with disabilities, who are able to, should get at least 150 minutes per week (2 hours and 30 minutes) of moderate­intensity, or 75 minutes (1 hour and 15 minutes) per week of vigorous­intensity aerobic activity, or an equivalent combination of moderate­ and vigorous­intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the week.

• Adults with disabilities, who are able to, should also do muscle­strengthening activities of moderate or high intensity that involve all major muscle groups on 2 or more days per week as these activities provide additional health benefits.

• Children and adolescents should do 60 minutes (1 hour) or more of physical activity daily. Most of the 60 or more minutes a day should be either moderate­ or vigorous­intensity aerobic physical activity, and should include vigorous­ intensity physical activity at least 3 days a week. Children and adolescents should include muscle­strengthening physical activity and bone­strengthening physical activity at least 3 days a week.

• When individuals with disabilities are not able to meet the above Guidelines, they should engage in regular physical activity according to their abilities and should avoid inactivity.

• All individuals should consult their health­care provider about the amounts and types of physical activity that are appropriate for their abilities. http://health.gov/paguidelines/pdf/paguide.pdf
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To promote each child’s healthy and logical development in a sport or physical activity, Long Term Athlete Development (LTAD) identifies sequential stages for training and competition that respects their physical, mental, and emotional development. This approach encourages lifelong physical activity for athletes of all levels of ability and disability, and it also provides an effective route for athletes to pursue excellence at the national and international level of competition.

LTAD is NOT just about developing the athlete — it is about developing the system in which the athlete learns and performs the sport so that optimal long-term development is supported. For athletes with disabilities, this means making sure that each sport program plans for and delivers what the athlete needs at each stage of development.

A brief overview of the stages is given below. For more details, refer to Canadian Sport for Life. The ages given below represent the normal range of ages at each stage for individuals without disability. Individuals with a disability, particularly those with an acquired disability, may pass through the stages at significantly different ages and at greater speed and time since acquiring a disability (rather than chronological age) becomes an important factor.

Active Start: Males & Females 0 – 6 yrs. Fun and varied activity everyday.

Children need to be introduced to relatively unstructured play that incorporates a variety of body movements. An early active start enhances development of brain function, coordination, social skills, gross motor skills, emotions, leadership, and imagination. It also helps children build confidence, develop posture and balance, build strong bones and muscles, promote healthy weight, reduce stress, improve sleep, learn to move skillfully, and learn to enjoy being active.

FUNdamentals: Males 6-9, Females 6-8 yrs. Learn all fundamental movement skills, play many sports, focus on agility, balance, coordination and speed.

Children need to participate in a variety of well-structured activities that develop basic skills. However, activities and programs need to maintain a focus on fun, and formal competition should only be minimally introduced.

Learning to Train: Males 9-12, Females 8-11 yrs. Learn overall sport skills as cornerstone of many sports. Play a variety of sports and develop specific skills in three sports.

Children are ready to begin training according to more formalized methods, but the emphasis should still be on general sports skills suitable to a number of activities. While it is often tempting to over-develop “talent” at this age through excessive single sport training and competition (as well as early positioning in team sports), this can be very detrimental to later stages of development if the child is playing a late specialization sport: it promotes one-sided physical, technical, and tactical development and increases the likelihood of injury and burnout.

Training to Train: Males 12-16, Females 11-15 yrs. (The ages that define this stage for boys and girls are based on the onset and end of the growth spurt). Build endurance; develop speed and strength towards the end of the stage. Improve sport specific skills. Focus on two sports.

At this stage, they are ready to consolidate their basic sport-specific skills and tactics. These youths may play to win and do their best, but they still need to focus more time on skill training and physical development over competition. This approach is critical to the development of top performers and maintaining activity in the long-term, so parents should check with their national organization to ensure their child’s program has the correct training-to-competition ratio.

Training to Compete: Males 16-23 +/-, Females 15-21 +/- yrs. Optimize fitness preparation and sport, individual and position specific skills. Learn to compete internationally. Focus on one sport.

This is where things get “serious.” They can either choose to specialize in one sport and pursue a competitive stream, or they can continue participating at a recreational level and thereby enter the Active for Life stage. In the competitive stream, high volume and high intensity training begins to occur year-round.

Training to Win: Males 19+/-, Females 18+/-yrs. Ages are sport specific. Podium Performances. One sport.

Elite athletes with identified talent enter a stage where they may pursue the most intense training suitable for international winning performances. At this stage, both world-class athletes with a disability and able-bodied athletes require world-class training methods, equipment, and facilities that meet the demands of the sport and the athlete.

Active for Life: Any age. A smooth transition from a competitive career to lifelong physical activity and participation in sport.

Young athletes can enter this stage at essentially any age. According to LTAD, if children have been correctly introduced to activity and sport through Active Start, FUNdamentals and Learning to Train programs, they will have the necessary motor skills and confidence (physical literacy) to remain Active for Life in virtually any sport they like. They may decide to continue playing their sport at the recreational level, or they may become involved in the sport as a game official or coach. They might also try new sports and activities: examples could be a hockey player taking up golf or a tennis player starting to cycle.

Development of athletes with disabilities requires two new stages in addition to the 7 stages listed above. These stages are called Awareness and First Contact/Recruitment and are particularly important for individuals with an acquired disability who, prior to injury or illness, may have had no contact with, and no knowledge of, sport for athletes with disabilities.

Awareness Stage: Sport opportunities for people with a disability are not always well known and someone who acquires a disability may have no knowledge of what sports are available. Sports programs need to develop awareness plans to make their offerings known to prospective athletes with disabilities.

First Contact/Recruitment Stage: Sports programs may only have one opportunity to create a positive environment for prospective athletes with disabilities. It may not be easy for them to make the first approach to a sport, and research shows that if they don’t have a positive first experience, they may be lost to the sport and to a healthy lifestyle.

The period following acquisition of a disability is one of transition and great change for most individuals. Some activities in which they were previously engaged may no longer be open to them in the same form, and they may not be aware of the many sporting and recreation activities that are available. The purpose of the Awareness and First Contact/ Recruitment stages is, therefore, to inform individuals of the range of activities in which they can participate and to provide ways for them to experience those activities. A positive first experience can go a long way to engaging persons with a disability in both competitive and recreational sporting activities. Athletes who retire from disability competition need to be encouraged to remain involved in the sport as coaches, program volunteers, fundraisers, mentors, or officials.

Editor’s Note: In the process of developing this guide BlazeSports America researched best practices in a number of fields. The information presented in section 2.1 and 2.2 is taken from the Canadian Sport for Life materials with permission. For more detailed information, visit www.canadiansportforlife.ca

1. The 10-Year Rule: Exactly how long it takes to become an elite athlete with a disability varies from sport to sport, with the nature of the disability, and considerably with the pre- injury sporting experience and expertise of trained athletes who acquire a disability. The highest level of performance in hotly contested sports appears to take the same time and level of commitment as it does for able-bodied athletes, which is approximately 10,000 hours of training over 10 years.

2. The FUNdamentals: Athletes, with and without a disability, need to acquire FUNdamental movement and sport skills, or physical literacy, through fun and games, and these needs to be achieved prior to puberty. Children with a disability face difficulties in acquiring FUNdamental skills because:

• overly protective parents, caregivers, rehabilitation facility staff, teachers, and coaches shield them from the bumps and bruises of childhood play.
• adapted physical education is not well developed in all school systems.
• some coaches and programs do not welcome children with a disability to their activities because of a lack of knowledge about how to integrate them.
• it takes creativity to integrate a person with a disability into a group activity where FUNdamental skills are practiced and physical literacy is developed.

The physical literacy skills needed by children with a disability vary greatly depending on the nature and extent of their disability and should include all such skills learned by able-bodied children (modified as required) as well as the additional skills required for effective use of assistive devices. Regardless of their previous physical skill, individuals who acquire a disability often have to learn new physical literacy skills such as wheeling their wheelchair, using a prosthetic limb, or accommodating a restricted range of movement. Even though they may be adults, it is critical that individuals effectively learn the FUNdamentals of new movement and sport skills so that those skills can be applied to a wide range of sports and recreational activities.

3. Specialization: Disability sports are late specialization sports (see Canadian Sport for Life document for more details, page 22) and it is critically important that children with congenital or early-acquired physical or intellectual disability be exposed to the full range of FUNdamentals before specializing in the sport of their choice. Similarly, adults with an acquired disability should master their new FUNdamental movement skills before specializing in a single sport.

4. Age Factors: Some congenital disabilities are known to influence childhood and adolescent development and the timing of puberty; however, much more research is needed before a full understanding is achieved. Although the timing of puberty may vary, the sequence of development that the adolescent goes through usually does not. For example, children with spina bifida are known to experience puberty earlier than their peers and individuals with intellectual disability tend to enter puberty early but complete the process later. Because of variations in the timing of puberty (and therefore peak height velocity), it is likely that there will also be variations in the ages at which optimum periods of trainability occur.

5. Trainability: Little or nothing is known about periods of optimum trainability for individuals with a disability. In the absence of information to the contrary, it is suggested that for children with a congenital disability, the ages of optimum trainability, as shown in Canadian Sport for Life, page 27, be adjusted based on the observed age of puberty. Whether there are optimum periods of trainability during post-injury rehabilitation needs to be investigated.

6. Physical, Mental, Cognitive, and Emotional Development: Sport can play an important role in helping individuals with a physical or intellectual disability to develop a new, positive self-image as well as enhance their self-concept. For this reason, sport programs should consider the mental, cognitive, and emotional development of athletes with disabilities in addition to their physical development. Consideration of mental, social, and emotional development is particularly important when working with athletes with intellectual disability and the developmental characteristics and implications for coaches need to be interpreted in light of each athlete’s mental and developmental age, rather than chronological age. With LTAD’s holistic approach to athlete development, programs for athletes with disabilities need to place emphasis on ethical behavior, fair play, and character building throughout the various stages. Particularly for athletes with an intellectual disability, consideration must be given to the athletes’ ability to understand and apply these concepts.

7. Periodization: There is no evidence that periodization for an athlete with a disability is substantially different from that for able-bodied athletes. It is therefore suggested that the recommendations on periodization in Canadian Sport for Life document be followed. Since disability may reduce functional muscle mass and aerobic capacity, fatigue in athletes with disabilities should be carefully monitored, and rest and recovery periods should be adjusted accordingly.

8. Calendar Planning for Competition: Within the able-bodied Canadian sport system, under-training and over-competition are common and the ratios for training to competition should be applied. There is no evidence to suggest different ratios for athletes with disabilities. Effective competition for athletes with disabilities in all classifications needs to be matched to the athletes’ stage of development. This can be a problem when there are few athletes in a particular sport or classification/division within that sport. Creative solutions to this problem need to be developed, particularly for athletes with greater levels of disability. Currently, local and international levels of competition (suitable for the Learning to Train and Training to Win stages) are more readily available than competition suitable for athletes at the Training to Train and Training to Compete stages. This gap in the competition calendar must be eliminated if optimum development is to occur.

9. System Alignment and Integration: Since Canadian Sport for Life focuses on athlete development through Canada’s sport system, No Accidental Champions focuses on aligning the many components of that system for athletes with disabilities. This includes development of competition, coaching, funding, facilities and equipment, training partners, sport science, ancillary services, daily living support, and talent identification and development. Without sport system alignment and integration, optimum benefits for an athlete with a disability will not be achieved.

10. Continuous Improvement: Sport for athletes with disabilities is relatively young and, like many newer sports, is developing at an incredible rate. New research, new equipment, and new techniques appear rapidly worldwide, and to put Canadian athletes “out front”, sport organizations must be on the alert to take advantage of all new information. Evaluating that information, selecting what information will be used, and then integrating it into programs and services must be an active, ongoing process, tied to the concept of continuous improvement, which permeates LTAD. This concept ensures that LTAD for athletes with disabilities:

• responds and reacts in a timely manner to new scientific and sport specific data, observations, and research
• is a continuously evolving vehicle for positive change in the sporting, recreation, and physical education lives of individuals with a disability.
• promotes ongoing education and sensitization of federal, provincial/territorial, and municipal governments, the mass media, and the Canadian sport system to the needs and expectations of athletes with disabilities.

While there are many similarities between athletes with disabilities and able-bodied athletes, there are some differences that the change LTAD process.

• Athletes may have been born with a disability (congenital disability) or may have acquired a disability later in life.
• Children with a congenital disability may not have the same opportunity to learn FUNdamental movement skills because they do not always have the same opportunities for vigorous, physical play during their early years (Active Start). This is sometimes due to long periods of hospitalization and the lack of suitable physical education programs, but may also be due to parents or caregivers being overly protective, a situation that can also occur with an acquired disability.
• Athletes with disabilities may operate in a sport environment in which there are participants not found in able-bodied sport. For example, runners who are blind need sighted guides and most sports require officials who determine the classification or division of competition into which the athlete best fits to ensure fairness of competition. Failure of the sport system to develop these supporting roles will have a long-term negative impact on athlete development and the competition experience.
• Many athletes with disabilities require equipment or facilities adapted to take full advantage of their athletic ability and to minimize the sport-performance impact of their disability. Because there may be only a few other athletes with disabilities with the same type and/or level of disability, access to appropriate competitive experiences may be difficult.
• Some athletes with disabilities require personal care support, interpreters, and other personnel not found in able-bodied sport.
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There are six measures of physical fitness:

1. Cardiorespiratory Endurance or Aerobic Fitness – the ability of the heart, lungs and blood vessels to work efficiently for an extended period of time (eg. fast walking, jogging, running, swimming, biking, and cross-country skiing).

The heart is a muscle that works to pump blood to the body. The harder the work or the more active an individual is the more blood your heart has to pump. Aerobic exercise or activity helps to make the heart fitter. Aerobic means “with air,” so aerobic exercise is a form of activity that requires oxygen to be delivered to the working muscles of the body (for runners, the primary muscles are in the legs; for swimmers, muscles throughout the body are used; for a wheelchair track athlete, the primary muscles are in the arms). When breathing, your lungs (part of the respiratory system) take in oxygen which is absorbed into the blood stream (part of the vascular system). Aerobic exercise makes a person breathe faster than normal (at rest) and also causes the heart to pump more rapidly and forcefully, while also making one sweat and breathe more frequently and deeply.

The more frequently one performs aerobic exercise the more activity the heart, lungs and blood vessels experience. Regular workouts help the cardiorespiratory and vascular systems deliver oxygen (in the form of oxygen-carrying blood cells) more efficiently to all parts of the body.

2. Muscular Strength – the ability of a muscle to create a force (eg. weight lifting).

Activities where the resistance against which the muscles work is medium to high will build muscle strength. For example, doing a push-up or pull-up will build muscles in the upper body. Weight lifting is the primary activity used by athletes for gaining increased muscle strength. Adults and teenagers who lift weights regularly will experience growth of their muscles. Due to some basic differences, a young woman who weight trains will gain in strength but her muscles are not likely to grow as much as a young man who lifts weights. Children are not likely to benefit very much from weight lifting so it is not a recommended activity until the teen years, and preferably at least 15 years of age.

Some activities that help to build stronger and bigger muscles include:

• push-ups
• pull-ups
• hill climbing (wheeling, walking, running)
• running (sprinting)
• weight training

3. Muscular Endurance – the ability to use muscles to create a force repeatedly or over a long period of time (eg. rowing, cycling, and raking leaves).

Regularly engaging in activities that offer low to medium resistance to the working muscles will promote increased muscular endurance. This means that muscles with greater endurance are able to work for a longer time than less fit muscles. Typically, if a movement activity can be repeated for more than about 15 times (called repetitions) when the resistance is low to medium then it produces improvement in muscular endurance. If the movement activity can be repeated fewer than about 15 times before the muscle becomes fully fatigued then it is considered to promote muscular strength.

Activities that promote muscular endurance include:

• weight training
• rowing
• running
• wheelchair racing
• cycling
• hand cycling

4. Flexibility – the ability to have a large range of movement around a joint (eg. gymnastics, ballet, dance, and martial arts).

If one has good flexibility they may be able to bend their joints and stretch their muscles very easily. However, flexibility varies from person to person and even joint to joint or muscle to muscle. Just like muscular strength and endurance, one must constantly work on flexibility it will be lost. Flexibility is important as it helps to avoid injuries to muscles and body joints. Good flexibility is also very important for most sports and many jobs that require physical activity. Therefore, stretching muscles and joints frequently, ensure that one can move the body through a full range of motion. People who are flexible can move more freely and without tightness or pain. Sports or activities that require good flexibility include:

• Tai Chi
• dancing
• martial arts
• yoga

5. Skill – agility, balance, reaction time and coordination (eg. throwing, kicking, jumping, swinging a bat/racket/club, and dancing).

Skill generally means having the ability to perform a complex movement activity very effectively. Typically, this means that the person possesses good coordination in addition to the other physical attributes required to perform the skill well. Good coordination means one’s muscles; brain and nerves work very well together when performing the skill. Examples of activities requiring skill include:

• golf swing
• soccer kick
• tennis serve
• dancing
• throwing a ball
• wheelchair mobility skills (weaves, turns, starts and stops)

6. Mental Attitude – determination to maintain your activity (exercise, sport, physical work), train and succeed.

Most successful athletes have a good mental attitude about their sport. They are responsible and disciplined in preparing and training for success in the physical activity which may require hard work, long hours and focus. The same qualities are needed even one is not an athlete but simply want to be more physically fit. Becoming fit or maintaining fitness once developed, also may require hard work, long hours and focus. Anyone can benefit from having a good mental attitude about activities in their life no matter the purpose of the activity.

Specificity – choose the right kind of activities to affect each component of physical fitness. Strength training results in specific muscle strength changes. Also, train for the specific activity of interest. For example, if you desire to improve cardio respiratory/aerobic fitness then one must engage in appropriate activities and, likewise, if one desires to become stronger then one must engage in appropriate activities to promote stronger muscles. However, activities that promote increases in strength are not likely to promote better cardiorespiratory/aerobic fitness and vice-versa. To become a better runner, one then must train by running. To become a better soccer player then one must train for soccer specific skills and fitness. Playing one sport will not necessarily help play another sport any better. Likewise, physical fitness training for one aspect of fitness will not necessarily help improve another aspect of fitness (strength training does not improve flexibility, aerobic training does not improve sport skills, etc).

Overload – The work hard enough, at levels that are vigorous, and long enough to overload your body above its resting level, to bring about improvement.

Regularity – At least three balanced workouts a week are necessary to maintain a desirable level of fitness.

Progression – increase the intensity (how hard one works at the activity), frequency (how often one participates in the activity) and/or duration (how long one participates in the activity) of an activity over periods of time in order to improve.

Physical activity promotes physical fitness. Physical activity is movement by a person of any type. Sport, exercise, physical work and leisure activities are all considered forms of physical activity. Some specific examples of physical activity are running, jumping, soccer, basketball, wheeling and weight lifting. Activities that we perform most everyday are also considered physical activity: walking, wheeling, climbing stairs, carrying groceries or working in the yard. Doing these activities on a regular basis can help improve our health or fitness. Health benefits can be achieved when the participant is active at a level or intensity that increases the heart rate (number of heart beats in one minute) and produces heavier than normal breathing.

Children can be physically active during the day by participating in physical education class, recess, and after school activity programs like sport, dance or play. If children live in a safe area or close to their school they can walk or ride their bike to and from school. Adults should also be physically active everyday. Parents and children can and should be active together. The benefits of regular physical activity include:

• Reduction in the risk for overweight, and secondary conditions, diabetes and other chronic diseases
• Improved academic performance
• Children feel better about themselves
• Reduction in risk for depression and the effects of stress
• Children prepare to be productive, healthy members of society and
• Improved overall quality of life.

The U.S. Department of Health and Human Services published the 2008 Physical Activity Guidelines for Americans. These guidelines suggest that substantial health benefits will be gained by doing physical activity according to the Guidelines presented below for different groups.

Children and Adolescents (aged 6–17)

• Children and adolescents should do 1 hour (60 minutes) or more of physical activity every day.
• Most of the 1 hour or more a day should be either moderate- or vigorous- intensity aerobic physical activity.
• As part of their daily physical activity, children and adolescents should do vigorous-intensity activity on at least 3 days per week. They also should do muscle-strengthening and bone-strengthening activity on at least 3 days per week.

Children Adolescents with Disabilities

The U.S. Department of Health and Human Services suggests families work with the child’s health care provider to identify the types and amounts of physical activity appropriate for children ages 6-17. When possible, children with disabilities should meet the guidelines for children and adolescents listed above or as much activity as their condition allows. Children and adolescents should avoid being inactive.

In turn, adults with disabilities should follow the adult guidelines listed below. If this is not possible, these persons should be as physically active as their abilities allow. Similar to children and adolescents, adults with disabilities should avoid inactivity

Adults (aged 18–64)

• Adults should do 2 hours and 30 minutes a week of moderate-intensity, or 1 hour and 15 minutes (75 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous- intensity aerobic physical activity. Aerobic activity should be performed in episodes of at least 10 minutes, preferably spread throughout the week.
• Additional health benefits are provided by increasing to 5 hours (300 minutes) a week of moderate-intensity aerobic physical activity, or 2 hours and 30 minutes a week of vigorous-intensity physical activity, or an equivalent combination of both.
• Adults should also do muscle-strengthening activities that involve all major muscle groups performed on 2 or more days per week.

Adults with Disabilities

Follow the adult guidelines. If this is not possible, these persons should be as physically active as their abilities allow. They should avoid inactivity.

Older Adults (aged 65 and older)

• Older adults should follow the adult guidelines. If this is not possible due to limiting chronic conditions, older adults should be as physically active as their abilities allow. They should avoid inactivity. Older adults should do exercises that maintain or improve balance if they are at risk of falling.

For all individuals, some activity is better than none. Physical activity is safe for almost everyone, and the health benefits of physical activity far outweigh the risks. People without diagnosed chronic conditions (such as diabetes, heart disease, or osteoarthritis) and who do not have symptoms (EG, chest pain or pressure, dizziness, or joint pain) do not need to consult with a health care provider about physical activity.

For more information on the 2008 Physical Activity Guidelines for Americans published by the U.S. Department of Health and Human Services visit: http://www.health.gov/paguidelines/default.aspx

Healthy eating is important for everyone – with and without a disability, inactive or very active and from recreational enthusiast to the competitive athlete. It is an important part of being healthy along with being physically active and feeling good about oneself. Making healthy choices however can be a struggle… juggling training/practice, workout, work, school, friends, family and other commitments.

Healthy Eating has numerous benefits

1. Better overall health
2. More energy
3. Decreased stress, adds to life enjoyment
4. Prevents pressure sores
5. Helps fight infections
6. Maintain a healthy heart
7. Stay regular
8. Improve sport performance
9. Maintain a healthy weight (which impacts all of the above)

Key Healthy Eating Messages (Adapted from the 2005 Dietary Guidelines for Americans)

These are general messages that can be promoted during programs and/or special events, and that apply to all individuals with or without a physical disability. People with physical disability do have unique nutrition concerns. This is for a number of reasons such as changes in activity level, onset of disability, changes in the body’s metabolism and body composition, changes in eating patterns and preparation, and many others.

There are some basics that apply to everyone…

The Dietary Guidelines for Americans explain how Americans, aged 2 and over, can make good food choices and be physically active, to promote health and reduce the risk for developing chronic disease such as heart disease, cancer, diabetes, and obesity. To read the full Dietary Guidelines report visit www.healthierus.gov/dietaryguidelines

MyPyramid promotes eating foods from the different food groups, and recommends being physically active. MyPyramid gives personalized nutrition information based on age, gender, and physical activity level. There is also recipe, snack ideas, handouts posters to share with program participants. Visit  www.mypyramid.gov

Key Messages

Not a quick fix – Healthy eating is not a quick fix, the latest fad or a one shot deal. It is about enjoying food and making healthy choices most of the time.

Balance, variety and moderation are the keys to healthy eating. This includes choosing foods from every food group and mixing up choices within each food group.

Making Healthy Choices – The Pyramid Way Following the US Department of Agriculture’s, My Pyramid can help make healthy choices every day through balance, variety and moderation.

Focus on fruits. Eat a variety of fruits – fresh, frozen, dried or canned. Choose real fruit as opposed to fruit juice for most of your fruit choices. For a 2,000-calorie diet, eat 2 cups of fruit each day (for example, 1 small banana, 1 large orange, and 1⁄4 cup of raisins).

Vary your veggies. Eat more dark-green veggies, such as broccoli, other dark leafy greens; orange veggies, such as carrots, sweet potatoes, pumpkin, and winter squash; and beans and peas, such as pinto beans, kidney beans, black beans, garbanzo beans, split peas, and lentils.

Make half your grains whole. Eat at least 3 ounces of whole-grain cereals, breads, crackers, rice, or pasta every day. One ounce is about 1 slice of bread, 1 cup of breakfast cereal, or 1⁄2 cup of cooked rice or pasta. Look to see that grains such as wheat, oats, or corn are referred to as “whole” in the list of ingredients.

Eat calcium-rich foods. Get 3 cups of lowfat or fat-free milk, or an equivalent amount of lowfat yogurt and/or lowfat cheese (11⁄2 ounces of cheese equals 1 cup of milk)— every day. For kids aged 2 to 8, its 2 cups of milk. Don’t or can’t consume milk, choose lactose-free milk products and/or calcium-fortified foods and beverages.

Go lean with protein. Choose lean meats and poultry. Bake it, broil it, or grill it. And vary protein choices—with more fish, beans, peas, nuts, and seeds.

A calorie is a calorie is a calorie. At the end of the day, excess calories, whether they come from fat, protein or carbohydrate, will be converted into fat in the body. Choosing smaller portions is key. US Dietary Guidelines recommend choosing most of one’s daily calories from carboyhydrates (55-65%), then protein, (<20%), followed by fat (<30%). Some carbohydrates are better (have more fiber) than others such as whole grain breads and cereals, fruit, vegetables, beans and lentils.

Special Nutrition Considerations for Individuals with Spinal Cord Injury and Other Mobility-Related Disabilities

Individuals with a spinal cord injury are susceptible to weight gain and other conditions related to weight gain. This is largely because after a spinal cord injury there is a loss in muscle resulting in a lower body metabolism (ranging from 12% to as high as 54% depending on the level of the spinal cord injury). A lower metabolism means that less calories are burned and most people with a spinal cord injury or other mobility-related disabilities can compensate with just everyday activities. This makes physical activity (aerobic and strengthening exercises) and healthy eating all the more important.

Other nutrition considerations for individuals with physical disability include:

Fiber

• Helps maintain digestive system and maintain regular bowel function
• Fiber also helps in maintaining a healthy heart
• Need 20-35 grams/day (increase amount gradually)
• Food sources: fruits, vegetables, whole grains (such as whole wheat bread, All Bran, brown rice, etc). Natural sources of fiber are best.

Calcium

• Helps to build teeth and bones and maintain bone mass (especially for women with a spinal cord injury or those who cannot ambulate).
• Also needed for blood clotting, and muscle and nerve functioning.
• Vitamin D is also needed to help calcium do its job in the body.
• Need 2-3 cups of dairy everyday (1 cup=1 cup milk or yogurt, 1 1⁄2 oz cheese) to get the 1200-1500 mg calcium daily (depending on gender and age). Talk to health care providers about the need for a calcium supplement.
• Food sources: dairy products (milk, cheese, yogurt), fortified soy milk, green leafy vegetables (spinach, kale, collard greens).

Protein

• Helps build muscle, skin and fight infections. Helps prevent and treat pressure sores/ulcers.
• Protein for people with spinal cord injury are generally the same as people without (unless active wound healing) – 0.8 g/kg of body weight.
• Food sources: Eggs, fish, lean meat, seafood, low-fat milk, cheese, beans and lentils. Ensure is a great source during active wound healing.
• High protein/low carbohydrate diet can lead to constipation and kidney stress.

Sodium

• Helps regulate fluid balance in the body and important for nerve transmission and muscle contraction.
• Limit intake to less than 2300 mg/day (~1 tsp). For people with hypertension, older adults and African Americans, limit to no more than 1500 mg/day
• Sources: table salt, canned foods and other prepared foods

The Bottom Line

• Choose a variety foods from all food groups.
• Choose whole grain breads and cereals – whole wheat, brown rice, oatmeal.
• Focus on fruits and vegetables: color your world.
• Make dairy low fat: Choose 1% or skim milk, yogurt and cheese.
• Choose Eggs, nuts, lean meats, poultry and fish to build healthy skin and muscle and fight infection.
• Use good fat for cooking like canola and olive oil.
• Choose water (at least 8 cups – 64oz/day) over juice or soda. If you drink juice, make sure the label says 100% fruit juice.
• Limit salt, alcohol and caffeine.
• Portion control – watch portion sizes.
• Calories count whether from fat, carbohydrate or protein. At the end of the day, it’s total calories that count.
• Eat breakfast every day – this is an important weight management tool for adults and important school-age children to be ready to perform well in school.
• Be a good role model and mentor parents/caregivers to be the same.
• Encourage families to meals together as often as possible.
• Be active every day at least 30 minutes/day for adults – 10-minute increments count.
• Make it easier to make healthy choices: Encourage your facility (eg. local parks and recreation, university, hospital) to include healthy snacks in vending machines and concession stands.

Goal Setting

Setting realistic and achievable goals is the first step to lasting change. Choose short (a few weeks) and long-term goals. Start small and choose ones that are realistic. Ask yourself: what is one change I can make now? For example, replace sodas with water. Revisit your goals often.

Background: On Friday, July 23, 2010, Attorney General Eric Holder signed final regulations revising the Department of Justice’s Americans with Disabilities Act (ADA) regulations. This included revising the Department’s ADA Standards for Accessible Design. The official text was published in the Federal Register on September 15, 2010. The revised regulations amend the Department’s Title II regulation, 28 C.F.R. Part 35, and the Title III regulation, 28 C.F.R. Part 36.

Key Compliance Dates: The following timeline outlines the significant compliance dates:

• July 23, 2010: Attorney General Holder signs final regulations.September 15, 2010: 2010 Standards for Accessible Design published in Federal Register. Compliance with new standards permitted, but not yet required.
• March 15, 2011: Effective date of New 2010 Standards for Accessible Design
• September 15, 2010 – March 15, 2012: If a title II or title III entity undertakes new construction or alterations, it may choose either the 1991 Standards or the 2010 Standards. Title II entities may also choose to use the Uniform Federal Accessibility Standards (UFAS). It must use that Standard for all elements in the entire facility.
• September 15, 2010 – March 15, 2012: State and local governments (public entities) have the option of choosing to follow the 1991 Standards, the UFAS, or the 2010 Standards when making architectural changes to provide program access.
• March 15, 2012: Compliance with 2010 standards becomes mandatory. This includes compliance with revisions to the 1991 Standards as well as supplemental requirements for which there are no technical or scoping requirements in the 1991 Standards (such as swimming pools, play areas, marinas, or golf facilities).

Download the DOJ fact sheet on the effective dates.

New Regulations: The Americans with Disabilities Act (ADA) requires the Department of Justice (the Department) to publish ADA design standards that are consistent with the guidelines published by the U.S. Architectural and Transportation Barriers Compliance Board (Access Board). The Department has adopted revised ADA design standards that include the relevant chapters of the Access Board´s 2004 ADA/ABA Accessibility Guidelines as modified by specific provisions of the Department´s revised rules implementing title II and title III of the ADA. The Standards contain an entire chapter (10) on “Recreation Facilities” and provide the standards and specifications specific to these facilities. Unless otherwise addressed, these regulations apply to the design and construction of recreation facilities and equipment wherever these elements are provided. (This includes office buildings with an exercise equipment room). The following summary highlights key components of the new regulations as explained in the 2010 ADA STANDARDS FOR ACCESSIBLE DESIGN. (Where applicable, Section numbers have been provided to identify the portion of the Standards referenced).

Recreation Boating Facilities (Sections 235, 1003): If boat slips are provided at a boating facility, the minimum number that must be accessible depends upon the size of the facility. (From 1 for 1-25 slips to 12+ where a facility has more than 1000 slips). (Where the number of boat slips is not identified, each 40 feet (12 m) of boat slip edge provided along the perimeter of the pier shall be counted as one boat slip for the purpose of this section. This requirement also applies to piers where the slips are not demarcated). Accessible boat slips must be dispersed throughout the various types of boat slips. Where boarding piers are provided at boat launch ramps, at least 5% (but no fewer than one) must be accessible. Gangways that are part of a required accessible route are to be accessible, subject to certain enumerated exceptions. (The new regulations also separately cover fishing piers and platforms (sections 237, 1005)).

Fitness Equipment (Sections 206, 236, 1004): At least one of each type of exercise equipment must be on an accessible route and must have a clear floor space (minimum of 30 inches x 48 inches) positioned to enable an individual with a disability to use the equipment.

• Accessible routes shall consist of one or more of the following components: walking surfaces with a running slope not steeper than 1:20, doorways, ramps, curb ramps excluding the flared sides, elevators, and platform lifts.
• The DOJ has advised that most strength training equipment and machines are considered different types. For example, there are many types of cardiovascular exercise machines, such as stationary bicycles, rowing machines, stair climbers, and treadmills. Each machine provides a cardiovascular exercise and is considered a different type for purposes of these requirements.
• Clear floor or ground space is permitted to be shared between two pieces of exercise equipment.
• One full unobstructed side of the clear floor or ground space shall adjoin an accessible route or adjoin another clear floor or ground space.

Golf Facilities (Sections 238, 1006): Newly constructed and altered golf facilities must have either an accessible route or golf car passages with a minimum width of 48 inches connecting accessible elements and spaces within the boundary of the golf course. An accessible route must be provided to the golf car rental area, bag drop-off areas, and other elements that are outside the boundary of the golf course. One or two teeing grounds (depending on the total number provided) per hole must be accessible. If weather shelters are provided, a golf car must be able to enter and exit the shelters. At least 5 percent, but no fewer than one, of practice putting greens, practice teeing grounds, and teeing stations at driving ranges shall be designed and constructed so that a golf cart can enter and exit the practice putting greens, practice teeing grounds, and teeing stations at driving ranges. (The 2010 regulations separately cover miniature golf facilities – sections 239 and 1007 – by requiring at least fifty percent of all holes on a miniature golf course to be accessible, consecutive, and on an accessible route.)

Swimming Pools (Sections 242, 1009): In general, at least two accessible means of entry/exit are required for swimming pools. Such accessible means of entry include a pool lift or sloped entry, and either a transfer wall, transfer system, or pool stairs. Wading pools must provide a sloped entry, and spas must provide a pool lift, transfer wall, or transfer system. Wave action pools, leisure rivers, and sand bottom pools where user access is limited to one area shall not be required to provide more than one accessible means of entry, either a pool lift, sloped entry, or a transfer system.

Saunas and Steam Rooms (Sections 241, 612): Where provided, saunas and steam rooms must be accessible, having appropriate turning space, doors that do not swing into the clear floor space, and, where provided, an accessible bench. A readily removable bench is permitted to obstruct the turning space and the clear floor space.

Play areas (Sections 240, 1008): Play areas designed, constructed, and altered for children ages two and over in a variety of settings, including parks, schools, childcare facilities, and shopping centers, are covered.  Accessible ground and elevated play components, accessible routes, ramps and transfer systems (typically a platform or transfer steps), and accessible ground surfaces must be provided.

Also included in the new regulations are issues related to facility accommodation including allowance of service animals, personal mobility devices, and automated telephone systems.

Reach Range Requirements (Section 308): The reach range requirements have been changed to provide that the side reach range must now be no higher than 48 inches (instead of 54 inches) and no lower than 15 inches (instead of 9 inches). The side reach requirements apply to operable parts on accessible elements, to elements located on accessible routes, and to elements in accessible rooms and spaces.

Service Animals (28 CFR § 35.1004: Definitions; 28 CFR § 35.136: Service Animals): Service animals are now clearly defined as “any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability.” (Miniature horses in some cases may be allowed). The new definition further requires that the tasks performed by the service animal must be directly related to the handler’s disability and the animal’s presence for emotional support is not sufficient. While service animals must be permitted, a facility may remove an animal from the premises if the animal is not under the handler’s control.  A facility may make two inquiries to determine whether an animal qualifies as a service animal, but only if it is not readily apparent that the animal is trained to do work for the individual with a disability. The inquiries should not ask for documentation and may include: if the animal is required because of a disability and what work or task the animal has been trained to perform.

Wheelchair (28 CFR § 35.1004: Definitions; 28 CFR § 35.137: Mobility Devices): A wheelchair is now defined as “a manually-operated or power-driven device designed primarily for use by an individual with a mobility disability for the main purpose of indoor, or of both indoor and outdoor locomotion. This definition does not apply to Federal wilderness areas.” The 2010 regulations require a public entity to permit individuals with mobility disabilities to use wheelchairs and manually-powered mobility aids, such as walkers, crutches, canes, braces, or other similar devices in any areas open to pedestrian use. As with service animals, a public entity may ask a person using a power-driven mobility device to provide a “credible assurance” that the mobility device is required because of the person’s disability. A valid, State-issued, disability parking placard or card, or other State-issued proof of disability meets this test. If such a document is not available, a verbal representation, not contradicted by observable fact, that the other power-driven mobility device is being used for a mobility disability should be accepted.

Automated telephone systems (28 CFR § 35.161: Telecommunications): Where a public entity communicates by telephone with applicants and beneficiaries, Text telephones (TTYs) or equally effective telecommunications systems shall be used to communicate with individuals who are deaf or hard of hearing or have speech impairments when a public entity communicates by telephone with applicants.

Meeting the New Obligations of the ADA Regulations: The first step in meeting the new obligations of the 2010 ADA regulations will be for every organization and public entity to familiarize themselves with the new regulations. (The revised ADA regulations implementing Title II and Title III are available online at: http://www.ada.gov/regs2010/ADAregs2010.htm). Once an organization understands the full scope of their obligations under the act, the entity should consider how to meet the requirements by modifying existing facilities, developing appropriate policies, and holding staff training.

For some organizations, these new regulations will not present major challenges – most of the 2010 Standards for Accessible Design are a codification of years old industry standards with only minor changes between these guidelines and those published in 2002 and 2004. Yet for others – such as those with features which are addressed for the first time in the regulations (such as wading pools) – an accessibility assessment becomes all the more critical.

A fact sheet on all the regulations is available online at: http://www.ada.gov/regs2010/factsheets/2010_Standards_factsheet.html

The Revised ADA regulations implementing Title II and Title III are available online at: http://www.ada.gov/regs2010/ADAregs2010.htm

The 2010 Standards for Accessible Design are available online at: http://www.ada.gov/2010ADAstandards_index.htm

• Examples of appropriate and inappropriate phrases to describe persons with disabilities.

Tips for Interacting with People with Disabilities

Appropriate etiquette when interacting with people with disabilities is based primarily on respect and courtesy.

• Tips to help you communicate effectively.

Disability Simulation

Disability organizations sometimes use “disability awareness days” to teach students, staff and volunteers about the disability experience. These disability awareness days may use simulations to convey what it’s like to live with a disability. For example, participants are blindfolded, or put into a wheelchair and told not to use their legs. However, many disability advocates feel that simulations are the wrong way to go.

Paralympic sport organizations from the local level to the International Paralympic Committee conduct “Blaze” or “Paralympic Day” programs that offer people without disabilities the opportunity to try Paralympic sports like Goalball, Wheelchair Basketball, and Sitting Volleyball. These experiential sport activities are structured and teach skills that enable participants to enjoy the activity while learning about the sport.