captivate literature review (id 3760)

LITERATURE REVIEW for CAPTIVATE: LOCAL PARTICIPATION FOR ALL A project of WA Local Government Association WA Disabled Sports Association The Centre for Cerebral Palsy Recreation & Sport Network Funded by Disability Services Commission Department of Sport and Recreation Richard Lockwood Anne Lockwood WA Disabled Sports Association [email protected] Ph/Fax 08 9336 3277 Perth, Western Australia February 2007

Upload: muhammad-hasam

Post on 24-Aug-2014




0 download


Page 1: Captivate Literature Review (Id 3760)



A project of WA Local Government Association WA Disabled Sports Association The Centre for Cerebral Palsy Recreation & Sport Network

Funded by Disability Services Commission

Department of Sport and Recreation

Richard Lockwood Anne Lockwood WA Disabled Sports Association [email protected] Ph/Fax 08 9336 3277

Perth, Western Australia February 2007

Page 2: Captivate Literature Review (Id 3760)


Disability is a fact of life for many Australians who live alone, in group homes, or with family and friends in the community. The rate of impairment is generally steady, but Australia has an aging population, and with aging comes the increased likelihood of impairment.

How we view impairment and disability has changed dramatically in recent years, but communities in general have been slow to realise that, although the impairment a person has is a reality, the disablement is caused by environmental and social barriers which have been put in place by aging infrastructure, poor planning and negative social attitudes. This is changing, with legislation, advertising campaigns, and community-focused planning making inclusion in community life a reality. Work and play are important aspects of community life, and people with disabilities are increasingly pushing to be part of these worlds.

The evidence presented in this literature review is that physical activity is a positive part of all our lives, for giving us vitality, creating networks and preventing many chronic diseases that are attributable to inactivity and poor diets. For people with disabilities there is the added complication of these secondary conditions that further exacerbate their impairments. Making community sport and recreation more inclusive for people with disabilities, their families and carers is an interesting challenge for local governments and their service partners. The evidence is that it needs a whole-of-local-government commitment in principle, and then appropriate strategic planning and actions. This will invariably involve activities such as community and organisation assessments, access audits, staff training, promotion of physical activity opportunities, and various partnerships to resolve areas such as resourcing, knowledge sharing, and provision of support.

Each local government is a unique entity with specific environmental and organisational characteristics that will influence its approach to ensuring that its sport and recreation services and facilities are inclusive. Community development principles offer guidance to a general approach to inclusion that can then be tailored to ensure further local ‘buy in’ and provision of appropriate opportunities for particular individuals and communities. Consistent with this approach, CAPTIVATE is specifically designed to support the training of sport and recreation service providers. The development of relevant policy and a range of specific ‘tools’ may assist local government and partnering providers to meet the fundamental requirement that for successful inclusion, local government will be genuinely committed and will develop the capacity necessary to ensure inclusive community sport and recreation.

R&A Lockwood Consultants Feb 2007

Page 3: Captivate Literature Review (Id 3760)


Section 1: Background, Introduction and Method Page

Background 1 Introduction 1-2 Method 2-3

Section 2: Disability and inclusion: Models and development

Defining disability 4-5 Changing perspectives on disability 5-10 Inclusion 10-11

Section 3: Local government and inclusive community sport and recreation

Local government 13-18 Legislation and policy 18-22 Disability and participation in sport and recreation 22-26

Section 4: Benefits of physical activity for people with physical disability

Physical activity and health benefits 28-29 Physical activity and disability 29-31 Physical activity and physical disability 31-38

Section 5: Barriers and enablers to participation/inclusion

Barriers and constraints 39-46 Enablers and supports 46-47

Section 6: Inclusive practice: Community sport and recreation 48-59

Section 7: Adult learning 60-64

References 65-80

R&A Lockwood Consultants Feb 2007

Page 4: Captivate Literature Review (Id 3760)

SECTION 1 Background, Introduction and Method


Project CAPTIVATE has drawn together three ‘disability’ service organisations that work in various ways with local government to provide sport and recreation opportunities for people with disabilities: The Cerebral Palsy Association, Recreation and Sport Network, and The West Australian Disabled Sports Association. It is an ‘umbrella’ project that aims to address the needs of these groups and those of the WA Local Government Association which were recently expressed in four separate project funding applications.

The funding agencies, the Department of Sport and Recreation and the Disability Services Commission, had previously worked together to develop the WA Strategic Framework for Inclusive Sport and Recreation, and ‘Captivate’ was seen as a natural extension of this Framework. Working with Local Government, other sport and recreation services providers, and people with disabilities, the project partners aim to develop resources for frontline staff delivering sport and recreation services provide training in the use of the resources, and develop relevant policy around inclusive sport and recreation. The Cerebral Palsy Association also wished to develop more specific resources and training with a focus on physical disability and targeted at fitness and aquatic staff in local government facilities.

The first stage of project CAPTIVATE was structured to seek evidence to inform the development of the various resources and training. The method prescribed in relevant contracts was:

Part I: a literature search Part II: a statewide ‘environmental scan’

This report represents the completion of Part I, the literature review.


The contracted requirement for the literature review was described in general terms reflecting its intended use i.e. to ‘underpin the project and the development of resources and policy’ and to ‘provide a foundation for the development of evidence based inclusive sport and recreation policies and practices that can be directly linked to inclusive practice’. Expectations about the nature of the content were further described to the researchers during consultation with each of the project partners and WALGA. The key areas indicated were:

The development and current thinking about ‘inclusion’, particularly in relation to people with disabilities.

Opportunities, capacity, and challenges to local government as an inclusive sport and recreation provider.

R&A Lockwood Consultants Feb 2007 1

Page 5: Captivate Literature Review (Id 3760)

Benefits of exercise for people with disabilities – and a specific review on evidence relevant to physical disability.

Barriers and enablers to participation and inclusion in community sport and recreation.

Recent evidence of successful inclusive sport and recreation in a local government context and the basis for success.

A brief review of current thinking on adult learning principles and practice.

Given this range of expectations, relevant evidence has been sought across several major areas. Consequently, the sections represent a set of topics that contribute to the whole, rather than developing a specific theme. The primary audience for this document comprises the project partners and those developing the resources and training for the project. It is thus written for workers from the three different ‘industries’ represented by the partners i.e. local government, sport and recreation, and disability.

This document will be most valuable when considered in conjunction with the reported findings of CAPTIVATE’s statewide Environmental Scan which summarise a significant amount of current West Australian input on the topics listed above. Together, the literature review and scan provide a perspective on current thinking and evidence in relation to inclusive sport and recreation.

Method Scope Reflecting the overall purpose of project CAPTIVATE, this document focuses on the inclusion of people with disabilities in ‘sport and recreation’ that is provided/delivered by local government employees or purchased by them from relevant professionals. It includes activities offered through local government programs and services, and those undertaken in local government facilities and grounds.


‘sport and recreation’ – reflects the terminology used in CAPTIVATE documents and is used as a generic term to refer to physical activity and in some cases physical leisure activities where the reported literature uses this term. ‘client’, ‘customer’, ‘consumer’, ‘patient’ – are used to indicate the person with a disability who is seeking or using a service. The terms reflect those used in the reported literature. ‘local government’, ‘councils’ – interchangeable terms. ‘people with disabilities’ ‘disabled people’ – interchangeable, and reflect those used in the reported literature. ‘disability’ – the notion of disability described in the Disability Discrimination Act (see Section 2). ‘inclusion’ – a broad notion that in practice extends from activities in ‘open’ settings to those that are ‘separate’ (see Section 2).

R&A Lockwood Consultants Feb 2007 2

Page 6: Captivate Literature Review (Id 3760)

Literature search process Relevant Australian and international literature was reviewed following systematic searches of library holdings through UWA Reid and Medical Libraries, and databases including MedLine, PubMed, SPORTdiscus, PEDro (Physiotherapy Evidence Database), PsycINFO, PsychLIT, AusportMed, AUSTROM, ABS, AMED, and multiple searches using Google Scholar and Web of Science.

Searches were conducted using the following key words and various combinations:

‘sport’ ‘recreation’ ‘leisure’ ‘physical activity’ ‘exercise’ ‘fitness’ ‘disability’ ‘impairment’ ‘function’ ‘handicap’ ‘community’ ‘health’ ‘access’ ‘supports’ ‘enablers’ ‘barriers’ ‘constraints’ ‘local government’ ‘council’ ‘municipality ‘inclusion’ ‘inclusive practice’, ‘inclusivity’ ‘carers’ ‘care givers’ ‘guidelines’ ‘best practice’ ‘policy’. For the more specific physical disability review, additional words and phrases searched included ‘cerebral palsy’ ‘spinal cord injury’ ‘acquired brain injury’ ‘musculo-skeletal’ ‘muscular dystrophy’ ‘multiple sclerosis’ ‘arthritis’ ‘post polio syndrome’ ‘rehabilitation’. The Cerebral Palsy Association of WA provided reprints of articles highly relevant to the ‘physical disability’ part of the review.

From the relevant articles identified, key author names and citations were further searched. The reference lists of key articles were also scanned for additional leads. Greater attention was given to locating and reviewing more recent articles, and especially ‘macro’ review articles after 1990.

Additional information was sought by contacting key industry leaders, organisations and government departments in Australia eg Australian Bureau of Statistics, Australian Institute of Health and Welfare, Human Rights and Equal Opportunity Commission, State Departments of Sport and Recreation, State disability authorities, Australian Local Government Association, State Disabled Sport and Recreation groups, and the Australian Institute of Sport.

The range of search procedures together resulted in many ‘hits’ that were scanned for relevance to the review topic. Given the range of sub-topics to be included in the review, and consequently the number of keywords, in many cases it was immediately obvious that the majority of hits were unsuitable. Those that appeared to be relevant tended to be identified in more than one search. The relevant articles were broadly assessed for robustness of research method and validity of reported findings and those found to be unsuitable in terms of these criteria were excluded from the review. The vast number of resulting ‘hits’ from searches relating several fields of interest is illustrated by a recent key review paper which, although not specifying a setting (eg local government), and using fewer data bases, employed many similar keywords. It reported 965 hits from which only 22 were immediately relevant (van der Ploeg et al. 2004) and further confirmed the lack of published work linking physical activity behaviour (and its determinants) and people with disabilities.

R&A Lockwood Consultants Feb 2007 3

Page 7: Captivate Literature Review (Id 3760)

SECTION 2Disability and inclusion: Models and developments

Individual and organisational views about disability and inclusion directly impact at many levels on the manner and extent to which inclusive sport and recreation opportunities are provided for people with disabilities. There is a wide range of current views held by policy-making agencies and various professionals whose work brings them into contact with people with disabilities and their families and carers.

This section illustrates the foundations and evolution of ‘inclusion’ as a relatively recent notion in the long history of discourse around ‘disability’. Some current definitions are noted, followed by a broader historical background, and selected implications for sport and recreation providers.

Defining disability

‘Disability’ is an umbrella term that may include impairment, activity limitation or participation restriction (World Health Organisation, 2002). There are no universally accepted definitions of ‘disability’, and even within jurisdictions, definitions and meanings may vary according to agency context and purpose. Social policy and service delivery contexts of the day often require differing approaches to definition eg in social debate and policy-making, disability definitions tend to be quite general and inclusive, and attempt to address all types and levels of disability. In contrast, those used for government benefits, pensions, employment schemes, insurance, and census are usually based on specific measures of impairment and/or incapacity that enable some form of classification, and thus criteria for decision-making and statistical groupings. To illustrate, in South Africa, The Employment Equity Act 55 of 1998 describes disability in terms of long-term or recurring physical or mental impairments which substantially limit their prospects of entry into or advancement in Employment; while the Social Assistance Act 59 of 1992 defines a disabled person as one who is older than 18 years and who has a physical or mental disability of longer than 6 months’ duration, which makes him/her unfit to provide sufficiently for his/her own maintenance (Committee Reports of the Taylor Committee, 2006).

In a local context, the service delivery focus of the current Western Australian Disability Services Act 1993 is also apparent in its definition that “disability” means a disability

which is attributable to an intellectual, psychiatric, cognitive, neurological, sensory, or physical impairment or a combination of those impairments;

which is permanent or likely to be permanent; which may or may not be of a chronic or episodic nature; and which results in —

o a substantially reduced capacity of the person for communication, social interaction, learning or mobility; and

o a need for continuing support services (West Australian Disability Services Act 1993).

R&A Lockwood Consultants Feb 2007 4

Page 8: Captivate Literature Review (Id 3760)

The notion of disability adopted for this paper is that described by the Australian Disability Discrimination Act 1992 which considers disability as:

total or partial loss of the person’s bodily or mental functions; or

total or partial loss of a part of the body; or the presence in the body of organisms causing disease or

illness; or the presence in the body of organisms capable of causing

disease or illness; or the malfunction, malformation or disfigurement of a part of

the person’s body; or a disorder or malfunction that results in the person learning

differently from a person without the disorder or malfunction; or a disorder, illness or disease that affects a person’s thought

processes, perception of reality, emotions or judgment or that results in disturbed behaviour;

The definition includes a disability that presently exists, previously existed but no longer exists, may exist in the future, or is imputed to a person. Related concepts are defined by the World Health Organisation:‘Impairment’ refers to loss or abnormality of body structure or function; ‘activity’ relates to the nature and extent of functioning at the levels of the person; and ‘participation’ reflects the nature and extent of a person’s involvement in life situations at the societal level and reflects the interplay between impairments, activities, health conditions and contextual factors (World Health Organisation, 2002). In addition to reflecting contexts and purpose, definitions indicate variations and progression in conceptualisation of disability both internationally and within Australia. These transitions over time reflect a close connection between prevailing attitudes and the way in which societies view and treat people with disabilities – including the opportunities and services made available to them. Some of these issues are further discussed.

Changing perspectives on disabilityUntil the 18th century disability was seen by many societies as an expression of witchcraft, possession by demons, or sin. These views were to some extent displaced by a more scientific understanding of impairment, and with it, a belief that medical science could cure, or at least rehabilitate, people with disabilities. An alternative view expressed during the 1960’s was that disability is a learned ‘pattern of behaviour’ that develops when there is long-term impairment (Nagi, 1965). However, despite this and other observations based on sociological foundation, it was the ‘medical model’ that was dominant internationally until the 1980’s.

Medical models were built on observations of impairment, and the need to classify and solve problems through medical intervention. The model was largely formalised by the World Health Organisations International Classification of Impairments, Disabilities and Handicaps (ICIDH) in 1980. The ICIDH was developed for a range of purposes in an international context eg population surveys, coding health information, health outcomes research, vocational assessment, and as a framework for social policy development. It introduced the conceptual separation of disability, impairment, and handicap, which had previously been used interchangeably and without any regard to the fundamental philosophical distinctions between them.

R&A Lockwood Consultants Feb 2007 5

Page 9: Captivate Literature Review (Id 3760)

Built on, but progressing from the medical model, the ICIDH defined impairment as loss or abnormality of psychological, physiological, or anatomical structure orfunction and distinguished it from disability, which was defined as ‘any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being (Wood, 1980, p. 27). It defined ‘handicap’ as disadvantage that resulted from the person’s impairment or disability and that limits or prevents the fulfillment of a role that is normal, depending on age, sex, social and cultural factors for that individual.

Many critics were quick to dispute these descriptions and the underlying model since it was seen to still view disability as stemming from the individual and as intrinsically linked to their impairment. It was the person with disability that was required to change - most commonly through medical intervention, thus facilitating the incorporation of the medical model as part of themselves i.e. persons with disability come to see, feel, know themselves and their social position as a function of their impairment. A commonly expressed criticism was the dominant focus on the notion of disability as an individual abnormality whereby disability is seen as “not being able to perform an activity considered normal for a human being, and handicap is the inability to perform a normal social role” (Oliver, 1990, p. 4).

This placement of the person’s disability or inability at centre stage often supported the tendency to blame individuals for the physical, psychological, and social outcomes of their impairment. Moreover the handicaps listed in the ICIDH were limited to a few survival roles (eg mobility and occupation). The focus was thus still on personal factors and there was inadequate recognition of the role of social environmental factors in creating ‘handicap’ and disadvantage. Operationally, this was reflected in the instrument’s failure to include a method of recording social barriers or facilitators that might be affecting a person’s ability in various activities (Bickenbach, Chatterji, Baddley, and Ütsün, 1999). At a policy level, other impacts were noted e.g. the ICIDH’s functional limitations focus resulted in individual adjustment and coping strategies becoming policy priorities for Censuses and other health care and social policy agencies in the UK. Thus despite the ICIDH’s widespread use in the following years, there was not universal acceptance of its underpinning assumptions, validity, or utility as a basis for empirical research (Oliver, 1990; Driedger, 1988).

The well-documented critiques of medical models commonly included the following observations(a) Labelling with medical terminology which ignores individual differences

and creates groupings that “are nothing more than terminological rubbish bins into which all the important things about us as people get thrown away” (Brisendon, 1998, p. 21).

(b) Labelling promotes stereotypes of disability that bring out pity, fear and patronising attitudes.

(c) Viewing disability as pathology results in reinforcement of dependence, the victim status and victim-blaming (Abberley, 1987).

(d) Disabled people are seen as the problem - they need to be adapted to fit into the existing physical and social world.

(e) The focus is on the patient not the person.(f) Treatment of people with disabilities was based on a notion of

'normality' whereby impairment was assessed against normality and people were judged on what they could not do, instead of what they could do.

R&A Lockwood Consultants Feb 2007 6

Page 10: Captivate Literature Review (Id 3760)

(g) Quality of life and decision-making about people with disabilities lies with the medical and associated professions who administer cures.

An alternative approach during the 1980’s was the Disabled People's International set of definitions that reflected early approaches to a ‘social model’ of disability:

Impairment: the functional limitation within the individual caused by physical, mental or sensory impairment.

Disability: the loss or limitation of opportunities to take part in the normal life of the community on an equal level with others due to physical and social barriers (Disabled People International, 1982).

These definitions reflect a fundamentally different explanation of the negative social experiences and conditions encountered by people with disabilities that that offered by the ICIDH. In this view disability is seen as a consequence of the failure of social organisation to take into account the differing needs of people with disabilities and remove the barriers they encounter.

During the 1990’s social perspectives achieved increasing prominence. They built on a human rights approach whereby disability was seen as society’s denial of opportunities to people with impairment (Oliver, 1990) and where society is seen as actually creating disability rather than it being an attribute of an individual. Since the disability ‘problem’ is created by an unaccommodating environment resulting from the prevailing attitudes toward disability, a political response is seen to be appropriate – and conversely, that medical interventions and control over the disability discourse, services etc are inappropriate (Oliver, 1990). Observations supporting this model include:

If I lived in a society where being in a wheelchair was no more remarkable than wearing glasses, and if the community was completely accepting and accessible, my disability would be an inconvenience and not much more than that. It is society which handicaps me, far more seriously and completely than the fact that I have spina bifida (Davis, 1989, p19).

… social model… incorporates a holistic interpretation of the situation facing disabled people. It suggest that people with physical and mental impairments can have satisfying life-styles as disabled people if the focus of attention is shifted towards the removal of disabling barriers rather than concentration only on the rehabilitation of disabled individuals (Finkelstein and Stuart, 1996, p.171).

In addition to the dominant medical and social perspectives there were other views lying between these two ‘poles’ including those that see disability as a form of social deviance (Goffman, 1963), or those emphasising a socio-cultural point of view (eg Oliver, 1990). These were quite prominent in some discourse but were overshadowed by an increasing focus on the social perspective. With growing acceptance of the social model of disability during the 1990’s some of the problems associated with the ICIDH were addressed in a revised version in 1996-97. This model, the ICIDH-2, included a greater focus on environmental factors in the form of three new ‘dimensions’ - Activity, Participation and Contextual Factors. It acknowledged that a) disability is not an attribute of an individual, but rather a complex collection of conditions, many of which are created by the social environment, b) the management of the problem requires social action, and it is the collective responsibility of society at large to make the environmental modifications necessary for the full participation of people with disabilities in all areas of social life, c) the issue is therefore an attitudinal or ideological one requiring social change, which at the political level becomes a question of human rights.

R&A Lockwood Consultants Feb 2007 7

Page 11: Captivate Literature Review (Id 3760)

The emphasis was on a new view of disability i.e. not simply from the individual medical perspective, but also from a human rights and human development perspective. However, while clearly expanding on the previously body-centred notion of disability (Gray and Hendershot, 2000), ICIDH-2 was again openly criticised by many disability rights advocates who still saw a dominating presence of medical-biological approaches and also a system based on the need to decide on and make comparative judgements against what is deemed ‘normal’ (Pfeiffer, 1998; Oliver, 1990).

This common critique was accompanied by an increasing call for a ‘renewed’ social model (eg Crow, 1996) which extends beyond theory into real life by avoiding the social model’s perceived denial or minimalisation of the physical and psychological pain of impairment - even though disability might be reduced. For example, in disability/inclusion training discussion of impairment is often glossed over or minimised for fear of confirming stereotypes of the `tragedy' of impairment, or making the issues too complicated to convey. A ‘renewed’ social model would ensure that inclusion (of people with a disability) remains the primary concern, but that impairment does exist alongside.

Others have supported this view by noting that the social model is more supportive of people with static conditions such as a person with spinal cord injury using a wheelchair, rather than people with chronic illness or those whose illness manifests as a form of disability. For example, for all that we may see a variety of conditions which cause chronic pain as socially constructed, there is no doubt that when one is lying in a hospital bed breathless, in pain, and distressed that this is more than just because of some social construct. Hence we can see that there is a medical component to disability even though there are significant insights to be gained from understanding that society does actually create much of the disadvantage that those who live with impairments experience (Newell, 2004, p. 6).

... tends to deny the experience of our own bodies, insisting that our physical differences and restrictions are entirely socially created. While environmental barriers and social attitudes are a crucial part of our experience of disability - and do indeed disable us - to suggest that this is all there is to it is to deny the personal experience of physical or intellectual restrictions, of illness, of the fear of dying (Morris, 1991, p.10).

Sometimes, in seeking to reject the reductionism of the medical model and its institutional contexts, proponents of independent living have tended to discuss disablement as if it had nothing to do with the physical body. (Williams, 1991, p. 521).

The achievement of the disability movement has been to break the link between our bodies and our social situation, and to focus on the real cause of disability, i.e. discrimination and prejudice. To mention biology, to admit pain, to confront our impairments, has been to risk the oppressors seizing on evidence that disability is “really” about physical limitation after all (Shakespeare, 1992, p.40).

R&A Lockwood Consultants Feb 2007 8

Page 12: Captivate Literature Review (Id 3760)

In 2001 the WHO attempted to address the debate between the medical and social models by recognising the validity of both and noting the appropriateness of both medical and social responses to the problems associated with disability. While most of these models were built on assumptions that regard mind, body, and society separately, later approaches place greater attention on the interaction between mind, body, and society, and this is reflected in what are loosely termed biopsychosocial models. Based on a more interactive biopsychosocial theory, these models acknowledge the dynamic interaction between health conditions and personal and environmental factors including physical environment, services available, and legislation (Dahl, 2002). This is reflected in the WHO’s third classification scheme, the International Classification of Functioning, Disability and Health 2001 (ICF) which gives examples of interacting factors including infrastructure, laws, regulations, climate, attitude, and ideologies. The ICF is seen to provide “a coherent, if uneven, guide through the competing discourses of disability” (Imrie, 2004). It reflects the view that “mind, body, and environment are not easily separable but rather mutually constitute each other in complex ways” (Marks, 1999, p25), and that disability is a compound phenomenon to which individual and social elements are both integral (Bickenbach et al. 1999). In a more practical sense, it has been noted that the focus on environment may enhance identification of barriers and facilitators of inclusion.

The ICF recognises that the population as a whole is at risk from acquiring impairment and chronic illness and that ageing will inevitably increase the proportion of people with impairments. Thus disability is not ‘special’ because all people over the course of their life span will have various and usually increasing needs. The concept of needs should not therefore be based on breaking the rules for the few but on designing a flexible world for the many. In addition however, there must be response to the needs and contexts of particular groups so that justice prevails in regard to access to services and equitable outcomes.

While the ICF represents a significant progression from earlier views and classification tools, some note that it still requires further explanation so that practitioners consistently interpret its content, particularly in relation to understandings about impairment, biopsychosocial theory and, the notion of universalisation as the basis for disability, health, and social programmes (Imrie, 2004). Some note that greater emphasis is needed on the key premise that the functional limitations of impairment become disabling as a consequence of broader social and attitudinal relations. It has also been noted that in practice, the integrated relationship between biology, personal or psychological, and social factors is not necessarily emphasised thus still enabling a focus on individual domains e.g. “far from being integrated, the three domains can be used independently, and the body and activity ones will be well accepted by biomedical, compensation, and programme eligibility gatekeepers” (Fougeyrollas and Beauregard, as cited by Imrie, 2004, p.13).

While the ICF illustrates an important development in the conceptualisation of disability, it has been noted that the important issue is not just another reconstruction of disability, but empowerment to enable people with disabilities to become full citizens (Keys and Dowrick, 2001).

Since the release of the ICF there has been a well published recent attempt to develop a model that specifically articulates links between the functioning of people with a disability and their physical activity behaviour (and determinants) (van der Ploeg, van der Beek, van der Woude, and van Mechelen, 2004). This model, the integrated Model of Physical Activity and Disability (PAD) directly builds on the

R&A Lockwood Consultants Feb 2007 9

Page 13: Captivate Literature Review (Id 3760)

ICF and integrates it with aspects of various models that describe the determinants of physical activity eg Social Learning/Cognitive theories, Health Belief Model, Theory of Planned Behaviours, the Transtheoretical Model, and in particular, the Attitude, Social influence and Self Efficacy model. If verified as a robust and useful model, it was cited as enabling a more accurate consideration of variables that determine physical activity of people with disabilities, including that of subgroups, and consequently, better design of targeted physical activity promotion. However, at this point the model has been limited to rehabilitation applications and it is not known how relevant it may be for people with a disability who are not undergoing rehabilitation and who do their physical activity in a community sport/recreation/leisure context.

In tracking major views about disability and the changes that have occurred over time, the focus has been on the dominant recent models – medical and rights-based (social model). However, it has been noted that other approaches to understanding disability are still quite prevalent in Australian society eg the charity approach that is reflected almost weekly at times in ‘disease label days’ and in some cases becomes competitive by “depicting people as being the most needy, the most pitiful and reinforces the tragedy and indeed catastrophe of disability…” (Newell, 2004, p.2). While altruistically and practically aimed at fundraising for various groups, this author does not see this approach as conducive to progressing Australian community attitudes from pity for those who are publicly portrayed as different and less fortunate, to inclusion of all in community life. The need for progress away from a paternalistic, sympathy-based approach toward a human rights based approach was clearly articulated by Phillip Adams in 1998 in his description of the reaction of public figures who denounced his ‘super crip’ strategies for the International Year of Disabled People eg ‘we are sick of paternalism, of people speaking for us’. His experience in authoring the Break Down the Barriers Campaign lead him to further observe that “human rights weren’t merely an issue in Burma or Afghanistan; they were missing here – every time our bigotry, our buildings or institutions placed a barrier in a disabled persons path” (Newell, 2004, p. 2).


Today the ICF formalisation of a biopsychosocial view of disability that stresses interactive processes is reflected in the broad notion of inclusion. Inclusion proposes that all people are recognised as individuals with the opportunity to participate in activities as a member of a community. This includes the right to take risks, make choices, make mistakes, to be independent and to reap the benefits of physical activity such as improved fitness, the acquisition of physical skills, and the learning of social norms, in a way similar to all people within a community.

In its discussion of the values of inclusion, The National Centre for Physical Activity and Disability (2007) in the United States makes the following statements and quotes; “to value inclusion, one must start by valuing the individual and appreciating that each person is different”; “inclusion allows people to value differences in each other by recognising that each person has an important contribution to make to our society”, “recreation inclusion refers to empowering persons who have disabling conditions to become valued and active members of their communities through sociocultural involvement in community based leisure settings”; “diversity is embraced and not lost in inclusion”; “recreation experiences that embrace this value of inclusion allow for facilitation of meaningful relationships between people with and without disabilities. It is

R&A Lockwood Consultants Feb 2007 10

Page 14: Captivate Literature Review (Id 3760)

only through the development of these relationships that stereotypes and stigmas can be eliminated”. In practice, inclusion is often seen to have three dimensions i.e. ‘just being there’ eg as a spectator, physically participating, and ‘being a member’ who is actively interacting with other members of the group and feels some sense of belonging.

The growing worldwide interest in the provision of quality inclusive services accessible to people with disabilities was initially driven by the rise of human rights as a major international issue, which in turn has resulted in the Charter of Rights and various other United Nations declarations. The rights approach has worked in conjunction with increasing recognition that impairment is often associated with social exclusion and is a further barrier to opportunity and engagement. As more people with disabilities move from institutional to community settings there is commonly a loss of peer contact and role models provided by other disabled people. Many are now individually segregated within their community. This isolation and segregation has exacerbated the need for active development of inclusive approaches in many facets of community living – including sport, recreation and leisure.

In both policy and practice in the sport and recreation context, inclusion means recognising individual differences, and providing for those differences by making adaptations and/or modifications. It means that the system responds to the needs of all participants.

An inclusive activity embodies characteristics of equal participation opportunities at an appropriate level, with appropriate support. It means that the system responds to the needs of all participants. It extends to ensuring that programs, services and facilities are accessible and welcoming to all people - including those with disabilities and their carers, friends and families. This view of inclusion is broader that earlier expressions which focussed on ‘open’ and ‘modified’ participation/settings. It is a very practical and activity based approach and it details an ‘inclusion spectrum’ comprising five alternative modes of activity;

a) Open – everyone in the group can participate without adaptation or modification

b) Modified – each person can form the task in the most appropriate way for them. This may involve changes to communication, rules, equipment, and environment

c) Parallel – working to a common theme but at an appropriate level using ability groupings

d) Disability sport – activities developed specifically for people with disabilities include participation by people who do not have disabilities

e) Separate – separate participation by an individual or group. (Australian Sports Commission, 2005)

Although inclusion is now an accepted goal, reality and the personal preferences of people with disabilities suggest the need for a choice of options that range from fully inclusive to segregated participation. Many community providers have pursued the more ‘open’ form of inclusion detailed above, but have also chosen to also recommend or offer specialised or separate services that increase participation by some individuals.

R&A Lockwood Consultants Feb 2007 11

Page 15: Captivate Literature Review (Id 3760)

Selected considerations The notion of inclusion has evolved from many views on disability and other topics and today there is a need for a consistent use of the term within and between relevant ‘industries’.

There are a variety of ways of understanding disability rather than just one set approach and a range of these beliefs is evident within communities and organisations today.

Tracking the major discourse over time shows how traditional approaches are seen to have contributed to the exclusion of many people with disabilities from full participation in community and society, and have contributed to further disadvantage.

The emerging model of inclusion that is reaching consensus in Australia is that all people are entitled to full participation and citizenship in their own community, with some adjustments and support when required.

Improving understanding of society’s contribution to disability can increase awareness of how this role is revealed in the attitudes, services, and facilities in sport and recreation settings. This in turn can promote the ability and confidence to identify opportunities for inclusion.

Some practical points

It is convenient to classify and/or label a person as ‘disabled’ – but it is appropriate and more effective to identify the support they may need to make choices types and levels of participation and activity

impairment is a physical fact the restrictions experienced by many people with a disability may be

overcome eg by making adjustments to sport and recreation services and settings, and where necessary by the use of appropriate aids.

‘multiple disabilities’ is better viewed as an individual’s level of functioning in one or more domains, and ‘severe disabilities’ refers to the fact that an individual requires high levels of support in a number of domains.

R&A Lockwood Consultants Feb 2007 12

Page 16: Captivate Literature Review (Id 3760)

SECTION 3Local government and inclusive sport and


Project CAPTIVATE is clearly directed at enabling local government to fulfil its role in ensuring inclusive community sport and recreation. This section of the review considers the local government context in terms of its roles, opportunities, and current challenges that are relevant to its involvement in inclusive community sport and recreation – either directly or through partnerships with sport and recreation providers and disability service providers. Subsections provide further context in terms of legislation/policy and characteristics of the ‘disability’ customer base eg size, nature, and current and potential participation in sport and recreation.

Local government

Publications regarding the role and activities of local government in sport and recreation and particularly in relation to inclusive practice are not well reported. Leading analysts and academics in the broader field of local government have also referred to this scarcity on a much wider scale when they comment that despite a vast amount of theoretical and empirical analysis of democratic government, there is relatively little research and resulting publications directly relating to local government. Enquiries made to the Australian Local Government Association (ALGA) and the West Australian Local Government Association (WALGA) also failed to identify a significant body of published information on relevant policy or project/program documents or reports. It has been suggested the relative lack of reported research into local government activities may be partly due to local government’s relatively low expenditure in comparison to State and Commonwealth Governments, and the fact that it has no constitutional status, instead deriving its powers and functions only from state acts and regulations (Dollery, Marshall, and Worthington, 2003).

Local government involvement in sport and recreation relates mainly to its provision of facilities and services, and for some, service purchasing, and the employment or contracting of relevant sport and recreation professionals. While many councils directly provide sport and recreation services, their role in this area is increasingly undertaken in partnership with other government and non-government organisations. Overall, councils currently employ a wide range of recreation/leisure professionals and many also purchase additional services from other organisations and sources.

Councils are now the largest single provider of community sport and recreation facilities. They are the main contributor (77 per cent) to support of venues, grounds and facilities, while other levels of government are the majority contributors (84 per cent) to participation and special events. Government spending on sport and recreation in 2000-2001 has been estimated at $110 per person with respective contributions by Commonwealth, state, and local governments calculated to be around $10, $45, and $54. Most of this funding (62 per cent) supports venues, grounds and facilities, with an additional 25 per cent spent on participation and special events, and the remainder on administration and regulation (Australian Bureau of Statistics, 2002).

R&A Lockwood Consultants Feb 2007 13

Page 17: Captivate Literature Review (Id 3760)

Research in regional Western Australia indicates that on the whole, communities are generally satisfied with sport and recreation facilities, the majority of which belong to local government. For example, 83 per cent of people were in strong or general agreement that sports facilities in their area were good, with rates highest in the Great Southern and lowest in the Kimberley, Gascoyne and Goldfields-Esperance. Satisfaction rates for recreation facilities were slightly lower (Patterson Market Research, 1999).

As governments and community organisations continue to promote physical activity as a means to improved health, greater community awareness will provoke increased demand for facilities and related services. Specific campaigns and programs (eg Be Active) that have a community based focus, together with an aging population with available leisure time will also contribute to this trend. Today there are more than 140 local governments in Western Australia distributed across the metropolitan area and nine WA Development Commission Regions. In the near future this number will fall due to structural changes including a number of amalgamations. Climate and geographic size vary enormously across councils with the smallest at 1.5 square kilometres and the largest measuring 371,696 square kilometres. There is also huge diversity in rate base, population characteristics, industry type, etc. These and many other factors contribute to the range of structures, activities, policies, roles and capacity for involvement in community services including sport and recreation.

In Western Australia local government has been firmly entrenched in the State constitution since 1979 and although amenable to change at the whim of the state government of the day, has maintained and expanded its substantial role and presence within the community. Its activities are governed by the Local Government Act 1995. In the recent climate of reform, this Act has been assessed by leading analysts as having a major focus on the process of local government, rather than on the outcomes or results towards which good local governance is applied (Craven, McKenzie and McCullagh, 2006). They further note that as a consequence, there is little precision or agreement regarding the appropriate role of a local government (p24). However, it is generally accepted that the roles of local government are described by each State’s legislative framework and that there are few limitations on what services local government can provide. In the last few decades the role of local government has expanded significantly, following the devolution of functions to local government from other levels of government. Broadly, local government has roles in governance, advocacy, service delivery, planning and community development, and regulation. In Australia, local government’s key functions tend to be narrower than in other advanced countries eg they are not directly responsible for health, police, education; but rather, their core services tend to focus on physical infrastructure (eg roads, waste management); regulatory functions (eg food, building, animals, noise); environment management/planning; information brokerage; local service coordination; and provision of community and recreation facilities and services. More recently the traditional core service roles have evolved and expanded to include a greater emphasis and involvement in human services. The vast range of activities and functional roles currently undertaken in Western Australia have recently been described in the Systemic Sustainability Study (Craven et al. 2006).

R&A Lockwood Consultants Feb 2007 14

Page 18: Captivate Literature Review (Id 3760)

Overall, local government occupies a unique position as one of the most responsive and accountable spheres of democracy in Australia. It has the potential to engage the community and respond to its needs like no other sphere of Government can. It

Provides a voice to local aspirations. Places fundamental value on local differences and system diversity. Encourages activities and policy aimed at improving local choice and local

voice. Can and will make choices that will differ from those made by others. Places a premium upon traditional democratic values that fully embrace

access, accountability, representativeness, and responsiveness (Dollery, Crase and Byrnes, 2006).

The position of local government thus affords many opportunities to positively impact on community life. These opportunities derive partly from its unique ability to

Understand the nature of the local community and its people. Influence the local physical, social and economic environment - eg sporting

and recreation facilities and water areas, parks, gardens, reserves, walkways, and other areas.

Provide targeted and flexible services and programs. Involve the community in local decision-making. Encourage and support community networks. Advocate for the local community (Australian Local Government Association,


A recent example of local government’s ability and potential to improve community life is illustrated through its role in designing the built environment to encourage physical activity for health benefits in an aging population. Creating environments that facilitate physical activity and social interaction for this target group offers a significant impetus and opportunity to also ensure accessible spaces and facilities for people with disabilities. A recent resource produced for local government by the Australian Local Government Association reflects many of the principles and practices that apply to inclusive sport/recreation/leisure/environments. It states “Local government is uniquely positioned to support age-friendly built environments by coordinating decision making within their local community, by promoting awareness of age-friendly built environments and by developing and implementing community design plans, strategies and policies that support age-friendly built environments” (Australian Local Government Association, 2006, p.8).

This document also clearly outlined the substantial benefits for those local governments who choose to improve efficiencies in the built environment eg. local government can benefit individuals through improved health and overall wellbeing, increase independence and greater social interaction, and therefore benefit the entire community. ALGA further notes that to achieve these outcomes, informed action is required by a range of key stakeholders within local government such as town planning, engineering, parks and gardens, sport and recreation and also aged and disability services; and that local government will need to continue to build partnerships with other spheres of government, the private sector and community organisations (Department of Health and Aging, 2004).

The unique strengths and opportunities for local government are currently matched by significant external and internal challenges. A major external challenge is the requirement to participate in a period of unprecedented change whereby most Australian councils are now joining in the global trends in structural and process reforms in local government. This has occurred to the extent to which it is considered that local government in Australia is now an international leader in adopting a more progressive managerial style. Leading analysts note that in recent years the reforms

R&A Lockwood Consultants Feb 2007 15

Page 19: Captivate Literature Review (Id 3760)

have precipitated major changes whereby “councils have restructured their organisational frameworks to cater for the outsourcing of services, developed commercial capabilities to compete in the business arena, adopted an orientation to outcomes as opposed to inputs, and introduced a range of corporate strategic practices” (Dollery et al. 2003, p232).

One of the most controversial key reform strategies has been the pursuit of efficiency through amalgamations. Some claim that it results in successful economies of scale, improved planning, greater access to professional expertise and a stronger customer focus but others note that this is tempered by disadvantages including loss of experienced staff through retrenchments, job insecurity, fewer outside staff (Dollery et al. 2003), and lack of acknowledgement of local government’s key role as a valued advocate for communities and neighbourhoods (Craven et al. 2006). To date, the use of amalgamations as a reform strategy has not happened in the same manner or to the same extent in Western Australia as in most other States. However, in Western Australia some smaller councils will amalgamate, and others are under considerable pressure to develop alternative strategies that will ensure that their future in the community is sustainable.

In addition to the pressures of ongoing structural reform, the Australian local government industry is shaped by intense fiscal pressure. Most councils currently face difficulties in raising sufficient funds to discharge their duties especially regarding infrastructure provision and maintenance. Despite the unprecedented growth in the Western Australian economy some 83 Western Australian local governments were identified in August 2006 as financially unsustainable. Reports noted a 4.5 per cent deficit in their operating surplus ratio, and a $1.7B infrastructure backlog. Those whose long-term finances were assessed as unsustainable included in particular, regional councils without large towns (73 per cent of those assessed as unsustainable), and those with declining (64 per cent) or above-average growth (16 per cent). It was further estimated that between 2006 and 2021, 35 local governments will experience reduction in population. Some of the associated challenges/options suggested for these councils were, to

engage the community to establish priorities within the resources available adjust/reduce services available and/or frequency to match local demand improve revenue outcomes from other levels of government (Craven et al.


In declining rural populations there are additional challenges related to the disproportionate loss of younger people. For growing communities there are other challenges including those related to the need to manage the coordination of infrastructure so that land is developed and released in a planned and timely manner in conjunction with appropriate economic and social infrastructure.

Most councils face potentially significant demands on revenue. These vary between areas but can include an emerging fiscal deficit at the local government level under current policy settings, a growth rate in GDP likely to outstrip growth in rate revenue, and slower growth in sources such as financial assistance grants. Additional pressures are likely to emerge from the increasing proportion of pensioner households. Future areas of significant budgetary demand have also been identified and include health and aged care, home support services, subsidy of medical services, community transport and a range of cultural and recreation services (Australian Productivity Commission, 2005). These trends clearly indicate growth in human service roles from the current position where almost half of local government expenditure is already in this area. Other pressures on revenue have been identified as; increased community expectations, the reluctance by the public to pay ‘realistic’ fees and charges, maintenance and modification of aging infrastructure that was constructed without consideration of people with any form of impairment, cost shifting, and the growing compliance roles (and administrative burden) associated

R&A Lockwood Consultants Feb 2007 16

Page 20: Captivate Literature Review (Id 3760)

with over 400 pieces of state legislation. With the jurisdictional roles funded by revenue from combined Commonwealth, State, and local governments, there are also ongoing funding and role tensions between the three levels of government.

The burden of cost-shifting from Commonwealth and State governments to local government has steadily increased in recent years to an extent where its impact on individual councils has been estimated at up to $1m per year. Specific cost shifting examples detailed by ALGA include:

a) Service gaps created by reduced or withdrawn state government services eg Home and Community Care, childcare and aged care services, valuations, safety and crime prevention, housing

b) Transfer of state or federal assets to regions eg, state roads, federal airportsc) Concessions and rebates created without compensation for councils eg

pensioner rebates, non-rateable federal/state landd) Increased regulatory and compliance requirements, and failure to provide

indexation of fees and charges eg various inspections, licensing, statutory planning and environmental protection fees (ALGA, 2007).

To help ease the burden carried by Australia's 700 councils, an intergovernmental agreement on cost shifting was signed in April 2006. It provides a framework to improve the way the three spheres of government - federal, state and local - relate to each other to achieve the best possible outcomes for communities. While its full impact is yet to be realised, the intended outcomes are to

a) Improve relationships between the three spheres of government by facilitating an open exchange of information and by encouraging greater co-operation.

b) Promote more effective and efficient government.c) Provide greater transparency in the financial arrangements between the three

spheres of government in relation to local government services and functions.d) Ensure effective consultation with local government, through local government

peak representative bodies where appropriate, on the delivery of services and functions. (ALGA, 2007).

Against the backdrop of revenue pressures, communities continue to place high expectations on their councils to ensure representation of local interests and high quality services including those extending beyond the traditional focus of local government. In WA this is reported to be particularly true in regional and rural areas (Craven et al. 2006). The overall trend in services demand is away from ‘services to the property’ toward ‘services to the person’ and in particular toward recreation and culture (Commonwealth Grants Commission, 2001). Consumer expectations are today largely prompted by their experience of services offered by the competitive and well-resourced private sector. The management of public expectations now requires new forms of cooperation between the public (eg by education about council operations and challenges, and involvement in decision making), local government (identify community needs and priorities), the private sector, other levels of government – as well as increased resourcing. Both the reform process and consumer demand have given rise to the need for an increasing level of professionalism in staff and elected members. New staff

R&A Lockwood Consultants Feb 2007 17

Page 21: Captivate Literature Review (Id 3760)

expertise is required to enable adjustment to operating environments that are based on competition and interaction between policy networks. Managers are now required to act more autonomously and also be much more accountable Similarly, elected members are faced with a growing complexity and technical side to decision-making, and thus councils are required to provide improved induction and continuing training for them. It has also been noted that many councils also need to develop new accountability measures as part of a corruption prevention approach (Dollery et al.2003).

Currently, the recruitment and retention of staff is increasingly challenging, especially in the context of a very strong WA economy. Population mobility is particularly high in the regions. A fifth of the regional population will move from their current region within five years; with the proportion that will at least ‘probably’ move highest in the Pilbara 66 per cent, Goldfields-Esperance 54 per cent, Kimberley 44 per cent and Gascoyne 43 per cent (Patterson Market Research, 1999, p34). Competition for staff is endemic amongst councils and there is widespread staff ‘predation’. While the tight labour market for professional staff will make shared service delivery an operational necessity, this level of competition and ‘predation’ has in many cases effectively reduced interest in resource sharing between councils. However, it is reported that some current partnerships have enabled the best use of existing staffing expertise (Craven, et al. 2006).

In general, the common solution to various fiscal pressures has been to attempt to achieve more for less. Most councils have been successful in this way and reforms have to some extent enabled this approach. However, it is not a sustainable solution in the face of ongoing threats to revenue and increased community expectations. While the initial focus has been on financial sustainability, other key local processes have been identified as important to ‘overall’ local government sustainability eg democratic ‘access’, ‘accountability’, ‘representativeness’ and ‘responsiveness’. Other factors supporting sustainability have been identified to include the capacity of local government in terms of its ability to formulate and implement agreed policy eg through well functioning elected leadership; sufficient administrative and technical expertise; and the right to make autonomous decisions. These aspects of local government activity will also require systematic approaches for sustainable change (Dollery et al. 2006). In the Western Australian context the recent Systemic Sustainability Report recommended that in order to effectively achieve its evolving role in the context of the current challenges and opportunities it should adopt “a joined up approach to five key points: Leadership in the process of change, better revenue outcomes, improved financial planning practice, new models for efficient service delivery, and securing talent and investing in expertise to ensure Councillors, Management and Staff are well equipped”. They further recommended development of an industry action plan capable of being implemented: by individual councils, between councils and WALGA; and between WALGA and other governments and stakeholders (Craven et al. 2006, p. 74).

Legislation and policyLocal government support of inclusive sport and recreation practice is partly guided by several pieces of legislation which provide relevant guidelines and incentives. This section briefly describes this legislation and mentions some relevant policy developments.

R&A Lockwood Consultants Feb 2007 18

Page 22: Captivate Literature Review (Id 3760)

The Acts relating to disability and equal opportunity together profess the right of all people to access and fully participate in community life, and also outline responsibilities for making the adjustments that enable inclusion, eg. in Western Australia by ensuring access to public buildings and facilities. The legislation is accompanied by Government policy statements and advisory statements that are readily available (eg from the Human Rights and Equal Opportunity Commission) to assist service providers and facility developers to meet their responsibilities and understand their rights.

For local government authorities the key legislation impacting on their provision of inclusive community sport and recreation is:

a) Disability Discrimination Act (Commonwealth 1993)b) Equal Opportunity Act (Western Australian 1984, amended 1988);c) Disability Services Act (WA 1993, 2002),d) Carers Recognition Act (WA 2004),e) Local Government Act (WA, 1995)

Details and requirements for each of these are available from the relevant authorities. Comprehensive guidance is further available from organisations such as Access Audits Australia which have produced many publications for use by government and non-government organisations on understanding access requirements/obligations and how to improve access to a variety of leisure, recreation facilities (eg Access Audits Australia, 2006).

Disability Discrimination Act (Commonwealth 1993): In the last decade or so the Commonwealth Disability Discrimination Act has encouraged vast improvements in access to public places and services. This has been achieved partly through Disability Action and Inclusion Plans (DAIPs) developed by many Local Government Authorities and sport and recreation providers. Lodgement of the DAIPS with the Human Rights and Equal Opportunity Commission further demonstrates the intention to be more inclusive, and constitutes a part-defence in the event of a claim being made against them. The Human Rights and Equal Opportunities Commission (HREOC) overseas the Disability Discrimination Act by monitoring DAIPS submitted by public authorities.

HEREOC has supported inclusive practice across the community by activities including

production of advisory notes or guidelines in a number of areas covered by the DDA: access to premises, insurance, public transport, and world wide web access

development of Disability Standards on public transport, employment, education and access to premises, and

conducting public inquiries resulting in outcomes such as a national captioned cinema program, significantly improved TV captioning and a range of electronic banking industry standards.

In a local government context HEREOC provides information and guidance at a local and national level, and assists with Action Plans and access to the built environment. For example, working with HEREOC in 1995, the Australian Local Government Association developed several guides and best practice manuals to assist local government to prepare Action Plans under the Disability Discrimination Act. Since that time many councils have used the DAIP process to assist them in identifying service barriers and in developing strategies to overcome them. Others have used the Disability Discrimination Act framework and authority to create new agendas within their organisations and to systematically address the goal of building an inclusive community.

R&A Lockwood Consultants Feb 2007 19

Page 23: Captivate Literature Review (Id 3760)

HEREOC noted in 2003 that Local government DAIPS tend to reflect both community consultation and a range of roles undertaken to create accessible and inclusive communities eg by

ensuring accessibility of their own services and facilities; playing a local leadership role in increasing awareness and acceptance of the

needs of residents and visitors with disabilities; regulating building and development; and providing/facilitating services

targeted to people with disabilities to enhance social participation.

It also commented that actions taken toward achieving the objectives of the Disability Discrimination

Act have undergone a shift in focus from education and awareness to practical involvement in identifying solutions to participation barriers

if people with disabilities cannot access their communities then, attitudinal change toward a more welcoming and inclusive community is unlikely

equal weight must be given to attitudinal change and practical changes that ensure people with disabilities can actually participate in all aspects of our community. (Ozdowski, 2003).

Disability Services Act (WA 1993, 2002): In WA the state Disability Services Act also requires that public authorities, their officers, employees, agents or contractors implement a Disability Access and Inclusion Plan (DAIP) that relates to their dealings with the general public and that ensures that their activities further the principles and objectives of that Act. Comprehensive documents (available from the DSC website) have been developed to assist local government to meet their obligations in relation to their DAIP eg.

Disability Access and Inclusion Plans - Resource Manual for Local Government You Can Make a Difference to Customer Relations for People with Disabilities in

Local Governments and State Government Agencies (2000) - a national resource endorsed by the Western Australian Local Government Association.

Advice on related matters is available from the Disability Services Commission.

Carers Recognition Act (WA 2004): This Act is aimed at changing the culture of service providers so that the impact on family carers is considered when services are planned, delivered and reviewed. It applies to the Department of Health, public hospitals, the Disability Services Commission and agencies they fund to provide services.

The Act requires that relevant agencies take all practicable measures to comply with the Carers Charter which states;

Carers must be treated with respect and dignity. The role of carers must be recognised by including carers in the assessment,

planning, delivery and review of services that impact on them and the role of carers.

The views and needs of carers must be taken into account along with the views, needs and best interests of people receiving care when decisions are made that impact on carers and the role of carers.

Complaints made by carers in relation to services that impact on them and the role of carers must be given due attention and consideration

It recognises carers as key partners in the delivery of care; that carers have their own significant needs apart from the needs of the care recipient; and provides a mechanism for the involvement of carers in the assessment, planning and delivery of services that impact on them and their caring role. Although not applying directly to all sport and recreation service providers, its principles and intent, together with the Carers Charter provide valuable guidance for consideration during the development of inclusive practice and services.

R&A Lockwood Consultants Feb 2007 20

Page 24: Captivate Literature Review (Id 3760)

Local Government Act: The Local Government Act 1995 controls the way in which Local government acts across a broad range of operational areas in which Australian local government is involved as a regulator and a facilities provider. In 2004 the Local Government Act of 1995 was amended to reflect the Western Australian Government’s Sustainability Strategy (2003) and now requires councils to work toward meeting the needs of current and future generations through integration of environmental protection, social advancement, and economic prosperity. The legislation is supported by various standards and codes that relate to the appropriate development of buildings and facilities. For example, technical requirements are outlined in the Building Code of Australia (with reference to various Australian Standards and Codes) with the aim of ensuring minimum requirements for health, safety and amenity in relation to buildings.

Policy In addition to legislation, Government support for inclusive sport and recreation is reflected in many current policy directions eg those relating to equal opportunity, substantive equality, sustainability, citizenship, physical activity, inclusive schooling, active ageing, whole-of-government partnerships, and non-government human services reform. Of particular relevance are statements of strategic intent and position made by the WA Departments of Sport and Recreation and the Disability Commission that reflect the value of community sport and recreation for all i.e. their respective roles in enhancing quality of life through participation and achievement in sport and recreation; and advancing the opportunities, community participation and quality of life of people with disabilities. The WA Department of Sport and Recreation’s recent SD4 framework further notes inclusivity as one of its key principles and states the need to maximise the social benefits that come from being involved in sport and recreation, and that inclusivity is of vital social benefits.

Practical developments supporting those statements include Department of Sport and Recreation’s Sport Sustainability Program, Community Grants Scheme, and delivery of programs including the Disability Education Program, Project CONNECT, Active After School Program, and the Active Schools Project; and DSC’s Review of Recreation Services, Policy Framework for Recreation for People with Disabilities, review of the Local Area Coordination scheme, research into Physical Activity of Clients in Supported Accommodation, development of the Disability Industry Plan of WA, and joint Strategic Framework for Inclusive Sport and Recreation. Additional support has been indicated through various grant schemes.

A key non-government agency that has developed policy is The National Information Communication and Network (NICAN). It is an independent national information service funded by the Commonwealth Department of Health and Aging. Following its inception as an Australian Bicentennial project in 1988, NICAN provides an on-line information service in sport, recreation and tourism for people with disabilities. As part of its mandate in 1994 NICAN sponsored the development of a National Recreation Network, made up of representatives from each State and Territory. This group developed a National Policy on Recreation for People with a Disability that was used as part of a national campaign to raise awareness about people with disabilities accessing community recreation. The policy was updated in 1999 (NICAN, 1999). Throughout Australia there are many examples of local government policy and commitment to improve community life through inclusive services and facilities. Some of these are available on individual websites for councils throughout Australia.

R&A Lockwood Consultants Feb 2007 21

Page 25: Captivate Literature Review (Id 3760)

Disability and participation in sport and recreation

As the major provider of community sport and recreation experiences, local government can make effective use of statistics and trends associated with disability, care giving, and participation in sport and recreation by people with disabilities. For example, this information can

Offer insight into the current magnitude and demographics of disability in the community.

broadly indicate the need for various types and levels of support required for community activities.

Inform service and facility planning and management, resource allocation, budgeting, and policy, including the development of DAIPs.

Indicate future community needs/demands for sport and recreation facilities and grounds, and for various services and programs.

Be used to describe people with disabilities and their families and carers as an important customer base.

Selected disability trends and statistics are listed below to indicate some of the major issues that can be explored with statistical support during the policy and service planning process. Further detail and assistance is readily available from sources including Australian Bureau of Statistics, Australian Institute of Health and Welfare, and the Disability Services Commission WA.

Rates of disability are rising in most countries. Although it is difficult to estimate the effect of factors such as greater awareness, better surveillance, and reduction of stigma in reporting, it is generally accepted that underlying disability rates have risen. Contributing influences have been identified as:

An aging population. Poverty (both a consequence and cause). Medical advances that have promoted survival across a wide spectrum of

diseases, traumas, and low birth-weight infants. New conditions that have emerged eg multiple chemical sensitivity, chronic

fatigue syndrome. Conditions that are apparently becoming more prevalent eg asthma, autism,

mental illness, and learning disorders (Fujiura, 2001).

In addition to these trends the impact of the rapidly rising prevalence of obesity on disability rates is yet to be realised. For example, one estimate for people aged 50–69 years in the USA, suggests that if current trends in obesity continue, disability rates will increase by 1 percent per year more than if there were no further weight gain (Sturm, Ringel and Andreyeva, 2004).

In general these trends extend to Western Australia where people with disabilities and their carers form a significant and growing proportion of the population. For example,

Ninety five percent of people with disabilities now live in the community, either alone (18%) or with family and carers (Australian Bureau of Statistics, 2004a), and almost 40% do not require assistance in activities of everyday life

One in five (405,500) people has a disability and an estimated 246,800 are carers for people with disabilities (Disability Services Commission, n.d.)

Disability in indigenous people is estimated at 2-2.5 times that for the non-indigenous population (Australian Institute of Health and Welfare, 2003)

It has been estimated that from 2006-2026 there will be an annual increase of 1.1% in the disability rate in the general population – including an annual

R&A Lockwood Consultants Feb 2007 22

Page 26: Captivate Literature Review (Id 3760)

increase of 3.9% for those aged 65 years and older (Disability Services Commission, n.d.)

Almost three quarters of people with disabilities have a physical disability – and physical disability rates increase with age ie 61% for 15-24 years to 79% for those aged 55-64 years (Australian Bureau of Statistics, 2004a)

70% of all assistance required by people with disabilities is provided by the informal network of family and friends (Australian Bureau of Statistics, 2004a)

In WA 246,800 carers provide day-to-day support for family or friends with disabilities (Australian Bureau of Statistics, 2004a)

Almost 45% of primary carers themselves have disabilities. In WA 63% of carers experienced a medium to large impact on their physical health (mainly orthopaedic or spinal injuries, cardiovascular conditions and mental health), 43% have been physically injured through care giving (Caring is a Health Hazard, 2006)

the supply of informal care, home-based care, and volunteers is decreasing due to trends including the aging population, later childbearing, smaller family sizes, increased family breakdown, and increased labour force participation by women (Australian Bureau of Statistics, 2004b)

Most primary carers are not employed, depend on pensions or benefits as their main source of income, and on average earn considerably less than non-carers (Australian Bureau of Statistics, 2004a)

It is also well established that people with a disability spend more time on leisure activities – partly because they are under represented in education and the workforce – particularly those with an intellectual disability

Understandings about participation in sport and recreation by people with disabilities have been largely based on extrapolation from behavioural models for the wider population and estimates and studies of participation rates. There has been no reported model linking participation and people with disabilities until a recent (but not fully validated) formulation that attempts to integrate models describing the nature of disability with those relating to physical activity in the ‘Physical Activity for people with a Disability’ model (PAD) (van der Ploeg et al. 2004). While there is increasing national and local information about participation rates and patterns for people with disabilities, there is often little distinction of whether the setting or programs involve local government.

Reports on ‘participation’ in sport and recreation may in some cases reflect inclusion, but statistical and research findings reporting participation rates mostly refer to indices of ‘attendance’ and ‘activity levels’ rather than other dimensions of engagement and involvement in an activity and context. This is well described in a study of participation goals, barriers, and supports/strategies people who have experienced a stroke, research indicated that participation is more than activity performance in context; instead, it relates to ‘being a part of’ the community and having access to participation opportunities and supports (Hammel, Jones, Gossett, and Morgan, 2006).

R&A Lockwood Consultants Feb 2007 23

Page 27: Captivate Literature Review (Id 3760)

Recent Australian statistics on participation in sport and recreation by people with disabilities and long-term health conditions do not refer specifically to local government services and facilities. However, as local government is by far the greatest provider of these opportunities, the following observations are likely to be relevant:

‘attendance at culture and leisure venues and participation in sport and recreation’, by people with disabilities is lower (55%) than for the wider community (70%) (Australian Bureau of Statistics, 2004c).

The highest rate of participation was in those aged 18 to 24 years (66.1%) and declined with increasing age to 41.1% for those aged 65 years and over ( Australian Bureau of Statistics, 2006 – applies also to following five statements).

Slightly more males (57.3%) participated in sports and physical recreation than did females (52%).

More than half of respondents report their involvement as a player, competitor, or the person who physically undertakes the activity.

Almost one-quarter of players participated in sport and physical recreation that was organised by a club, association or another organisation and over 42% of players participated in some non-organised sport.

The most popular sports and physical activities were walking for exercise (24.0%), swimming (8.8%), aerobics/fitness (7.4%), golf (6.1%), cycling (4.1%), fishing (4.0%) and tennis (3.9%). Activities with high male participation were golf, cycling and fishing. Females were more likely to participate in swimming, aerobics/fitness and tennis.

Participation levels increased as the degree of core activity limitation reduced. There were similar rates of participation amongst disability types classified as

'Sight, hearing, speech' (51.3%) and 'Physical conditions' (50.7%). A lower rate was reported for those with an Intellectual disability condition (40.0%). (Australian Bureau of Statistics, 2006) p9

Carers who in addition to reporting the many positive impacts of caring, also note lack of recreation time and social isolation (Australian Bureau of Statistics, 2005)

Many people with disabilities and their carers (eg Carers Association of Australia, 2000) wish to be more involved in sport and recreation. After ‘visiting relatives or friends’, it is reported as their main activity away from home (Australian Bureau of Statistics, 2004a)

13% of adults in WA do not participate in any physical activity and an additional 32% do not participate at a level sufficient to benefit their health (McCormack, Milligan, Giles-Corti, and Clarkson, 2003), and from the national figures presented above (ABS, 2004), it is likely that non-participation rates for people with disabilities are even higher.

The body of knowledge about participation in physical activity by people with disabilities is not large but continues to grow. A recent study of activity levels of children with disabilities in metropolitan Perth found that less than half of the children and adolescents with disabilities performed sufficient physical activity to meet the Australian guidelines (Packer et al. 2006). More importantly the group reported that as children grew older, they participated in less activity, with less than one quarter of the adult group reaching the activity levels of the national benchmarks.

An Australian study using interviews with parents of recently graduated school children with disabilities, revealed that very few accessed community leisure facilities or were involved in leisure activities outside their own home (Dempsey, 1991).

R&A Lockwood Consultants Feb 2007 24

Page 28: Captivate Literature Review (Id 3760)

Hanley (1996) also found that the most frequently engaged passive leisure activities of people with disabilities were, listening to music (35%), watching television (35%) and going to movies or drive in (26.8%), reading (16.9%), arts and crafts (14.2%), and playing computer games (12.6%). Other Australian research found that people with high support needs tended to engage in passive activities such as watching television, going to the movies and the theatre, and social activities with family and friends (Lockwood and Lockwood, 1991). A study of 194 people with disabilities in South Australia reported that the major involvement in sports, arts, or other recreation was ‘non-involvement’ (13%), followed by arts/crafts (10%), swimming/aquarobics/hydrotherapy (8%), tenpin bowling (6%) and special groups such as Scouts, Wheelchair sports (6%) (Edgecombe and Crilley, 2002). Several other studies have indicated that the majority of leisure activities engaged in by people with disabilities tend to be passive in nature and home based (eg Rosen and Burchard, 1990; Crapps et al., 1985).

However, researchers have also indicated significant participation by people with disabilities in away from home and physically orientated activities. For example, in an examination of the main types of away from home leisure activities of people with disabilities and the frequency of participation over the preceding year, visiting friends and relatives was found to be the most frequently engaged leisure activity of the preceding 12-month period (67.1%), followed by engagement in social and community activities (25%), and then engagement in sporting activities, which accounted for 16.7% of all responses (Dempsey and Simmons, 1995). Similarly, in New Zealand a study of the leisure participation and employment patterns and attitudes of people with a diverse range of disabilities indicated that, walking (53%), gardening (14%), cycling (13%), playing with the family (11%), gym and weight training (9%) and team sports (8%) were the most engaging activities (Hillary Commission and Workbridge, 1994). A similar study conducted by Hanley (1996) revealed that swimming (36.8%), wheelchair sports (28.7%), walking (25.7%) and tenpin bowling (25.7%) were frequent activities.

In a milestone study, Sport England (2002) examined physical activities of 6564 adults with disabilities in England. Including walking, 51% of adults with disabilities had participated in at least one activity in the four weeks prior to the survey, compared with 75% of the general population. Excluding walking, the participation rates were 38% for disabled adults compared to 59% for non-disabled adults. Including walking, people with an ambulation disability were least likely to have participated in at least one activity (23%). The most popular activities were walking, swimming, cue sports, cycling aerobics, keep fit or yoga, gym, gymnastics, darts, golf (putting or pitch and putt), football, and tenpin bowling or skittles. Including walking, across all disability types a very low percentage of respondents participated in more than 3 sports (1-4%). The number of different sports played decreased as the number of disabilities increased, and as age increased. Disabled professionals were more likely to have participated in at least one sport (61%) compared with 33% of disabled, unskilled manual workers and 34% of disabled, skilled manual workers. Participants from CALD backgrounds were less likely to have participated (22-30%). Very few people with disabilities (<1%) were members of a specialist sports club for people with a disability, whereas 16% had been a ‘member of any type of club’ so that they could participate in a sporting activity. Most (81%) recalled enjoying most or some sports or physical activities at school. Some (56%) felt that their health problem had limited their participation in sport or physical activity whilst at school; 19% were never or only sometimes given the opportunity to take part in sport during school lessons; 12% were encouraged to take part in certain sports because of their health; and 21% were discouraged from taking part in certain sports because of their health. Sixty-five per cent of disabled adults who participated in sport in the 12 months before interview would like to play more of their sport(s). Swimming was the sport that the highest number of disabled adults would like to take up as an additional sport (18%). This was followed by aerobics, keep fit or yoga (14%) and cycling (11%).

R&A Lockwood Consultants Feb 2007 25

Page 29: Captivate Literature Review (Id 3760)

Twenty per cent of those who had not participated in any sport in the 12 months before interview would like to do so.

This study, carried out by the Office of National Statistics, provided a useful benchmark for future interventions. The survey showed that participation rates for all of the disability types interviewed were significantly lower than for the non-disabled population, and concluded that there was much more to be done to achieve parity in participation. The evidence also suggested that people with a disability were more likely to be excluded from physical activity when their disability was combined with low income and wider social disadvantage.

Some of the conclusions were that there should be an emphasis on providing better information, competent support (whether that be trained volunteers, sport centre staff, or carers), to enable people with a disability to have the confidence to take part in sport or to try new sports. A similar study in Western Australia would provide invaluable baseline data and other information on which to develop and evaluate intervention strategies.

In an earlier study Sport England (2001) surveyed sporting opportunities available for young people with a disability and the results pointed strongly to the need to improve provision and support in both school and community settings in order to improve early experience of sport.

In the United States, activity levels of older adults were estimated using a cross-sectional approach. It reported that 28.8% of older adults with disabilities were active at a recommended level, 35.7% insufficiently active, and 35.5% inactive. Among persons with and without disabilities, groups with the highest odds of inactivity and insufficient activity were women, persons aged over 75 yrs, African-Americans, persons with lower education levels and low incomes, and those who were obese (Brown, Yore, Ham and Macera, 2005). This result was supported by the finding that in a large representative sample of 4038 adults in the United States only 25% met the recommended levels for moderate physical activity (Boslaugh and Andresen, 2006).

Available evidence thus suggests that although the sport/recreation/leisure participation patterns of many people with disabilities are generally reflective of those in the general population, participation rates in physical activity for this group are lower. The current evidence base for patterns of participation for people with disabilities in Western Australia is not strong and would greatly benefit from further research. Amongst other outcomes, improved knowledge would assist all sport and recreation providers in planning for inclusion. By improving understanding of specific ‘underactive’ groups it would also help development of strategies to maximise the benefits to be gained from current Federal and State strategies to encourage increased participation by specific sub-groups eg ‘Be Active’.

R&A Lockwood Consultants Feb 2007 26

Page 30: Captivate Literature Review (Id 3760)

Selected considerations Local governments have a both a role and the capacity and unique opportunity to ensure inclusive community sport and recreation.

To undertake this role it faces significant challenges from the current reform agenda, fiscal pressures, staffing issues, and increasing demands from the community.

In addition to internal efficiencies etc brought about through current reforms and policy development relating to its services, appropriate approaches are likely to include partnerships between councils (to pool or share service capability while retaining local political representation), and between with disability and sport and recreation service providers.

People with disabilities and their carers form a significant current and potential ‘customer base’ for local government sport and recreation services and facilities. Most people with disabilities live in the community.

Over 300,000 West Australians who need some assistance with activities such as self care, mobility, communication, transport etc may also require various forms of support to take part in community sport and recreation. Many will require minimal or no additional support to participate in community sport and recreation.

Those with multiple impairments and needing assistance in several key areas of daily life (severe and multiple disabilities) will require greater levels of support.

Carers are a significant group in terms of both service provision and service needs.

The caring role is associated with significant health risks some of which are known to be reduced by participation in physical activity.

R&A Lockwood Consultants Feb 2007 27

Page 31: Captivate Literature Review (Id 3760)

SECTION 4Benefits of physical activity for people with physical


This section briefly considers some of the benefits of physical activity for the general population, and then in relation to disability. The major focus is on the requested review of literature on the benefits of physical activity for people with a physical impairment/disability.

Physical activity – health benefits

Since WWII there has been a relative decrease in morbidity and mortality from communicable and infectious disease, but a rapid increase in diseases associated with modern living. These include smoking-related diseases, cardiovascular and endocrine disease arising from reduced physical activity, increased cancer and other related diseases arising from poor diet, exposure to cancer-producing agents, and sexually transmitted diseases.

Although people have long valued the positive benefits of regular exercise and physical activity, it was only in the second half of the twentieth century that scientific support for the many health benefits of physical activity became widely documented (Bauman, Owen and Rushworth, 1990). The development of National Physical Activity Guidelines for adults in Australia later recommended at least 30 minutes of moderate-intensity physical activity (including brisk walking) on most days of the week, with each session lasting at least 10 minutes. This is generally interpreted as 30 minutes on at least five days of the week, a total of at least 150 minutes of moderate activity per week; and the guidelines for children and adolescents recommend at least 60 minutes of moderate to vigorous physical activity every day.

In 2000 just over one half of Western Australians (58%) reported participating in sufficient physical activity to meet the guidelines, or undertaking 60 minutes of vigorous-intensity physical activity per week (Bull, et al 2000). A recent national survey (Australian Bureau of Statistics, 2006) indicated that in the last ten years the proportion of people reporting sedentary or low exercise levels has not changed significantly, based on age-adjusted estimates from the last three National Health Surveys (69% in 1995, 69% in 2001, and 70% in 2004-05).

Many health (as well as social and economic) benefits for both individuals and communities are reported to be associated with participation in recreation and physical activity. Suitable regular daily physical activity is a major factor in preventing chronic diseases and can provide a wide range of physical, social and mental health benefits (World Health Organisation, 2006a). Conversely, physical inactivity increases all causes of mortality, doubles the risk of cardiovascular disease, Type 2 diabetes, and obesity. It also increases the risks of colon and breast cancer, high blood pressure, lipid disorders, osteoporosis, depression and anxiety (World Health Organisation, 2006b). The 2003 Australian Burden of Disease Study indicates that physical inactivity was the fourth leading cause of burden of disease in Australia.

R&A Lockwood Consultants Feb 2007 28

Page 32: Captivate Literature Review (Id 3760)

It was estimated that physical inactivity was responsible for approximately 7% of the total burden of disease and injury for all Australians (6% of total for males and 7% of total for females) (Begg et al. cited in Australian Institute of Health and Welfare, 2006).

An increase in the level of physical activity and the associated improvements in the health of the community will also provide significant benefits to the economy by decreasing the burden on the health care system. A recent Australian study estimated the direct annual health care cost attributable to inactivity to be around $377 million per year (Stephensen, Bauman, Armstrong, Smith and Bellew, 2000). They also calculated that 122 deaths per year from coronary heart disease, non-insulin dependent diabetes and colon cancer could be avoided for every 1% increase in the proportion of Australians who achieved the recommended level of physical activity. It is now well established that disease prevention is only one aspect of health and that being physically active has a wide range of mental and social health benefits.

Co-ordinated health promotion campaigns are now commonplace in many developed countries, including the United States, Great Britain, Australia, Canada, and New Zealand. These Australian campaigns typically target low physical activity levels and poor dietary patterns. The current national physical activity initiative was backed by a series of preparatory papers (Egger, Donovan, Swinburn, Giles-Corti and Bull, 1999) that reviewed the research literature concerning health benefits of regular physical activity, examined health intervention strategies to increase activity in the population, and set activity benchmarks for the Australian population. These papers reviewed a wide range of studies of different occupational, gender and cultural groups and clearly demonstrated a decreased risk of premature mortality and morbidity with both increased occupational and leisure time physical activity From all of these reviews, it is now recognised that physical inactivity is an independent risk factor for a range of diseases, and that physical activity is important in the maintenance of optimal health. In WA, various campaigns have targeted Local Government as the critical agent for change at a community level.

Compared to other Australian States, West Australians are reasonably active (Bull et al. 2000), with 58% of the WA population reaching activity benchmarks. The current Premier’s Physical Activity Task Force physical activity promotion campaign has a target of increasing this level by five percent by 2011. As part of this strategy, campaign managers are beginning to examine particular groups who are believed to have lower participation rates than the wider community e.g. people with disabilities, aged, people from culturally and linguistically diverse backgrounds, and Aboriginal and Torres Strait Islander people.

Physical Activity – Disability

Robust Australian research on the health benefits of physical activity for people with disabilities in physical activity is very limited, and this review therefore draws heavily on overseas work, particularly from the United States, England, and Canada. Much of this is laboratory or therapy based rather than community based. Little is known about means of assessing fitness of people with disabilities, because there are few appropriate assessment tools to measure physical activity (Heath and Fentem, 1997) or norms against which to compare an individual result.

Progress has been made to develop such tools including that by Washburne et al. (2002) who developed and trialed the Physical Activity Scale for Individuals with

R&A Lockwood Consultants Feb 2007 29

Page 33: Captivate Literature Review (Id 3760)

Physical Disabilities. This scale requests the number of days a week and hours daily (categories) of participation in recreational, household, and occupational activities over the past seven days, and was shown to have reasonable internal consistency and utility. Another such scale has been developed by Rimmer, et al. (2004a). These scales may provide tools for further developments in physical activity research. Comparisons against able-bodied physical activity norms are unlikely to be valid for many reasons. For example, the impairment might reduce the capacity being measured (Rimmer, Braddock and Pitetti, 1996). This is particularly so with neuro-muscular and locomotor impairments. General population targets for activity are themselves broad generalisations that don’t take into account ceiling effects and are therefore inappropriate for many people with disabilities, who may be operating near their physical capacity if they have limited movement potential.

Research and interpretation of results from studies of people with disabilities is also challenged by the variability within most disability groups. For example obtaining a matched group of subjects with spinal cord injuries for a study on say, the benefits of a given exercise regime, is very difficult. Getting the same segmental level and severity (completeness) of spinal lesion, matching a sufficient number of subjects on key demographic as well as pre-disability variables (activity levels, fitness, motivation) presents a serious challenge to researchers adopting traditional experimental research and matched-cohort clinical trial methodologies. Often the effect size required (eg training effect) is not matched by a sufficiently large sample and thus experimental power (confidence) is low. However, as therapists are aware, small changes in function are in reality, often major milestones in treatment regimes, in progress toward independent living, and in improving quality of life.

Few reported studies of physical activity in people with disabilities have taken advantage of the strengths of qualitative, case-based research (McBurney, Taylor, Dodd, and Graham, 2003). In this approach, gains from a treatment are examined in detail across a number of cases, and conclusions can be drawn from the frequency of positive gains using non-parametric statistical techniques or emerging themes in exploratory work. This approach is receiving increased attention in broad areas of clinical research where large numbers of sub-types are difficult to find. Such fundamental research would contribute to the development of appropriate activity standards for people with disabilities. This problem is not unique to Australia. For example Rimmer et. al. (1996) also lamented the lack of purposive research in this area.

It is increasingly acknowledged that the multiple benefits of physical activity extend to people with disabilities. Reported physical benefits (eg Rimmer et al. 2004b) include improved cardio-vascular and respiratory function, as well as musculo-skeletal function (strength, flexibility balance and coordination); and psychological benefits include greater self-control, goal setting, cathartic expression of self etc, and the social strengths of friendships, social networks, and team membership arising from participation and from competition. The general medical benefits from regular activity also include the reduced risk from cardio-vascular disease and type II diabetes in later life, obesity, reduced muscle bulk and tone with subsequent muscle weakness, muscle spasm, bone loss (osteoporosis), reduced joint mobility, predisposition to falls, mental states arising from poor self-esteem and self-worth leading to depression and other psychiatric conditions. These benefits are reduced when physical impairments lead to lower levels of physical activity (Taylor, Baranowski, and Young, 1998).

R&A Lockwood Consultants Feb 2007 30

Page 34: Captivate Literature Review (Id 3760)

Significant social, emotional, and cognitive benefits are known to be experienced by all who participate in recreation, regardless of disability. Research on recreation participation by people with disabilities reports that it increases self-determination (Devine, et al. 1997), develops friendships (Schleien, et al. 1990) and provides an opportunity to practice learned skills (Modell et al. 1997) and to build life skills (Green and DeCoux, 1994). It is reported to also provide a forum to dispel myths and challenge stereotypes about the limitations of those with disabilities (Devine, 2004; Devine and Wilhite, 2000), to remove the fear that the recreation experience for non-disabled participants would be diminished (Obrusnikova et al. 2003;), and to improve communication, physical fitness and social skills for youth with and without disabilities (Schleien et al. 1994).

Physical activity and Physical Impairment/disability

This section addresses a specific request that the literature review investigate the benefits of exercise for people with physical disabilities. It aims to investigate available published research in order to contribute to the development of learning materials and training for sport/recreation/fitness professionals working in local government facilities, where customers may include people with physical disabilities. Various descriptions of physical disability are in use (eg The Physical Disability Council of Australia, 2007) but for the purpose of this review the National Community Services Data Committee (2006) discussion is seen to be appropriate:

Physical/diverse disability is associated with the presence of an impairment, which may have diverse effects within and among individuals, including effects on physical activities such as mobility. The range and extent of activity limitation and participation restrictions will vary with the extent of impairment and the environment. Environmental factors and support needs are related to areas of activity limitation and participation restrictions, and may be required for long periods. Level of supports may vary with both life changes and extent of impairment. Physical disability is used to describe conditions that are attributable to a physical cause or impact on the ability to perform physical activities, such as mobility. Physical disability includes paraplegia, quadriplegia, muscular dystrophy, motor neurone disease, neuromuscular disorders, cerebral palsy, absence or deformities of limbs, spina bifida, arthritis, back disorders, ataxia, bone formation or degeneration, scoliosis etc. Impairments may affect internal organs such as lung or liver (p69).

As a subset of physical impairments, musculo-skeletal impairments are included because of the high prevalence in the Australian community. Musculoskeletal conditions are defined as conditions of the bones, muscles and their attachments, and include joint problems such as arthritis. Although there are more than 100 musculoskeletal conditions the most common are osteoarthritis, rheumatoid arthritis, osteoporosis and back pain (Australian Institute of Health and Welfare, 2004). In 2001, 32% (6 million) of the Australian population reported having a disease of the musculoskeletal system and connective tissue as a long-term condition, where the condition lasted, or was expected to last, six months or more. Fourteen percent of the population reported having arthritis, 1.6% of the population reported having osteoporosis and 21% of the population reported having back pain as a long-term condition. This equates to just under one-third of the population.

A physical disability may be either congenital or acquired. It may require that people use assistive devices such as wheelchairs, walkers, frames and crutches, and artificial limbs to obtain mobility. Some people with high support needs will also require additional assistance in various settings and activities including those of interest to this review i.e. recreation centres, and fitness and aquatic facilities.

R&A Lockwood Consultants Feb 2007 31

Page 35: Captivate Literature Review (Id 3760)

Several specific disabilities are chosen for discussion to illustrate findings that may inform development of resources for sport and recreation staff in local government settings. These are: Spinal Cord Injury, Post Polio Syndrome, Cerebral Palsy, Duchenne Muscular Dystrophy and arthritis. Where possible, generic issues will be addressed, because most of the functional limitations arising from physical disabilities are those concerned with independence, mobility, transport and physical access.

Spinal cord injury (SCI)

Damage to the spinal cord, most commonly through motor vehicle or other accidents, can result in complete or partial paralysis of sensory, motor, and sympathetic functions below the level of the lesion. Damage to the cord at the neck (cervical) level results in quadriplegia (all four limbs affected) and below that level paraplegia (lower limbs affected). In WA, there are about 30 new cases reported each year (O’Connor, 2002) and these are mostly young males aged 15-24 years. Apart from paralysis of the limbs (sensory and motor functions), there are many other possible medical and social consequences reported (eg Hjeltnes and Jansen, 1990; Yekutiel et al. 1989), including:

Problems with breathing Loss of the ‘muscle pump’ assisting venous return, thus resulting in blood

pooling in lower limbs and therefore a decreased oxygen carrying capacity in the circulatory system

Muscle wasting and spasm in muscles of affected limbs Poor bladder control and incomplete evacuation leading to urinary tract

infections Pressure sores Reduced sweating response Bone demineralisation including lower limb osteoporosis and greater risk of

fractures from falls and minor injuries Reduced sexual function Changed blood lipid composition, and potentially obesity and diabetes Over-use injuries in shoulder girdle muscles and joints, especially rotator cuff

tendinitis, frank tears, general impingement syndrome, carpal tunnel syndrome, wrist tendonitis, and elbow pain

Muscle imbalances due to overly strong anterior chest and arm muscles overpowering weak posterior scapular and cervical stabilisers.

The higher the lesion, the greater the impact on body function. A low level of physical capacity may be associated with a decrease in activity (Janssen et al. 2002; Dallmeijer et al. 1999; Muraki et al. 2000), functional status (Dallmeijer and van der Woude, 2001; Noreau et al. 1993) and participation (Norea and Shephard, 1992). A vicious cycle of decreased capacity leading to decreased activity, which in turn leads to further decreases in physical capacity, may often be the result (Haisma et al. 2006).

Since Sir Ludwig Guttman set up the Stoke-Mandeville Centre in Britain during World War II, active rehabilitation involving physical activity and sport has been a core tool in therapy. From humble beginnings in 1948, competition between wheelchair sportspersons has grown into the spectacular high performance Paralympics, with many thousands of competitors. The basic premise of the underlying therapy has been that stronger bodies are more able to meet the demands of independent living. With better housing design, and home support services available, the vast majority of people with Spinal Cord Injury now live independently in the community.

R&A Lockwood Consultants Feb 2007 32

Page 36: Captivate Literature Review (Id 3760)

Since those achievements however, and with the increased evidence of benefits of physical activity, there has been heightened interest regarding the type and amount of exercise that will maximise positive outcomes for people with SCI. To date, one of the significant barriers to understanding the effects and limitations of exercise for people with SCI is the lack of appropriately specific measurement protocols for various fitness standards (Haisma et al. 2006). The lower maximum oxygen uptake values for paraplegia has been attributed to the differential effect of arm versus leg exercise resulting from the use of predominately smaller muscle mass being used (Bergh, Kanstrup, and Ekblom, 1976), as well as attributes of SCI such as reduced sympathetic control, and lower habitual activity of subjects (Cooper et al. 1992; Hooker et al. 1993; Knechtle et al. 2003; Mossberg et al. 1999). In the absence of such protocols, it seems appropriate to use test-retest benchmark measures for each individual to measure progress and set fitness goals. Individuals with paraplegia show upper body strength similar to an age and gender matched able-bodied population (Phillips et al. 2000), but in tetraplegia, expression of strength may be further reduced by completeness of the lesion, extent of neurological recovery and associated muscle spasm (May et al. 1997; Noreau and Vachon, 1998). Even the measurement of lung function may present different responses than those from the general population (Kelley et al. 2003).

In the last few years progress has also been made in developing exercise protocols (Stewart et al. 2000) to exercise paralysed limbs, either alone (Theisen et al. 2002; Jacobs et al. 2001; Theisen, et al. 1993) or in combination with volitional upper body exercise (Jacobs et al., 2001; Raymond, et al. 2002; Theisen et al. 2002). This is normally done using Functional Electrical Stimulation, with electrodes placed over the participating muscles and activated in patterns to mimic pedalling actions at cadences chosen by the individual. These exercise modalities are now in widespread use, particularly in North America and Europe.

Since it has been established that many people with SCI can benefit physically and medically from regular physical activity across a wide range of activities (eg strength training, circuits, swimming, aerobics, dance, handcycling), research has investigated barriers to participation. In a comprehensive study the experiences of 72 people with SCI were investigated in terms of barriers to activity (Scelza et al. 2005). The authors reported that while 74% expressed an interest in an exercise program, less than half (45.8%) were currently active in any kind of exercise program. Less than half (47.2%) reported that their physician had recommended an exercise program for them. The most frequently cited concerns about barriers to exercise fell into three areas:

1) lack of motivation, lack of energy, lack of interest2) resources (eg cost of an exercise program, not knowing where to

exercise), and3) structural or architectural (eg accessibility of facilities and

knowledgeable instructors). More individuals with tetraplegia reported concerns over exercise being too difficult and that health concerns kept them from exercising. Note: the author, (Scelza) also has first-hand insight into the issue - he sustained a spinal cord injury at age 17 years of age, uses a wheelchair, and is an active wheelchair basketball player.

In another study of 2726 people with SCI, environmental barriers were found to affect quality of life much more than did impairment; and the top five environmental barriers reported were the natural environment, transportation, need for help in the home, availability of health care, and governmental policies (Whiteneck et al. 2004). Post Polio Syndrome (PPS)

R&A Lockwood Consultants Feb 2007 33

Page 37: Captivate Literature Review (Id 3760)

The Spinal Cord Injury category also includes a large sub-group of people who have had poliomyelitis, mostly contracted in Western Australia during the 1950’s. Poliomyelitis is an acute viral disease that attacks the brain and the ventral horn of the spinal cord. Damage to the lower motor neurons usually results in atrophy and weakness of muscle groups, perhaps paralysis and possibly deformity. A second type, bulbar poliomyelitis, infects the medulla oblongata and may result in dysfunction of the swallowing mechanism along with respiratory and circulatory distress.

Beginning in the early 1990’s, an increasing number of people who had previously been diagnosed with poliomyelitis reported an associated decline in health status, which was to become known as the post-polio syndrome (PPS). The main impact of PPS includes reduced energy, pain, reduced physical mobility, poor sleep, emotional reactions, and social isolation. Increased pain during exercise and increased fatigue has been widely reported (Nollet et al. 1999), while manually tested strength did not decrease - although this does decrease over time in this group (Klein et al. 2000). This has been explained in a subsequent study by Nollet et al. (2001) as reduced submaximal work capacity of post polio subjects in association with reduced muscle capacity and therefore elevated energy cost. Because of a reduced movement economy, energy cost was elevated, thus predisposing subjects to premature fatigue in sustained activity. This fatigue is both central and peripheral, and was more marked in those with PPS, indicating that defective central or reflex drive may contribute to their new weakness (Allen et al. 1994). A systematic review concluded that the rate of decline in muscle strength is slow, and prognostic factors have not yet been identified (Stolwijk-Swuste et al. 2005). These researchers recommended long-term follow-up studies with unselected study populations and age-matched controls, and with a specific focus on prognostic factors.

From an exercise perspective, various authors have recommended continued aerobic activity to offset PPS (eg Willen, Cider, and Sunnerhagen, 1999). Although reports on type of exercise are conflicting, these authors note that the key factor seems to be exercise intensity e.g. that strengthening exercises should be non-fatiguing. They further suggest to exercise every other day with the perceived rate of exertion should be less than ‘very hard’; loads should be held for only 4-5 seconds; and there should be a 10-second rest between bouts and a 5-minute rest between sets; and about 3 sets of 5-10 repetitions.

Other research indicates that in addition to specifying exercises for those body areas experiencing the deleterious effects of disuse, the exercise prescription also should consider how to protect both muscles and joints that are experiencing the adverse effects of overuse and body areas with very significant chronic weakness - generally, areas where the muscles have less than antigravity strength on manual muscle testing (Agre, 1995). More specifically, this author reported that appropriate strengthening programs, show a 60% increase on isokinetic strength, improved cardiorespiratory status, no decline in strength in 6-12 months, and 5% increase in isometric strength.

Cerebral Palsy Cerebral Palsy may be described as a set of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination, but that don’t worsen over time. Even though cerebral palsy affects muscle movement, it isn’t caused by problems in the muscles or nerves. It is caused by abnormalities of the motor control centres of the brain. The majority of children with cerebral palsy are born with it, and although the early signs of cerebral palsy usually appear before a child reaches 3 years of age, it may not be detected until years later. The most common signs are a lack of muscle coordination when performing voluntary movements (ataxia); stiff or tight muscles and exaggerated reflexes (spasticity); walking with one foot or leg dragging; walking on the toes, a

R&A Lockwood Consultants Feb 2007 34

Page 38: Captivate Literature Review (Id 3760)

crouched gait, or a ‘scissored’ gait; and muscle tone that is either too stiff or too floppy. Speech is also affected to some degree, and there may be some associated intellectual and behavioural dysfunction, but this is not universal.

For people with cerebral palsy, it has long been recognised that passive and active movement is essential to prevent muscle spasm, which could lead to bone deformity and reduced mobility in the growing years. The physical characteristics of cerebral palsy e.g. muscle weakness, spasticity, and in-coordination can result in impaired gait, insufficient strength to propel wheelchairs and utilise walking aids, and reduce activities of daily living. Improving functional capacity in these activities is one of the principal goals of therapy.

Recently, the use of strength training as an adjunct to therapy has been explored and several studies have clearly indicated positive outcomes. For example, in a typical study of a 10-week resistance training program, significant strength gains without increases in muscle spasm have been demonstrated (Andersson et al. 2003). Many other studies have reached the same conclusion (eg Unger, Faure, and Frieg, 2006; Morton, Brownlee, and McFadyen, 2005; Blundell et al. 2003; Dodd, Taylor, and Graham, 2003; Damiano and Abel, 1998; Damiano, Vaughan, and Abel, 1995). A systemic review of the literature compared ten studies that included a strength training intervention and which met rigorous research criteria (Dodd, Taylor, and Damiano, 2002). It reported that eight of the 10 studies concluded that strength training increased the muscle strength of people with CP. Significantly, they also concluded that there was no evidence of increased spasticity or reduced range of motion following strength training. On the contrary, there was limited evidence that spasticity might even be reduced and range of motion increased with training. Importantly, one of the included studies (Darrah, Wessel, Nearingburg, and O’Connor, 1999) indicated that involvement in a community training program improved subject’s feelings about their appearance. The increase in self esteem and self-efficacy associated with fitness programs has not been well documented, although Shields et al. (2006) concluded that adolescent females with CP have a lower self-concept than females without disability in the domains of physical appearance, social acceptance, athletic and scholastic competence and therefore may be an at-risk group owing to their vulnerable self-concept. As Dodd, Taylor, and Graham (2004) have suggested, there may be some deleterious effects of a strength program on self-concept.

While recent research findings may be very interesting and informative, care in interpretation is warranted. For example, approaches that compare different studies encounter difficulties with variations across the research in key areas such as subject selection (eg sample size, age, impairment type, gender), the treatment (frequency, duration, load), and the measurement criteria (strength gains, range of motion, functional tasks). Other reported studies encounter many sources of variance that may reduce the validity and/or reliability of their findings. Some do not include any control group, nor report reliability of variables measured. For example, van der Linden et al, (2004) found that test-retest correlations for gluteus maximus strength in children with CP was .75-.83. While this is acceptable, it still only accounts for 50-60% of the variance on this measure. There is a possibility that in some studies the true treatment effect may be masked by such variability. Research reporting on reliability includes a study of the six-minute walk test for people with CP, which concluded that the first test result should be discarded to significantly improve reliability (Andersson et al. 2003). Other studies have shown children with CP display greater variability in test performance than their able-bodied peers (Brehm, Becher, and Harlaar, 2007); and that people with CP have different patterns of muscle activation compared to controls (Rose and McGill, 2005; Tedroff, Knutson, and Soderberg, 2006) and are unable to recruit higher threshold motor units or to drive lower threshold motor units to higher firing rates.

R&A Lockwood Consultants Feb 2007 35

Page 39: Captivate Literature Review (Id 3760)

Using a case-study approach, Kariyawasam, Phillips, and Blackmore (2006) studied the effects of a twice-weekly 8-week circuit training program on 11 subjects (8-15 years) with spastic type CP. The dependent variables included muscle strength, walking ability, stair-climbing and other functional skills, as well as a range of other factors such as activity preferences and participation in recreation. Significant improvements occurred in muscle strength, walking ability, balance and in other outcomes such as desire to continue the program. In another study Chad et al. (1999) found that strength training increased the bone mineral density in a group of primary-aged CP children.

There is increasing evidence that regular strength and conditioning exercises is beneficial for people with Cerebral Palsy. Importantly the link between therapy and community is being bridged by projects such as ‘Captivate’. An example of developments in this regard is the DVD and training booklet produced by La Trobe University for use by fitness instructors (Dodd and Taylor, 2005).

Duchenne muscular dystrophy (DMD) DMD is an X-linked recessive disease that affects approximately one in 3500 male births. Boys with DMD have a progressive and predictable muscle deterioration. Their muscles lack dystrophin, a protein essential for membrane stability, whose absence induces contraction-related membrane damage and activation of the inflammatory cascade leading to muscle failure, necrosis, and fibrosis. Although DMD is present at birth, clinical symptoms are not evident until 2-6 years of age. Initial symptoms include leg weakness, increasing spine kyphosis, and a waddle-like gait. Continuous muscle wasting leads to progressively weaker muscles, usually leading DMD patients to require a wheelchair by the age of 8-12 years. Muscle weakness increases at a slow pace, and contractures of the hips and ankles develop before the age of 10 years. Usually between the ages of 8 and 12 years severe contractures and muscle weakness are apparent, and most children are unable to ambulate. Scoliosis develops in 90% of boys who use a wheelchair full-time. Loss of ambulation may lead to secondary conditions such as pressure sores and obesity. Additionally, the respiratory muscles are also affected which leads to frequent respiratory infections and eventual death due to respiratory failure between the ages of 15 and 25 years.

There has been a long-ranging debate about the effects of exercise on DMD, as animal models seem to indicate a different response to humans. Moderate exercise may ameliorate the muscle wasting which is part of the normal development of the disease and many medical experts advocate for an active but not strenuous life-style. (Grange and Call, 2007; Ansved, 2003; American Academy of Pediatrics, 2005). Strength studies have shown an increase in strength of experimental groups compared to controls, whose strength showed a steady decline. The results of the above human studies suggest that persons with DMD who exercise can improve their muscular strength through resistance exercise. However, the mode, intensity, duration, and frequency have not been fully elucidated. The evidence suggests that eccentric exercises should be avoided as they may lead to muscle damage.

R&A Lockwood Consultants Feb 2007 36

Page 40: Captivate Literature Review (Id 3760)

Multiple Sclerosis (MS) MS (also known as disseminated sclerosis or encephalomyelitis disseminata) is a chronic, inflammatory disease that affects the central nervous system. MS can cause a variety of symptoms, including changes in sensation, visual problems, muscle weakness, depression, difficulties with coordination and speech, severe fatigue, short term memory loss, problems with balance, over heating and pain. It will cause impaired mobility and disability in more severe cases. MS symptoms may lead to physical inactivity associated with the development of secondary diseases. However, a growing number of studies indicate that exercise in patients with mild-to-moderate MS provides similar fitness and psychological benefits as it does in healthy controls. White and Dressendorfer (2004) reviewed numerous studies describing the responses of selected MS patients to acute and chronic exercise compared with healthy controls, and reported that most training studies reported positive outcomes that outweighed potential adverse effects of the exercise intervention. These authors also advocate careful programming of exercise routines, citing the unpredictable clinical course of the disease.

A range of specific positive benefits of physical activity have been reported for people with MS (Brown and Kraft, 2005). For example positive qualitative outcomes were observed in a study group of people with MS who undertook a 10-week program of progressive strength training. It was further reported that with positive and knowledgeable leadership, the group’s key intrinsic factors were enjoyment, determination, seeing the signs of progress, and a previously held positive attitude about the benefits of exercise (Dodd et al. 2006). Others confirmed the benefits of a short-term aerobic training program, with improvements in aerobic threshold (AT) (VO2+13%; work rate [WR])+11%), an improvement of health perception (vitality+46%; social interaction+36%), an increase of activity level (+17%) and a tendency to less fatigue - all this in four weeks and no symptom exacerbation! (Mostert and Kesselring, 2002). Similar findings include improvements in fitness, mood states and fatigue levels after a 10-week, three session per week of arm and leg ergometry (Petajan et al. 1996); and a six-month exercise trial was found to be beneficial for patients with mild to moderate levels of in MS (Romberg et al. 2004).


People with osteoarthritis have also been shown to safely participate in exercise programs and many have relief of pain and disability (Clyman, 2001), but with the warning that the effects of longer term participation i.e. beyond six months have not been well documented (Ettinger, 1998; Focht, 2006). Hurley, Mitchell and Walsh (2003) advocate continued exercise as a means of facilitating appropriate health beliefs, behaviours, pain coping, and self-management strategies in people with arthritis.

For aging people, maintaining activity is a factor in reducing disability onset, but little is known about ‘dose’ effects (Spirduso and Cronin, 2001). For many people with physical disabilities, fatigue and pain may be constant companions and impact significantly on their ability to exercise. This is particularly so in many hereditary neuromuscular disabilities (Kilmer, 1998; Miller, 2006).

Other Physical Disabilities

There are many other physical impairment types that result in limitations to activities of daily living, employment capacity and health of individuals. Many of these are short-term, such as orthopaedic impairments (fractures, hip replacements etc).

R&A Lockwood Consultants Feb 2007 37

Page 41: Captivate Literature Review (Id 3760)

Some are medium term (such as chronic back pain), and some are progressive and/or episodic (such as multiple sclerosis, muscular dystrophy, motor-neurone disease, and a wide range of other neuromuscular disorders). Some are largely, but not exclusively, age-related (eg arthritis, osteoporosis and general physical decline). The general medical consensus is that physical activity in these impairment types is to be encouraged to retain muscle and bone strength, coordination and cardio-vascular health. Relevant evidence for this view is ably summarised by McDonald (2002).

Selected considerations People with physical disabilities can benefit from regular physical activity.

Before embarking on activity programs, individuals should consult with their medical practitioner for a medical clearance and advice on the type and intensity of exercise to be undertaken.

Fitness staff should be aware of any limitations to activity and make appropriate adjustments to activities.

Access will be a major consideration for many people with a physical disability and staff should ensure that the normal access requirements are met and that equipment is made accessible and useable for individual clients

If necessary, arrangements should be made for carers/support staff to assist.

R&A Lockwood Consultants Feb 2007 38

Page 42: Captivate Literature Review (Id 3760)

SECTION 5Barriers and enablers to participation/inclusion

An understanding of the enablers and barriers to participation may provide some explanation for physical activity levels and can assist in planning strategies for increasing involvement of people with disabilities (King, Law, King, Rosenbaum, Kertoy, & Young, 2003). This section firstly describes the notion of barriers and constraints as they apply to sport and recreation participation, and notes related models. It then details broader influences on participation in physical activity, reports research on reported barriers/constraints for people with disabilities, and presents specific Australian findings on the views of people with disabilities regarding what is important in enabling or supporting their participation in community sport and recreation.

Barriers and constraints The view of ‘barriers’ and ‘constraints’ adopted is that described by Jackson (1988), who defined ‘constraints’ as factors that “inhibit people’s ability to participate in leisure activities, to spend time doing so, to take advantage of leisure services, or to achieve a desired level of satisfaction” (p. 203). The degree to which this inhibition operates can range from very minimal, to complete prevention – in which case it is often referred to as a ‘barrier’, and these are often experienced in regard to physical access. This distinction is rarely made however, in the reported research as most of it refers to self-reported perceived ‘barriers’.

Of all the attempts to model leisure constraints/barriers the most enduring one is that proposed by Crawford and Godbey (1987), which still enjoys widespread currency in the recreation literature. These authors proposed a conceptual model consisting of three categories of constraint – intrapersonal, interpersonal and structural.

Intrapersonal constraints - involve individual psychological states and attributes that interact with activity preferences rather than intervening between preferences and participation eg stress, fear of safety, anxiety, confidence, motivation, religiosity, prior socialisation into specific leisure activities, perceived self-skill, and beliefs about the appropriateness and availability of various leisure activities. In addition, people with disabilities also include fatigue and pain, the disability itself, lack of knowledge about where to find a program, and limited access to knowledge about their capabilities for activity.

Interpersonal constraints arise from interactions with others such as family, friends, co-workers; and include lack of social support/companionship for participation in physical activity.

Structural constraints - are barriers that arise as a result of external conditions in the environment eg lack of time, money, transport, or accessibility issues, suitable equipment and access to knowledgeable staff.

A further development of this model proposed a hierarchical model of these leisure constraints (Crawford, Jackson and Godbey, 1991).

R&A Lockwood Consultants Feb 2007 39

Page 43: Captivate Literature Review (Id 3760)

Thus an individual might experience constraints at any one or all three of the levels, but the solution will be most important at the intrapersonal end of the continuum rather than at the structural end of the continuum. This was supported in a study by Alexandris and Carroll (1997) who found that individuals who experience higher levels of intrapersonal constraints are less likely to participate in sports than individuals who experience lower levels of intrapersonal constraints. Further, if intrapersonal constraints can be overcome, individuals are likely to participate in sport activities even when interpersonal and structural constraints are present. While no specific later applications/testing of this model were found for people with disabilities, there are many other research studies on aspects of perceived barriers to participation by this group.

An alternative approach categorised barriers to recreation for people with disabilities into three groups;

Barriers found in the community eg attitudes, poor understanding, cost, transport, physical access – often brought about by ignorance, misconception stereotyping, and fear

Barriers imposed by disability services eg misconceptions of recreation, lack of service linkages, lack of access to information/support

Barriers to the individual eg lack of social skills, communication, motivation, low self-expectation, inappropriate behaviour, fear, lack of a friend or companionship (Culyer 1997, cited in Edgecombe and Crilley, 2002)

Culyer notes that while the recreation service provider has an obligation to facilitate participation by addressing attitudes and aspects of service accessibility, the responsibility lies largely with the person with a disability who may or may not be adequately prepared to meet this challenge.

A recent model (Smith, Austin, Kennedy, Lee, and Hutchison, cited in NCAPD 2006, p1) proposes two main types of barriers:

Intrinsic Barriers - constraints resulting from his or her own physical, emotional, and cognitive limitations; reside within the individual and can be temporal or permanent; may arise or be related to causes such as parental overprotection, inadequate educational opportunities, or segregation from peers.

Environmental Barriers - can be physical, such as architectural or trees and mountains, or can be imposed by society or economic conditions, such as negative attitudes and finances. While an individual may be able to overcome intrinsic barriers through personal action, since environmental barriers are imposed on the individual, the individual may feel helpless to overcome them.

However, the need to look beyond the individual and their demography and psychology to additional factors eg health status, social connections and satisfaction with local area facilities is reflected in an Australian study (MacDougall et al. 1997). In this examination of perceptions of 1765 residents with disabilities in South Australia, factors associated with low activity were age group, education, general health (women), reduced mobility, number of social connections (men) and degree of satisfaction with recreation facilities. Other broader factors influencing participation in recreation by people with disabilities might be partially explained by the ‘inverse care law’, that is, those most in need of services are least well provided with them (Hart, 1971). In Australia for example, this applies particularly to Aboriginal people and their communities as well as other marginalised groups. It is also consistent with the fact that poorer and less well-educated people are less likely to likely to pursue healthy physical activities (Archeson, 1998), which then contributes to their poorer health and higher mortality.

R&A Lockwood Consultants Feb 2007 40

Page 44: Captivate Literature Review (Id 3760)

Although specific research into barriers and supports to inclusive sport and recreation at a local government level is not well represented in publications, several studies were identified. One highly relevant report is that from an Australia-wide information gathering exercise designed to provide The Australian Sports Commission Participation Division with feedback to its National Programs and Indigenous Sport Units (Cormack, 1999). A series of community discussions was conducted in twelve selected local government authorities across Australia to gather information from “grass roots” physical activity delivery agencies (including local government) to gain an understanding of their attitudes and support needs with relation to juniors, women, people with a disability, Indigenous people, people from non English speaking backgrounds and older Australians. The resulting report noted that local delivery groups felt under-prepared in the areas of inclusive practices and catering for special needs, and that their apprehensions were related to some of the following identified barriers to inclusion:

Lack of volunteers with specialist training to support individual disabilities. Not enough people with a common disability to make up a competition

structure. Lack of awareness of integration practices. Access to facilities. In some areas this was being addressed through council

audit but in others impossible to address. Uncertainty of how to find, target, deliver to people with a disability. Apprehension with regards to increased quality of care required. Transport for less mobile participants. The perception that people with a disability do not want to participate in

mainstream options. “if they did, why don’t they just come down to see us?” Where people were living in special accommodation, difficult for carers to

accommodate the variety of interests within the household so it is avoided. Difficulties for participants to move from disabled sporting structures into

mainstream structures where the assessment of ability is subjectively governed by mainstream sporting bodies.

Lack of knowledge of the support services, programs and resources available to assist in this area.

Lack of ability to recognise a place for people with a disability in some of the more traditional mainstream options.

Safety issues and the subsequent perceptions arising.

In their Access Action on Line document The Municipal Association of Victoria (2005) notes local government’s responsibility to ensure accessibility of its community services and consideration of the needs of people with disabilities – including in a sport and recreation context. Based on a range of evidence from local communities they identified some key ‘access’ issues as:

Lack of support staff to resource organisation to address access issues. Insufficient respite care services. Lack of skilled direct care staff. Lack of accessible recreation options for young children, teenagers and

adults. Lack of accessible community transport. Limited accessible child care services. Lack of information about accessible programs and services. High cost of programs and services. Lack of appropriate consultation about service planning and delivery. Limited physical access to events and displays. Inadequate funding to community support groups. Limited staff awareness of access issues. Lack of planning for disability access across all council areas of

responsibility. Lack of Adult Day Care service.

R&A Lockwood Consultants Feb 2007 41

Page 45: Captivate Literature Review (Id 3760)

In a local example, the Town of Victoria Park in Western Australia surveyed its residents with a disability and their carers as part of the development of its Disability Access and Inclusion Plan (Fletcher, 2005). They reported that barriers to information may impact on satisfaction regardless of whether the respondent is or is not currently participating in recreation, leisure or social activities. Other barriers included physical barriers such as poor access to venue and lack of accessible parking, and economic barriers. ‘Identified needs’ included:

Improved programming to facilitate inclusion in recreation. Information to be expanded to meet the needs of people with disabilities in

order to encourage participation through ‘Come and Try days’ complimented by a range of affordable incentives to participate.

Improve support - to get to an activity and to participate during the activity.Of respondent carers, 65% indicated ‘Never participating in recreation, leisure or social activities’ and identified the following as preventing or restricting participation:

Lack of information regarding activities Lack of free time Work commitments Issues relating to health, age and disability Lack of formal assistance Lack of energy Lack of transport Live out of the area Not enough variety to do things together Lack of choice options geared toward ‘oldies’

In particular, the following responses were identified as preventing or restricting the carer from participating with the person they provide care for in recreation, leisure or social activities:

Lack of information regarding activities Nothing interesting to me Lack of transport Age and Disability Work commitments Lack of free time Lack of motivation Cost Lack of ACROD parking

Other Australian studies have also reported barriers to inclusion of people with disabilities in community sport and recreation eg

Inadequate transportation, social isolation, lack of information, lack of qualified coaches, lack of convenient facilities, and lack of trained staff – a sample of 64 respondents living in the Sunshine Coast (Patterson, Hanley and Auld, 1996)

Limitations imposed by their disability, financial restrictions (usually associated with low disposable income), dependence on parents and friends to provide transport, lack of information about current and future programs, and the lack of suitable programs in the local area – metropolitan participants in Western Australian recreation services (Lockwood and Lockwood, 1991)

Negative attitudes in the community, insufficient services or funding - support services; funding for the activity, transport, and/or equipment or materials, high cost, limited income, access issues—steps, buses, light switches, disabled toilets, footpaths, kerbs, seating, and lack of, or difficult to access, information- – interviews with 500 people in Victoria (Johnson, 2000).

Client perceptions that staff of recreation centres had little understanding of disability issues and were uncertain of what steps needed to be taken to ensure safety and access (Lockwood and Lockwood, 1996).

The impact of financial constraints was indicated by an Australian national poll by Scope (2005), a Victorian Association providing disability services, which noted that

R&A Lockwood Consultants Feb 2007 42

Page 46: Captivate Literature Review (Id 3760)

63% of respondents were reported as having limitations with their social and recreational activities, and that this was mainly due to financial constraints. It is also noted that people with disabilities are over represented in low-income statistics and that disability often places serious burdens on individuals, their families and carers - rarely offset by disability allowances and concessions.

The need for people with disabilities to feel welcome and accepted in services and facilities is now well articulated, but is still often expressed as a barrier to participation. Researchers have described social acceptance in a physical activity context as a feeling that participation is welcomed and not ridiculed when skills look different from peers without disabilities (Devine and Lashua, 2002). Other research on psychosocial factors in recreation participation by people with disabilities (Bendini, 2004) further reported three reactions to perceived stigma; hiding from public scrutiny, adopting an attitude of defiant resistance in a desire to prove oneself, or embracing one’s disability and accepting limitations while simultaneously seeking the challenge of recreation participation. The impact of feeling welcome and included was summarised in a study of recreation participants with disabilities - when limited social acceptance is present, active participation in community life is inhibited and b) the more a person felt socially accepted by his or her peers, the greater their recreation frequency and higher their level of satisfaction (Devine and Dattilo, 2000). Others report that people with disabilities who had a degree of self-efficacy and were highly motivated, were more likely to maintain exercise programs in the community (Kinne, Patrick, and Maher 1999).

International evidence based on large-scale studies indicates a broad range and similar types of barriers to participation in community sport and recreation. One of the most comprehensive overseas studies is the Sport England survey (2002) of over 6500 people with disabilities which cited the main reasons for non-participation in physical activity as:

Health limitations (74%). Lack of time (5%). Lack of money (5%).

Other relevant findings from this study included: 14% reported a negative experience in sport due to their health problem or

disability – 39% of these respondents had a disability relating to their musculoskeletal system.

Of those who had participated in any sport in the 4 weeks before interview 72% said that they needed help or adapted facilities to take part in sport.

The most frequently identified ‘help needed’ was having ‘someone to keep me company’ (18%), ‘someone to advise me what I can try given my health’ (10%); and ‘someone to lead me or supervise me to ensure my safety’ (9%).

34% of disabled adults who currently participated in sport stated that they did not need any help or facilities to participate in any of their sports more frequently.

Another important English study identified barriers to sports participation as physical access, changing facilities, attitudes of staff and other users, programming, and staff availability, with transport continuing to present major difficulties (French and Hainsworth, 2001).

R&A Lockwood Consultants Feb 2007 43

Page 47: Captivate Literature Review (Id 3760)

In the United States a national survey of public park and recreation agencies identified five predominant barriers to inclusion (Devine and Kotowski, 1999). The two most frequently cited barriers were lack of financial resources and direct and indirect constraints on staff. Agencies reported that while they predominantly fund inclusive services through general operating budgets, the cost of service provision exceeded available funds. This finding is consistent with an earlier study that cited financial constraints as a barrier to successful recreation inclusion (Schleien, Germ and McAvoy, 1996). Constraints on staff included a lack of accessible public transportation, inadequate availability of adaptive recreation equipment, and lack of knowledge of how to provide accommodations to these participants. Closely behind constraints on staff as a barrier to inclusion, inadequate preparation of staff was identified as a significant obstacle. Agencies reported that staff members were not adequately trained in behaviour modification, in conducting program modifications or facilitation of adaptive equipment. Other constraints identified were transportation, architectural, programmatic, attitudes, administration, and the small size of the community.

Again in the United States, participation barriers and facilitators for persons with disabilities in fitness and recreation programs/facilities were described in a study conducted in 2002 across ten regions (Rimmer, Riley, Wang, Rauworth and Jurkowski, 2004). The study included consumers with disabilities, architects, fitness/recreation professionals, and city planners and park district managers. From the 178 barriers and 130 facilitators identified, the following themes were extracted:

barriers and facilitators related to the built and natural environment economic issues emotional and psychological barriers equipment barriers barriers related to the use and interpretation of guidelines, codes, regulations,

and laws information-related barriers professional knowledge, education, and training issues perceptions and attitudes of persons who are not disabled, including

professionals policies and procedures both at the facility and community level; and availability of resources.

The researchers concluded that the degree of participation in physical activity among people with disabilities is affected by a multifactorial set of barriers and facilitators that are unique to this population. They further noted specific barriers as:

mobility restrictions that are often a consequence of a physical impairment dependence on understanding carers and support workers reduced opportunities to develop friendships and community links diminished transport options need for specialised equipment and trained service providers reduced access to facilities and programs

In 2005, research by the same authors found that in their trial of an accessibility tool on 35 health clubs, persons with mobility disabilities and visual impairments still had difficulty accessing various areas of these facilities (Rimmer et al. 2005).

Some of the identified literature relates specifically to the inclusion of children with disabilities. Most tends to be dominated by activity in a school setting or rehabilitation context rather than in a local government community context.

R&A Lockwood Consultants Feb 2007 44

Page 48: Captivate Literature Review (Id 3760)

However, one important English study investigated inclusion of children with disabilities in local community leisure. The Contact a Family survey (Shelley, 2002) provided a snapshot of families’ experiences, all of which pointed to a high degree of social exclusion of disabled children and young people. Their analysis identified that families face many barriers and therefore do not even attempt to use many leisure services. Parents reported how put off they were by public attitudes and by practicalities such as long queues and inaccessible transport eg 79% had never been to a football match, 72% had not visited museums and 62% had not been to bowling alleys – even though these amenities were more likely to be accessible and welcoming. Moreover, when families did try to use leisure services they often encountered rigid rules and obstacles. Reported specific barriers included:

Physical barriers: eg physically disabled children and young people are clearly dependent upon basic physical access. Their parents or carers need allocated disabled parking spaces.

Attitudinal barriers: eg many of the children had no physical disabilities. However, they face other hurdles - those with Autism and Asperger Syndrome, can find long queues and large crowds intolerable. Many children with learning difficulties long to play sport and join clubs but are excluded because of their unusual behaviour or need for extra support.

Parents in this study also indicated that what they would find most helpful was Trained staff (almost two thirds of parents). Tow cost and effective volunteer buddy schemes which helped their young

person join mainstream clubs.Other issues that were noted as being linked to staff attitudes ie

Help for children who find large groups difficult. Clear information on what is available. Activities which include siblings. A greater variety of activities to suit different interests.

The authors noted that it was not surprising that 52% of parents felt that their children would be better off in special clubs or a separate provision where staff are trained to cater specifically for their children. They further state that families need choices and that children only achieve equity of access if they can use both specialist and mainstream services.

A large scale study of disabled children (Sport England, 1999) surveyed 5,600 young people aged 6-16 years, and with a response rate of almost 50%, found that while most participated in sport, they did not participate in sport as much as other children or as much as they wished. The most common reported barriers were lack of money, health considerations, unsuitability of local sports facilities, and having no one to go with. Later, Sport England survey of 2,293 6-16 year old children and adolescents with a disability and found that 21% of respondents felt that staff at sports clubs were not welcoming (Finch 2001).

Downes and Briffa (2004) cite further evidence that for children with disabilities, aspects of the inclusive setting such as attitudes of peers and the support of staff can act both to support and to limit participation in physical activities (Goodwin and Watkinson; Hutzler, cited in Downes and Briffa, 2004). In referring to other research Downes and Briffa also concluded that experiences such as episodes of social isolation, questioned competence to participate, and restricted participation, created barriers to participation in physical activity (Blinde and McCallister; Goodwin and Watkinson, cited in Downes and Briffa, 2004).

R&A Lockwood Consultants Feb 2007 45

Page 49: Captivate Literature Review (Id 3760)

Barriers to inclusive community sport and recreation have been associated with type and ‘severity’ of disability and other demographics including gender and ethnicity. For example, people with serious mental illness who were enrolled in community-based psychiatric rehabilitation reported that although they valued physical activity, significant barriers existed (McDevitt, Snyder, Miller and Wilbur, 2006). These included mental illness symptoms, medication sedation, weight gain, fear of unsafe conditions, fear of discrimination, and interpretations of program compliance. Being in a psychiatric rehabilitation program was also seen to have had the effect of leaving activity initiation up to the program staff, which some participants perceived was part of required program compliance.

An investigation of women with disabilities in inclusive recreational settings, reported that “the emotional toll” of being in negative public situations and the experience of “pity” affected their attitudes toward leisure. Although physical and financial restraints were often part of the equation, social and psychological comforts were reported as the key to the success of any inclusion program (Bendini and Henderson, 1994, p. 260).

Recent research in NSW schools is of relevance in that it raises the question of how do parents with a disability engage with professionals delivering services to their children? While the research relates to parent experiences with schools, it raises many important considerations of relevance to sport and recreation services. Findings were discussed and strategies were presented around five categories of interest: What people think about parents who have a disability? Dealing with staff, Access and information, Taking part in school activities, How the school can make people who have a disability feel welcome (Robinson, Hickson and Strike, 2001).


As with the literature on ‘barriers’ and ‘constraints’ there are many examples that identify research findings relating to supports/enablers to inclusive sport and recreation. Findings of a study undertaken in the South Australian local government setting closely reflect those of the wider Australian and international literature (Edgecombe and Crilley, 2002). This study conducted focus groups and surveys of people with disabilities and reported the responses of 161 people who indicated ‘issues of importance’ when participating in community sport and recreation. These are used to broadly indicate supports/enablers. The following issues were noted in order of importance:

Provision and promotion of accurate information to me about ‘disability friendly’ access, amenities, venues, services and programs.

Service providers knowing and understanding how they can overcome barriers to my participation (rated most highly by those with vision impairment or an injury).

Access to programs/services within community groups for me (rated equally most highly by those with intellectual impairment – with transport).

Knowing about the range of funding sources for programs and services (rated most highly by those with a ‘nervous system’ impairment).

Availability of support services/personnel for me (rated most highly by those with musculoskeletal impairment).

Access to equipment that assists my participation. Availability of transport (rated equally most highly by those with

intellectual impairment – with access to programs/services). Having access to frequent and regular updates on information and ideas

from other South Australians with a disability. Service providers having better details about me and others with a

disability eg favourite sport, arts, other activity.

R&A Lockwood Consultants Feb 2007 46

Page 50: Captivate Literature Review (Id 3760)

Knowing about the benefits of my participation in sport, arts and other recreation choices.

Successful athletes and artists with a disability as role models (p45).

In this study the importance ratings were also related to severity of disability, with those who described their disability as ‘severe’ placing most weight on service provider knowledge/understanding, knowing about funding sources, access to equipment, availability of support services/personnel, and access to programs/services within community groups. Those with ‘moderate’ levels of disability mostly noted provision and promotion of accurate information about ‘disability friendly’ access, amenities, venues, services and programs; while those with ‘slight’ levels of disability focused on knowing about the benefits of my participation in sport, arts and other recreation choice. Other findings indicate what was most important was ‘knowing about the benefits of my participation’; and for swimming/aquarobics it was ‘having access to frequent and regular updates on information and ideas from other South Australians with a disability’. The extent to which this is related to the type and ‘severity’ of disability is not known (Edgecombe and Crilley, 2002).

Selected considerations Many studies worldwide have reported constraints and supports to inclusive sport and recreation, and stated the need for them to be removed – but little is known about the complex relationship between internal and external constraints.

Types of identified barriers may suggest strategies that support inclusion eg skill and confidence building, information, social/activity networks, supports, welcoming staff, accessible facilities, need for adaptations etc.

Identification of barriers/constraints may help locating and assisting individuals.

If particular groups of people have limited participation, the identification and removal of constraints is an equity issue.

Non-participants are often most in need of assistance in participation, but the service provider is more likely to target people who are current participants.

R&A Lockwood Consultants Feb 2007 47

Page 51: Captivate Literature Review (Id 3760)

SECTION 6Inclusive Practice: Community sport and recreation

International and Australian literature reporting ‘best practice’ of inclusive sport and recreation is readily available and describes the approaches of many government agencies as well as research of specific groups, and broader academic research. It variously refers to both ‘principles’ and ‘practical strategies’, and in a few cases, a set of ‘guidelines’. Most however, simply provides examples of what organisations are doing eg programs describing various opportunities for people with disabilities. The literature also includes several international textbooks for professionals working in inclusive sport and recreation eg Schleien, Ray, and Green, 1997; Hutchison and McGill, 1998; Carter and LeConey, 2004) but little based on the Australian experience (eg Lockwood and Lockwood, 1999). Much of the literature is from the United States and has a strong focus on professional delivery of ‘therapeutic’ recreation, by specially trained staff who work with individuals and in many cases also with organisations in order to help them move toward delivery inclusive services. The inclusive practice movement in Australia however, is not strongly therapy-based but promotes the notion that inclusion is everyone’s responsibility and that with adjustments and assistance where required, human services can become more inclusive. In terms of local government, a degree of caution is warranted when translating the experience of organisations in other countries to the Australian context, given some of the major differences in role, and geographic, cultural, political, and social circumstances.

In terms of a broad framework, there is generic evidence that a capacity building and strengths approach would be appropriate for development of inclusive sport and recreation in a local context. These foundations are well described in the West Australian Department for Community Development’s (2006) review of contemporary literature in the field. This document notes that strengths based approach is internally focussed, concentrating on the problem-solving capacities of community members, associations and organisations. It stresses the importance of local investment, creativity, hope and control. Being internally focused, it is relationship driven, constantly building the relationships between and among community members, associations and organisations (Kretzmann and McKnight, as cited in Department for Community Development, 2006, p.2). In defining capacity it states that it is simply the ways and means needed to do what has to be done and that it includes skills, people, plans, commitment, resources and everything that is brought to bear on a process to make it successful (Frank and Smith, as cited in Department for Community Development, 2006, p.3). In terms of outcomes, it reports Kretzmann and McKnight’s view that the most powerful communities are those that can identify the gifts of those people at the margins and pull them into community life (cited in Department for Community Development, 2006, p.3). This document offers further guidance to all community service delivery and of direct relevance for the industries involved in CAPTIVATE ie, sport and recreation, disability, and local government.

The views of Muirhead (cited in Department for Community Development, 2006, p.5) are discussed, whereby he makes a distinction between a developmental approach and a program approach to working in communities. He notes that in broad terms developmental approaches tend to be far more empowering, and can actively build relationships at the local level. Such an approach is likely to keep people much more energised and involved than ‘program approaches, and often lead to groups and communities with far greater capacity. He also notes that there are times when a ‘program approach’ is more preferable. This is often when things just need to get done, and those things are clearly defined eg a facility has to be run legally and efficiently; a building needs to be built; an event needs to be organised; a funded

R&A Lockwood Consultants Feb 2007 48

Page 52: Captivate Literature Review (Id 3760)

project needs to be finished. The difference between the two approaches is illustrated below.

(Community) Developmental approach

(Social) Program approach

Focus on people Focus on ‘program’- (funding, pre-determined outcome, etc)

Enabling PrescribingEmpowering ControllingRelationships first Outcomes firstDriven by person/family/groups

Driven by agency/departments

Step by step “grand plan”Starts from where we are Starts from where ‘typical’ people areStrong on ‘appropriateness’ Strong on ‘equity’

The main aim of a community capacity building and strengths approach is for it to lead to sustainable solutions and resilience (Rogan, cited in Department for Community Development, 2006, p. 8). One of the strengths of the approach is its eye to the longer term - is not about putting money and resources in to fix something in the short term but about building physical and social infrastructure to enable longer term resilience and sustainability. Within local government and other recreation service provider organisations one form of expression of this approach is through broad supporting policies that are embedded in the general planning cycle, and are not dependent on piecemeal external funding. Inclusion of people with disabilities becomes simply part of the ‘core business’ of providing human services to the residents of the particular community.

For local government, an inclusive approach involves actively promoting general sport and recreation programs and facilities to people with disabilities and then planning ahead for their participation. All employees and contractors share in the responsibility for inclusion, and can promote inclusion by showing their acceptance of all people and a willingness to make adjustments where needed.

The need to establish ‘best practice’ guidelines was acknowledged by the Western Australian Disability Services Commission. Following a review of its recreation services, the Commission established a Recreation Review Task Force consisting of both service and industry representatives, and auspiced by ACROD (WA). One of its tasks was to develop best practice guidelines that promote inclusion of people with disabilities in recreation across a range of settings. It established the following best practice principles and three sets of guidelines specific to government and funding bodies; service providers; and individuals, self-help groups, families and carers (ACROD, 2001). In summary, it recommended the following points

R&A Lockwood Consultants Feb 2007 49

Page 53: Captivate Literature Review (Id 3760)

Best practice principles for Inclusive Recreation: People with disabilities are valued members of society, and have a right to be

included and participate fully in community life. Recreation services recognise people as individuals with unique and diverse

abilities, needs and aspirations. Services support people with disabilities to participate in a range of recreation

activities and pursuits of their choice. Services are planned with the individual and/or family, reflecting the person’s

beliefs, culture, preferences and changing needs. Services facilitate relationships and supports that develop naturally, while

recognising that some people may need more specialised supports. People with disabilities participate in fulfilling recreation activities and pursuits

of their choice that provide opportunities for adventure, challenge and creativity; People with disabilities are included in their local neighbourhoods and

communities; Services work in partnership with clients, carers, and other agencies to

facilitate the development of natural support networks, relationships and friendships; and

Services are responsive to the changing recreation needs and choices of individuals and take account of the changing recreation environment.

Guidelines for Best Practice for Inclusive Recreation: Government & Funding Bodies Reorientation of services from respite & alternatives to employment to health

and quality of life A whole of government approach that encourage partnership building and

interagency & interdepartmental collaboration Programs should reflect an ecological approach to community inclusion that

combines individual and environmental strategies and aim to build sociol capital and sustainability.

Programs need to be evaluated and include: Formative; Outcome; Impact and Process evaluation.

Programs need to encourage promotion strategies including the promotion of positive role models of people with a disability in the community and the benefits of sport and recreation

Programs need to encourage a community development focus that uses collective empowerment to strengthen community action to achieve community inclusion

Programs need to recognise the value of self-help groups and peer support strategies in the inclusion process.

Programs need to aim to build inclusive policy and address systemic barriers & enablers

Programs need to aim to develop partnerships between disability specific service providers and generic services.

Programs need to include health and quality of life outcomes and recognise general recommendations for physical activity levels, such as the 30 minutes a day benchmark (PATF).

Guidelines for Best Practice for Inclusive Recreation: Recreation Service Providers Have inclusive policies in place. Provide appropriate resources and a warm and welcome environment. Ensure staff and carers are trained and have positive attitudes and beliefs

towards community inclusion and are appropriately trained Implement recognised inclusion training for key players; staff; trainers coaches

and group members Training needs to be experientially based and address: Attitudes & Beliefs;

Communication; Conflict Resolution; Inclusive Policies.

R&A Lockwood Consultants Feb 2007 50

Page 54: Captivate Literature Review (Id 3760)

Include Leisure Education as the first step in the inclusion process, with an opportunity for people to recognise their own skills and abilities.

The goal of the leisure education strategies should be to increase health and quality of life and needs to include leisure counselling; recreation planning; information dissemination and a coaching component.

Leisure Skills Coaching needs to be holistic and develop individual personal, social and leisure skills and include role modelling and opportunities for trial & error before community inclusion ie. Come & try days & trial at lower grades & for skill development.

Programs and activities need to be based on individual needs and Include family and carers in the process.

Programs and activities need to be fun, affordable, and flexible. Programs and activities should encourage people to adopt valued roles. Programs and activities need to include strategies for social interaction and

building friendships, including mentor and buddy programs and peer support strategies.

Guidelines for Best Practice for Inclusive Recreation: Individuals; Self-help Groups; Families & Carers

View recreation and its benefits as a priority for health and quality of life. Try to incorporate 30 minutes of recreation every day. Seek a recreation service with trained staff and fully accessibility facilities and

activities. A good service will offer choice and flexibility and an appropriate level and

length of support to suit your individual needs. A good service will provide leisure education and leisure skills coaching before

community inclusion. The goal of the leisure education strategies should be to increase health and

quality of life and include leisure counselling; recreation planning; information dissemination and a coaching component.

Leisure counselling should provide an opportunity for you to identify your own skills and abilities.

Leisure skills coaching needs to be holistic and develop individual personal, social and leisure skills and include role modelling and opportunities for trial & error before community inclusion ie. Come & try days & trial at lower grades & for skill development (ACROD, 2001).

The guidelines represent an attempt to address inclusive sport and recreation from the perspective of three key stakeholder groups ie government and funding agencies, recreation service providers, and customers. In some of the points the guidelines are quite detailed and there is a strong focus on particular views regarding leisure education, leisure skills coaching and leisure counseling models.

In the local government context no overarching ‘best practice’ guidelines specific to inclusive sport and recreation were identified from the literature or from specific requests to policy staff at ALGA and WALGA. However, general guidance is offered through other documents that emphasise community development/capacity building/strengths principles and practice. For example, the Australian Local Government Association (2005) has published guidelines to assist councils in promoting age friendly environments. The rationale includes the significant benefits and opportunities for councils. Although specifying ‘age friendly’, other sections are very instructive for the sport and recreation context, and include discussion of broader principles and strategies. For example, topics include: Promote age friendly

built environments (16 examples of initiatives); Foster age-friendly community planning and design (11 initiatives); and Support recreation facilities, parks and tracks (12 initiatives).

R&A Lockwood Consultants Feb 2007 51

Page 55: Captivate Literature Review (Id 3760)

Other approaches to best practice are reported in several Australian states. In Victoria, for example, relevant suggestions and descriptions of examples of successful inclusive recreation are reported by the Municipal Association of Victoria (n.d.) through ‘Access Action On Line’. It states that local government is responsible to ensure that all of its community services activities are accessible to and consider the needs of people with disabilities. In addressing selected access issues it makes some suggestions for action – which are applicable to all service areas including sport and recreation:

Develop a Disability Action Plan for the whole of Council Review respite care services in line with changing user needs Provide specialist training and incentives to direct care staff Explore options with external service providers to develop a wider range of

supportive recreation options for people with disabilities Assess options for provision of accessible community transport utilising Council

buses Plan for upgrade to accessible vehicles Review Family Day Care Scheme and train carers to broaden child care options

for children with disabilities Develop and circulate information in alternative formats relating to accessible

services, facilities and programs provided by Council which are accessible to all Establish a Disability Advisory Committee to assist Council with addressing

access issues and for consultation on service planning and delivery issues Provide reduced cost services to people in receipt of disability benefits Develop and utilise access checklists for staging of events and displays Allocate a percentage of community support funding to disability support

/advocacy groups Provide training to staff in disability awareness issues Employ Community Resource and Development Officers to assist in making

children’s services accessible

Further details of successful practice are given in the section ‘What Some Councils Have Done’ eg:

Facilitated partnerships with compatible community agencies to provide recreation and leisure programs for young people with disabilities – Boroondara

Auspiced the inclusion of an Access for All Abilities Program Officer responsible for facilitating leisure opportunities for people with disabilities – Boroondara, Hume, Frankston, Brimbank

Provided a Community Recreation Outreach Project (CROP) providing a range of leisure options for people with psychiatric disabilities – Boroondara

Reviewed leisure centre contracts to include concessional strategies that will increase the utilisation of services by people with disabilities- Wodonga

A comprehensive Australian approach to current inclusive sport and recreation practice that involves local government facilities, services, and/or partnerships is the Access All Abilities Program (AAA) (Sport and Recreation Victoria, 2007). It is also noteworthy for the thorough evaluation and subsequent report made available on the website – including details on strengths and limitations. Through Sport and Recreation Victoria, the Victorian Government provides funding to a network of community-based organisations (including ten local government areas, using five different models) that assist local sport and recreation organisations to develop environments in their community that include, and are accessible to, people with disabilities. The Program aims to increase the number and overall availability of sport and recreation environments for people with a disability and works to influence local level planning processes and encourage an increase in the development of accessible sport and recreation environments. AAA has three components: a network of 24 AAA Program Providers, a Strategic Partnership that provides strategic advice to Sport and Recreation Victoria on sport and recreation access issues for people with a disability, and considerable funding to support projects.

R&A Lockwood Consultants Feb 2007 52

Page 56: Captivate Literature Review (Id 3760)

The AAA program has resulted in several relevant resources including ‘Partnerships and possibilities: creating more inclusive sports recreation and arts opportunities’ (Sport and Recreation Victoria, 2007). Case studies and snapshots are provided to describe innovative, creative and flexible approaches that have been developed through partnerships and co-operation between various organisations. Reported rewards for partner organisations included sharing successes, and creativity dividends for the workers and services involved. They note the significant role of local government in the development of recreation opportunities in their communities, leadership ability, and resourcing to facilitate community participation; benefits for community sport and recreation providers eg having increasing participants; and challenges for disability service providers and successful partnership initiatives with community providers whereby disability support services have a role in providing advice, information and/or specific resources. Comprehensive handbooks have been developed eg Good access is good business, Management (for Councils), Outdoors and aquatic centres, and many other useful titles.

AAA stresses the need for new ways of working and the value of collaboration and partnerships. They note several articles on the VicHealth website that describe different forms of collaboration, and the key essentials including processes and structures which promote successful partnerships. Examples of partnerships are given:

Partnerships with Recreation - Fitness & Aquatic Centres Partnerships promoting Leisure Groups & Social Groups Partnerships with Community Centres Partnerships for Recreation as Respite

Some Local Government Initiatives to Increase Access and Participation are also described (Sport and Recreation Victoria, 2007).

At a national level, the Australian Sports Commission Participation Division initiated an information gathering exercise to provide feedback to its National Programs and Indigenous Sport Units. A series of community consultations was conducted in twelve selected communities across Australia to gather information from ‘grass roots’ physical activity delivery agencies (including local governments) to gain an understanding of their attitudes and support needs with relation to juniors, women, people with a disability, Indigenous people, people from non-English speaking backgrounds and older Australians. It reported the following strategies as appropriate for targeting people with a disability:

Provide training for caregivers and delivery personnel on how to best accommodate for this target group – including who to ask, how to ask, ideas on integration, modifications that may be necessary - a general ‘how to go about it guide’.

Grading participants according to their level of ability as opposed to age group. Setting up competition structures that offer a bye for each team during which

time they participate in a competition with a group of people of varying abilities – a skill based social competition utilised here without the emphasis of season points.

Splitting teams whereby able and disabled play together as it appears in the competition draw.

Establishing specialised competitions for people with a disability and encouraging the participation of able-bodied participants eg. wheelchair sports.

Buddy systems whereby able participants mentor a person with a disability. Engaging with the parents and caregivers to ascertain the special

considerations required for participation of people of varying abilities (Cormack, 1999).

Various descriptions of inclusive sport and recreation practice in Australian local government settings are available and suggest that good inclusive practice is well

R&A Lockwood Consultants Feb 2007 53

Page 57: Captivate Literature Review (Id 3760)

embedded in many local government facilities and services. However, very few organisations report on evaluations of these initiatives, or on their current or projected sustainability. The wide variety in detail and ‘models’ mirrors that of local government contexts and there is no single reported approach that has been systematically evaluated and applied across a range of settings in Australia. The diversity of contexts, together with the huge range of abilities/disabilities of current and potential sport and recreation participants suggests the need for a well-tailored and flexible approach – and avoidance of a particular ‘recipe’ for success. The prolific community development and capacity building literature stresses that each community is unique with regard to its needs, resources and services – including those relating to sport/recreation/leisure. This uniqueness requires that organisations (including local government) conduct appropriate local community and organisational assessments so that they can make informed decisions about the facilities and service they are able to offer. For example, the Town of Victoria Park recently undertook a major action research project concerning current and future demand of recreation services by people with disabilities living in its catchment area (see Section 5).

The need for specific and realistic understanding of various contexts is supported by prominent Australian researchers who have worked extensively with local government in the area of improving sport and recreation participation in people with disabilities throughout Australia and New Zealand (Crilley and Murray, 2000). They note the many common and highly publicised statements that relate to improving participation in sport/recreation/leisure eg; eloquent text in official reports, stated service intentions of key decision-makers and service providers, statements of positive intent in local government corporate documents, awards for ‘excellence’, and higher level reminders (eg WA Office of the Auditor General, the Commonwealth Government’s Active Australia). They emphasise that they are not in any way attacking these expressions, but that they should be used more as a stimulus to action, and that there is a need “to carefully identify and study systematically, the reality of the situation regarding participation in sport and recreation services” (p2).

Internationally, the Canadian emphasis is on community development, as evidenced by the highly successful Canadian Association for Community Inclusion (, a not-for-profit organisation that is building many hundreds of inclusive communities across Canada. Although the emphasis is on people with developmental/intellectual disabilities, the models are readily supportive of all people with disabilities. The Association has produced a number of reports on Respite and Community inclusion which make for thoughtful reading and are downloadable from its website.

In the United States there is a vast relevant body of literature including that from the National Center on Accessibility ( and the National Center on Physical Activity and Disability. Many monographs and other resources from these centres and other organisations were reviewed online.

R&A Lockwood Consultants Feb 2007 54

Page 58: Captivate Literature Review (Id 3760)

Selected monographs relevant to best practice in inclusive recreation include the National Center on Accessibility’s documents: Best Practice of Inclusive Services, The Value of Inclusion; Project GAIN, A Model for Best Practices in Inclusive Recreation Programs; Making A Splash: Inclusion of People with Disabilities in Aquatic Venues; and Principles for Adapting Activities in Recreation Programs and Settings (National Center on Accessibility, n.d.).

While much of the literature comes from a therapeutic recreation specialist perspective there are many examples of inclusive community recreation and leisure approaches that may offer ideas for local governments and sport and recreation providers. The reports relate to a variety of organisations, both government and private. Again, many indicate that while they regard their approaches as successful and instructive, the development of local initiatives requires local planning and ‘buy in’ by stakeholders rather than direct transfer of reported models. Selected summary points from reports of ‘what works well’ in inclusive community sport and recreation in the United States are listed below, followed by contact details for viewing information about selected examples. Selected summary points:

Apply good generic service development practice eg assessment, planning (including an action plan), implementation, and evaluation processes

Know your community ego Involve the community in finding out potential customer base and their

needso Understand local resources – disability, sport and recreation, volunteers,

equipment etco Investigate opportunities and challenges to developing partnerships

between service providers eg explore the shared use of resources and expenses, equipment purchase

Within the organisation – adopt appropriate administrative, program, and staff policies and practices eg

o Administrative: An inclusive statement made at the highest level Welcoming language readily evident eg in recreation registration

forms, advertising, activity descriptions Feedback/input from participants, caregivers, advocacy groups is

channeled to appropriate personnel Budgets are sufficient to support inclusion Awareness of alternative funds available for inclusion strategies Marketing of services and facilities to target groups policies are in place with regard to

participant confidentiality [interpretation of appropriate legislation)

real or perceived architectural, transportation, policy and practice barriers

fees and charges liability, duty of care staffing eg the use of part-time, contract, and volunteer


R&A Lockwood Consultants Feb 2007 55

Page 59: Captivate Literature Review (Id 3760)

Program:o Work with participants and carers/families to

elicit/review participant needs – consider implications for managing these needs

o Information is gathered on whether programs meet participant expectations and preferences

o Scheduling of activities takes into account available transport, including that provided through council and other organisations

o Program supplies and equipment are available – including access to adapted/modified equipment

o Identify/develop resource materials used to support inclusion

o Assessment, program monitoring, and evaluationo Accessible information on programs and serviceso Policies on

program registration health and safety - responding to emergencies

o Develop/use forms that can be replicated eg for assessment, planning, implementation, and evaluation processes.

Staff:o Have experience, qualifications, and opportunity for

training in inclusive practiceso Roles and Responsibilities are well definedo Have adequate administrative support and

assistanceo Awareness and specific knowledge about Individuals

with Disabilities – risk managemento All staff to be aware of implications of legislationo One person designated to oversee the agency’s

inclusion efforts - Develop management and leadership to facilitate inclusion

o Staff composition reflects the diversity of the community interests and needs

o Documents are in place to assess the extent to which inclusive programs and services occur.

Two examples of the development of a model of inclusive community sport and recreation are ‘Providing Inclusive Recreation Opportunities: The Cincinnati Model’ (National Centre for Physical Activity and Disability, 2006a), and ‘A Community Inclusion Model: City of Reno’ (National Centre for Physical Activity and Disability. (2006b). Both of these examples give detailed considerations for recreation services.

What constitutes ‘best practice’ from a customer point of view is a key consideration in attempting to identify what is most important for service delivery organisations. In research to determine which community sport and recreation services are most valued by disabled youngsters and their families, The Social Policy Research Unit at the University of York in England found that the children’s perceptions were firmly grounded in the clubs and activities they attended, and revolved around four key themes:

Staff attitudes: staff attitude and approach was a key criterion of quality. Children continually highlighted the importance of how staff perceived and treated them. In particular they valued staff making them feel welcome and part of the service.

R&A Lockwood Consultants Feb 2007 56

Page 60: Captivate Literature Review (Id 3760)

Relationships: quality services were those which respect friendships and seek to nurture them.

Personal development: quality services encourage choice making; they unobtrusively interweave personal self-development with fun.

Community links: services which enabled them to participate in activities as well as opportunities to go out to and enjoy local amenities. Sharing Value Project.

In the same study, parent carers identified the following key factors: Helpful staff attitudes and approach - listening to and

acting on parents’ ideas and experiences. Accessible information – jargon free and providing regular

updates. (Shelley, 2002, p26.).

This research resulted in a set of best practice strategies for the study context through its recommendations to local authorities, social service providers, and staff in leisure and play settings:

Local Authorities:o Provide Leisure Passes for parent carers to avoid queues

and get concessions.o Provide more disabled parking spaces at key leisure

centres and monitor and police them.o Extend the Blue Badge Scheme to include a greater

range of disabilities.o Fund volunteer buddy schemes which assist disabled

children and young people to attend clubs and activities.o Fund escorted taxi services to take disabled young

people to clubs.o Install gates beside stiles on tourist paths and country

walks.o Upgrade public toilets in key public areas, including

large shopping malls and parks, to include changing beds for older children in nappies.

o Provide funding for integrated playgrounds, in terms of equipment and wheelchair access.

o Only give planning permission to new local leisure ventures when they meet standards on accessible toilets, changing facilities and physical access.

o Publish annually updated local guides to accessible facilities and activities for children.

o Publish guidance on good practice to private providers.

Social Services:o Make leisure and play an integral part of the framework

for the assessment of children in need and their families.o Ensure that representatives of the Leisure and Youth

Services are an integral part of the multi-agency planning for disabled children’s services.

o Consult with disabled children and young people and their families about their unmet leisure needs and wishes and build these into programming.

o Quality Protects Management Action Plans.o Support practical initiatives such as one to one buddy


Staff in all leisure and play settings:o Make disability awareness training compulsory for all


R&A Lockwood Consultants Feb 2007 57

Page 61: Captivate Literature Review (Id 3760)

o Include specific training such as deaf awareness.o Include equal opportunities and awareness of multiple

disadvantages of families from minority ethnic communities.o Employ disabled people to provide services.o Promote a can-do attitude.o Portray images of disabled children in all publicity

material.o Offer a range of activities for different ages, interests

and abilities.o Purchase items and equipment which will increase the

range of activities for disabled children.

R&A Lockwood Consultants Feb 2007 58

Page 62: Captivate Literature Review (Id 3760)

The Inclusive Fitness Initiative (IFI) is an excellent English model, which has been in operation since 2001, receiving in total £6m from the Sport England Lottery Fund (Inclusive Fitness Initiative 2006). The IFI operates around five key principles:

Accessible facilities Inclusive fitness equipment Staff with appropriate training and skills Appropriate, inclusive marketing strategies The development of alternative inclusive sporting opportunities

The combination of these elements ensures that the IFI creates not only accessible facilities, but inclusive environments. The IFI now boasts a network of over 180 inclusive facilities across England. Every IFI Site has undergone an access audit to ensure that their Accessible changing room facilities most effectively meet the needs of people with disabilities. These access audits focus specifically on the fitness related services including changing and catering services etc.

The IFI has been working in partnership with fitness equipment manufacturers for more than five years to ensure that the equipment available on the market is as inclusive as current technology and development will permit. It has worked alongside the industry to create a unique list of accredited fitness equipment. They suggest a minimum equipment set would include

Treadmill Upright and/or recumbent cycle Upper body ergometer Leg curl Leg extension/leg press Upper body multistation and/or a range of accredited upper body resistance

equipment Package of small equipment

In addition to access and equipment, IFI has also developed ‘Gym Buddies’, whose role is to

accompany and/or work out alongside disabled user(s) within the fitness suite and provide additional support e.g. adjusting weight stacks/ start positions and programming consoles etc;

motivate, encourage, mentor and befriend a disabled person and support them in achieving their fitness goals;

help break down barriers to participation for disabled people i.e. access, communication, social and psychological.

All Gym Buddies receive basic disability equality training and a gym induction, and are not expected to lift and carry or transfer disabled users onto any of the fitness equipment, provide transport or assist disabled user to change or personal care , prescribe exercise, or to assist with or administer medication.

Inclusion is also an ongoing challenge for many other groups of people who have been marginalised and are now calling for better participation in the community. Their experiences and resources can provide an excellent model for reshaping community inclusive practice. For example, the Victorian Centre for Multicultural Issues (1996) has developed a series of research reports and information (tip) sheets targeted at specific community organisations - clubs, sport and recreation centres etc to assist them to provide inclusive and welcoming environments. Although not disability-specific it provides well-documented approaches to inclusive practice in sport and recreation.

R&A Lockwood Consultants Feb 2007 59

Page 63: Captivate Literature Review (Id 3760)

Points for Consideration Evidence for relevant best practice ranges includes a limited number of ‘guidelines’, several textbooks, and many Australian and international program descriptions.

General principles of inclusion, together with the knowledge of ‘hands on’ practitioners working in specific settings provide the foundations for flexible and sound practice..

Each Local Government Authority represents a unique set of social, financial and geographic circumstances on which to derive priorities, policies and practices that will meet statutory obligations and the demands of its constituents: one size does not fit all!

Inclusion is successful for both service providers and customers when it becomes embedded in normal business - in strategic and operational planning, adaptability, flexibility in management and service delivery, and in strategies for building welcoming and sustainable communities. This involves commitment by senior management, opportunities for appropriate staff training, and the assignment of appropriate resources. Specific sport and recreation services contribute to inclusion by providing activity choices appropriate for the skill and motivation of the individual, access to networks and supports, barrier-free environments, adequate transport arrangements, and an affordable cost structure which will open opportunities for people with disabilities to become participants.

R&A Lockwood Consultants Feb 2007 60

Page 64: Captivate Literature Review (Id 3760)

SECTION 7Adult learning

This section is presented to meet the project request that literature on ‘adult learning’ be briefly summarised to present recent approaches and key points that may be of relevance in developing CAPTIVATE’S training resources and delivery.

‘Adult learning’ as a concept has now been somewhat superseded by the notion of ‘Lifelong learning’, in which learning is seen a continuous process throughout life stages. It has taken on new importance in Australia, since most people will now require re-training as they shift to new jobs and careers, and with new technologies and knowledge within existing jobs. Axford and Moyes (2003) have recently prepared an annotated bibliography for the Lifelong Learning Network as part of the Commonwealth Department of Education Science and Training funded project, ‘LifeLong learning in Australia: policy directions and applications’. The bibliography demonstrates the breadth of issues currently being addressed. It is arranged under a series of subject headings that reflect: traditional education and training structures; current moves towards increased cross-sectoral provision of education and training; and current trends towards linking education and training.

In parallel with ‘lifelong learning’ there is the notion of ‘Multiple Intelligences’ which proposes that people have different intrinsic talents and ways of viewing the world and learning. These are independent of age and are seen to imply different learning strategies. Several publications and tests are available to determine an individual’s learning style (e.g. Smith and Dalton, 2005). Multiple intelligences have been further described by Gardner (1993, 1999) who also notes the different learning stimuli/opportunities that various types of people best respond to:

Linguistic Learner: learns best by: saying, hearing and seeing words. Logical/Mathematical Learner: learns best by: categorising, classifying. Spatial Learner: learns best by: visualising, dreaming, using the mind's eye. Musical Learner: learns best by: rhythm, melody and music. Bodily/Kinaesthetic Learner: learns best by: touching, moving, interacting with

space. Naturalistic Learner: learns best by: studying natural phenomenon. Interpersonal Learner: learns best by: sharing, comparing, relating,

interviewing. Intrapersonal Learner: learns best by: working alone, on individualised projects.

Originally, Gardner developed the list as a theoretical model about the psychology of the mind, rather than a practical way to address individual differences. However, it is now seen as one tool for understanding a learner’s strengths and weaknesses as well as highlighting the need to address individual differences by providing a range of activities and experiences to facilitate learning.

Despite abundant theoretical exploration, evidence available about ‘what works’ is somewhat scarce, as reflected in a recent key analysis of post school learning; “the amount of ‘scientifically known’ knowledge in the sector is modest. By virtue of its scattered, piecemeal, grounded and small-scale character, much has a folksy quasi- anecdotal character” (Cullen, Hadjivassiliou, Hamilton, Kelleher, & Sommerlad, 2002, p.29).However, for adult learning there is some general agreement and widespread adoption of the following propositions:

R&A Lockwood Consultants Feb 2007 61

Page 65: Captivate Literature Review (Id 3760)

In general all theories of adult education are based on valuing and building on the prior learning and experience of adults. Adults bring experience to a course that it is important to recognise, value and engage with. They contribute and add to knowledge by bringing this experience into engagement with ‘validated’ disciplinary knowledge. Both the subject and the teacher can gain.

Successful adult learning using methods that treat learners with respect, for example by taking into account other personal and situational variables. Personal variables may include including aging, life phases, and developmental stages (eg marriage, job changes and retirement). Situational variables include part-time versus full-time learning, and voluntary versus compulsory learning (Leicester and Field, 2000).

The teacher is above all a facilitator and a mentor of learning, for example, by

o setting a positive climate for learning,o clarifying the purposes of the learner(s),o organising and making available learning resources,o balancing intellectual and emotional components of learning, ando sharing feelings and thoughts with learners but not dominating,o effectively becoming the manager of the processes or the facilitator

(Knowles, 1999).

An adult class is a community of learners providing important mutual support. Tapping this energy and creating a learning environment in which students feel confident to speak and learn freely is part of the skill of the adult educator. This applies both to individual learners and where possible, to groups where they can also learn collectively from each other.

The learning environment – social and physical – has many impacts on individual and group learning processes. People require a degree of social and physical comfort to be receptive and engaged in learning. Structural elements such as seating arrangements, lighting, noise, lack of interruption etc need to be well considered and planned.

The learning context - ‘on-the-job’ training, and especially in specific work contexts, is highly valued because it is relevant, the new information and skills can be practiced and are directly applicable, and problems with knowledge transfer are reduced (McGill and Beaty, 1992).

It is important to start where people are at and where their interests are, rather than imposing an alien framework upon them. At the same time, the teacher takes them forward, and does not simply stay where they are. There is an element of negotiation and leadership as well as the essential ‘student-centredness’. Recognising and adapting to the fact that people have different learning styles is part of this flexibility.

Adults need to see the point of a particular learning experience, so the sessions should be personal, practical and problem-centred, not theoretical (Burns, 1995).

Learners vote with their feet. They will stay away if they are not motivated and involved. Participation is essential. Active learning that is seen as ‘relevant’, is a means to this (Cullen et al. 2002, p.29).

Additional features of adult learning (andragogy) are illustrated in descriptions of how it differs from childhood school-based learning (pedagogy), for example:

R&A Lockwood Consultants Feb 2007 62

Page 66: Captivate Literature Review (Id 3760)

Adult learners have different motivation to learn. Adult learners are less susceptible to ‘authority’ figures. Most adult learning is short-term with a specific learning goal in

mind, whether that be acquiring particular skills or building knowledge. Adult learners experience personal change and growth via

‘experiential learning’ (Knowles, 1990; Cross, 1981; Kolb, 1984; Rogers, 1973).

Other characteristics of the effective adult education experience have been identified as:

It places the learner at the centre of the enterprise. It develops a cooperative learning environment that involves the

learners in the planning process through Analyses of learner needs – being able to articulate needs and goals is

an important aspect of adult education planning (Malouf, 1993). However, it has also been noted that simply asking people what they want, may not produce the goals for a training module because their answers could be restricted by whatever notions they already have about learning – usually school-based education.

Development of learning objectives based on those needs. Program design incorporates sequential learning activities. Methods and resources are specifically designed to achieve the learning

objectives. The quality of the learning experience is evaluated with consideration of the

requirement for further learning.

From the trainer/instructor point of view a wide range of pointers emerge and have been variously listed in many resources and publications. Most of these are well known and published research has not added any significant new approaches. They can be used selectively as planning hints or checklist items to re-evaluate processes at various points of delivery. They include:

Be well prepared

Establish good rapport with individuals by using techniques which make people feel comfortable (use ice-breakers, social activites, competitions etc).

Engage with the learners at all stages of training. Aim to develop situations that promote confidence, security, and self-esteem of


Engage learners in planning training, workshops etc based on their particular needs, experiences, problems.

Use participants’ prior knowledge to build knowledge base for training. Plan alternative activities and choices dependent on knowledge and

experience. Focus on individual competency rather than qualification.

Give background information/exercises to orient individuals

Conduct the workshop in a non-distracting but relevant environment. Develop a cooperative learning environment. Provide low-risk activities in small group settings.

Use collaborative, authentic problem-solving activities, typical of those in the workplace.

Anticipate problems applying the new ideas to their setting - offer suggestions

R&A Lockwood Consultants Feb 2007 63

Page 67: Captivate Literature Review (Id 3760)

Structure learning in a sequence of activities by breaking learning modules into logical small ‘chunks’.

Plan for building individual success incrementally. Plan to consolidate knowledge/progress at the end of each activity - give brief

overviews, summaries, examples.

Be sensitive to feedback without labouring the point. Adjust the pacing and timing when necessary. Allow time to hear and encourage individual stories. Link these to current target to keep ‘on track’. Encourage participants input in order to ‘adjust’ agenda.

Link theory to practice eg by using stories. Allow time for self-reflection within the training. Help participants become more effective and confident through guided practice

and establishing routines. Discuss and help learners plan for direct application of the new information. Address issues and problems in ‘natural’ settings by some follow-up and

support following training – eg via e-mail chat boards, access to expert opinion, mentoring by others recognised for their expertise in the field (eg more ‘advanced’ students, senior instructors etc.).

provide opportunity for more advanced learning experiences. Provide participants with material to work with eg Work manual, Notes Provide participants with further information, contacts etc

In addition to face-to-face training, the growing use of modern electronic technology has allowed a new form interactivity between instructor and learner. It also allows individuals to work in their preferred time and at their own pace, to develop networks, and reach more remote regions where training would not normally be available. The Australian Flexible Learning Framework (2006) supports e-learning opportunities, especially through the E-learning for Creative Community Partnerships’ program. However, despite the vast changes in learning technology, many discussions indicate that while it can be used to facilitate learning, there is no single ‘right way’ to integrate technology into the learning context. The key is to provide the most effective learning content and environment for particular individuals and groups. This suggests the need to regularly revisit the basic principles and applications of long held understandings about adult learning.

Where learning materials are to be developed, general and adult learning principles suggest some basic considerations for any form of package include the following (including examples relevant to inclusive sport/recreation):

Examine and where possible build on learning from existing training packages (eg Active and Able Disability Awareness Resource, Disability Education Program, Access Audits Australia) and any evaluations of their use. Use of jargon-free, concise, simple non-medical, terminology which is related to where support/care/thought will be required. Application to the particular setting - eg sport and recreation access issues, demands, issues/problems. Emphasis on the positive outcomes eg engagement, participation, and social/health benefits rather than on disability. Lack of reliance on/assumptions about competency/access to technology eg internet CD etc. Where possible use real-world examples and allow practice in realistic relevant settings Appropriate instructional design.

R&A Lockwood Consultants Feb 2007 64

Page 68: Captivate Literature Review (Id 3760)

Appropriate presentation format suitable for a range of learners, preferences, abilities and purposes. Provision for updates.

Further resources:

Adult Learning Australia: Campaign for Learning (UK): National Institute for Adult Continuing Education (NIACE – UK): The All Wales Adult Learners' Forum: Adult Learners' Forum in Edinburgh: The Centre for Research on the Wider Benefits of Learning (UK): Adult Learners Week (Australia): Learning Communities Catalyst (Australia): Australian National Training Authority (ANTA): Learning Circles Australia: Study Circles Resource Centre (USA): National Link of Neighbourhood Houses and Community Learning

Centres across Australia:

R&A Lockwood Consultants Feb 2007 65

Page 69: Captivate Literature Review (Id 3760)


S2. Disability and inclusion: Models and developments Abberley, P. (1993). The Significance of the OPCS Disability Surveys. In M. Oliver, M.

(Ed.), Social Work: Disabled People and Disabling Environments. London: Jessica Kingsley Publishers.

Australian Sports Commission. (2005). Disability Education Presenter Kit: Module 2: Getting Ready for School: Inclusion. Australia, Canberra: Author.

Bickenbach, J.E., Chatterji, S., Baddley, E.N., Ütsün, T.B. (1999). Models of disablement, universalism and the international classification of impairments, disabilities and handicaps, Social Science and Medicine, 48. 1173-1187.

Brisenden, S. (1998). Independent living and the medical model. In T. Shakespeare (Ed.), The Disability Reader: Social Science Perspectives. London: Cassell.

Committee reports of the Taylor Committee into a social security system for South Africa. (2006). Social security for people with disabilities. Committee Report No 9 . Retrieved January 10 2007, from,

Crow, L. (1996). Renewing the Social Model of Disability. Coalition (July), 5-9.

Dahl, T.H. (2002). International classification of functioning, disability and health: An introduction and discussion of its potential impact on rehabilitation services and research. Journal of Rehabilitation Medicine, 34, 201-204.

Davis, A. (1989). From Where I Sit. London: Triangle.

Disability Discrimination Act 1992. Retrieved January 11 2007, from,

Disability Services Act 1993. Retrieved January 4 2007, from,

Disabled People International. (1982). Proceedings of the First World Congress. Singapore: Author.

Driedger, D. (1988). The Last Civil Rights Movement. London: Hurst and Co.

Finkelstein, V., & Stuart, O. (1996). Developing new services. In G. Hales (Ed.), Beyond Disability: Towards an Enabling Society. London: Sage Publications.

Goffman, E. (1963). Stigma: Notes on the Management of a Spoiled Identity. New York: Simon and Schuster.

R&A Lockwood Consultants Feb 2007 66

Page 70: Captivate Literature Review (Id 3760)

Gray, D.B., Hendershot, G.E. (2000). The ICIDH-2: Developments for a new era of outcomes research. Archives of Physical Medicine and Rehabilitation, 81(2), S10-S14.

Imrie, R. (2004). Demystifying disability: A review of the International Classification of Functioning. Disability and Health Sociology of Health & Illness, 26 (3), 1–19.

Keys, C., & Dowrick, P. (2001). People with Disabilities. Empowerment and Community Action. New York: Haworth Press.

Marks, D. (1999). Disability: Controversial Debates and Psychosocial Perspectives. London: Routledge.

Morris, J. (1991). Pride against Prejudice. London: Women's Press.

Nagi, S. (1965). Some conceptual issues in disability and rehabilitation. In M. Sussman (Ed.), Sociology and rehabilitation (100-113). Ohio: Ohio State University Press.

Newell, C. (2004). Encountering disability in Australian Society. Retrieved January 10 2007, from,

Oliver, M. (1990). The Politics of Disablement. London: The MacMillan Press Limited.

Pfeiffer, D. (1998). The ICIDH and the need for its revision. Disability and Society, 13(4), 503–23.

Shakespeare, T. (1992). A Response to Liz Crow. Coalition, (September), 40-42.

The National Centre for Physical Activity and Disability. (2007). Retrieved January 12 2007, from,

van der Ploeg, H., van der Beek, A., van der Woude, L., & van Mechelen W. (2004). Physical Activity for People with a Disability: A conceptual model. Sports Med, 34(10), 639-649.

Williams, G. (1991). Disablement and the ideological crisis in health care. Social Science and Medicine, 33(4), 517-524.

Wood, P. (1980). International Classification of Impairments, Disabilities and Handicaps. Geneva: World Health Organisation.

World Health Organization (2002). Towards a Common Language for Functioning, Disability and Health: ICF . Retrieved January 10 2007, from,

S3. Local government and inclusive sport and recreation

Access Audits Australia. (2006). Access for All. Retrieved January 15 2007, from,

Australian Bureau of Statistics, (2002). Sport and Recreation Funding by Government, Australia, 2000-01 (No. 4147.0). Canberra, Australian Capital Territory.

R&A Lockwood Consultants Feb 2007 67

Page 71: Captivate Literature Review (Id 3760)

Australian Bureau of Statistics. (2004a). Disability Ageing and Carers, Australia: Summary of Findings (No. 4430.0). Canberra, Australian Capital Territory.

Australian Bureau of Statistics. (2004b). Australian Social Trends (No. 4102.0). Canberra, Australian Capital Territory.

Australian Bureau of Statistics. (2004c). Australia Now, Australian Social Trends, Family and Community: Social interactions outside the home. Retrieved January 11 2007, from,[email protected]/0/0478185eb37fe097ca256e9e00277edc?.

Australian Bureau of Statistics. (2006). Australian Social Trends 2005. (No. 4102.0). Canberra, Australian Capital Territory.

Australian Bureau of Statistics. (2006). Sport and Physical Recreation Participation Among Persons with a Disability: Some Data from the 2002 General Social Survey. Canberra, Australian Capital Territory. Author.

Australian Institute of Health and Welfare. (2003). Australia's welfare 2003. Canberra, Australian Capital Territory: Author.

Australian Local Government Association (2007). Intergovernmental agreement (IGA) on cost shifting. Retrieved January 11 2007, from,

Australian Local Government Association. (2006). Age-friendly built environments: Opportunities for Local Government. ALGA. Research Report. Retrieved January 2007, from,

Australian Productivity Commission. (2005). Economic Implications of an Ageing Australia. Canberra: Australian Capital Territory. Author.

Boslaugh, S.E., & Andresen, E.M. (2006). Correlates of physical activity for adults with disability. Prev Chronic Dis. Retrieved January 11 2007, from, jul/05_0207.htm.

Brown, D., Yore, M., Ham, S., & Macera, C. (2005). Physical activity among adults >or=50 yrs with and without disabilities, BRFSS 2001. Med Sci Sports Exerc. 37(4), 620-629.

Caring is a Health Hazard. (2006). Independent Living centre and Office for Seniors’ Interests and Volunteering. Retrieved 15 January 2007, from,

Commonwealth Grants Commission. (2001). Review of the Operation of the Local Government Act 1995. Canberra: Author.

Commonwealth Grants Commission. (2004). 2002-2003 Report on the Operation of the Local Government (Financial Assistance) Act 1995. Canberra, Australian Capital Territory: Author. Retrieved January 12 2007, from,

R&A Lockwood Consultants Feb 2007 68

Page 72: Captivate Literature Review (Id 3760)

Crapps, J., Langone, J. & Swaim, S.(1985) Quality And Quantity Of Participation In Community Environments By Mentally Retarded Adults Education, And Training. Mental Retardation. 20(2), 123-9.

Craven, G., McKenzie, F. & McCullagh, G. (2006). Systemic Sustainability Study: In your hands: Shaping the future of local government in Western Australia. Perth.

Dempsey, I. (1996) Recreation and people with a disability: some issues and misconceptions, Australian Disability Review. 4, 41-49.

Dempsey, I. & Simmons, B. (1995) National Profile Of Away From Home Leisure Activities Of People With A Disability. Australian Leisure, 6(4), 22-25

Disability Services Commission (n.d.). Facts and figures. Retrieved January 6 2007, from,

Department of Health and Aging. (28 July, 2004). Age-friendly built environments. Paper presented to the Community and Disability Services Ministers’ Conference, Canberra.

Dollery, B., Crase, L., & Byrnes, J. (2006). Overall Local Council Sustainability in Australian Local Governmen t. Retrieved January 10 2007, from,

Dollery, B., Marshall, N., & Worthington, A. (2003). Reshaping Australian Local Government: Finance, Governance and Reform. Sydney: University of New South Wales Press.

Edgecombe, S. & Crilley, G. (2002). Improving participation for South Australians with a disability in sport, arts, and other recreational choices. Adelaide: CERM.

Fujiura, G.T. (2007 ). Emerging Trends in Disability . Retrieved January 9 2007, from,

Fujiura, G.T. & Rutkowski-Kmitta. (2001). Counting disability. In G. Albrecht, K. Seelman, & M. Bury (Eds). Handbook of disability studies. Thousand Oaks, CA: Sage.

Hammel J, Jones R , Gossett A & Morgan E 2006. Examining Barriers and Supports to Community Living and Participation After a Stroke from a Participatory Action Research Approach. Occupational Therapy Innovations, 13(3), 43 – 58.

Hanley, E. (1996). Working With The People To Develop The Communities Of Brisbane. Brisbane North Region Sport, Recreation And Fitness Community Needs Assessment Of People With Disabilities. Brisbane: Department of Community Development.

Hillary Commission & Workbridge Inc. (1994). Listening To People With Disabilities: Research Into Participations and Attitudes To Sport, Fitness And Leisure And Employment. Report. New Zealand.

Lockwood R, Lockwood A, 1991. Recreation priorities for people with disabilities in Western Australia. Australian Journal of Leisure and Recreation, 1 (3) 7-13.

R&A Lockwood Consultants Feb 2007 69

Page 73: Captivate Literature Review (Id 3760)

McCormack, G., Milligan, R., Giles-Corti, B., and Clarkson, J.P. (2003). Physical activity levels of Western Australian adults 2002: Results from the adult physical activity survey and pedometer study. Perth, Western Australia: Western Australian Government.

National Community Services Data Committee. (2004). National community services data dictionary. Version 3. Canberra: Australian Institute of Health and Welfare.

NICAN. (1999). National policy on recreation for people with a disability. Canberra: NICAN. Retrieved January 13 2007, from, .

Ozdowski, S. (2003, 29 July). Speech by HEREOC Acting Commissioner presented at Local Government Community Services Conference - Just and Vibrant Communities, Townsville, Queensland. Retrieved 12 January 2007, from,

Packer, T., Briffa, T., Downs, J., Ciccarelli, M., & Passmore, D. (2006). The Physical Activity Study of Children and Adolescents with a Disability. Perth: Curtin University of Technology.

Patterson Market Research. (1999). The views of Western Australians living in the regions: The State Report. A Study Undertaken for Department of Commerce and Trade, Regional Development Council, Ministry for Planning, and Regional development Commissions. Perth: Author.

Rosen, J. And Burchard,S. (1990) Community Activities And Social Support Networks Education, And Training. Mental Retardation 25(2), 193-204

Sport England (2001). Disabled Young Peoples Participation in Sport 2001. York, England: Social Policy Research Unit, University of York.

Sport England. (2002). Access for Disabled People. London: Sport England.

Sturm, R., Ringel, S., & Andreyeva, T. (2004). Increasing Obesity Rates And Disability. Trends Health Affairs, 23(2), 199-205.

S4. Benefits of physical activity for people with physical disabilities

Agre, J.C. (1995). The role of exercise in the patient with post-polio syndrome. Ann N Y Acad Sci. 25(753), 321-34.

Allen, G.M., Gandevia, S.C., Neering, I.R., Hickie, I., Jones, R., & Middleton, J. (1994). Muscle performance, voluntary activation and perceived effort in normal subjects and patients with prior poliomyelitis. Brain, 117(4), 661-70.

American Academy of Pediatrics Section on Cardiology and Cardiac Surgery. (2005). Cardiovascular health supervision for individuals affected by Duchenne or Becker muscular dystrophy. Pediatric, 116(6), 1569-73.

R&A Lockwood Consultants Feb 2007 70

Page 74: Captivate Literature Review (Id 3760)

Andersson, C., Grooten, W., Hellsten, M., Kaping, K., & Mattsson, E. (2003). Adults with cerebral palsy: walking ability after progressive strength training. Dev Med Child Neurol., 45(4), 220-8.

Ansved, T. (2003). Muscular dystrophies: influence of physical conditioning on the disease evolution. Curr Opin Clin Nutr Metab Care, 6(4), 435-9.

Australian Bureau of Statistics. (2006). National Health Survey: Summary of Results, Australia, 2004-05, (No. 4364.0). Canberra, Australian Capital Territory:Author.

Australian Institute of Health and Welfare. (2004). Australia's Health, (No. 44). Canberra, Australian Capital Territory: Author.

Australian Institute of Health and Welfare. (2006). Australia's Health, (No. 73). Canberra, Australian Capital Territory: Author.

Bauman, A., Owen, N., & Rushworth, R.L. (1999). Recent trends and socio-demographic determinants of exercise participation in Australia. Community Health Studies, 14, 19-26.

Bergh, U., Kanstrup, I.L. & Ekblom, B. (1976). Maximal oxygen uptake during exercise with various combinations of arm and leg work. J Appl Physiol, 41, 191–196.

Blundell, S.W., Shepherd, R.B., Dean, C.M., Adams, R.D., & Cahill, B.M. (2003). Functional strength training in cerebral palsy: a pilot study of a group circuit training class for children aged 4-8 years. Clin Rehabil., 17(1), 48-57.

Brehm, M.A., Becher, J., & Harlaar, J. (2007). Reproducibility evaluation of gross and net walking efficiency in children with cerebral palsy. Dev Med Child Neurol. 49(1), 45-8.

Bull, F., Milligan, R., Rosenberg, M., & MacGowan, H. (2000). Physical Activity Levels of Western Australian Adults 1999. Perth: Western Australia: Health Department of Western Australia and Sport and Recreation Way2Go.

Brown, T.R. & Kraft, G.H. (2005). Exercise and rehabilitation for individuals with multiple sclerosis. Phys Med Rehabil Clin N Am., 16(2), 513-55.

Centres for Disease Control and Prevention (2006). Healthy People 2010 Data Base: Focus Area 22- Physical Activity and Fitness. Retrieved 10 Jan 2007, from,

Chad, K.E., Bailey, D.A, McKay, H.A., Zello, G.A., & Snyder, R.E. (1999). The effect of a weight-bearing physical activity program on bone mineral content and estimated volumetric density in children with spastic cerebral palsy. Jnl of Pediatrics, 135(1), 115-17.

Clyman, B. (2001). Exercise in the treatment of osteoarthritis. Curr Rheumatol Rep., 3(6), 520-23.

Cooper, R.A., Horvath, S.M., Bedi, J.F., Drechsler-Parks, D.M., & Williams, R.E. (1992). Maximal exercise response of paraplegic wheelchair road racers. Paraplegia, 30, 573–581.

Dallmeijer, A.J., van der Woude, L.H., Hollander, P.A., & Angenot, E.L. (1999). Physical performance in persons with spinal cord injuries after discharge from rehabilitation. Med Sci Sports Exerc., 31, 1111–1117.

R&A Lockwood Consultants Feb 2007 71

Page 75: Captivate Literature Review (Id 3760)

Dallmeijer, A. J. & van der Woude, L. H . (2001). Health related functional status in men with spinal cord injury: relationship with lesion level and endurance capacity. Spinal Cord, 39, 577–583.

Damiano, D.L., & Abel, M.F. (1998). Functional outcomes of strength training in spastic cerebral palsy. Arch Phys Med Rehabil., 79(2), 119-25.

Damiano, D.L., Vaughan, C.L., & Abel, M.F. (1995). Muscle response to heavy resistance exercise in children with spastic cerebral palsy. Dev Med Child Neurol., 8, pp.731-9.

Darrah, J., Wessel, J., Nearingburg, P., & O’Connor, M. (1999). Evaluation of a community fitness program for adolescents with cerebral palsy. Pediatr Phys Ther., 11(18), 18-23.

Devine, M.A. (2004). Being a 'Doer' Instead of a 'Viewer': The Role of Inclusive Leisure Contexts in Determining Social Acceptance for People with Disabilities. Journal of Leisure Research, 36(2), 137-60.

Dodd, K.J., Taylor, N.F., Denisenko, B. & Prasad, D.S. (2006). A qualitative analysis of a progressive resistance exercise programme for people with multiple sclerosis. Disabil Rehabil. 28(18), 1127-34.

Devine, M. A., & Wilhite, B. (2000). Meaning of disability: Implications for inclusive leisure services for youth with and without disabilities. Journal of Parks and Recreation Administration, 18(3), 35-52.

Devine, M.A., S. Malley, K. Sheldon, J. Dattilo, & D.L. Gast (1997). Promoting Initiation of Community Leisure Participation for Adults with Mental Retardation. Education and Training in Mental Retardation and Developmental Disabilities, 32(3) 241-254.

Dodd, K.J., Taylor, N.F., & Graham, H.K. (2004). Strength Training Can Have Unexpected Effects on the Self-Concept of Children with Cerebral Palsy. Pediatr Phys Ther. 16(2), 99-105.

Dodd, K.J., Taylor, N.F. & Damiano, D.L. (2002). A systematic review of the effectiveness of strength-training programs for people with cerebral palsy. Arch Phys Med Rehabil. 83(8), 1157-64.

Dodd, K.J., Taylor, N.F., & Graham, H.K. (2003). A randomized clinical trial of strength training in young people with cerebral palsy. Dev Med Child Neurol. 45(10), 652- 7.

Dodd, K.J. & Taylor, N.F. (2005). Strength training for young people with cerebral palsy (DVD and booklet). Melbourne, COMET La Trobe University.

Egger, G., Donovan, R., Swinburn, B., Giles-Corti, B. & Bull, F. (1999). Physical Activity Guidelines for Australians - Scientific Background Report. Perth: University of Western Australia and The Centre for Health Promotion and Research.

Ettinger, W.H. (1998) Physical activity, arthritis, and disability in older people. Clin Geriatr Med. 14(3), 633-40.

Focht, B.C. (2006). Effectiveness of exercise interventions in reducing pain symptoms among older adults with knee osteoarthritis: a review. Journal of Aging and Physical Activity, 14(2), 212-235.

R&A Lockwood Consultants Feb 2007 72

Page 76: Captivate Literature Review (Id 3760)

Grange, R.W., & Call, J.A. (2007). Recommendations to define exercise prescription for Duchenne Muscular Dystrophy. Exerc Sport Sci Rev. 35(1), 12-7.

Green, F. P., & DeCoux, V. (1994). A procedure for evaluating the effectiveness of a community recreation program. Therapeutic Recreation Journal, 28(1), 41-47.

Haisma, J.A., van der Woude, L. H. V., Stam1, H. J., Bergen, M. P., Sluis ,T. A .R., & Bussmann, J. B. J. (2006). Physical capacity in wheelchair-dependent persons with a spinal cord injury: a critical review of the literature. Spinal Cord, 44, 642–652.

Heath, G. & Fentem, P. (1997). Physical activity among persons with disabilities - a public health perspective. Exerc Sport Sci Rev. 25, 195-234.

Hjeltnes, N. & Jansen, T. (1990). Physical endurance capacity, functional status and medical complications in spinal cord injured patients with long-standing lesions. Paraplegia. 28, 428-432.

Hooker, S.P., Greenwood, J.D., Hatae, D.T., Husson, R.P., Matthiesen, T.L. & Waters, A.R. (1993). Oxygen uptake and heart rate relationship in persons with spinal cord injury. Med Sci Sports Exerc., 25, 1115–1119.

Hurley, M.V., Mitchell, H.L. & Walsh, N. (2003). In osteoarthritis, the psychosocial benefits of exercise are as important as physiological improvements. Exerc Sport Sci Rev. 31(3),138-43.

Jacobs, P.L., Nash, M.S., & Rusinowski, J.W. (2001). Circuit training provides cardiorespiratory and strength benefits in persons with paraplegia. Med Sci Sports Exerc, 33, 711–717.

Janssen, T.W., Dallmeijer, A.J., Veeger, D.J., & van der Woude, L.H. (2002). Normative values and determinants of physical capacity in individuals with spinal cord injury. J Rehabil Res Dev, 39, 29–39.

Kariyawasam, J., Phillips, S. & Blackmore, M. (2006). Effects of a circuit training program for children with cerebral palsy: A case study presentation. Perth: Cerebral Palsy Association of Western Australia.

Kelley, A., Garshick E., Gross, E.R., Lieberman, S.L, Tun, C.G., & Brown, R. (2003). Spirometry testing standards in spinal cord injury. Chest,123, 725–730.

Kilmer, D.D. (1998). The role of exercise in neuromuscular disease. Med Rehabil Clin N Am. 9(1), 115-25.

Klein, M.G., Whyte, J., Keenan, M.A., Esquenazi, A., & Polansky, M. (2000). Changes in strength over time among polio survivors. Arch Phys Med Rehabil. 81(8), 1059-64.

Knechtle, B., Muller, G., Willmann, F., Eser, P. & Knecht, H. (2003). Comparison of fat oxidation in arm cranking in spinal cord-injured people versus ergometry in cyclists. Eur J Appl Physiol, 90, 614–619.

McDonald, C.M. (2002). Physical activity, health impairments, and disability in neuromuscular disease. Am J Phys Med Rehabil. 81(11), 108-20.

May, L.A., Burnham, R.S., & Steadward, R.D. (1997). Assessment of isokinetic and hand-held dynamometer measures of shoulder rotator strength among

R&A Lockwood Consultants Feb 2007 73

Page 77: Captivate Literature Review (Id 3760)

individuals with spinal cord injury. Arch Phys Med Rehabil, 78, 251–255.

McBurney, H., Taylor, N.F., Dodd, K.J., & Graham, H.K. (2003). A qualitative analysis of the benefits of strength training for young people with cerebral palsy. Dev Med Child Neurol. 45(10), 658-63.

Miller, R.G. (2006). Fatigue and therapeutic exercise. J Neurol Sci. 15(242) 37-41.

Modell, S.J., Rider, R.A. & Menchetti, B.M. (1997). An exploration of the influence of educational placement on the community recreation and leisure patterns of children with developmental disabilities. Percept Mot Skills. 85(2), 695-704.

Morton, J.F., Brownlee, M., & McFadyen, A.K. (2005). The effects of progressive resistance training for children with cerebral palsy. Clin Rehabil. 19(3), 283-9.

Mossberg, K., Willman, C., Topor, M.A., Crook, H., & Patak, S. (1999). Comparison of asynchronous versus synchronous arm crank ergometry. Spinal Cord, 37, 569–574.

Mostert, S. & Kesselring, J. (2002). Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple sclerosis. Mult Scler. 8(2), 161-8.

Muraki, S., Tsunawake, N., Tahara, Y., Hiramatsu, S., & Yamasaki, M. (2000). Multivariate analysis of factors influencing physical work capacity in wheelchair-dependent paraplegics with spinal cord injury. Eur J Appl Physiol., 81, 28–32.

National Community Services Data Committee. (2006). National community services data dictionary. Version 4. Canberra, Australian Capital Territory: AIHW.

Nollet, F., Beelen, A., Sargeant, A.J., de Visser, M., Lankhorst, G.J., & de Jong, B.A. (2001). Submaximal exercise capacity and maximal power output in polio subjects. Arch Phys Med Rehabil. 82(12), 1678-85.

Nollet, F. & Beelen, A. (1999). Strength assessment in postpolio syndrome: validity of a hand-held dynamometer in detecting change. Arch Phys Med Rehabil , 80, 1316–23.

Noreau, L., & Vachon, J. (1998). Comparison of three methods to assess muscular strength in individuals with spinal cord injury. Spinal Cord, 36, 716–723.

Noreau, L., Shephard, R.J., Simard, C., Pare, G. & Pomerleau, P. (1993). Relationship of impairment and functional ability to habitual activity and fitness following spinal cord injury. Int J Rehabil Res., 16, 265–275.

Noreau, L. & Shephard, R.J. (1992). Return to work after spinal cord injury: the potential contribution of physical fitness. Paraplegia, 30, 563–572.

Obrusnikova, I., Valkova, H., & Block, M.E. (2003). Impact of inclusion in general physical education on students with disabilities. Adapted Physical Activity Quarterly, 20, 230-246.

O’Connor, P. (2002). Spinal Cord Injury Australia 2000-2001. Canberra, Australian Capital Territory: AIHW.

Petajan, J. H., Gappmaier, E., White, A.T., Spencer, M.K., Mino, L. & Hicks, R. (1996). Impact of aerobic training on fitness and quality of life in multiple sclerosis. Ann

R&A Lockwood Consultants Feb 2007 74

Page 78: Captivate Literature Review (Id 3760)

Neurol. 39(4), 422-23.

Physical Disability Council of Australia. (2007). Definition of Physical Disability in Australia. Retrieved January 8 2007, from,

Phillips, B.A., Lo, S.K., & Mastaglia, F.L. (2000). Muscle force measured using ‘break’ testing with a hand-held myometer in normal subjects aged 20–69 years. Arch Phys Med Rehabil. 81, 653–661.

Raymond, J., Davis, G.M., & van der Plas, M. (2002). Cardiovascular responses during submaximal electrical stimulation-induced leg cycling in individuals with paraplegia. Clin. Physiol. and Funct. Imaging., 22(2), 92–98.

Rimmer, J., Riley, B. & Rubin, S. (2001). A new measure for assessing the physical activity behaviors of persons with disabilities and chronic health conditions: the Physical Activity and Disability Survey. Am J Health Promot. 16(1), 34-42.

Rimmer, J.H., Braddock, D., & Pitetti, K.H. (1996). Research on physical activity and disability: an emerging national priority. Med.Sci.Sports Exerc, 28(8), 1366-1372.

Rimmer, J.H., Riley,B., Wang, E., & Rauworth,A. (2004). Development and validation of AIMFREE: Accessibility instruments measuring fitness and recreation environments. Disability and Rehabilitation. 26(18), 1087-1095.

Rimmer, J.H., Riley, B., Wang, E., Rauworth, A., & Jurkowski, J. (2004). Physical activity participation among persons with disabilities: Barriers and facilitators. American Journal of Preventive Medicine. 26(5), 419-425.

Romberg, A., Virtanen, A., Ruutiainen, J., Aunola, S., Karppi S.L., Vaara, M., Surakka, J., Pohjolainen, T., & Seppanen, A. (2004). Effects of a 6-month exercise program on patients with multiple sclerosis: a randomized study. Neurology, 14(63), 2034-8.

Rose, J., & McGill, K.C. (2005). Neuromuscular activation and motor-unit firing characteristics in cerebral palsy. Dev Med Child Neurol. 47(5), 329-36.

Shields, N., Murdoch, A., Loy, Y., Dodd K.J., & Taylor. N.F. (2006). A systematic review of the self-concept of children with cerebral palsy compared with children without disability. Dev Med Child Neurol. 48(2), 151-7.

Schleien, S., Hornfeldt, D., & McAvoy, L. 1994. Integration and environmental/outdoor education: The impact of integrating students with severe developmental disabilities on the academic performance of peers without disabilities. Therapeutic Recreation Journal, 28, 25-34.

Schleien, S., Fahnestock, M., Green, R., & Rynders, J. (1990). Building positive social networks through environmental interventions in integrated recreation programs. Therapeutic Recreation Journal, 4, 42-52.

Scelza, W.M., Kalpakjian, C.Z., Zemper, E.D., & Tate, D.G. (2005). Perceived barriers to exercise in people with spinal cord injury. Am J Phys Med Rehabil. 84(8), 576-83.

Spirduso, W.W., & Cronin, D.L. (2001). Exercise dose-response effects on quality of life and independent living in older adults. Medicine and Science in Sports and

R&A Lockwood Consultants Feb 2007 75

Page 79: Captivate Literature Review (Id 3760)

Exercise, 33(6), S598-S608.

Stephenson, J., Bauman, A., Armstrong, T., Smith, B., & Bellew, B. (2000). The Costs of Illness Attributable to Physical Inactivity in Australia: a preliminary study. Canberra: Public Health Division, Commonwealth Department of Health and Aged Care.

Stewart, M.W., Melton-Rogers, S.L., Morrison, S., & Figoni, S.F. (2000). The measurement properties of fitness measures and health status for persons with spinal cord injuries. Arch Phys Med Rehabil, 81, 394–400.

Stolwijk-Swuste, J.M., Beelen, A., Lankhorst, G.J., & Nollet, F. (2005). The course of functional status and muscle strength in patients with late-onset sequelae of poliomyelitis: a systematic review. Arch Phys Med Rehabil. 86(8), 1693-701.

Taylor, W.C., Baranowski, T., & Young D.R. (1998). Physical activity interventions in low-income, ethnic minority, and populations with a disability. American Journal of Preventative Medicine, 15, 334-343.

Tedroff, K., Knutson, L.M., Soderberg, G.L. (2006). Synergistic muscle activation during maximum voluntary contractions in children with and without spastic cerebral palsy. Dev Med Child Neurol. 48(10), 789-96.

Theisen D, Fornusek C, Raymond J, Davis GM. 2002. External power output changes during prolonged cycling with electrical stimulation. J Rehabil Med. 34(4), 171-5.

Unger, M., Faure ,M., & Frieg, A. (2006). Strength training in adolescent learners with cerebral palsy: a randomized controlled trial. Clin Rehabil. 20(6), 469-77.

van der Linden, M.L., Aitchison, A.M., Hazlewood, M.E., Hillman, S.J., & Robb, J.E. (2004). Test-Retest repeatability of gluteus maximus strength testing using a fixed digital dynamometer in children with cerebral palsy. Arch Phys Med Rehabil. 85(12), 2058-63.

Washburn, R.A., Zhu, W., McAuley, E., Frogley, M., & Figoni, S.F. (2002).The physical activity scale for individuals with physical disabilities: development and evaluation. Arch Phys Med Rehabil., 83(2), 193-202.

White, L.J. & Dressendorfer, R.H. (2004). Exercise and multiple sclerosis. Sports Med. 34(15), 1077-100.

Willen, C., Cider, A., & Sunnerhagen, K.S. (1999). Physical performance in individuals with late effects of polio. Scand J Rehabil Med. 31(4), 244-9.

Whiteneck, G., Meade, M.A., Dijkers, M., Tate, D.G., Bushnik, T. & Forchheimer, M.B. (2004). Environmental factors and their role in participation. Arch. phys. med. rehabil., 85(11), 1793-803.

World Health Organisation. (2006a). Chronic Disease Information Sheets: Physical Activity. Retrieved February 12 2007, from,[email protected]/productsbyCatalogue/71AB5A496A0B30CACA25724A00108DB6?OpenDocument

World Health Organisation. (2006b). Move for Health: Sedentary lifestyle: a global public health problem. Retrieved February 12 2007, from,

R&A Lockwood Consultants Feb 2007 76

Page 80: Captivate Literature Review (Id 3760)

Yekutiel, M., Brooks, M., Ohry, A., et al. (1989). The prevalence of hypertension, ischemic heart disease and diabetes in traumatic spinal cord injured patients and amputees. Paraplegia, 27, 58-62.

S5. Barriers and enablers to participation/inclusion

Bedini, L. & Henderson, K. (1994). Women with disabilities and the challenges to leisure service providers. Journal of Park and Recreation Administration, 12(1), pp. 17-34.

Bedini, L. A. (2000). "Just sit down so we can talk": perceived stigma and community recreation pursuits of people with disabilities. Therapeutic Recreation Journal, 34, 55 - 68.

Cormack, E. (1999). Australian Community Sport and Recreation at a Glance. Canberra: Australian Sports Commission.

Crawford, D. & Godbey, G. (1987). Reconceptualising barriers to family leisure. Leisure Sciences, 9, 119-27.

Crawford, D., Jackson,E., & Godbey, G. (1991). A hierarchical model of leisure constraints. Leisure Sciences, 13, 309-20.

Devine, M. & Lashua, B. (2002). Constructing social acceptance in inclusive leisure contexts: the role of individuals with disabilities. Therapeutic Recreation Journal. 36(1), 65-83.

Devine, M. A. & Dattilo, J. (2000). Social Acceptance and Leisure Lifestyles of People with Disabilities. Therapeutic Recreation Journal, Vol.34, No.1, 306-322.

Devine, M. A., & Kotowski, L. (1999). Inclusive leisure services: Results of a national survey of park and recreation departments. Journal of Park and Recreation Administration, 17(4), 56-72.

Downs, J., Briffa, T. (2004). Levels of physical activity in children with disabilities: A review of the literature and mapping study of organizations in Western Australia. Perth: Therapy Focus Inc.

Finch, N. (2001 ). Disability Survey 2000: Young People with a Disability and Sport. Retrieved January 2007 from .

Fletcher, M. (2005). Barriers to respite, in-home support and recreation within the Town of Victoria Park: a Community Development approach: Summary Report. Perth: Town of Victoria Park.

French D. & Hainsworth, J. (2001). 'There aren't any buses and the swimming pool is always cold!': obstacles and opportunities in the provision of sport for disabled people. Managing Leisure, 6(1) 35-49.

Hart, J. (1971). The inverse care law. The Lancet: February. Retrieved January 20 2007, from,

R&A Lockwood Consultants Feb 2007 77

Page 81: Captivate Literature Review (Id 3760)

Jackson, E. (1988). Leisure constraints: A survey of past research. Leisure Sciences. 110, 203-215.

Johnson, J. (2000). The Aspirations of People With a Disability Within an Inclusive Victorian Community. Melbourne: DisAbilty Services Victoria, Department of Human Services.

King, G., Law, M., King, S., Rosenbaum, P., Kertoy, M.K. & Young, N. (2003). A Conceptual Model of the Factors Affecting the Recreation and Leisure Participation of Children with Disabilities. Physical and Occupational Therapy in Pediatrics, 23(1), 63-90.

Kinne, S., Patrick, D.L., & Maher, E.J. (1999). Correlates of exercise maintenance among people with mobility impairments. Disabil Rehabil. 21(1), 15-22.

Lockwood, A.D., & Lockwood, R.J. (1997). Training needs of community-based workers who deliver sport, recreation, leisure and fitness services to people with disabilities. Australian Disability Review. 2, 10-19.

Lockwood, A.D., and Lockwood, R.J. (1996). Non involvement in physical activity: Hidden barriers and disabilities. Australian Disability Review. 4(96), 50-58.

Lockwood, R. & Lockwood, A. (1991). Recreation priorities for people with disabilities in Western Australia. Report to The Gordon Reid Foundation, Lotteries Commission of Western Australia. Perth: Author.

MacDougall, C., Cooke, R., Owen, N., Willson, K., & Bauman, A. (1997). Relating physical activity to health status, social connections and community facilities. Aust N Z J Public Health. 21(6), 557-8.

McDevitt, J., Snyder, M., Miller, A., & Wilbur, J. (2006). Perceptions of barriers and benefits to physical activity among outpatients in psychiatric rehabilitation. J Nurs Scholarsh. 38(1), 50-5.

Municipal Association of Victoria. (2005). Access on Line: Community Planning and Services. Retrieved January 16 2007, from, .

National Centre for Physical Activity and Disability. (2006a). Providing Inclusive Recreation Opportunities: The Cincinnati Model . Retrieved January 20 2007, from,

National Centre for Physical Activity and Disability. (2006b). A Community Inclusion Model: City of Reno. Retrieved January 20 2007, from,

National Centre on Physical Activity and Disability (2006). Fact Sheets. Retrieved January 18 2007, from,

Patterson, I., Hanley, E. & Auld, C. (1996). Constraints to participation in sport and recreation activities for people with disabilities: a study. Australian Disability Review, 2, 38-52.

Rimmer, J., Riley, B., Wang, E., & Rauworth, A. (2005). Accessibility of health clubs for people with mobility disabilities and visual impairments. Am J Public Health, 95(11), 2022-8.

R&A Lockwood Consultants Feb 2007 78

Page 82: Captivate Literature Review (Id 3760)

Robinson, S., Hickson, F., & Strike, R. (2001). More than getting through the gate: The involvement of parents with a disability in their children’s school education in NSW. NSW: The Disability Council of NSW.

Schleien, S., Germ, P., & McAvoy, L. (1996). Inclusive community leisure services: Recommended professional practices and barriers encountered. Therapeutic Recreation Journal, 30(4), pp. 260-273.

SCOPE. (2005). 1 in 4 poll . Retrieved January 18 2007, from,

Shelley, P. (2002). The Contact a Family survey - Everybody here? Play and leisure for disabled children and young people. United Kingdom: Contact a Family.

Sport England. (1999). Young People and Sport national Survey 1999. London: Sport England.

S6. Inclusive practice: Community sport and recreation

ACROD. (2001). Report: Recreation Review Working Party . Retrieved December 13 2006, from,

Australian Local Government Association. (2005). Age-friendly built environments: Opportunities for local government. Retrieved February 12 2007, from,

Carter, M., & LeConey S. (2004). Therapeutic Recreation in the Community: An Inclusive Approach. Champaign, Illinois: Sagamore Publishing Inc.

Cormack, S. (1999). Australian Community Sport and Recreation at a Glance. Canberra: Australian Sports Commission. Retrieved January 6 2007, from, - 16k –

Crilley, G. & Murray, D. (2000, October 10). Active Australians? Rhetoric and Reality at Local Government Sports and Leisure Facilities. Paper presented at the 2000 Parks & Leisure Australia National Conference, Gold Coast, Queensland. Adelaide, South Australia: CERM Publications.

Department for Community Development. (2006). Contemporary Literature on Capacity Building and the Strengths Perspective and Good Practice Wisdom for the Capacity Building Strategic Framework 2005 to 2007. Author. Retrieved February 3 2007, from,

Hutchison, P., & McGill, J. (1998). Leisure, integration, and community. Concord, ON: Leisurability Publications, Inc.

Inclusive Fitness Initiative. (2006). The Inclusive Fitness Initiative. Retrieved February 14 2007, from, http:/

Lockwood, R., & Lockwood, A. (1999). Recreation and Disability in Australia. Perth, Western Australia: The University of Western Australia, DUIT Multimedia.

R&A Lockwood Consultants Feb 2007 79

Page 83: Captivate Literature Review (Id 3760)

Municipal Association of Victoria. (n.d.). Access Action On Line . Retrieved December 11 2006, from,

National Center on Accessibility (n.d.). (2007). Monographs. Retrieved January 11 2007, from,

Schleien, S.J., Ray, M.T., & Green, F.P. (1997). Community Recreation and People with Disabilities: Strategies for Inclusion. Baltimore: Paul H. Brookes Publishing Company.

Shelley, P. (2002). Everybody here? Play and leisure for disabled children and young people. A Contact a Family survey of families’ experiences in the UK. London: Contact a Family. Retrieved January 12 2007, from,

Sport and Recreation Victoria. (2007). Access for All: Access for All Abilities Program. Retrieved January 12 2007, from,

Victorian Centre for Multicultural Issues (1996). Recreation resource kit. Retrieved February 14 2007, from,

R&A Lockwood Consultants Feb 2007 80

Page 84: Captivate Literature Review (Id 3760)

S7. Adult learning

Axford, B. & Moyes, T. (2003). Lifelong Learning: an Annotated Bibliography. Department of Education, Science and Training . Retrieved January 10 2007, from,

Burns, R. (1995). The Adult Learner at Work. Sydney: Business & Professional Publishing.

Cross, K.P. (1981). Adults as Learners. San Francisco: Jossey-Bass.

Cullen, J., Hadjivassiliou, H., Hamilton, E., Kelleher, J., & Sommerlad, E. (2002). Review of current pedagogic research and practice in post-compulsory education and lifelong learning. London: Tavistock Institute. Retrieved January 10 2007, from,

Gardner, H. (1993). Frames of Mind: The theory of multiple intelligences. New York: Basic Books.

Gardner, H. (1999). Intelligence Reframed. Multiple intelligences for the 21st century. New York: Basic Books.

Knowles, M. (1999). The Adult Learner: A neglected species. Houston: Gulf Publishing Company.

Kolb, D. (1984). Experiential Learning as a Source of Learning and Development. Prentice Hall, Eaglewood Cliffs.

Leicester, M. & Field, J. (2000). Lifelong learning: education across the lifespan. London: Routledge Falmer.

Malouf, D. (1993). How to teach adults in a fun and exciting way. Sydney: Business & Professional Publishing.

McGill, I., & Beaty, E. (1992). What is action learning and how does it work? Action Learning: a practitioner’s guide. London: Kogan Page.

Rogers, J. (1973). Adult Learning. London: Penguin.

Smith, P. & Dalton, J. (2005). Getting to grips with learning styles. National Centre for Vocational Education and Research . Retrieved January 11 2007, from,

The Australian Flexible Learning Framework. (2006). Retrieved January 11 2007, from

R&A Lockwood Consultants Feb 2007 81