Community Exercise Programs

Getting Older adults OUTdoors (GO-OUT) Program

In this study we are evaluating the short-term and long-term effects of a 1-day educational workshop followed by a 10-week program of group, task-oriented outdoor walking training (the GO-OUT program) compared with the workshop and subsequent 10 weekly reminders, on increasing outdoor walking activity in older adults with difficulty walking outdoors. A secondary objective is to evaluate the effect of GO-OUT on self-reported outdoor walking, physical activity, lifespace mobility, participation, emotional health, HRQL, balance, leg strength, walking self-efficacy, walking speed, walking endurance, heart rate (HR) and blood pressure (BP).

Registration: http://www.clinicaltrials.gov. Unique identifier-NCT02339467

Knowledge Translation

Barclay R, Webber S, Ripat J, Grant T, Jones CA, Lix LM, Mayo N, van Ineveld C, Salbach NM. Safety and feasibility of an interactive workshop and facilitated outdoor walking group compared to a workshop alone in increasing outdoor walking activity among older adults: a pilot randomized controlled trial. Pilot and Feasibility Studies. https://doi.org/10.1186/s40814-018-0367-4

Salbach NM, Barclay R, Webber SC, Jones CA, Mayo N, Lix LM, Ripat J, Grant T, van Ineveld C, Chilibeck PD. A theory-based, task-oriented, outdoor walking programme for older adults with difficulty walking outdoors: protocol for the Getting Older Adults Outdoors (GO-OUT) randomised controlled trial. BMJ Open 2019;9:e029393. doi: 10.1136/bmjopen-2019-029393

Webber SC, Hahn F, Lix LM, Tittlemier BJ, Salbach NM, Barclay R. Accuracy of thresholds based on cadence and lifestyle counts per minute to detect outdoor walking in older adults with mobility limitations. Journal of Aging and Physical Activity 2020;28(5):782-786. Available from: 10.1123/japa.2019-0235.

Together in Movement and Exercise (TIME^TM) Program

The TIME^TM program is a group, task-oriented community-based exercise program that incorporates a healthcare-recreation partnership. In this partnership, health professionals, such as physical therapists or kinesiologists, train and provide ongoing support to fitness instructors who deliver the exercise program in community centres. The TIME^TM program is a licensed, evidence-based program that was developed by physical therapists at the Toronto Rehabilitation Institute-University Health Network.

In 2014, Dr. Salbach founded the Canadian Advisory Collaborative for TIME^TM (CAN-ACT). The CAN-ACT mission is to facilitate knowledge exchange to inform education, practice, research, and policy to advance the implementation, sustainability, and evolution of the TIME^TM program for people with balance and mobility limitations.

CAN-ACT Terms of Reference
CAN-ACT Members

Educating people with stroke about community-based exercise: Cross-sectional e-survey of physical therapy practice and perceived needs

Best practice guidelines recommend that health care professionals assess readiness to exercise in people with stroke, provide them with an appropriate exercise program, and educate them regarding the availability and accessibility of community resources such as community-based exercise programs

We conducted an online survey of 186 physical therapists in rural (21%), suburban (43%) and urban (37%) locations in Ontario, Canada

37% reported typically providing education to 70-100% of patients with stroke and 53% perceived a lack of suitable programs

Knowledge Translation

Lau C*, Chitussi D*, Elliot S*, Giannone J*, McMahon MK*, Sibley KM, Tee A, Matthews J, Salbach NM. Facilitating community-based exercise for people with stroke: cross-sectional e-survey of physical therapy practice and perceived needs. Physical Therapy 2015;96:469-478. DOI: 10.2522/ptj.20150117

 *MScPT students

Exploring the role of healthcare partnerships in the TIME^TM program among fitness coordinators and instructors: A qualitative study

• Healthcare partners play an important role in the TIME^TM program: they introduce the TIME^TM program to potential recreation partners, facilitate licensing and fitness instructor training, visit TIME^TM classes and provide feedback and education to fitness instructors
• In this ongoing qualitative study, we are interviewing TIME^TM fitness coordinators and fitness instructors to explore their perceptions of the healthcare partner role and how to optimize this role to maintain the safety and quality of the TIME^TM program

Knowledge Translation

Webinar: What are fitness coordinators’ and instructors’ experiences working with healthcare partners in the Together in Movement and Exercise (TIME™) program? Presenter: Nancy Salbach. Sponsor: Ontario Central East Stroke Network.

Skrastins O*, Tsotsos S*, Aqeel H*, Qiang A*, Renton J*, Howe J, Tee A, Moller J, Salbach NM. Fitness coordinators’ and fitness instructors’ perspectives on implementing a task-oriented community exercise program within a healthcare-recreation partnership for people with balance and mobility limitations: a qualitative study. Disability & Rehabilitation, 2019. http://dx.doi.org/10.1080/09638288.2019.1570357

*MScPT students

Exploring the impact of the TIME^TM program among people with stroke and multiple sclerosis and their caregivers: A qualitative study

• Little is known about the effects of the TIME^TM program on everyday activities, caregiver assistance and caregiver health
• We interviewed 9 people with stroke, 4 people with multiple sclerosis, and 12 caregivers
• The TIME^TM program was perceived to improve balance, mobility, everyday functioning, and social/leisure activities, and decrease the need for caregiver assistance
• Caregivers described emotional health benefits as well as challenges with program transportation and cost

Knowledge Translation

Webinar: How does the TIME^TM program affect the daily lives of participants with neurological conditions and their caregivers? Results of a qualitative study. Presenter: Nancy Salbach.

TIME^TM Study Summary of study results prepared for TIME^TM participants and caregivers

Merali S*, Cameron JI, Barclay R, Salbach NM. Characterising community exercise programmes delivered by fitness instructors for people with neurological conditions: a scoping review. Health and Social Care in the Community 2016; 24(6), e101-e116. DOI: 10.1111/hsc.12282

Merali S*, Cameron JI, Barclay R, Salbach NM. Experiences of people with stroke and multiple sclerosis and caregivers of a community exercise program involving a healthcare-recreation partnership. Disability & Rehabilitation 2019. https://www.tandfonline.com/eprint/VnbrsW76ak8qVWjtA6s5/full?target=10.1080/09638288.2018.1519042

*MSc student

Scaling up group, task-oriented community exercise programs for people with balance and mobility limitations: A mixed methods study of the TIME^TM program

• We hosted a 1-day meeting of 53 stakeholders, including physical therapists, fitness instructors, recreation and healthcare managers, researchers, educators, health policy experts, stroke network representatives, trainees, and TIME^TM participants and their caregivers, in Toronto, Ontario
• We identified and prioritized challenges and action plans for improving delivery of group, task-oriented community exercise programs incorporating a healthcare-recreation partnership
• A survey of TIME^TM program delivery at 28 community centres confirmed that registrants consistently include people with stroke, acquired brain injury, and multiple sclerosis and 76-100% of participants typically re-register in 39% of centres

Knowledge Translation

Community Exercise Forum newsletter

Report on the TIME^TM Provider Survey

Salbach NM, Howe J, Baldry D, Merali S*, Munce SEP. Considerations for expanding community exercise programs incorporating a healthcare-recreation partnership for people with balance and mobility limitations: a mixed methods evaluation. BMC Research Notes. 2018. DOI: https://doi.org/10.1186/s13104-018-3313-x

*MSc student

Safety, feasibility and potential benefit of the TIME^TM program among people with neurological conditions: A pilot study

• We pilot tested the 12-week TIME^TM exercise program among 14 individuals with balance and mobility limitations at two community centres
• Findings supported the safety and feasibility of the TIME^TM model
• Significant improvement in balance and walking, based on Berg Balance Scale scores and 6-minute walk test performance, was observed in 9 people with stroke

Knowledge Translation

Salbach NM, Howe J, Brunton K, Salisbury K, Bodiam L. Partnering to increase access to community exercise programs for people with stroke, acquired brain injury or multiple sclerosis. Journal of Physical Activity and Health 2014; 11, 838-845. DOI: http://dx.doi.org/10.1123/jpah.2012-0183

Effectiveness of a task-oriented walking intervention in improving walking competency in community-dwelling individuals post-stroke

• We conducted a two-site randomized controlled trial and compared task-oriented training of walking and upper extremity function in 91 individuals post-stroke
• Task-oriented training was associated with improved walking speed and distance measured using the 5-metre walk test and 6-minute walk test, respectively, and balance self-efficacy measured using the activities-specific balance confidence (ABC) scale
• The Stroke Rehabilitation Evidence-Based Review highlighted this trial as one of the most important clinical studies in stroke rehabilitation for providing evidence of the task-specificity of training

Knowledge Translation

Salbach NM, Mayo NE, Wood-Dauphinee S, Hanley JA, Richards CL, Côté R. A task-orientated intervention enhances walking distance and speed in the first year post stroke: a randomized controlled trial. Clinical Rehabilitation 2004;18(5):509-519. DOI: 10.1191/0269215504cr763oa

Salbach NM, Mayo NE, Robichaud-Ekstrand S, Hanley JA, Richards CL, Wood-Dauphinee S. The effect of a task-oriented walking intervention on improving balance self-efficacy poststroke: a randomized, controlled trial [published erratum in: J Am Geriatr Soc 2005;53 (8):1450]. Journal of the American Geriatrics Society 2005;53(4):576-582. DOI: 10.1111/j.1532-5415.2005.53203.x

Salbach NM, Mayo NE, Hanley JA, Richards CL, Wood-Dauphinee S. Psychometric evaluation of the original and Canadian French version of the Activities-Specific Balance Confidence Scale among people with stroke. Archives of Physical Medicine and Rehabilitation 2006;87:1597-604. DOI: 10.1016/j.apmr.2006.08.336

Salbach NM, Mayo NE, Robichaud-Ekstrand S, Hanley JA, Richards CL, Wood-Dauphinee S. Balance self-efficacy and its relevance to physical function and perceived health status after stroke. Archives of Physical Medicine and Rehabilitation 2006;87:364-70. DOI: 10.1016/j.apmr.2005.11.017

Liu J*, Drutz C*, Kumar R*, McVicar L*, Weinberger R*, Brooks D, Salbach NM. Use of the six-minute walk test post-stroke: is there a practice effect? Archives of Physical Medicine and Rehabilitation 2008;89:1686-92. DOI: 10.1016/j.apmr.2008.02.026

*MScPT students