1. FITNESS FACILITY ACCESSIBLITY IN THE TWIN CITIES METROPOLITAN AREA Hannah Y. Stoelzle, OTS October 26, 2012

2. Introduction  In 2005, the Morbidity and Mortality Weekly Report indicated there were 54 million Americans with a disability. (Center Disease Control (CDC), 2007)  Statistics expected to rise with aging population - baby boomers. (CDC, 2007)

3. Disability & Exercise  Individuals with disabilities have higher rates of chronic conditions:  Diabetes  Hypertension  Obesity  Depression (United States Department of Health and Human Services, 2000)  12.8% of individuals without a disability reported being physically inactive during the week compared to 25.6% of individuals with a disability (CDC, 2007)

4. Americans with Disability Act (ADA)  Signed into law in 1990  Regulated by Department of Justice  Five Sections in ADA Title III: Public accommodations  Disability Rights Movement made disabilities visible to the public.

5. Previous Research Researchers evaluated the accessibility of fitness facilities in Kansas City. (Figoni, McCain, Bell, Degnan, Norbury, & Rettele, 1998) Researchers studied the accessibility of fitness facilities in western Oregon (Cardinal & Spaziani, 2003). Researchers evaluated at ADA compliance of aquatic facilities in north Texas Area. (Pike, Walker, Collins, & Hodges, 2008) Researchers in Western Wisconsin examined the ADA compliance for fitness facilities in a rural area. (Johnson, Stoelzle, Finco, Foss, & Carsten, 2012)

6. Occupational Therapy American Occupational Therapy Association (AOTA)  Encourages practitioners advocate for individuals with disabilities need for accessibility.  OT Code of Ethics and Standards encourages that practitioners eliminate health disparities. Practitioner ADA Knowledge  Redick et al. (2000) found that OT practitioners have little knowledge on Title III standards, which results in practitioners failing to educate consumers and business owners on ADA standards.  Lack of education of ADA standards may negatively impacts community independence among special populations.

7. Method 1. Approval from St. Catherine University Institutional Review Board 2. Identified Metropolitan Twin Cities Area 3. Defined fitness facility 4. Located all eligible fitness facilities 5. Randomly selected 50 eligible fitness facilities 6. Sent each eligible facility a participation letter and IRB form 7. Made follow-up phone calls 8. Drove to willing participants 9. Completed the AIMFREE

8. Twin Cities Metropolitan Area (United States Census Bureau, 2000)

9. Instrument Accessibility Instrument Measuring Fitness and Recreation Environment Professional Version (AIMFREE) 12 Domains Section A: Access Routes Section B: Equipment Section C: Information Section D: Locker Rooms & Showers Section E: Hot Tubs, Whirlpools, Sauna Section F: Elevators Section G: Bathrooms Section I: Professional Support/Training Section L: Swimming Pool Section M: Parking Section N: Telephones Section O: Water Fountains (National Center on Physical Activity and Disability, 2012)

10. Participants  Participated: 20  Declined: 17  No Response: 21  Closed: 9 TOTAL: 67

11. Demographics Twin Cities Metropolitan  Anoka County: 1  Carver County: 2  Dakota County: 8  Hennepin County: 3  Ramsey County: 4  Scott County: 2  Washington County: 0

12. Demographics  18 facilities were in strip-malls or industrial parks  2 facilities were free standing that provided large square footage.  15 facilities were open 24 hours a day, 7 days a week with limited staffing.  The 24 hour facilities provided emergency necklaces for members to wear that linked to local emergency services. Building Types Operating Hours & Supervision

13. Results Figure 1. Degree of accessibility compliance by AIMFREE category

14. Discussion  All previous studies found that none of the facilities were 100% ADA compliant. (Cardinal & Spaziani, 2003; Figoni et al., 1998, Pike et al., 2008; & Johnson et al., 2012)  Western Oregon had low compliance of route accessibility. (Cardinal & Spaziani, 2003)  North Texas Area had higher compliance of water fountains at 70.2%. (Pike et al., 2008)  Western Wisconsin had low compliance in facility staff participation in education conferences related to fitness accessibility. (Johnson et al., 2012) Similarities

15. Discussion  Kansas City had a lower compliance of water fountains at 15%. (Figoni et al., 1998)  North Texas Area had low compliance of bathroom accessibility. (Pike et al., 2008)  Kansas City study found entrance areas to be of higher compliance. (Figoni et al., 1998)  Western Oregon and Kansas City had high compliance of accessibility to telephones. (Cardinal & Spaziani, 2003; Figoni et al., 1998 ) Differences

16. Limitations 1. Small sample size Due to time constraints 2. Single evaluator Data only collected in female bathrooms and locker rooms 3. Owners self-report Employee training and information answers dependent on accuracy and honesty of fitness facility owners or managers 4. Facility size Larger facilities provide more space, may provide more opportunities for accessibility

17. Future Research Identify ADA compliance of fitness facilities around the United States Identify structural barriers Break down educational and psychosocial barriers Collaborate with fitness facility owners and individuals with disabilities Identify specific needs and accommodations for individuals with disabilities Conduct focus groups with architects, fitness facility owners, and individuals with disabilities. Study personal experiences Obtain personal stories from individuals with disabilities Identify factors that impact their ability to be physically active within fitness facilities

18. Structural Recommendations At least 36 inches pathway Space next to equipment for transferring Well-lit Environment Raised buttons on display screens Low weight increments Audible cues Equipment Contrast Non-glare surface Seen from all sitting height Information

19. Educational Recommendations Use person before disability Do not be afraid to ask Do not move assistive equipment without asking Communication Attend health and accessibility conferences Opportunities for employees to learn physical adaptations for special populations Education

20. Conclusion  Study found that Twin Cities Metropolitan Area fitness facilities were not 100% ADA compliant.  Need for future research to identify structural and educational barriers inhibiting individuals with disabilities from physical activity opportunities.  Fitness facility owners can implement low cost changes to promote an inclusive exercise environment for all populations  Occupational therapists have a role in educating clients and advocating for their needs related to public accessibility.

21. MOTA Karen Sames, MBA, OTR/L, FAOTA Kristi Haertl, PhD, OTR/L Marquell Johnson, PhD Thank You!

22. Questions?

23. References Cardinal, B.J., & Spaziani, M.D. (2003). ADA compliance and the accessibility of physical activity facilities in western Oregon. American Journal of Health Promotion, 17, 197 – 201. Centers for Disease Control and Prevention (CDC). (2007). Physical activity among adults with a disability – United States, 2005. Morbidity and Mortality Weekly Report, 56, 1021 -1024. Cardinal, B.J., & Spaziani M.D. (2003). ADA compliance and the accessibility of physical activity facilities in western Oregon. American Journal of Health Promotion, 17(3), 197-201. Figoni, S.F., McCain, L., Bell, A.A., Degnan, J.M., Norbury, N.E., & Rettele, R.R. (1998). Accessibility of physical fitness facilities in the Kansas City metropolitan area. Topics in Spinal Cord Injury Rehabilitation, 3(3), 66-78. Johnson. M., Stoelzle, H., Finco, K., Foss, S., & Carstens, K. (2012). ADA compliance of fitness facilities in western Wisconsin. Topics in Spinal Cord Injury Rehabilitation.

24. References National Center on Physical Activity and Disability. (2012). Accessibility Instrument Measuring Fitness and Recreation Environment Professional Version (AIMFREE). Retrieved from http://www.ncpad.org/yourwrites/fact_sheet.php?sheet=481 Pike, H., Walker, J., Collins, J., & Hodges, J. (2008). An investigation of ADA compliance of aquatic facilities in the north Texas area. American Journal of Health Promotion, 23, 139 – 146. Redick, A.G., McClain, L., & Brown, C. (2000). Consumer empowerment through occupational therapy: The Americans With Disabilities Act Title III. The American Journal of Occupational Therapy, 54, 207-213. United States Census Bureau. (2000). State and County QuickFacts. In U.S. Census Bureau. Retrieved January 20, 2011, from http://quickfacts.census.gov/qfd/index.html. http://quickfacts.census.gov/qfd/index.html United States Department of Health and Human Services. (2000). Healthy People 2010. Washington, DC: US Government Printing Office.