Universal Fitness Innovation & Transformation
He has had very little vision since birth. Carl uses a white cane to help him navigate public spaces and he has an excellent memory to help him remember pathways and routes. At 31 years old, Carl is pretty independent, although he needs support when he is becoming familiar with a new space. Carl is an avid computer user and works in the tech industry. Carl is very good at describing the kind of support he needs to be successful with a new activity.
She has recently lost her vision due to diabetic retinopathy (she is also diagnosed with Type 2 diabetes mellitus. Jaimie has struggled with healthy lifestyle choices for almost all of her 54 years. As such she is very overweight, smokes regularly, and is new to physical activity. Her doctor has strongly advised her to start exercising to help her manage her diabetes. Jaimie has been struggling to accept her visual impairment and is frustrated with her recent loss of independence.
Visual impairment affects 285 million people internationally. 39 million of these people experience complete blindness and 246 million have partial sight. Approximately 90% of these people live in economically developing countries and approximately 65% over 50 years of age (WHO, 2014). The International Classification of Diseases (update and revision, 2006) outlines four levels of visual function.
Some people are born with a visual impairment, however most people develop their impairment. The main causes of visual impairment are cataracts, macular degeneration and diabetic retinopathy and glaucoma.
A cataract is a clouding that covers the eye lens causing vision to become blurry or cloudy and lights can become glaring or may seem too bright. They are the most common cause of blindness across the globe and occur when the protein in the eye lens builds up clouding part of the lens. The cataract continues to grow over time and can eventually cause blindness. Again healthy lifestyle choices can prevent cataracts. For example, a healthy diet and physical activity can support the participant in maintaining healthy blood pressure, weight, blood sugar levels, eating plenty of vegetables and fruit and protecting the eyes from direct sunlight. Click here to see what a participant with cataracts may see
In economically developed countries people with diabetes mellitus type 1 & 2 (DM1 & DM2) are almost twice as likely to experience visual impairments than those without DM2. Diabetic retinopathy is caused by DM1 and DM2 and includes of a range of conditions that all consist of damage to the retina. In the USA this is the most common cause of visual impairment affecting more than half of those with DM2. 90 percent of visual impairment due to DM2 is preventable by choosing healthy lifestyle choices especially in relation to diet (reducing sugar levels and blood pressure) and physical activity (reducing blood pressure). There are two main types of retinopathy, non-proliferate and proliferate (proliferate means rapid reproduction of cells). In the former, the capillaries (tiny blood vessels that transport blood from veins to arteries) swell and form pockets and as more and more of these blood vessels swell the individual moves from mild, to moderate, to severe non-proliferate retinopathy causing blurry vision. Almost everyone who has DM1 and DM2 will get at least a mild version of this. This eventually progressed to proliferate retinopathy as the blood vessels become permanently closed in which case the individual will start to see floating spots which eventually leads to blindness. Click here to see what participants with proliferate retinopathy may see
People with DM2 are also more likely to experience glaucoma (40%) and cataracts (60%) than the general population.
Macular degeneration is mostly an age-related visual impairment that affects central vision making activities of daily living that require fine vision (e.g., reading, driving) difficult. It is caused by the gradual break-down of the macula which is the central part of the retina that is responsible for focusing central vision. Click here to see what participants with macular degeneration may see
Glaucoma is caused by pressure that builds up in the eyes. This pressure often causes the clear fluid in front of the eyeball (aqueous humour) to build up in the anterior chamber pinching the blood vessels that bring blood to the retina and the optic nerve. This causes damage over time, leading to visual impairment in the form of blind spots that get larger over time, eventually causing blindness. Click here to see what participants with glaucoma may see
Use the consultation as an opportunity to get to know the participant. In addition to gathering medical information and fitness/ physical activity experience, you can also focus on goal setting and learning about participant preferences. In addition to discussing the exercises themselves, ask the participant about how they will get to the fitness centre, and the level of support they need to access the locker room, and prepare for exercise.
You want to support the participant to be as independent as possible. Depending on the individual, this may change over time as they become more familiar with the setting and feel more confident and capable.
Here are some tips to help you when you meet someone with a VI for the first time:
For People with visual impairments can experience various levels of impairment and also various levels of inclusion in society and activities of daily living, depending on many environmental (people’s attitudes and the physical environment) and personal factors (motivation, confidence etc). This population are also more likely to have lower levels of fitness that those without visual impairments. Unless the participant has other conditions or impairments that have implications for exercise (in these cases, be sure to see the relevant UFIT Explorer guidelines), the participant will be able to participate in fitness activities once they are guided through the environment and they feel safe.
Participants who are recovering from surgery or who experience glaucoma should always breathe in a slow and controlled manner and avoid high intensity activities and inverted positions in which their head is below their body as this increases the pressure in the eye and can cause permanent damage. Guiding the participant in becoming familiar with the Rate of Perceived Exertion Scale (RPE Scale) will support them with maintaining moderate intensity.
Smiley Face Relative Perceived Exertion Scale
Every person is like every other person, like some other person, and like no other person.
Participants will generally not be taking medication for their visual impairment, unless they have recently had eye surgery in which case they may be taking pain medication. However, participants with other conditions and/or impairments may be prescribed medication for that. In this case, see the UFIT Explorer guidelines for that condition and check whether the medication has any implications for exercise
The tips and strategies found within the inclusive TIMES section will help you to create an environment that will support your participant’s participation in physical activity as independently as possible. It is important that you involve the participant whenever possible, along the way to ensure the program that you design will meet their needs physically, as well as emotionally and socially. Introducing a few simple strategies such as offering visual images of the participant’s program will help them to be more independent in completing their fitness programme. Ultimately, they will gain confidence and belief in their abilities (increasing self-efficacy) and experience self-determination (sense of control over their own destiny). This is key to establishing healthy habits that will be adopted for the long term.
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