‘We Want to Build a Blueprint’: MCPHS Professor is on a Mission to Make Fitness Accessible

Christopher Joyce’s research is developing innovative ways to make strength training accessible for people with cerebral palsy, Down syndrome, and autism.

Finding the time, motivation, and energy to exercise can be challenging enough for the general population, but people with disabilities often face additional barriers when it comes to engaging in physical activity.

That's why Massachusetts College of Pharmacy and Health Sciences (MCPHS) physical therapy professor Christopher Joyce is teaming up with AdaptX, a local organization focused on making fitness more accessible and inclusive.

Joyce is the research director at AdaptX's Rick Hoyt Research Lab, which is on a mission to leverage research to improve the inclusivity and accessibility of exercise. The lab is supported by The Hoyt Foundation, a nonprofit founded by the late Dick Hoyt, who completed over 1,000 runs, duathlons, and triathlons with his late son, Rick, who was paralyzed from the neck down and lived with cerebral palsy.

"There's no question that exercise is helpful, but research shows that people with disabilities engage in physical activity at much lower rates than the general population," Joyce said. "We want to empower organizations and gyms to create a welcoming and supportive space for people who have intellectual and physical disabilities."

Breaking Down Barriers to Fitness

There’s a myriad of challenges to engage in exercise that people with disabilities face, Joyce explained. Some of the primary barriers include a lack of trained fitness professionals, individualized and effective programming, and inclusive training environments.

Joyce said making fitness more accessible doesn't require complex, separate facilities for people with disabilities and pointed to fitness centers that easily accommodate athletes of all abilities. Rather, it's most critical to foster a more inclusive environment and equip fitness professionals with the knowledge and understanding they need to work with individuals with disabilities.

"While an organization needs to be structurally accessible and may need to make some modifications to the space and equipment, it's arguably more important to address the organization's culture and make sure the staff has the training and ability to bring in people from diverse backgrounds," Joyce said.

Most fitness professionals don't have the education or exposure to working with people with intellectual or physical disabilities. One aim of the research lab is to help bridge this gap by using its scholarship to develop best practices and educational materials for fitness professionals and facilities.

"We want to build a blueprint that will empower more people to exercise so they can reap the many physical, social, and mental benefits of exercise," Joyce said.

Research for Inclusive Training

The lab launched its first study in 2021, which looked at how to help individuals with cerebral palsy improve their lower extremity strength. People with this neurological condition often can't sustain the high load required to build muscular strength. The researchers investigated whether blood flow restriction, a technique that temporarily limits blood flow to a muscle, could replicate the high-stress, high-intensity load required for exercise gains.

"People who have cerebral palsy have biomechanical and neuromuscular impairments that make it very difficult to perform normal strength training exercises under high loads," Joyce said. "If we can simulate high-intensity exercises using blood flow restriction, then we can circumvent the fact that they can't put a heavy barbell on their back and do squats or other high-load strength training moves." Their findings were published in “The Journal of Neurologic Physical Therapy” last October.

The next study will examine whether high-intensity exercise could help more young adults and adolescents with Down syndrome hit the weekly recommendations for exercise, which are 150 minutes of moderate or 75 minutes of vigorous exercise. Because populations with intellectual and physical disabilities often face greater time constraints, the researchers want to explore how to use high-intensity exercise to help reduce the time burden of physical activity since you can get the same benefits in half the time.

"But to do this, we need coaches trained in high-intensity exercise, particularly for people with intellectual and physical disabilities, because they require different motivational strategies, coaching techniques, and adaptations to exercise," Joyce explained.

The researchers want to test a training module that will help coaches learn how to adapt high-intensity training for young people with Down syndrome. They will then examine how participants respond to a high-intensity training program by examining their aerobic capacity, strength, and physical function.

The group has applied for funding and hopes to launch the study early this year.

Joyce is also incorporating some of this work and research into his classes at MCPHS to help address the gap in education. He's brought students to AdaptX and invited the founder, Brendan Aylward, to visit the Worcester campus and help students learn how to increase fitness opportunities for individuals with disabilities.

"Our curriculum adamantly supports a social model of disability and recognizes social determinants of health in the different areas across ethnic, racial, and gender disparities, so this work aligns very seamlessly with our academic mission," he said.