Explaining physical activity in children with visual impairments: a family systems approach.

Explaining physical activity in children with visual impairments: a family systems approach. Promotion of habitual Regular or customary; usual.A habitual drunkard, for example, is an individual who regularly becomes intoxicated as opposed to a person who drinks infrequently. physical activity in children is a concern ofmany interested in preventing the development of risk factors for heartdisease later in adulthood (U.S. Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979Health and Human Services, HHS [DHHS DHHS Department of Health & Human Services (US government)DHHS Dana Hills High School (Dana Point, California)DHHS Deaf and Hard of Hearing ServicesDHHS Deaf and Hard of Hearing Services ], 1996). Physical activity is also important as a preventativemeasure for other adulthood diseases such as osteoporosis osteoporosis(ŏs'tēō'pərō`sĭs), disorder in which the normal replenishment of old bone tissue is severely disrupted, resulting in weakened bones and increased risk of fracture; osteopenia . For instance,Bloomfield (2005) recommends that efforts to promote bone health throughphysical activity should begin as young as age 8. Improved quality oflife, increased attention, psychological health, and even thedevelopment of basic functional living skills are further believed to berelated to maintaining a regimen regimen/reg��i��men/ (rej��i-men) a strictly regulated scheme of diet, exercise, or other activity designed to achieve certain ends. reg��i��menn.1. of appropriate levels of physicalactivity (Sallis & Patrick, 1997; Tomporowski, 2003). However, inlight of all the perceived benefits of physical activity, studiesdemonstrate that children do not engage in adequate levels of physicalactivity to promote healthy lifestyles (DHHS). In individuals withdisabilities, inactivity inactivitySedentary activity Internal medicine An absence of physical activity and/or exercise, a predictor of obesity. See Couch potato. Physical activity, Vigorous exercise is especially an issue of concern given theneed for adequate fitness levels to complete many functional tasks. The need for heightened levels of fitness in order to navigate (1) "Surfing the Web." To move from page to page on the Web.(2) To move through the menu structure in a software application. barriers found in both home and community settings is important forchildren and adults with visual impairments (Kobberling, Jankowski,& Leger, 1989). This is a critical mobility issue for children giventhe need for independence in daily living activities that increases withage and becomes a necessity during adulthood. In addition, issues ofmobility within the larger community are a concern later in adulthood ifindividuals who lack vision rely on public transportation (which may ormay not be accessible depending on fitness levels needed toindependently reach bus stops). In all, it is imperative that adequatelevels of physical activity are encouraged in children and adolescentswith visual impairments to facilitate independence into adulthood. Thefollowing study is an initial investigation using a family systemsframework of activity levels in a select group of children andadolescents with visual impairments. PHYSICAL ACTIVITY AND CHILDREN WITH VISUAL IMPAIRMENTS To date, most research done with children with disabilities revealsthat they are at greater risk to be inactive in��ac��tive?adj.1. Not active or tending to be active.2. a. Not functioning or operating; out of use: inactive machinery.b. (Hogan hoganDwelling of the Navajo Indians of Arizona and New Mexico. The hogan is roughly circular and constructed usually of logs, which are stepped in gradually to create a domed roof. , McLellan, &Bauman, 2000; Kozub, 2003; Longmuir & Bar-Or, 2000). The nature ortype of disability is important in determining the risk of inactivityand potential development of other health and personal problems. Sacksand Wolffe (1998) reported in their study of three individuals that twoof the participants with visual impairments spent more time at home bythemselves because they were not allowed to travel on their own becauseof overprotective o��ver��pro��tect?tr.v. o��ver��pro��tect��ed, o��ver��pro��tect��ing, o��ver��pro��tectsTo protect too much; coddle: overprotected their children. parents. This puts children with visual impairments atrisk for issues related to overdependence as well as inactivity.Longmuir and Bar-Or reported in their investigation that children withphysical and sensory sensory/sen��so��ry/ (sen��sor-e) pertaining to sensation. sen��so��ryadj.1. Of or relating to the senses or sensation.2. disabilities are at particular risk of sedentary sedentary/sed��en��tary/ (sed��en-tar?e)1. sitting habitually; of inactive habits.2. pertaining to a sitting posture.sedentaryof inactive habits; pertaining to a fat, castrated or confined animal. lifestyles. Further, physical activity patterns indicate that althoughadolescents with visual impairments demonstrate a similar trend indecreased physical activity with age, consistent with nondisabled peers,the rate of decline is steeper for the former group (Kozub & Oh,2004; U.S. DHHS, 1996). Currently, the status of physical activity patterns of childrenwith visual impairments and determinants are not sufficientlydocumented. Access to physical education, recreation, and athleticprograms may be limited for individuals with visual impairments becauseof instructional, as well as community barriers and a general lack ofopportunity (Kozub & Porretta, 1998; Lieberman, Wilson-Houston,& Kozub, 2002). Children with visual impairments have significantlylower levels of habitual physical activity, consider themselves less fitrelative to peers, and report more limitations for physical activityparticipation that may be explained by mobility and orientation issues(Lieberman & McHugh, 2001; Longmuir & Bar-Or, 2000). Moreover,children with visual impairments show delays in motor development, suchas poor balance and inefficient gate, which may be byproducts ofsedentary behaviors during the developmental years (Bouchard &Tetrault, 2000; Horvat et al., 2003). FAMILY SYSTEMS APPROACH Any number of family strengths and weaknesses potentially play arole in how each person functions within a community. The presence of achild with a visual impairment Visual ImpairmentDefinitionTotal blindness is the inability to tell light from dark, or the total inability to see. Visual impairment or low vision is a severe reduction in vision that cannot be corrected with standard glasses or contact lenses and has the potential to accentuate ac��cen��tu��ate?tr.v. ac��cen��tu��at��ed, ac��cen��tu��at��ing, ac��cen��tu��ates1. To stress or emphasize; intensify: weaknesses that already existed such as poor marital Pertaining to the relationship of Husband and Wife; having to do with marriage.Marital agreements are contracts that are entered into by individuals who are about to be married, are already married, or are in the process of ending a marriage. communication, lackof family time because of work, and other resource issues. Understandingfamily systems theory is one avenue for both education and healthprofessionals to encourage strong family relationships, to build linksbetween family members, and to promote physical activity, which leads tohealthy lifestyles (Turnbull & Turnbull, 1990). Families are the "seeds" of a healthy community(Zabriskie & McCormick, 2001). Given the theorized link between eachfamily member and the larger collective, it is important thatindividuals develop basic physical skills to avoid dependence thathinders family functioning and draws from community resources. In familysystems theory, what impacts one member, potentially impacts the entirefamily (Turnbull & Turnbull, 1990). Thus, children's lack ofhealth-related fitness can impact many facets of family life, includingrecreational physical activity options for the family. Familyfunctioning, as an outcome of having healthy and active members, may bea critical factor in determining how some families with children withdisabilities can build on existing strengths such as play skills foundin siblings siblingsnpl (formal) → fr��res et s?urs mpl (de m��mes parents), sports-related interests from parents, and interest withinthe families of maintaining healthy lifestyles for all members (Kozub,2001). In family systems theory, the potential exists for increases infunctional skills of one family member to impact positively on theentire group. Although the complexity of families where one or morechildren have disabilities is great, the potential for positive changesbeginning with small factors such as productive use of family leisuretime can, in turn, strengthen existing relationships and have farreaching benefits (Kozub, 2001; Zabriskie & McCormick, 2003). It isimportant that physical activity opportunities are facilitated forsuccessful development of children with disabilities. This activitywithin a family context is an important factor worth exploring at theprogrammatic pro��gram��mat��ic?adj.1. Of, relating to, or having a program.2. Following an overall plan or schedule: a step-by-step, programmatic approach to problem solving.3. level (Fiorini, Stanton, & Reid, 1996; Kozub, 2001). The available literature suggests that family leisure choices,including physical activity, contribute to family relationships and thequality of family life (Kozub, 2001; Mactavish, Schleien, &Tabourne, 1997; Zabriskie & McCormick, 2001, 2003). Some researchershave tried to explain family leisure activity based on familyadaptability a��dapt��a��ble?adj.Capable of adapting or of being adapted.a��dapta��bil and cohesion cohesion:see adhesion and cohesion. Cohesion (physics)The tendency of atoms or molecules to coalesce into extended condensed states. This tendency is practically universal. (Olson et al., 1992; Zabriskie &McCormick, 2001, 2003). Family cohesion is defined as the aspect of"independence or differentiation" in the family system,whereas family adaptability addresses a family's flexibility oradaptability to different situations or experiences (Zabriskie &McCormick, 2001). Two other features of family relationships that may explainmovement behavior in children with visual impairments include parent andsibling sibling/sib��ling/ (sib��ling) any of two or more offspring of the same parents; a brother or sister. sib��lingn. physical activity. Both of these topics have been studiedexclusively in families without children with disabilities and thefollowing sections highlight known findings. PHYSICAL ACTIVITY AND PARENTS Physical activity patterns of parents are important and potentiallylinked to patterns found in their children. The rise in incidence ofobesity and sedentary lifestyles today creates a need to study potentiallinks between family members from all segments of the population. It hasbeen recognized that parents determine the quantity of exercise thatchildren experience by providing a role model, creating access tofacilities, and finding suitable community opportunities (Prochaska,Rodgers, & Sallis, 2002). Parental encouragement and facilitation FacilitationThe process of providing a market for a security. Normally, this refers to bids and offers made for large blocks of securities, such as those traded by institutions. were also reported as important factors in determining physical activitylevels of children (Welk, Wood, & Morss, 2003). It is possible that mothers and fathers have different impacts ontheir children's level of physical activity. For example, in astudy by Mathias, Brynteson, Adams, and Caldwell (1997), the activityrole modeling of the father influenced children's exerciseintensity, whereas the mothers' activity level influenced theamount of stretching activities done by children. In contrast, otherstudies found that fathers' physical activity predictedchildren's activity level (Raudsepp & Viira, 2000; Thompson etal., 2003), as did mothers' activity levels (Fogelholm, Nuutinen,Pasanen, Myohanen, & Saatela, 1999; Mota & Silva sil��vaalso syl��va ?n. pl. sil��vas or sil��vae1. The trees or forests of a region.2. A written work on the trees or forests of a region. , 1999).However, it is not clear in these studies if either mother's orfather's exercise behavior is the leading determinant determinant,a polynomial expression that is inherent in the entries of a square matrix. The size n of the square matrix, as determined from the number of entries in any row or column, is called the order of the determinant. forchildren's physical activity levels. Moreover, the potentialfactors that mediate MEDIATE, POWERS. Those incident to primary powers, given by a principal to his agent. For example, the general authority given to collect, receive and pay debts due by or to the principal is a primary power. physical activity patterns in children withdisabilities based on parent activity level are unclear. PHYSICAL ACTIVITY AND SIBLINGS Siblings are typically exposed to similar reinforcement reinforcement/re��in��force��ment/ (-in-fors��ment) in behavioral science, the presentation of a stimulus following a response that increases the frequency of subsequent responses, whether positive to desirable events, or historiesand opportunities to engage in various activities collectively. Thepermanent nature of relationships among siblings makes this dynamic apotential influence on several aspects of personal development,particularly during childhood, but also throughout later adolescence adolescence,time of life from onset of puberty to full adulthood. The exact period of adolescence, which varies from person to person, falls approximately between the ages 12 and 20 and encompasses both physiological and psychological changes. andadulthood. However, the impact of one sibling's level of physicalactivity on another sibling has not received much attention byresearchers. The available literature, however, suggests that such alink exists (Thompson et al., 2003), but the impact may vary by thegender of the siblings (Raudsepp & Viira, 2000). Again, studies onsibling relationships are needed to generalize generalize/gen��er��al��ize/ (-iz)1. to spread throughout the body, as when local disease becomes systemic.2. to form a general principle; to reason inductively. findings to families whohave a child with a disability. Because inactivity is especially prevalent in children with specialneeds (Kozub, 2003; Kozub & Oh, 2004; Longmuir & Bar-Or, 2000),it is important to study factors that influence their activity level.This study had two purposes: (a) examine the relationship between thephysical activity level of children with visual disabilities andphysical activity of their parents and siblings, and (b) ask parents andtheir children with visual disabilities about the factors that influencephysical activity patterns. METHOD PARTICIPANTS Six school age children (from five families) with visualimpairments, their siblings without visual impairments (n = 6), andparents (n = 5) consented to participate in this study. A criterionsampling approach was used to select families for the study based on thecriteria of having children with visual impairments, a younger or oldersibling close to the target child's age, and having all membersreside in the same home with at least one biological parent.Participants were recruited from a Midwestern School for the Blind andnone of the children with visual impairments had any known co-existingphysical or mental impairments. The information regarding how thechildren with visual impairments were classified by their school ashigh, low, or totally blind was not available. Consequently, we verifiedthese participants' visual abilities using the vision-relatedclassification system of the United States United States,officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. Association for BlindAthletes (USABA USABA United States Association of Blind AthletesUSABA United States Amateur Baseball Association ) criteria. The physical educator in the school madethese classifications, following the guidelines guidelines,n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. in Sherrill (2004). Children who are blind (n = 2) have no light perception in eithereye and required guide ropes to run during their annual fitness testing(B1), children with low vision (n = 1) are able to participate inphysical education classes with modifications and have the ability torecognize the shape of a hand at a 2/60 visual acuity visual acuityn.Sharpness of vision, especially as tested with a Snellen chart. Normal visual acuity based on the Snellen chart is 20/20.Visual acuityThe ability to distinguish details and shapes of objects. (B2), and childrenwith high vision (n = 3) have the ability to read enlarged print withoutmagnification MagnificationA measure of the effectiveness of an optical system in enlarging or reducing an image. For an optical system that forms a real image, such a measure is the lateral magnification m (B3). The characteristics of the children with visualimpairments and their siblings are presented in Table 1. Two of thechildren with visual impairments are siblings (brother and sister). Themother for these sibling participants is a 40-year-old female weighing135 pounds. Joey's and Jennifer's caregivers are also motherswho were 38 and 47 years of age, respectively. These parents weighed 138and 130 pounds, respectively. Fathers represented in the study (Josephand Jasmine's caregiver care��giv��ern.1. An individual, such as a physician, nurse, or social worker, who assists in the identification, prevention, or treatment of an illness or disability.2. participants) were 40 and 55 years of ageand weighed 280 and 178 pounds, respectively. None of the parents haveany known disabilities or health impairments that affected physicalactivity participation. Of the five participating families, three live in rural locales andtwo live in suburban areas close to school for the blind. Parents wereasked to complete the Family Adaptability and Cohesion Scale II (Olsonet al., 1992) to provide an estimate of cohesion and adaptability. Thisscale allows for cohesion ranking from 1 to 8 (8 showing high levels ofcohesion) and adaptability scores from 1 to 7 (7 showing high levels ofadaptability). All families who participated in this study had highscores of family cohesion (M = 8) and adaptability (M = 6.6).Demographic information for these participants is found in Table 1. DATA COLLECTION AND ANALYSIS A mixed method research design was used to examine physicalactivity in children with visual impairments (Patton, 1990). Thequantitative data collected for this study included activity counts overa 7-day period during summer vacation Summer vacation (also called summer holidays or summer break) is a vacation in the summertime between school years in which students are off for 3 months, depending on the country and district. using triaxial tri��ax��i��al?adj.Having three axes.tri��axi��ali��ty n. accelerometers(RT3) for all participating children, including siblings, and one of theparents from each family. Qualitative data were collected by Q-sortinterviews of the parents (at the end of the week in conjunction withfinal pick up of activity monitors) and culminating standardizedopen-ended interviews with the children with visual impairments whoparticipated in the study (Patton). Quantitative Data Collection on Physical Activity. Triaxialaccelerometers have been used to study physical activity in childrenwith mental retardation mental retardation,below average level of intellectual functioning, usually defined by an IQ of below 70 to 75, combined with limitations in the skills necessary for daily living. and visual impairments (Kozub, 2003; Kozub &Oh, 2004). Information about participants' height, weight, and agewas used to initialize To start anew, which typically involves clearing all or some part of memory or disk. the monitors prior to data collection.Participants (children with visual impairments, siblings, and parents)were asked to wear activity monitors on their right hip for a 1-weekperiod during waking hours. Participants were allowed to remove monitorsfor sleeping or any activities where immersion immersion/im��mer��sion/ (i-mer��zhun)1. the plunging of a body into a liquid.2. the use of the microscope with the object and object glass both covered with a liquid. in water couldpotentially damage accelerometers (such as showering or swimming).Researchers called households during the week and reminded participantsto wear monitors and checked to make sure monitors were functioningproperly. During data collection, two of the monitors had to be replacedbecause of battery failure. Physical activity scores included the number of minutes that anindividual was involved in bouts Bouts is the name of Aelbrecht Bouts (c. 1452-1549), An early Netherlandish painter Dirk Bouts, Netherlandish painter of moderate to vigorous physicalactivity (MVPA MVPA Military Vehicle Preservation AssociationMVPA Music Video Production AssociationMVPA moderate to vigorous physical activityMVPA multi-voxel pattern analysisMVPA Motor Vehicle Protection Association (UK)). MET (metabolic equivalents or amount of energyexpenditure at rest) values were also calculated for each participantusing RT3 energy value scores. This provided a Standardized value ofMVPA sensitive to each participant's size, age, and genderconsistent with the previous studies (Kalakanis, Goldfield Goldfield,small town, SW Nev., a former gold-mining center. Gold was discovered there in 1902, and after an early period of disappointment, large yields of high quality gold were extracted. , Paluch,& Epstein, 2001; Kozub, 2003; Kozub & Oh, 2004). Specifically,MET values greater than or equal to 4.5 (four and one-half times theamount used by a resting person) were used to define the bouts of MVPAfor children with visual impairments, Siblings, and their parents. Totalactivity counts were also compared using all data including those minutevalues below MVPA levels. This was done to study the overallrelationships among participants' daily movements within eachfamily during the study. Qualitative Data Collection. Qualitative data were gathered byinterviewing parents and their children with visual impairments. Parentinterviews followed a Q-sort methodology in which respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. were askedto sort items of importance, indicating that an item was important tonot important (McKeown & Thomas, 1988). The Q-sort selections weredeveloped for the current study using procedures described in Kozub(2003). The two categories of Q-sort items presented to participants at thebeginning of interviews included (a) "most important in my familysituation to help explain why my son or daughter is physically activeoutside of school" and (b) "school physical education programsshould teach my child." Each category had its own deck of cardscontaining responses either related to family or school physicalactivity. Interviews of parents occurred at home where the respondent In Equity practice, the party who answers a bill or other proceeding in equity. The party against whom an appeal or motion, an application for a court order, is instituted and who is required to answer in order to protect his or her interests. felt comfortable. Participants were asked to read the questions and sortthe cards on the board to correspond to numeric numericsee numerical.numeric clustersee ten-key pad. values indicating levelsof agreement (+1 through +5) or levels of disagreement (-5 through -1),and an uncertain response (0; see Table 2), After completing each item,participants were asked open-ended questions such as "Why isfitness important for your child with visual impairments?"depending on which items were sorted as important to their child. After analyzing data from the parents, a final interview withchildren with visual impairments was conducted. In order to more deeplyexplore issues relevant to each family, the researchers developedspecific interview questions based on themes that emerged from parentinterviews and results from the quantitative data. Interviews forchildren with visual impairments took place at their school in the fallafter the initial summer data collection. These interviews wereaudiotaped. Interviews for participants ranged from 30 to 35 min. The audiotaped interviews of the parents were transcribed verbatim ver��ba��tim?adj.Using exactly the same words; corresponding word for word: a verbatim report of the conversation.adv. by the researchers and read to identify the preliminary key phrases andthemes. Content analysis that involved identifying, coding,categorizing, and labeling the patterns was used to find themes fromeach transcription (Patton, 1990). Each paragraph and sentence wasclosely examined and coded for later analysis and comparison. Afterreaching consensus between the researchers, general themes related tofamily perspectives on physical activity were identified. The sameprocedures were used for the child. Constant comparison steps were used in analysis of the interviewsof parents and children (Boeije, 2002; Patton, 1990). This includedmaking comparisons between the interviews provided by parents andchildren as well as comparing across both groups. ESTABLISHING TRUSTWORTHINESS trustworthinessEthics A principle in which a person both deserves the trust of others and does not violate that trust , CREDIBILITY AND TRANSFERABILITY Multiple triangulation triangulation:see geodesy. The use of two known coordinates to determine the location of a third. Used by ship captains for centuries to navigate on the high seas, triangulation is employed in GPS receivers to pinpoint their current location on earth. approaches were used to establish thetrustworthiness of data and the credibility of findings. Triangulationrefers to the use Of multiple data sources, multiple investigators tocollect and analyze data, and multiple data collection methods (Patton,1990). Triangulation of data Was achieved by using data from the RT3monitors in conjunction with participants' responses on theinterviews. To ensure the emerging findings accurately reflected theperspectives of parents, member checks were conducted by mailing thetranscriptions of the interviews to the parents and allowing respondentsan opportunity to verify responses. In addition, investigatortriangulation was used to enhance the trustworthiness and credibility byhaving a researcher who was not directly involved in the interviewprocess review all data and themes. RESULTS PHYSICAL ACTIVITY LEVELS The physical activity data are presented in Table 2. The greatest7-day activity count resulted from Joey Joeyafter Joseph Grimaldi, famous 19th-century clown. [Am. Hist.: Espy, 45]See : Clowns (403 minutes of MVPA). Thisparticipant also had the highest percentage of parent physical activity(21%). For Jack and Jane (siblings with visual impairments), thepercentage of sibling (without visual impairment) physical activity washigh (53% and 43%, respectively), whereas the percentage of parentphysical activity was low (3% and 0%, respectively). The lowestpercentage for sibling and parent physical activity was found inJennifer's family (11% and 0%, respectively). For all participantsexcept Joey, parent physical activity was lower than sibling physicalactivity. Whereas parent MVPA ranged from 5 to 21 min per day, siblingMVPA ranged from 28 to 119 minutes per day. Physical activity levelsvaried with age, as older participants were less active than younger(see Table 2). The oldest participants (Jennifer and Jack) were active81 and 75 min, respectively, over the 7-day period, whereas the 4younger participants' activity ranged from 271 to 403 min total. Correlations between total movement behaviors for participantswithin families varied considerably. This includes minute-by-minuteanalyses of all participants' movement during the 7 days includingthose intervals where MVPA did not occur. Moderate correlations betweenJack and his nondisabled sister resulted (r = .51, p < .001) but wasnot found in Jane (sibling with a visual impairment from the samefamily) whose physical activity counts did not relate to her youngersibling's activity values. Further, these children with visualimpairments had negligible This article or section is written like a personal reflection or and may require .Please [ improve this article] by rewriting this article or section in an . relationships with their parent activityvalues over the 7 days. Jack and Jane had a low relationship betweentheir activity counts during the study (r = .21, p < .001). Joey hada significant correlation between her minute intervals of movement andthose recorded in her mother over the 7 days (r = .30, p < .001).However, because of repeated failure of her brother's RT3 unit, noestimate of the relationship between Joey and her brother'sphysical activity was calculated. The remaining participants (Joseph,Jennifer, and Jasmine jasmine(jăs`mĭn, jăz–)or jessamine(jĕs`əmĭn), any plant of the genus Jasminum of the family Oleaceae (olive family). ) had similar moderate correlations between theirmovement values and those recorded in their siblings (r = .42, r = .34,and r = .40, all p < .001). Child-to-parent relationship betweenmovement values over 7 days between Joseph and his father was low (r =.22, p < .001). The remaining participants had no significantrelationships between their overall minute activity values and theirparents over the 7 days. Q-SORT RESPONSES Q-Sort responses found in Table 2 represent the extreme scoreditems by families. For Joey, Joseph, and Jasmine statements were sortedas positive only for items "most important to their familysituation." The same is seen in results from these participants inrelation to school-related responses. Jane's, Jack's, andJennifer's mother sorted items related to scheduling, inactivity,and fitness as impacting to their family situation. As was the case withfamily situation responses, school responses indicating importance weresorted by parents indicating many items important to their families.Only Joey's mother indicated that use of community physicalactivity settings is never important in relation to what physicaleducators should teach her child. MAJOR THEMES EXPLAINING PHYSICAL ACTIVITY IN FAMILIES Most Important to My Family. Responses based on individual Q-sortitems elaborated on in interviews resulted in a theme indicating factorsthat are important to families where children with visual impairmentsare raised (see Table 2). The most important statement resulting fromparent interviews was "transportation to physical activitysettings" identified by all five families. A second importantfactor in the first theme was "a family member is taking part inphysical activity." For Joey, Joseph, Jasmine, and Jane this wasexpressed in parent selections of the Q-sort response, indicating parentinvolvement is important. During open-ended responses, parents of Joey,Jane, and Jasmine expressed that sibling involvement was equallyimportant. Despite this, percentages of parent involvement in physicalactivity with their child with a visual impairment were low, refutingthe notion of co-participation (see Table 2). Further, five of theparents emphasized the importance of friend/peer involvement in physicalactivity either by choosing if"a friend is involved" or"play games or sports with peers." Parent interviews revealed that "safety" was an importantissue for their children with visual impairments. Parents' busyschedule also influenced their own involvement in physical activity.Parents mentioned in their interviews the importance of fitness andphysical activity skills. Although most of the families reported safetyas an important issue, children with visual impairments were notconcerned about their safety during physical activity (in contrast totheir parents' fears). Children with visual impairments alsoindicated that physical activity was important for their well-being, andthey were much more active when they were younger. As they got older,children didn't feel that they had the same energy as when theywere younger. Children with visual impairments reported that althoughtheir parents were not able to do physical activities with them, parentswere providing transportation to the physical activity settings. School Physical Education Programs ShouM Teach Physical ActivityOptions. Four of the parents reported that it was important for theschool to teach how to use community physical activity settings andteach physical activities that can be used at home. One of the parentsreported that it was the parents' responsibility to find communityphysical activity options for their child with visual impairments. The children with visual disabilities indicated a preference forschool personnel to teach physical activity skills that can be usedoutside of school with their parents and siblings. The followupinterviews further revealed that extended family plays a critical rolein physical activity levels of children with visual impairments, asother family members function as a playmate or facilitate physicalactivity. DISCUSSION These preliminary data provide insight into the perspectives of howdisability may interact with family physical activity. Two majorcategories of themes related to family situations and school programmingappear highly important for promoting physical activity in children withvisual impairments and family involvement as a whole. After discussionof physical activity levels in children with visual impairments andtheir family members, the major themes explaining physical activity arediscussed. This is followed by sections on educational implications andlimitations of these data. PHYSICAL ACTIVITY LEVELS IN CHILDREN WITH VISUAL IMPAIRMENTS Findings supported that as some children with visual impairmentsget older, physical activity levels decrease. The two adolescents werethe least active of the children with visual impairments studied andboth indicated age-related decline in follow-up interviews. This isconsistent with other researchers studying age-related trends inphysical activity (Kozub, 2003; Sallis, Prochaska, & Taylor, 2000).It is also interesting to note that parent physical activity at a MVPAlevel did not occur at any time when the two older children were engagedin MVPA. This is in contrast to the youngest child (Joey), who had thehighest percentage of bouts of MVPA occurring in conjunction with parentactivity at this level. In all, most of the parents of these childrenwere inactive and this may contribute to the low percentage of MVPA thatoccurred. The only exception was Joseph's dad who participated in21 min of MVPA per day occurring mostly when the child with a visualimpairment was not active. A large amount of moderate levels of physicalactivity in children with visual impairments occurring in conjunctionwith their parent's MVPA is not supported. Sibling bouts of MVPA occurred during times when the child with avisual impairment was active at a higher percentage than noted in theparent comparison. Further, all but one of the overall correlationsbetween siblings taking into account all activity values over the 7 dayswere moderate in magnitude. The highest values of time engaged in MVPAby both the child with a visual impairment and a sibling occurred withJane and her younger sister. These values indicate that Jane was mainlyactive consistent with her sister during higher intensity periods(percentage of time engaged in MVPA at the same time). Since no data areavailable about the nature of interactions between siblings during theseperiods of MVPA, it is only speculative that they were engaged in thesame activity. The lowest percentage of bouts corresponding to MVPAengaged at the same time occurred in Jennifer who had a male adolescent ad��o��les��centadj.Of, relating to, or undergoing adolescence.n.A young person who has undergone puberty but who has not reached full maturity; a teenager. sibling. These data demonstrate a need to consider the effect of genderof sibling, as well as developmental issues, as potential variables thatinteract with age-related inactivity trends in adolescents with visualimpairments. MAJOR THEMES EXPLAINING PHYSICAL ACTIVITY The first theme to emerge from parent interviews concerning familysituational items highlights the importance of parents and others inphysical activity participation for children with visual impairments. Mlparents except Jane's stated that caregiver involvement in physicalactivity was important. This was in some ways inconsistent with thequantitative findings that demonstrated that percentages of parentinvolvement in MVPA did not always coincide with child bouts of physicalactivity. Parents in this study appeared to assume a facilitator role byproviding transportation rather than being actively involved in physicalactivity with their children with visual impairments. Extended family, which included cousins and grandparents, was alsoemphasized during the interviews of parents and children with visualimpairments. Participation of extended family in physical activity wasdemonstrated by either involvement in physical activity with the childor by providing transportation to the setting. Transportation was achallenge for these children with visual impairments because thephysical activity and sport facilities were far from the living area forall families studied. A busy family schedule was another barriermentioned by three parents as a reason for not being involved inphysical activity. This is a viable rationale explaining low percentagesof parents participating in physical activity for all of theparticipants. Time limitations of the caregivers of children withdisabilities as a barrier to physical activity for families isconsistent with Kozub (2003). Peer involvement was an important factor based on parent and childinterviews. Specifically, Jack made statements that indicate a lack ofpeer relationships: "No, I go home but I don't get around. Idon't ... I don't like to get ... I am not a peopleperson." Further, Jennifer indicated a lack of female friendsaround the house. The lack of a peer group may be an importantconsideration influencing the age-related decline noted in Kozub and Oh(2004). A natural tendency for older adolescents to seek involvementwith peers rather than parents exists (Prochaska et al., 2002). Thiswould explain the low amounts of MVPA in the older children with visualimpairments who appear to lack peer groups at home. Jennifer indicatedthat what she likes most about physical education class is "That itis really fun and I am with my friends." Safety emerged as an important theme for parents in the study,which supports previous findings by Sacks and Wolffe (1998). This isalso reiterated specific to physical activity for children with lowvision in Lieberman and McHugh (2001). The parents of Joey and Jennifermentioned safety as a problem for their children: "I am a littlebit more protected of her because of her not being able to seewhat's there ... you either have to walk her through things more orexplain it more to her"; and "I keep an eye on her and Idon't let her do something like riding the four wheeler--stuff likethat." These statements support that some parents of children withvisual impairments are protective, which may impact on how the childdevelops skills related to independence necessary for adulthood. Safetyissues are an area in need of further study to determine the long-termimpacts of parent decision making that potentially constrainsindependent physical activity in children with visual impairments. School-related themes from items concerning "what schoolsshould teach my child" were consistent in pointing to community orlifetime activities. Children with visual impairments and their parentsstated that school programming should focus on teaching skills necessaryto remain physically active outside of school and in the community as awhole, as Jennifer's parent indicated: "This is important forthem to know how to play (talks about physical activity skills).They'll have self-esteem and ... interact with other people.It's a better head start in life ... in lower grades and start inthere." These lifetime skills are believed critical for individualswith disabilities to become active participants in community settings,and the necessary skills must be identified and taught during the formaleducation process (Kozub, 2001). Limitations in basic skills can hinder hin��der?1?v. hin��dered, hin��der��ing, hin��dersv.tr.1. To be or get in the way of.2. To obstruct or delay the progress of.v.intr. family involvement in community physical activity if parents are unableto serve as program providers. Further, basic physical skills (such asadequate balance or special awareness) may also generalize to tasks ofdaily living. For example, if school programming teaches fundamentalmovement skills such as walking, running, or even safe falling, thechild with visual impairment can apply these to sport, to other leisureactivities, and potentially to daily life. Although participants in this study wanted the school to teachabout community physical activity skills, they still think that it istheir responsibility to find out where resources exist in their localefor their children to be physically active. As Jack's, Jane'sand Joey's parents indicate: "For me I need to find out, Imean ... I take their suggestions but they don't ... It is kind ofhard you know. I think it is more my responsibility to find something todo outside of the school." "I mean the school could help withthat, but I still think it is the parent's job. I can also do thatand help her be aware of what's out in the community, to bephysically active and stuff." Studies show low levels of fitness in children with visualimpairments (Lieberman & McHugh, 2001; Longmuir & Bar-Or, 2000).According to according toprep.1. As stated or indicated by; on the authority of: according to historians.2. In keeping with: according to instructions.3. all parents, one of the most important things for theschool to focus on is fitness. Although two of the parents mentionedtheir children with visual impairment were fit, all parents felt thatschool might have more information about physical fitness, so it was theschools' responsibility to teach their children. "To me, theschool ... I think that they are qualified to do health and fitness typethings more than I am, so that's more important for them todo." This was also consistent with the findings of semistructuredinterviews with parents of children with mental retardation (Kozub,2003). EDUCATIONAL IMPLICATIONS The key component to consider is the skills each child with avisual impairment has in relation to physical activity participation.Without the necessary skills, children become adults who lack thepotential to engage in physical activity and experience quality of lifebenefits noted earlier. School is one setting where physical activityskills are taught to children. For children with visual impairments,school personnel can teach physical activity skills that can be used indifferent settings including home (Kozub, 2001). School programming thatis supportive of home activities is an important topic at individualizededucation program In the United States an Individualized Education Program, commonly referred to as an IEP, is mandated by the Individuals with Disabilities Education Act (IDEA). In Canada an equivalent document is called an Individual Education Plan. meetings that may benefit both parents and educators.In addition, siblings should be included in home and community physicalactivity considerations for young children with visual impairments.School personnel can have family/ child activity nights where childrenand families come together to be physically active while parents learnabout adaptations for their children (Morgan & Morgan, 2004). Interested parents who have children with visual impairments shouldbe encouraged to document their physical activity behavior in exerciselogs. This ensures a level of accountability and may help educationalteams in setting realistic fitness goals for children with visualimpairments. Once physical activity goals have been established,progress toward these goals should be monitored so that "goodideas" become good habits. In the end, parents and their childrenmake many physical activity decisions independent of school staff, anddocumentation of this process is critical to determine actual barriersfrom poor decision making. Because transportation was noted as one of the barriers forchildren with visual impairments in this study, children with visualimpairments should be taught important functional skills related toindependent use of public transportation where appropriate. If this isnot an option, families should be encouraged to work together andperhaps form networks independent of school resources that help childrenwith disabilities access community physical activity options. LIMITATIONS Small sample size is a limitation of the current study. The sampledoes not completely reflect the diversity of all families with childrenwith visual impairments. In addition, participants with visualimpairments in this study are a select group from a special school forthe blind and that does not provide insight on children from integratedsettings. Therefore the interpretation of the results is limited tothese participants. Limitations in wearing monitors may have resulted in loss ofactivity counts if children with visual impairments and their siblingswere swimming at the time of the study. This may have resulted in afailure to capture aquatics activity bouts where participants wereactive within or independent of the family, thus affecting theinterpretation of the findings. Because the study was conducted over 1 week during the summer, aseasonal effect is possible. It would be problematic to generalize theseresults to other times of the year such as winter where periods of harshweather may impact on physical activity levels of the children withvisual impairments and their siblings. The current study offers a"snapshot (1) A saved copy of memory including the contents of all memory bytes, hardware registers and status indicators. It is periodically taken in order to restore the system in the event of failure.(2) A saved copy of a file before it is updated. " of information useful in understanding familydynamics and physical activity behaviors. Further studies are needed forlonger periods. CONCLUSIONS This study highlights a few of the determinants of physicalactivity for children with visual impairments and the potential forcaregiver and sibling influences. These findings demonstrate that olderchildren with visual impairments are prone to inactivity and that thismay be a pattern within some families. Further, age-related declines inphysical activity are consistent with research on individuals withoutdisabilities. It is crucial to study physical activity within the familybecause the potential exists for children with visual impairments toadvance into adulthood and remain dependent on family members. Morestudies are needed to help explain inactivity in persons with visualimpairments and to determine interventions that increase physicalactivity for all family members. School personnel can benefit fromviewing inactivity in terms of family determinants given the variabilityfound in these data that indicate that some children with visualimpairments are active at the same time as other family members.Replication In database management, the ability to keep distributed databases synchronized by routinely copying the entire database or subsets of the database to other servers in the network.There are various replication methods. of this study with a larger sample size and longer period oftime is strongly encouraged to better explain physical activity inchildren with visual impairments. REFERENCES Bloomfield, S. A. (2005). Contributions of physical activity tobone health over the lifespan. Topics in Geriatric geriatric/ger��i��at��ric/ (jer?e-at��rik)1. pertaining to elderly persons or to the aging process.2. pertaining to geriatrics.ger��i��at��ricadj.1. Rehabilitation rehabilitation:see physical therapy. , 21,68-76. Boeije, H. (2002). 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Atlanta, GA:National Center for Chronic Disease Prevention and Health Promotion,Centers for Disease Control and Prevention Centers for Disease Control and Prevention(CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. . Welk, G. J., Wood, K., & Morss, G. (2003). Parental influenceson physical activity in children: An exploration of potentialmechanisms. Pediatric Exercise Science, 15, 19-33. Zabriskie, R. B., & McCormick, B. P. (2001). The influences offamily leisure patterns on perceptions of family functioning. FamilyRelations, 50, 281-290. Zabriskie, R. B., & McCormick, B. P. (2003). Parent and childperspectives of family leisure involvement and satisfaction with familylife. Journal of Leisure Research, 35, 163-189. NALAN NALAN NAVOCEANO Administrative Lan R. AYVAZOGLU, Doctoral Student; HYUN-KYOUNG OH, DoctoralStudent; and FRANCIS M. ROZUB, Assistant Professor, Department ofKinesiology, Indiana University Indiana University,main campus at Bloomington; state supported; coeducational; chartered 1820 as a seminary, opened 1824. It became a college in 1828 and a university in 1838. The medical center (run jointly with Purdue Univ. , Bloomington. Please address all correspondence to Nalan R. Ayvazoglu, Departmentof Kinesiology, Indiana University, HPER HPER Health, Physical Education and Recreation 179, Bloomington, IN 47405,(812) 720-0377. (nayvazog@indiana.edu) Manuscript received November 2004; accepted April 2005.TABLE 1Participant Demographic Data and Descriptive Statistics (n = 6) Vision Level Age School USABA Classification Classification Target Child SiblingJack Totally Blind B1 14 7Jane Totally Blind B1 10 7Joey Low Vision B2 6 11Joseph High Vision B3 11 3Jennifer High Vision B3 13 13Jasmine High Vision B3 11 9 Gender Target Child SiblingJack Male FemaleJane Female FemaleJoey Female MaleJoseph Male MaleJennifer Female MaleJasmine Female MaleNote. USABA = United States Association for Blind Athletes.TABLE 2Physical Activity (PA) and Q-Sort Responses by Participants % of BoutsParticipant in Where SiblingRank Order of Was InvolvedPA PA Estimates for 7 Days in MVPAJack (a) 30 bouts 2.5 min per bout 75 total min of MVPA 43Jane (a) 58 bouts 6.62 min per bout 384 total minutes of MVPA 53Joey 96 bouts 4.2 min per bout 403 total min of MVPA Data MissingJoseph 95 bouts 2.85 min per bout 271 total min of MVPA 34Jennifer 37 bouts 2.19 min per bout 81 total min of MVPA 11Jasmine 83 bouts 3.59 min per bout 298 total min of MVPA 48 % of Bouts Where aParticipant in Parent Was Q-Sort Selection (a)Rank Order of InvolvedPA in MVPA FamilyJack (a) 0 -5 lacks adequate fitness to play -5 my busy schedule +5 a friend is involved +5 knows how to play activity +5 transportation is availableJane (a) 3 +5 a friend is involved -5 lacks adequate fitness to play -5 my busy schedule +5 knows how to play.activity +5 transportation is availableJoey 21 +5 family member is taking part +5 feels safe doing the activity +5 concerned with health or fitness +5 enjoys playing the activity +5 my spouse's willingness to helpJoseph 7 +5 family member is taking part +5 has adequate skill to play at level of peers +5 concerned with health or fitness +5 enjoys playing the activity +5 transportation is available +5 my inactivity or lack of interest +5 my spouse's willingness to helpJennifer 0 -5 my busy schedule -5 my inactivity or lack of interest +5 a friend is involved +5 family member is taking part +5 concerned with health/fitness +5 knows how to play activity +5 transportation is availablejasmine 4 +5 a friend is involved +5 family member is taking part +5 concerned with health or fitness +5 transportation is available +5 my busy scheduleParticipant in Q-Sort Selection (a)Rank Order ofPA SchoolJack (a) +5 how to use community PA settingsJane (a) +5 how to use community PA settingsJoey -5 how to use community PA settings -5 about lifetime PA skills +5 about fitness aspects of PA +5 skills so ... can play competitive sports +5 play games and sports with peers +5 specific activities to promote fitnessJoseph +5 how to use community PA settings +5 physical activity skills that can be used at home +5 that physical activity is fun +5 skills so ... can play competitive sports +5 many options exist for PA +5 about lifetime PA skills +5 play games and sports with peers +5 specific activities that promote fitnessJennifer +5 how to use community PA settings +5 play games and sports with peersjasmine +5 about fitness aspects of PA +5 skills so ... can play competitive sports +5 about lifetime PA skills +5 play games and sports with peersNote. PA = Physical Activity; MVPA = Moderate to Vigorous PhysicalActivity; Q-sort questions include Family--"most important in my familysituation to help explain why my son or daughter is physically activeoutside of school" and School--"physical education programs shouldteach my child." Items included those that were ranked +5 in responseto important for my child and -5 in response to never important for mychild.(a) indicates two children with visual impairments from the samefamily.