By Dr. Jamie Hoffman, CTRS, and Maggie Palchak

What is an adaptive water sport?

It's that time of year again where the weather is hot and the water is refreshing! Water sports are activities/sports that are carried out in, on, or under water. Adding adaptive to the activity/sport means that it is accessible to most anyone regardless of physical, intellectual, or visual challenges. By answering a few simple questions, you can embark on the path to finding the best adaptive water sport to meet your goals.

• First, are you comfortable around and in water, and able to swim?
• Are you interested in being on the water, in the water, or under the water?
• Do you want to participate in adaptive water activities/sports in a pool, lake, river, or ocean?
• Are you planning on participating with your family or a group of friends. Are you looking for a workout opportunity, or perhaps you aspire to become a competitive racer?
• What are your strengths – will you paddle or swim utilizing your legs, arms, or both?
• Will you use your vision or senses, or that of another individual to guide you?
• Will you rely on your judgment or that of your partner?
• And is balance a strength or a challenge for you?

The answers to these questions will help you and your adaptive sports provider find the best adaptive water sport/activity to meet your needs. Adaptive water sports activities can include but are not limited to: swimming, water exercise, water skiing, wakeboarding, prone paddle boarding, stand-up paddle boarding, seated or wheelchair-accessible paddle boarding, surfing, snorkeling, scuba diving, free diving, sailing, kayaking, rowing, and whitewater rafting. Equipment can range from using the traditional piece of equipment like a tandem ocean kayak to utilizing a Liquid Access adaptive sit water ski.

The beauty of utilizing water for fun and physical activity is that it provides a supportive environment, which allows for individuals with all abilities to participate inclusively with minimal to maximum modifications or equipment. Simple modifications of utilizing a pool noodle, which can be purchased at your local store, can provide buoyancy enough for someone to float independently. Identifying your comfort level in, on, and under water is a great way to assess the starting point for your engagement in adaptive water sports.

Having acquired a new disability, whether it be a spinal cord injury (SCI) or a traumatic brain injury (TBI), your body's position and relationship with water may experience a significant change reflecting your new body composition and level of ability. This is an important thing to acknowledge as your ability to swim or maintain comfort in, on, under, or around water may have changed. Your judgment may also be altered from your past experiences. Make sure you never swim or participate in watersports/activities alone. Always practice the buddy system.

Depending on your level of interest from maintaining a recreational pursuit to competing at the paralympic level in your chosen adaptive water sport, the equipment, training, and resources are available either in your own community or throughout the country.

How do I get started?

With the endless opportunities to participate in adaptive water sports you might be wondering, where and how do I get started? There are various types of adaptive water activity/sports programs that exist in the community in order for Veterans to access equipment and facilities for little to no cost. Attend an adaptive surfing clinic or camp! This is a one-day or multi-day program that provides a variety of equipment for participants to demo (e.g., Operation Ampt, San Diego, CA). Find an adaptive kayaking program! Some community programs offer an ongoing kayaking or paddle boarding program, providing weekly paddles or private lessons with staff support and equipment (e.g., Access Leisure, Sacramento, CA, or Disabled Sports Eastern Sierra, Mammoth Lakes, CA, or The CSUS WELL Recreational Therapy Program, Sacramento, CA, Environmental Traveling Companions (ETC), San Francisco, CA). Visit an adaptive kayaking center! Bay Area Outreach Program (BORP, Berkeley, CA) is a local example of an adaptive kayaking center that allows persons with disabilities and Veterans to grab adaptive kayaks and paddle directly from their location during open program hours. Lastly, what do you do when you want to play but don't have the toys, you rent! The City of Reno, NV, has made their adaptive recreation equipment such as handcycles, recumbent trikes, and sports wheelchairs available to rent. Renting makes it affordable for participants to try before they buy, be a weekend warrior, gain skills, and be involved in more than one sport

Why should I participate in adaptive water sports/activities?

Are you trying to find the WHY? Why should I try out adaptive water sports/activities? Why is it beneficial? The benefits are endless and include physical, social, and psychological benefits. Findings indicated that participation in adaptive sports positively influenced quality of life, overall health, quality of family life, and quality of social life. Athletic identity was also reported and compared with other samples of people with and without disabilities (Zabriskie, Lundberg, Groff, 2005).

There are numerous physical benefits to water activity including swimming and paddling. Increased cardiovascular endurance, range of motion, flexibility, posture, muscular and bone strength are a few of the physical benefits to the body. When you think about your own personal social deficits or needs, starting to swim or continuing to swim or paddle may create access to new relationships and social outlets. Swimming, surfing, paddle boarding, and kayaking are very social activities allowing participants to create friendships and comradery as you play as a group and form social bonds. Many surfing, kayaking, and whitewater rafting groups meet up for coffee or meals, and establish daily/weekly/monthly sessions for both accountability and fun. While exploring new areas in the community can be fun in, on, around and under the water, the psychological benefits of water activity allow some individuals to find their flow and maintain life balance. Psychological benefits include reduced stress levels, decrease in anxiety, improved mood, better sleep, and the promotion of new thought patterns that promote feelings of calm and wellbeing.

If this is not enough motivation to start or continue participating in adaptive water sports/activities, then the bottom line is that it will allow you to get outside, off of your technology, and have the water cool you off and provide some fun! Make sure you stay hydrated and wear sunscreen when you are participating in adaptive water sports/activities! Getting out of your regular routine and trying a new leisure activity is a positive way to utilize your free time or pass the time. For more information, contact your recreational therapist or go to your local sailing club, swimming pool, or kayaking shop and ask about local paddles or clubs. Water enthusiasts are generally friendly, fun and kind people, so get out there and get wet!

By Christina Patron, RDN

Are you getting enough fluids? The average adult needs anywhere from 8 to 13 cups of fluids daily. As the weather warms up, you may find you need more than usual. Sensations of thirst may be your first indication that your fluid levels are dropping. Other signs include headaches, dry/sticky mouth, dry skin, fatigue, constipation, dizziness upon standing, irritability, and dark urine.

Keeping a beverage on hand and sipping throughout the day can help you stay optimally hydrated. When it comes to exercising, you want to begin adequately hydrated. That may mean drinking 1-2 cups of fluids in the hour or so prior to your workout. Even a 2% decrease in your fluid weight can negatively impact your performance. If you have a high sweat rate and for exercise lasting longer than one hour, you may need to sip on electrolyte-rich fluids during your workout. For every pound of sweat lost during a session, you should consume 16 ounces of fluids in replacement.

In most cases, water is your best choice for hydration. Other options for hydration include mineral or sparkling water, milk, and 100% juice, or electrolyte-rich products, such as coconut water, sports drinks, or electrolyte water additives.

You also get approximately 20% of your fluids from the foods you eat, so reach for high water content fruits and vegetables, such as watermelon, oranges, and cucumber, or foods that are liquid at room temperature, such as soup or gelatin.

Adaptive athletes may need to pay special attention to their hydration if they have decreased sweat rates or urine collection bags. Avoid dehydration prior to a sporting event and while traveling as much as possible. If you tend to gain weight during an exercise, you may be overhydrating and can try alternative cooling methods, such as cooling garments or towels, ice packs, or iced beverages.

Before exercise or competition, optimize your hydration by drinking fluids with meals and using electrolyte-rich beverages or products. Talk with your medical team if you have concerns with hydration.

By April Wolfe, CTRS, Dr. Jamie Hoffman, CTRS, and Maggie Palchak

What is adaptive cycling?

Cycling is a sport which is accessible to most anyone regardless of physical, intellectual, or visual challenges. By answering a few simple questions, you can embark on the path to finding the best cycle design for your goals.

• First, are you interested in riding on the road, or are you looking to get your wheels dirty?
• Are you planning on a family ride, a commuter option, a workout opportunity, or perhaps you aspire to become a competitive racer?
• What are your strengths - will you pedal with your legs or arms?
• Will you use your vision or that of a pilot to guide you?
• Will you rely on your judgment or that of your partner?
• And is balance a strength or a challenge for you?

The answers to these questions will help you and your adaptive sports provider find the best cycle to suit your needs. Bike designs range from traditional two-wheeled options to upright or recumbent three-wheeled bikes, which offer greater stability to those with balance challenges. Bikes can be pedaled with legs or arms and may include hand, elbow, or butt controlled brake levers, foot and leg support pedals to assist with proper alignment, and specialized grips designed to accommodate individuals with cervical spinal cord injuries or amputations.

Additional options include seat positions varying from an upright seated position, kneeling, or fully reclined supine position. Upright traditional road bikes can also be adapted to become trikes – approved for Paralympic competition. Finally, pedal assists include human-powered tandem options and electric pedal assist for most any bike. There are even some fully powered electric “bikes” available, which require no pedaling at all.

If you are planning to ride any electric assist bike off-road, remember to check local regulations regarding motorized vehicles on the specific trails you plan to explore before setting out.

How do I get started?

With all this great adaptive cycling equipment you might be wondering, where and how do I get started? There are various types of adaptive cycling programs that exist in the community in order for Veterans to access this equipment for little to no cost.

Attend an adaptive cycling clinic or camp! This is a one-day or multi-day program that provides a variety of equipment for participants to demo (e.g., Mark Wellman Adventure Day, Sparks, NV).

Find an adaptive cycling program! Some community programs offer an ongoing cycling program, providing weekly rides, or private lessons with staff support and equipment (e.g., Access Leisure, Sacramento, CA, or Disabled Sports Eastern Sierra, Mammoth Lakes, CA, or The CSUS WELL Recreational Therapy Program, Sacramento, CA).

Visit an adaptive cycling center! Bay Area Outreach Program (BORP, Berkeley, CA) is a local example of an adaptive cycling center that allows persons with disabilities and Veterans to grab adaptive bikes and ride directly from their location during open program hours.

Lastly, what do you do when you want to play but don't have the toys? You rent! The City of Reno, NV, has made their adaptive recreation equipment, such as handcycles, recumbent trikes, and sports wheelchairs, available to rent. Renting makes it affordable for participants to try before they buy, be a weekend warrior, gain skills, and be involved in more than one sport.

Why should I ride my bike?

Are you trying to find the WHY? Why should you try out cycling? Why is it beneficial? The benefits of cycling are endless and include physical, social, and psychological benefits. Findings indicated that participation in adaptive sports positively influenced quality of life, overall health, quality of family life, and quality of social life. Athletic identity was also reported and compared with other samples of people with and without disabilities (Zabriskie, Lundberg, Groff, 2005).

There are numerous physical benefits to cycling. Increased cardiovascular endurance, range of motion, flexibility, posture, muscular and bone strength are a few of the physical benefits to the body. When you think about your own personal social deficits or needs, starting to cycle or continuing to cycle may create access to new relationships and social outlets.

Cycling is a very social activity allowing riders to create friendships and comradery as you ride as a group and form social bonds. Many cycling groups meet up for coffee or meals post-rides, and establish daily/weekly/monthly rides for both accountability and fun. While exploring new areas in the community can be fun on your cycle, the psychological benefits of riding allow some individuals to find their flow and maintain life balance. Psychological benefits include reduced stress levels, decrease in anxiety, improved mood, better sleep, and the formation of new thought patterns that promote feelings of calm and well-being.

If this is not enough motivation to start or continue cycling, then the bottom line is that it will allow you to get outside, off of your technology, and have the wind blow through your hair or over your skin. Getting out of your regular routine and trying a new leisure activity is a positive way to utilize your free time, or pass the time.

For more information, contact your recreational therapist, or go to your local bike shop and ask about local rides or clubs. Cyclists are generally friendly, fun and kind people!

By Stephanie Tow, MD, FAAPMR, CAQSM

To officially compete in a Paralympic sport, athletes must have a physical, visual, or intellectual impairment.

• Physical impairments are further categorized into the following impairment types: impaired muscle power, impaired passive range of movement, limb deficiency, leg length difference, short stature, hypertonia, ataxia, and athetosis.
• Eligible impairments vary by sport.
• Some sports include all three impairment types, while others may be exclusive to one impairment type or a subset of impairment types.

Eligible impairments must be secondary to an eligible diagnosis that is permanent or progressive.

Athletes undergo a process called classification to determine the impact of an athlete’s impairment(s) on their sport performance based on a medical/physical examination and a technical assessment related to the sport.

Classification systems for Paralympic sports were developed with the intent to make the competition as fair as possible while minimizing the impact of an athlete’s impairment on their performance outcomes.

The goal of classification is to group Para athletes who have a similar degree of sport-specific activity limitation from their impairment into a sport class.

• Each classification sport class may have athletes with different impairments and diagnoses competing against each other.

Paralympic classification systems have evolved over time with research but still have much potential for improvement.

Learn more about Paralympic classification

By Maggie Palchak

While down here in the Bay Area it may currently look and feel like spring, up in Tahoe and in the Sierras, only a few hours away, the snow is beautiful and winter sports are in full swing. If you haven’t previously explored the winter sports arena, you may be surprised to learn that there are actually MANY adaptive sports opportunities for all.

If it has been years since you last dabbled in winter sports, look again! The innovation and progress that have been made in this field are astounding, and the opportunities are endless. As Sebastian DeFrancesco, one of the early innovators in adaptive sports, said, “If anyone wants to do anything now in a wheelchair, you can do it. There are no limits.”

There are many programs that cater to adaptive athletes in winter sports, including Alpine (downhill) skiing, Nordic (cross-country) skiing, snowboarding, and biathlon, which combines cross-country skiing and rifle shooting. In fact, Disabled Sports Eastern Sierra (DSES) is holding a Biathlon Camp (March 16-22) specifically for military athletes. This is a pilot program for the DSES initiative to create the National Wounded Warrior Center in the Eastern Sierra, and the more people who attend the better for the program! Learn more about the Center on their website.

DSES is a nonprofit organization dedicated to changing lives of individuals with physical and cognitive disabilities through year-round outdoor sports and activities. They provide a variety of modern adaptive equipment and demo opportunities across the region. If you are interested in more opportunities, DSES is offering Mono Ski Madness from March 5-7, available to mono skiers of all ages, civilian or military. They also currently offer daily lessons in Alpine skiing, snowboarding, and Nordic skiing.

Up in Tahoe, Squaw Valley offers discount passes for adaptive athletes and also has a robust adaptive ski school. Achieve Tahoe offers a discount to Veterans participating in their adaptive sports programs.

In our October 2020 blog post, staff physicians wrote about the many benefits of adaptive sports. Adaptive athletes tell us that the thrill and exhilaration of outdoor sports truly change their lives. We hope you take advantage over the next several months to get outside and explore the world of winter sports!

By Paige Dyrek, MD

Adaptive sports initially originated to assist in the rehabilitation of Veterans injured in World War II. In 1944, the British government selected Dr. Ludwig Guttmann to manage the spinal cord injury center at Stoke Mandeville Hospital in England. Dr. Guttmann, a pioneer of the Paralympic movement and founder of the Paralympic games, revolutionized the management of paralyzed Veterans by encouraging physical rehabilitation and social reintegration through organized sports.

As the 1948 London Olympic Games were set to begin, Dr. Guttmann organized the Stoke Mandeville Games, which is recognized as the first competitive event for wheelchair athletes. The Stoke Mandeville Games expanded annually to include different sports and athletes from across the world, ultimately becoming known as the Paralympic Games.

The first official Paralympic Games were held in Rome, Italy, in 1960 and brought together over 400 athletes from 23 countries. The first Winter Paralympic Games took place in Sweden in 1976 and included non-wheelchair athletes with other physical, intellectual, and visual impairments. Due to a close relationship between the International Paralympic Committee (IPC) and International Olympic Committee (IOC), both events recur every four years in the same cities and venues.

In 2008, the Paralympic Games reached a milestone in Beijing where it became the second largest sporting event in the world behind only its counterpart. Today, the Paralympic Games have expanded to include 28 sports, with six of these taking place in the winter. In the 2016 Paralympic Games held in Rio de Janeiro, over 4,000 athletes competed and represented nearly 160 countries.

The Paralympic Games represent inclusion, equity, and hope, and provide an international platform for people with disabilities to showcase their athletic achievements. All eyes will be on Tokyo, Japan, this summer as athletes from across the world travel to compete on sport’s biggest stage.

Check out the timeline of the Paralympic Games

To highlight our Veteran athlete population, we have decided to interview some of our local heroes and dive into their backgrounds, how they got into adaptive sports, and the impact adaptive sports have had on their lives.

See below for our first Q&A of the series, which highlights one of our inspirational Veteran athletes, Demond Wilson. The interview was conducted by Steven Toyoji, one of the directors of the Riekes Center.

Q: What is your name?
A: My name is Demond Wilson.

Q: Where are you from?
A: I am from Vallejo, California.

Q: Would you mind providing a brief overview of your service history?
A: My service history started in 1996 right out of high school. I joined the Marines, and became involved in the Infantry and TRAP Force Unit, which is rescue of aircraft personnel, and I eventually got out with honorable discharge in 2000. And then started working in a refinery after that.

Q: How were you first introduced to adaptive sports or recreation?
A: After my injury -- I’m a C5 C6 quadriplegic -- after recovery I was going through the VA and through VA's Recreation Therapy program where they introduced some different adaptive sports opportunities like cardio and biking. Then they introduced me to Steven at the Riekes Center, and he got me involved in sports and getting back into therapy and strength and conditioning in order to improve my health.

Q: So what was the activity that you started with at the Riekes Center?
A: The original activity that I watched was quadriplegic rugby, and once I saw that -- I used to be an athlete in high school and [played] sports -- I decided I wanted to get involved in the program and started playing wheelchair rugby.

Q: What were your initial thoughts following the experience?
A: Following [the] injury, I didn’t think I’d be able to, you know, kinda get back into sports or what type of what I can do, and then once I got into the Riekes Center, [I] seemed to be around more wheelchairs, and I just knew I can adapt and overcome my injury. And it was just a lot of hard work and getting used to the new body I should say.

Q: What other adaptive sports or recreation opportunities have you participated in?
A: Being in the military, I’ve participated in Veteran’s wheelchair games with Rec Therapy, every year it’s held in different states, and we do a variety of sports [and] activities, such as archery, track and field, doing shot put and javelin, there was weightlifting, that was another big one for me, and table tennis. The Valor Games is another event where I competed in archery, biathlon, and rowing.  Winter Sports Clinic in Aspen, CO sponsored by the DAV [Disabled American Veterans]. I also attended the Reno Military Sports Camp with the City of Reno and did some offroad biking, rugby, archery, and waterskiing. Waterskiing is a good one, especially on a hot day. Wheelchair softball with the San Francisco Giants Paralympic Team. I got involved with BORP over in Berkeley and was able to get fitted with one of their handcycles and just jump in and ride along the bay trail.

Q: What (if any) additional impact have your experiences in adaptive sports or recreation had on you?
A: The impact that recreational sports has had on me is [that] it's been good for my motivation, to keep my spirits -- a healthy mind -- to keep my mind focused on doing anything else other than just sitting around watching TV. And just being able to adapt and use different tools necessary in order to do different recreational events, and getting out and doing all types of different sports, and it just keeps you motivated for the most part, and [helps you] stay busy.

Q: Are there any other sports or recreation opportunities you want to participate in?
A: Yes, there [have] been a few, I’ve been scuba diving, is one of them. I’m not the biggest fan of the water, but after putting on scuba gear in the pool, it’s been a good experience, so that would be one. And, you know, I can always go parachuting or something like that, but I just like to do whatever group activity is possible, and just try to enjoy as many different recreational programs or just sports events as I can.

Q: Do you have any advice for individuals who have never participated in adaptive sports or recreation?
A: For any advice, I would say: don’t give up. With any type of sports or recreation that you can do, go for it, and you know it’s always good you never know who else you can motivate. So, just don’t stop, keep pushing, and keep going forward. Do all your goals that you have planned still, just because any change in your body or anything like that, it doesn’t change much.

Bonus Questions:

Q: What is your favorite dessert?
A: My favorite dessert is peach cobbler actually. Yeah, peach cobbler with a little vanilla ice cream, or possibly apple pie a la mode, I’m not really picky on desserts.

Q: Do you have any hidden talents?
A: You know, there are a few talents that I’ve been starting to pick up on, such as art, I guess. So I’ve been trying to paint a little bit and get onto my artistic side that I never really knew I had, so yeah, art has been a new little challenge for me.

Q: Who is your favorite athlete and why?
A: I’m going to go with Tom Brady because he is a perfectionist when it comes to trying to perfect himself and achieve his goals when it comes to winning.

By Daniel Koehler, Psy.D

The general consensus is that exercise is good for our health, but the benefits extend far beyond the physical. Regular engagement in an exercise program or adaptive sports has been repeatedly shown to have multi-layered benefits on one’s physical, mental, and social wellbeing. In addition to disease prevention and management of chronic health conditions, exercise/physical activity has been shown to improve sleep, alleviate symptoms of stress, depression, anxiety, and PTSD, increase one’s energy and stamina, and promote better cognitive performance. Additionally, for adaptive sports athletes in particular, it has also promoted greater perceived social connection, sense of identity, and perceived self-competency.

In the United States, we often talk about “health”, or what it means to be “healthy”. It is not the absence of disease, but rather a practice towards achieving greater physical, mental, and social well-being. This sense of well-being is subjective and may differ for each individual. Perceptions of one’s quality of life may change over time, and particularly with development or acquisition of disease or disability. Our physical, mental, and social well-being are interconnected, with disturbance in one area often contributing to decreased perception of health and functioning in the others. For instance, an acquired disability can often bring about a sense of change and loss, leading to increased likelihood of mood disturbance (depressed mood, loss of interest in activities, isolation, anxiety, disrupted sleep), which can in turn impact one’s motivation to engage in both physical activities and social relationships. Decreased participation in physical activity may worsen one’s perceptions of their abilities/limitations, reinforcing mood disturbance, which may in turn negatively impact one’s motivation to be active. Similarly, decreased social participation may lead to increased feelings of isolation, changes in one’s self-perceptions, and reinforce mood disturbance. Thus, we have a vicious cycle.

So, why not use physical activity and adaptive sports as a way of taking back control of your life and enhancing your physical, mental, and emotional well-being, all at the same time?

So how does it work? Regular engagement in exercise can have positive effects on the body and mind. Both moderate to strenuous exercise can lead to an increase in the availability of chemicals in the brain called neurotransmitters (e.g., serotonin, dopamine, and norepinephrine) that are often diminished with depression. In essence, exercise can trigger the body to utilize its own natural anti-depressant mechanisms, which may lead to reductions of mood symptoms if the exercise regimen is sustained over time. Moreover, exercise can enhance self-efficacy, the belief that one possesses the necessary skills to complete a task as well as the confidence that the task can actually be completed with the desired outcome. Individuals with depression may often feel decreased self-efficacy in coping with their symptoms, leading to negative self-evaluations and sense of helplessness. Working towards exercise goals can promote greater sense of self-efficacy, which can enhance motivation to continue making lifestyle changes to improve overall quality of life. In adaptive sports, camaraderie among fellow athletes and team-mates can provide meaningful social connection, promote a sense of identity and self-efficacy, and reinforce engagement in physical activity, which can have beneficial effects on one’s mental health. On a cognitive level, adaptive athletes can see improvements in cognitive performance as part of the process in skill acquisition in their sport. Skill-building and application in adaptive sports promote utilization of one’s attentional abilities, processing speed, and executive functions, which may be translated to other areas of an adaptive athlete’s life.

So why not exercise your body, mind, and spirit all at the same time? Reach out to the VA Adaptive Sports Program, or talk with your PCP about ways you can introduce physical activity as part of your daily or weekly routine.

By Huy Diep, RTC and Debbie Pitsch, MPT

The VA offers Veterans with significant physical impairments an array of adaptive recreational and sporting equipment. Whether a Veteran is a recreational or competitive athlete, the VA will provide the adaptive equipment that best meets the Veteran’s needs. Examples of adaptive equipment include but are not limited to handcycles, sporting wheelchairs, mono-skis, running legs, swimming arms, etc.

If the equipment utilized for a specific activity is not adaptive in nature, the VA can also provide the modifications to a standard device (such as a bicycle or kayak) to make it useable by Veterans with varying disabilities. For example, the VA will not provide a two-wheeled bicycle since it is not inherently adaptive; however, the VA can modify the pedals, brakes, or handlebars as needed, or provide special terminal devices or prosthetic legs to make the standard bicycle accessible. All recreational equipment issued must have a proper prescription written by a qualified clinician.

There are many requirements to receive adaptive recreational and sporting equipment through the VA. The most important requirement is having a strong medical justification such as significant weakness, loss of use of an arm/leg, or significant loss of balance such that you cannot use standard sporting equipment. Significant chronic pain, arthritis, obesity, PTSD/depression or service connection do not meet the VA’s requirement for adaptive sporting equipment. To start the process, you will need to get medical clearance from your doctor to participate in the sport and identify a specific therapeutic goal. Your doctor will also need to send a consult to recreation therapy, occupational therapy and/or assistive technology to start the evaluation process. The total process can take 6-12 months to complete.

Requirements include the following:

• Complete an exercise log for three months to show dedication to sport and commitment to consistent exercise
• Participation in local sport-specific camps or clinics and/or VA national events is encouraged
• Complete equipment trials of various equipment to determine most appropriate options
• Demonstrate safe use of the adaptive equipment and safe ability to transfer on/off equipment
• Skin is intact on all surfaces in contact with equipment
• Availability to consistently access chosen adaptive sport locally on a regular basis
• Ability to transport and safely store adaptive equipment
• Has the finances to maintain and utilize adaptive equipment
• Identifies a buddy/partner to assist and support them in identified sport if needed
• Received comprehensive education and training on activities available for specific disability and equipment options for identified recreational activity.

**If you are interested in a team sport such as wheelchair tennis, basketball, rugby, etc., you will need to provide evidence of consistent participation on an organized team. Please contact your recreation therapist or assistive technology at 650-444-7245 if you have any further questions.

Items not provided by the VA:

• Standard, non-adaptive equipment
• Clothing for sport participation
• Spare/alternative components (wheels, skis)
• Tool kits/repair kits
• Component upgrades that are not justified
• Non-adaptive accessories and supplies such as helmets, face masks, shoes, gloves, water bottles/hydration packs, etc.

For Veterans who do not meet the above criteria for adaptive recreational or sporting equipment through the VA, please check these other funding options:

• Challenged Athletes Foundation (CAF) provides opportunities and support to people with physical disabilities, so they can pursue active lifestyles through physical fitness and competitive athletics. CAF believes that involvement in sports at any level increases self-esteem, encourages independence, and enhances quality of life.
• The High Fives Foundation is dedicated to raising money and awareness for athletes that have suffered a life-altering injury while pursuing their dream in the winter action sports community.
• I'M ABLE Foundation grants are awarded to disabled individuals and supporting organizations and provide hand-cycles, adaptive skis and instructional training programs for those in need. Their purpose is to unleash the potential in physically challenged children and adults to be more active, enjoy the benefits of physical fitness, and spend more time in the great outdoors.
• The Kelly Brush Foundation is committed to empowering those with paralysis through sports and recreation. Their grant programs help people with paralysis purchase adaptive sports equipment.
• Semper Fi Fund (SFF) provides relief for financial needs that arise during hospitalization and recovery as well as assistance for those with perpetuating needs. Their program provides support in a variety of ways including service member and family support, specialized and adaptive equipment, adaptive housing, adaptive transportation, education, and career transition assistance, PTS and TBI support, Team Semper Fi, and America’s Fund.
• Team PossAbilities: The purpose of a PossAbilities grant or scholarship is to provide support for our members to improve the quality of life, assist in the reintegration of those with disabilities into the community and society, and to meet the specific needs of our members.
• The Independence Fund's mission is to provide the tools, therapies, and guidance that those Veterans severely injured in the line of duty are otherwise not receiving.

By Donald Kasitinon, MD; Emily Kraus, MD; Emily Miller, MD

• Adults with disabilities are three times more likely to have heart disease, stroke, diabetes, or cancer when compared to adults without disabilities.
• Over 50% of persons with disabilities in the United States with a mobility impairment do not get aerobic exercise, an important health behavior to help avoid these chronic diseases.
• Regular physical activity and sports participation provide important health benefits for, including:
  - Improved cardiovascular and muscle fitness
  - Better ability to do tasks of daily life
  - Decreased rates of obesity
  - Improvements in quality of life, life satisfaction, community reintegration, mental health, and employment.

Please visit our Facebook page to watch our recorded workshop - Why exercise? - to learn more about the importance of exercise and how to get involved in adaptive sports at VA!