Understanding the experience of community-based fitness professionals supporting people with disability to engage in sport and exercise: a national survey

Abstract Purpose The benefits of sport and exercise participation for people with disability are well acknowledged. However, people with disability report numerous barriers to participating in sport and exercise, including negative interactions with fitness professionals. Limited research is available from the perspective of fitness professionals. This study aimed to understand the experience of fitness professionals supporting people with disability to engage in sport and exercise. Materials and methods A cross sectional survey study was used to gather quantitative and qualitative data on community-based fitness professionals from Australia, with or without experience working with a person with disability. Results A total of 72 fitness professionals took part in the study with most reporting experience and confidence in working with people with disabilities. Several barriers were identified with participants highlighting the lack of disability-specific training. Participants also identified potential facilitators, including effective collaboration with allied health professionals. Conclusion There is emerging interest for fitness professionals to support people with disability to engage in sport and exercise. However, changes are required within the education provided to fitness professionals and with the current collaborative model with allied health professionals to better support the participation of people with disability in sport and exercise. IMPLICATIONS FOR REHABILITATION As physical activity is pertinent to ongoing health and wellbeing of people with disability, with support, fitness professionals could provide a cost-effective solution to assist in enabling people with disability to access sport and exercise activities. Fitness professionals require continuing disability-specific education and input from allied health professionals to appropriately support their clients with disability. Changes are required within the Australian fitness industry and in the model in which allied health and fitness professionals collaborate to better support people with disability to engage in sport and exercise. Additional barriers external to the fitness professional such as the physical environment, funding restrictions and lack of societal awareness, continue to impede on people with disabilities’ participation in sport and exercise settings and should also be acknowledged.


Introduction
Disability has been suggested to occur when the interaction between an individual's health condition and environmental factors impacts their ability to fully engage within their daily occupations [1].currently approximately 15% of the world's population live with disability [1].Recent data shows that people with disability are more likely to report experiencing poorer mental and physical health when compared to those without disability, with physical inactivity and weight related concerns rated as the highest health risk factors [2].there is clear evidence to support the benefits of regular participation in physical activity including reduced risk of chronic health conditions, improved cognitive ability, and improved physical and mental health and wellbeing [2,3].For people with disability, physical activity participation has the further benefit of increasing physical function and independence, reducing pain, increasing feelings of empowerment, and providing opportunities for social inclusion [4,5].however, despite the recognised benefits of physical activity, approximately 71% of people with disability (compared with approximately 50% of people without disability), do not engage in sufficient physical activity for good health [2,6].
sport and exercise are two ways in which people participate in physical activity.although both sport and exercise involve planned, structured activities that result in physical exertion, voluntary movements and energy expenditure, sport has the additional requirements of a set of rules and often involves a form of competition [7].Over the past two decades there has been increasing interest in the potential benefits of sport and exercise on overall health, well-being, and quality of life for people with disability [7].this has been observed through the increased development of sport and exercise programs specific to people with disability, as well as the inclusion of twenty-eight sports within the Paralympic games [8].however, despite this increase in research and interest the literature consistently shows that people with disability report low levels of sport and exercise engagement [9].Given the discrepancies in overall health and wellbeing, and the established benefits of sport and exercise, change is needed to facilitate greater participation by people with disability [2].
Barriers for people with disability engaging in sport and exercise have been found to be multifaceted including both personal and environmental factors [10].Personal barriers to sport and exercise participation identified by people with disability include lack of understanding of the benefits of sport and exercise participation, perceived negative attitudes experienced from members of the community, as well as reduced self-esteem, self-confidence, and fear of the unknown [2,[9][10][11][12][13]. environmental barriers include lack of social support, lack of necessary funding, inaccessible facilities, programs and equipment and lack of training and education of fitness professionals [2,[9][10][11][12][13][14][15][16].
increasingly, fitness professionals such as sport coaches, personal trainers, instructors, and gym managers (collectively referred to as fitness professionals throughout this article), have been recognised for their crucial role in supporting people to engage in sport and exercise [4,17].For example, personal trainers are seen to represent the ethos of the gym cultural environment, as well as possessing the knowledge to support clients to reach their goals, while coaches have been identified as important "social agent[s]" in engagement in sport [4, 17,p.547, 18].For fitness professionals working with people with disability specifically, available literature has largely focused on the perspective of the person with disability [5,18].Within this research people with disability have highlighted that fitness professionals frequently lack the knowledge and skill to appropriately tailor and adapt activities and exercises, as well as can display negative attitudes and stigma towards people with disability participating in sport or exercise [5,15].For example, within a 2021 scoping review exploring the barriers for people with a physical disability engaging with gym settings, authors identified specific staff characteristics (e.g., lack of knowledge of disabilities, or exercise adaptations), and gym user-management relationship (e.g., discrimination, attitude focused on physical prowess, not accepting attitude, lack of communication skills) as barriers to participation [19].similarly, Bossink et al. 's [12] systematic review highlighted that staff anxiety, staff expertise and staff interest were major barriers in supporting people with intellectual disabilities to engage in sport and exercise.
conversely, despite some studies describing them as barriers, others have highlighted the potential for community-based fitness professionals to act as facilitators, providing important support for people with disability wanting to engage in sport and exercise [11,[20][21][22].Within these studies, positive interaction with fitness professionals was reported to be integral to the success people with disability experienced engaging in sport and exercise [20][21][22].
although there has been a growing body of literature exploring the barriers and facilitators of sport and exercise participation from the perspectives of people with disability, limited research is available from the perspective of the fitness professionals themselves.two recent qualitative studies aimed to address this gap.Obrusnikova et al. [23] evaluated the beliefs of 32 personal trainers from three american YMca community fitness facilities on their experience providing personal training to people with intellectual disability. in a similar study design, cunningham et al. [4] interviewed 16 staff from three community and one university gym on their experience working with people with disability.authors found that although staff were positive about working with people with disability, they identified several challenges in their role such as managing the expectations of other gym users, lack of awareness of exercise opportunities of people with disability, lack of accessibility of the built environment and access to transport, and lack of staff training [4,23].Participants in both studies expressed the need for more disability specific training for fitness staff [4,23], with participants in cunningham et al. [4] also identifying the need for collaboration with health professionals.
Whilst providing valuable insights these findings are limited in their generalisability due to only evaluating a small sample of staff exclusively working in gyms within similar locations.Due to the wide range of exercise and sporting opportunities available, further research is required to better understand the perspectives of fitness professionals working with people with disability across a range of different contexts and settings.to address this gap this study aimed to understand, (1) if and how community-based fitness professionals were supporting people with disability participate in sport and/or exercise, ( 2) what barriers they have faced when working with people with disability, and ( 3) what changes are required within the fitness industry to support fitness professionals work with people with disability.Furthermore, due to the novel finding within cunningham et al.'s [4] study highlighting the potential for interprofessional collaboration between community-based fitness professionals and allied health professionals, this study also aimed to understand what this potential collaboration might involve.

Methods
this study was given ethics approval by the University of Queensland (2021/he0002303).a cross sectional survey study design was used as this design permitted the collection of a large amount of population-based data [24].survey studies have also been shown to encourage participation from hard-to-reach respondents due to being convenient and anonymous [24].

Survey development
as there were no pre-existing surveys available exploring the experience of community-based fitness professionals working with people with disability, survey questions were developed through the thorough review of disability, physical activity, sporting and exercise physiology literature [9-16, 21,22], in combination with the expertise of the first author (Jh, an occupational therapist and qualified personal trainer with clinical and research experience supporting people with disability engage in sport and exercise) [24].an initial draft of the survey was developed by the first author (Jh) and reviewed by another author (hG).the pilot survey was then tested and evaluated by three independent examiners in relation to the survey's usability and its relevance to the research aims.independent examiners included one occupational therapist with experience in survey design, one exercise physiologist and one exercise scientist.the pilot survey was reviewed after each trial by authors Jh and hG.
the final survey consisted of 36 questions and included both open and closed response questions to allow quantitative and qualitative data to be collected simultaneously within the same tool.Questions one to six of the survey collected demographic and professional data.the remaining sections asked questions addressing, (1) if and how community-based fitness professionals were working with people with disability (questions 7 to 16), (2) community-based fitness professionals confidence working with people with disability (questions 17 to 21), (3) training completed to support people with disability (question 22), (4) barriers to supporting people with disability access sporting and exercise services (questions 23 to 29), (5) changes required to better support people with disability participate in sport and exercise (questions 30 and 31), and (6) the potential way in which fitness professionals might be supported by allied health professionals (questions 32 to 35). a full copy of this survey has been included within supplementary Material 1.

Data collection
Participants were invited to complete the survey if they were an adult (>18 years) and worked as a community-based fitness professional in australia.this excluded allied health professionals such as exercise physiologists and physiotherapists.all types of fitness professionals were included (e.g., Pilates instructors, coaches, personal trainers, aqua instructors, etc.) to ensure diversity amongst the types of sports and exercise settings that people with disability might choose to engage in. to also gain insight as to why a fitness professional might choose to not work or not have had the opportunity to work with a person with disability, participants were encouraged to complete the survey irrespective of professional experience working with this population.
surveys were distributed through the online Qualtrics [25] software which allowed data to be collected whilst maintaining participant anonymity.an email databased was created through an internet search identifying N = 169 relevant community-based sporting and exercise organisations in which a survey link was emailed directly.additionally, surveys were shared on relevant sporting and exercise Facebook pages and groups.snowball sampling was also used as participants were encouraged to share the survey amongst their networks therefore a response rate could not be calculated.all participants were required to self-identify if they met the selection criteria and were asked to provide informed consent to participate prior to commencing the survey.all surveys were completed on a voluntary basis and no participants were financially compensated for their time.

Data analysis
Data were analysed sequentially with the closed response questions analysed first followed by the content analysis of the open answer responses [26].integrating the data sequentially permitted the qualitative data to supplement the statistical data with contextual and lived experiences in a modified explanatory-sequential approach [27].Deidentified quantitative data were downloaded and analysed through Microsoft excel Version 16.63.1 [28].Data were manually reviewed for substantiated missing data or for participants who did not meet the eligibility criteria.each question was analysed using the frequency of responses and was converted into percentage of total respondents.Blank responses were not removed to inform the researchers of trends in participants not answering questions, suggesting possible unwillingness or uncertainty in responses.Qualitative data were analysed through content analysis to identify common words, themes, and ideas [24].the short answer responses were examined and coded independently by two members of the research team Jh & eM, who met on two occasions to discuss until consensus of final categories was met.When consensus was not met, third author hG was consulted.

Demographic details
Demographic and professional data are outlined in table 1. seventy-two (n = 72) fitness professionals participated in the survey.One participant was excluded due to identifying as a Physiotherapist.Most participants identified as female (79%, n = 57), with the most common profession being personal trainer (21%, n = 15).however, it should be noted that 26% (n = 19) of the respondents selected "other" and identified in the open response as a Pilates/yoga instructor or swim/aqua teacher.this reflected the services provided by participants within their organisations, with the most common being personal training (47%, n = 34), body weight/functional fitness (47%, n = 35), group-based fitness (47%, n = 34), sport specific training (33%, n = 24), Pilates (32%, n = 23), and yoga (26%, n = 19).similarly, the main locations in which these services were delivered included commercial (28%, n = 20) or home gyms/studios (28%, n = 20), and sport specific facilities (32%, n = 23).almost all participants had completed some form of accredited training to be recognised as a qualified fitness professional, with only 4% (n = 3) not having any formal training.Within australia training options include certificate iii and iV, or Diploma level training, or a bachelor's and/or master's degree.Most fitness professionals had completed either a certificate iV (29%, n = 21) and/or Diploma (28%, n = 20) in their specific field.Participants had varying levels of experience working within the health and fitness industry with 24% (n = 17) having less than 5 years of experience working in the fitness industry, 6% (n = 4) having more than 30 years of experience, and the majority (71%, n = 51) having between 5 and 30 years of experience.almost all participants had experience working with people with people with disability (74%, n = 53).however, only a third of participants (33%, n = 24) directly advertised their services to people with disability.a total of 68% (n = 49) of participants reported receiving on the job experience working with people with disabilities, and almost half had gained their knowledge through face-to-face (49%, n = 35) and/or online (49%, n = 35) workshops, or from mentorship from another health or fitness professional (43%, n = 31).Only seven participants identified having no training or experience working with people with disability.

Fitness professionals experience working with people with disability
Fitness professionals were asked to identify their overall level of confidence (1, not confident at all, to 5, extremely confident) when working with different client populations, including physical (disorders of the musculoskeletal, circulatory, respiratory, and nervous system), sensory (impairments in hearing and vision loss), psychiatric (e.g., anxiety, depression, anorexia nervosa, etc), neurological (e.g., multiple sclerosis, traumatic brain injury, etc.), and cognitive/intellectual disability (intellectual and developmental disabilities relating to difficulty with thought processes, learning communication and executive function) (Figure 1).Overall, participants perceived themselves to have a moderate (3.6) level of confidence when working with people with disability, with similar levels of confidence reported across all disability types.Differences were noted in the number of services participants had provided to each client population with disability (n = 177) (table 2) when compared to the number of services provided to people without disability (n = 344).the most common services provided by fitness professionals followed a similar trend to those provided to people without disability, with the five most frequently delivered services for all disability types including personal training, body weight/ functional fitness, group fitness, Pilates, and population specific training.
When working with clients with disability the most common goal addressed by participants was to improve confidence/ self-efficacy (81%, n = 58) and to support mental health/wellbeing (76%, n = 55).Despite their experience working with people with disability, majority (65%, n = 57) of participants were not registered with the National Disability insurance scheme (NDis) (australian specific government initiative for people with disability providing access to funding for services and resources to support health and wellbeing).elaborating on their response, several participants noted that they did not believe that the process of completing the application to become a registered provider was worth the outcome due to the small amount of funding provided to clients to access sport and exercise services.
Within the open responses, participants provided further insights into their overall experience of working with people with disability.through these data two categories emerged (1) the additional skills required to improve client outcomes, and (2) internally rewarding.Within the first category, participants  highlighted that fitness professionals must be client centred and have a clear understanding of how to tailor their training to their client's individual needs and goal/s.they expressed the importance of not making any assumptions based on their previous experience working with clients with disability and the need to "truly understand the person's needs [and] not assume… because of the disability label" (Participant 39).Within category two, participants revealed that they found working with people with disabilities to be internally rewarding, and for some "the most rewarding part" of their role (Participant 9 and 64).Participants noted that the need "to be more creative" (Participant 42) in their practice to modify their training sessions to the individual needs of their client added to this enjoyment.

Barriers to fitness professionals working with people with disability
Within the open responses, participants identified the education gaps for australian fitness professionals as a barrier to working with people with disability.this was highlighted by one participant who explained, "it's very rewarding but i feel our industry is lacking in educating fitness professionals, so they do lack the knowledge and confidence to work with disabilities" (Participant 72).Participants also identified inconsistent communication between fitness professionals and allied health professionals with participants sharing their experiences of often feeling undervalued within their role.Furthermore, several participants indicated that for people with disability wanting to engage in physical activity, these clients were more commonly referred to allied health professionals, despite community-based fitness professionals posing a potentially more cost-effective option.
Participants noted that whilst they had the desire to work with people with disability more frequently, they often had limited opportunity.
Participants also identified several barriers they perceived their clients with disability faced when accessing sport and fitness services (table 3).Many (65%, n = 47) agreed that their clients had experienced barriers when attempting to access services, with only 11% (n = 8) believing that their client/s had not faced barriers at all (n = 14 identified that they did not know and n = 3 skipped this question).across all client populations, participants consistently highlighted the lack of disability specific education available to fitness professionals (28%, M = 20), as well as society's understanding of the benefit of sport and exercise for people with disability (20%, M = 20).the client's own confidence, and the difficulty they perceived they would experience participating in sport or exercise (28%, M = 20) were also as high for clients with a physical, sensory, and neurological disability.For clients with a psychiatric disability self-esteem (29%, n = 21) was identified as the greatest barrier, and for clients with a cognitive/intellectual disability, the client's social skills (29%, n = 21) were identified as the biggest barrier to sport and exercise participation. it should be acknowledged that many (46%, M = 33) skipped this question which may suggest that participants were unsure of the specific barriers faced by their clients.

Changes required to better support people with disability access sport and exercise
although only half (49%, n = 35) of participants believed that changes were required within their own individual service to make it more accessible to people with disability, almost all (96%, n = 69)  believed that changes were required within the fitness industry (table 4). the five changes most frequently identified by participants included, the need for improvements within the foundational training of fitness professionals to include more information on how to safely and effectively work with people with disability (61%, n = 44), the introduction and requirement of accredited training and certification programs specific to working with people with disability (54%, n = 39), education regarding how to appropriately adapt exercises to meet the needs of people with disability (52%, n = 37), mentoring and supervision opportunities (51%, n = 36), and assistance with environmental modifications (48%, n = 35).
Within the open responses, five categories emerged describing ways in which fitness professionals could be better supported to work with people with disability.categories included: (1) increasing fitness professional knowledge and understanding of disability, (2) increased advocacy from the fitness industry, (3) funding opportunities, (4) environmental modification support, and (5) collaboration with stakeholders.increasing fitness professionals' knowledge was the most frequently written response with one fitness professional highlighting that "accessible education courses and training… [need to be] readily available" (Participant 4).some fitness professional specified that training needed to extend beyond physical disability calling for training to include topics such as communication, as well as ensuring that there was "more focus or understanding on invisible disability as opposed to obvious physical disability" (Participant 8).Participants also identified the need for advocacy from the fitness industry to promote the role of fitness professionals in supporting people with disability to engage in sport and exercise citing a lack of awareness, exposure, and appreciation from referrers and within the health industry.two participants highlighted that whilst fitness professionals were a "more cost effective" (Participant 16) option than allied health professionals, they were "underutilised… [and should be] an option available in conjunction with other health professional[s] to provide a more regular schedule of exercise session[s] per week" (Participant 38).additionally, participants identified the need for clarity and guidance regarding industry policies as participants identified that management "concern clients [with disability] might injure themselves" (Participant 54) acted as a barrier for fitness professionals working with people with disability.
Funding opportunities were also identified as lacking both in terms of payment for the fitness professional themselves and funding for the service they provided.One participant highlighted that the "poor pay most [fitness professionals] experience, inhibit instructors from taking on more training to better support clients with disabilities" (Participant 54).Other considerations identified included, funding to purchase sport specific equipment, and funding to cover the initial outlay of the necessary environmental modifications such as building changes.environmental modifications were a category that was further expanded on as an area that required change.accessibility of pools was highlighted by two participants stating that "easier and safer access to pools for people unable to use the stairs with rail" (Participant 71) was required.in gyms, participants recognised the need for a "ramp to enable entry" (Participant 37) and "gym equipment with accessibility features" (Participant 63).
the final category identified was collaboration with stakeholders, specifically the support workers assisting their client with disability.Participants highlighted the need for education of their client's support workers as their client's with disabilities participation in sport and/or exercise largely relied on the assistance provided by their support worker.

Collaboration with allied health
approximately half of the participants identified the need for better collaboration between fitness professionals and allied health professionals (49%, n = 35).several participants (66%, n = 47) identified that they had previously worked with an allied health professional with the most common being a physiotherapist (63%, n = 45), exercise physiologist (47%, 34), and occupational therapist (38%, n = 27).approximately half (57%, n = 41) of those who had experience collaborating with an allied health professional reported finding their support helpful, however 18% (n = 9) reported the input of allied health professionals to be unhelpful.When collaborating with allied health professionals, participants reported most frequently seeking input for specific exercise recommendations (44%, n = 32), professional development (43%, n = 31), support and education regarding their client's specific condition/s (42%, n = 30), and education and information on how to best support their client's psychosocial needs (34%, n = 24).
through the open responses two categories emerged describing the collaboration between fitness professionals and allied health professionals, (1) improve client outcomes and (2) the limitations of current practice.a common response indicated that effective collaboration with allied health professionals had the potential to result in improved client outcomes as the client would receive "more support" (Participant 57) and a "client-centred approach" (Participant 7).Participants also identified the potential benefit of improving their own professional knowledge, seeing collaboration as an opportunity for "upskilling" (Participant 13), allowing them to "give support [to people with disability] with confidence" (Participant 63).although identifying several benefits to collaborating with allied health professionals, limitations to current practice were also present.limitations discussed by participants included the allied health professional having inadequate time to allow for effective communication and collaboration, as well as differences amongst the allied health professional's "experience level" (Participant 13).

Discussion
this study aimed to understand if and how community-based fitness professionals within australia were working with people with disability, identifying potential barriers to their practice, ways to better support their role working with people with disability, as well as the potential role of allied health professionals.Overall findings of this study found that although most participants identified having experience and a moderate level of confidence to work with people with disability, many believed that further support was required for them to fulfil this role more effectively.it should be noted that this study saw a higher response rate from female participants.although difficult to calculate given the limited regulation within the australian fitness industry, this higher response of female participants appeared incongruent with the australian fitness professional workforce (approximately 50%) [29].however, similar results were found by Obrusnikova et al. [23], who also demonstrated a higher female response rate (65%).these numbers appear to be more in line with the disability sector which consistently averages higher number of female staff (approx.70%), including allied health professionals in this sector (approx.89% female staff ) [30].
Most participants in this study identified having experience working with people with disability, whilst reporting an overall moderate level of confidence.to our knowledge, no previous studies have quantified fitness professional's perceived level of confidence when working with people with disabilities.however, inconsistent with these findings, previous studies have highlighted that staff anxiety and staff expertise were barriers to participation for people with disability when engaging in physical activity [12].this discrepancy may be explained by the respondent's demographics, as only four participants reported not having experience working with people with disability.although working within more general community fitness settings (e.g., commercial gyms, fitness studios and sporting facilities), participants within this study perceived they demonstrated similar attributes and attitudes to participants within previous studies who worked within a disability specific setting and were described to facilitate client engagement.Within this study, fitness professionals highlighted the importance of being client centred, as well as setting meaningful goals.similarly, participants within Richardson and Motl's [22], study expressed the need to develop an equal relationship with their clients with disability in which their clients were active agents in their change.
When discussing barriers for community-based fitness professionals wanting to work with people with disability, the two most consistently identified barriers included lack of disability specific training, and lack of societal understanding regarding the benefits of sport and exercise to people with disability.these results have been echoed within the literature, with additional barriers identified including, physical environment and transport constraints, cost, as well as attitudes of other fitness service users [4,18].interestingly, most participants did not respond when asked about the barriers experienced when working with people with sensory, psychiatric, neurological, and cognitive and intellectual disabilities.this might suggest that either participants had not had experience working with these populations, or they did not believe these clients experienced barriers.this lack of response may further highlight the need for more focused research and education on all disability types, to support fitness professionals to identify and address potential barriers.
When exploring the disability-specific education obtained by the participants in more detail there appeared to be a gap in the foundational training provided.as a result, most participants reported receiving disability specific training through on-the-job experience, as well as continuing professional development through workshops which they sourced independently.similarly, within Obrusnikova et al.'s [23] study, 41% of participants also reported that they had gained their experience through on the job experience observing other personal trainers providing services to a person with disability.a second study involving a systematic review of evidence-based knowledge translation for fitness professionals found there to be limited research on how fitness professionals generally gained their knowledge [31].however, authors indicated that common sources included textbooks, networking, seminars, media, and scientific journals [31].
the lack of disability specific training that is easily accessible to community-based fitness professionals raises queries regarding the utilisation of evidence-based practice (eBP) which requires the integration of the best available research evidence, clinical expertise, and the client's values and circumstances [32].although eBP is widely considered best practice for health professionals, to our knowledge no research exists outlining eBP for community-based fitness professionals working with people with disability [32].Within their systematic review to identify best practice for exercise professionals working with clinical populations (e.g., chronic health conditions), authors suggested that for qualified exercise professionals to be part of interdisciplinary health teams, best practice for allied health professionals should be similarly applied to exercise professionals [33].Further research is required on how to best educate and train community-based fitness professionals to support people with disability.this should involve a critical evaluation of the current fitness qualifications (e.g., certificate iii and iV in Fitness), as well as supplementary resources available to fitness professionals (e.g., networking, workshops) to ensure fitness professionals draw from best practice guidelines when working with people with disability.
Finally, this study aimed to understand ways in which fitness professionals perceived they could better collaborate with their allied health colleagues when supporting shared clients to engage in sport and exercise.although previous research identified allied health professionals as potential support for community-based fitness professionals, these studies had not yet indicated the type and/or effectiveness of this support from the perspective of the fitness professionals, allied health professionals, or the person with disability [4].Within this study, most fitness professionals had experience collaborating with an allied health professional.Many described this input as helpful in improving client outcomes.in Regan et al.'s [21] study, authors indicated that fitness professionals frequently collaborated with a physical therapist (referred to as a Physiotherapist in australia) when working with a person with disability.however, to our knowledge this is the first study that has specifically identified that participants had experience working with physiotherapists, as well as exercise physiologists, occupational therapists, psychologists, as well as wider health staff (e.g., osteopaths, speech pathologists, etc).Despite many identifying having had a positive experience working with allied health professionals, limitations regarding the current collaborative practice between professionals were identified.limitations included varying levels of experience of the allied health professionals, as well as the perceived power imbalance between tertiary trained and diploma/certificate trained professionals.these limitations would need to be addressed to strengthen collaboration between the professionals, while further research is required from the allied health professional's perspective to ensure any potential barriers are addressed effectively.additionally, participants identified ways in which allied health professionals could provide further support to shared clients, including providing specific exercise recommendations, as well as providing guidance on necessary medical, psychological, and executive functioning needs.to provide further guidance and structure to this collaborative process, people with disability, allied health professionals, and fitness professionals could contribute to a co-design framework to facilitate improved client care, when supporting people with disability to participate in sport and exercise.Overall, these findings advocate for a wider interdisciplinary health team approach, and the development of a practice framework guiding this process.

Limitations
this study provided novel insights into the experiences of community-based fitness professionals working with people with disability, however limitations remained.Firstly, despite efforts to advertise to all community-based fitness professionals across several social media platforms and email campaigns, the participant response rate remained low, with a high percentage of participants already working with people with disability.this could suggest that participants who completed this survey had an invested interest in this space.additionally, the low response rate may indicate that few community-based fitness professionals in australia are currently interested in working with people with disability, and/or lack an understanding of their potential role in supporting this client population.similar limitations of respondent bias are present in other studies in this area, suggesting that future research needs to find solutions to survey "hard-to-reach" fitness professionals who do not have experience or interest in working with people with disabilities [4,23].Furthermore, there was a low response from coaches (n = 9) therefore less discussion regarding sport specifically.this resulted in findings being largely focused on individuals within the fitness industry providing exercise services.a limitation of using closed questioning is that there is an assumption that the answers have the same meaning for all participants [34].the addition of definitions throughout the survey, for example providing a description for each type of fitness professional (e.g., coach, instructor, etc) may have added further context for some questions.a strength of this study was that it combined quantitative data with qualitative data to provide richer insight into the responses.a further strength of this study was that it gained perspectives from a range of fitness professionals and discussed a variety of disability client populations to give insight into the general climate of fitness professionals working with people with disability in australia.

Implications for practice and future research
this study found that within australia community-based fitness professionals perceive themselves to have a moderate level of confidence to work with people with disability.however, it also highlighted that there is room for improvement within the australian fitness industry to ensure community-based fitness professionals feel supported to effectively work with this client population.For example, improvements in the disability specific training and education provided to community-based fitness professionals was noted, as well as improved education of the community and relevant stakeholders regarding the benefits of sport and exercise for people with disability, and the role community-based fitness professionals can play in facilitating this.additionally, whilst several benefits were identified regarding interprofessional collaboration between community-based fitness professionals and allied health professionals, a practice framework clearly outlining professional scopes of practice, as well as a co-design approach providing recommendations on what best practice might look like would support future practice.Finally, it should be acknowledged that although providing important insights to the experience of community-based fitness professionals working with people with disability, due to the small sample size these findings may not be representative of the experience of all fitness professionals working in australia.

A note on language
this research study utilised person first language when acknowledging people with disability, as what is predominantly used in australia.however, recognition is made that some people may prefer identify-first language [35].

Figure 1 .
Figure 1.Participant's reported confidence on working with a person with disability.

Table 1 .
General demographic data.

Table 2 .
services offered to people with disability.

Table 3 .
barriers to supporting individuals with disability to engage in sport and exercise.

Table 4 .
suggested changes required to the fitness industry.