Genevieve Blackburn
Genevieve Blackburn says her TIME™ fitness instructor, George Hojbota, motivates her to try her best, every class. “When he says ‘you can do it,’ we shout, ‘yes we can!’” (Photo: UHN)​

As Genevieve Blackburn began anticipating her discharge from rehab, following treatment for neuropathy, she didn't know when – or if – she'd ever have the confidence she needed to move independently from her wheelchair to a walker.

"I was scared to make that transition without assistance– I was worried I wouldn't have enough stability and fall," she says. 

Three years later, Genevieve, 65, has not only gained the confidence, but has taken it one step further and alternates between using a walker and a cane.

According to Genevieve, it's all thanks to her twice-weekly participation in Together In Movement and Exercise (TIME™) - a community exercise program developed by physiotherapists at Toronto Rehab for individuals with balance and mobility deficits resulting from an underlying medical condition.

"When you return home from rehab, if you don't have the incentive of a structured program you might not do anything at all," says Genevieve."If I didn't have TIME, I wouldn't have come as far as I have."

Now in its 10th year, TIME has grown from a local, grassroots program to a cross-country leader in post-rehab exercise, and has continued to evolve its program to meet the needs of the community it serves.

Filling a gap in the community

It was 2006 when more and more patients at Toronto Rehab were expressing to their physiotherapists a desire to keep exercising and be physically active upon discharge.

"They'd say to us, 'what am I going to do now, to maintain my health? How am I going to continue exercising like I do with you?'" recalls Jo-Anne Howe, Clinical Educator and Physiotherapist.

"We thought why don't we try to partner with a community recreation centre? They can provide the space, we can train their fitness instructors, and together, we'll serve this unique population."

One year later, the first two TIME programs, each consisting of 7 participants, launched in partnership with Toronto Parks, Forestry and Recreation.

Criteria to join TIME originally included being able to walk at least 10 metres with or without a walking aid, but without the help of another person. Participants also needed to be recovering from a stroke, brain injury, or be living with Multiple Sclerosis (MS).

The evidence-based program consists of a set of balance and mobility strengthening exercises instructors follow, after participating in a 6-hour training session led by a physiotherapist. A tool-kit provides instructors further resources and support.

Functional, task-related exercises include sit to stand; modified lunging; bending and reaching; step ups; and walking.

"We use steps and other props to simulate snow banks or other obstacles that we would encounter in day-to-day life," says Genevieve.

While physiotherapists aren't present during class, they do play a consultative role and drop in from time to time.

"We didn't just want to say 'here's this program – run with it.' We're always there to support the instructors – it really is a partnership," says Jo-Anne.

Benefits beyond exercise

TIME may offer beneficial exercise for individuals with mobility issues, but it's also mitigating their risk of becoming socially isolated.

"TIME provides participants with an opportunity to get out of the house and be with other people who have similar experiences," says Jo-Anne.

"We have a lot of laughs," adds Genevieve. "While we're all from different walks of life, we have mobility issues in common, which have become a big part of each of us."

Genevieve says her group likes to meet one hour before class for coffee, and if someone doesn't show up, the group will call or text to see if they're ok.

TIME Leadership
Celebrating the 10th Anniversary of TIME™: Mark Bayley, Medical Director, Brain & Spinal Cord Program, Toronto Rehab; Sue Jewell, Senior Vice President, UHN, and Executive Lead, Toronto Rehab; Lorene Bodiam, Advocate for People with Disability, Toronto Parks, Forestry and Recreation ; Jo-Anne Howe, Clinical Educator and Physiotherapist; Joanne Zee, Senior Clinical Director, Brain and Spinal Cord Rehab Program & Business Development. (Photo: UHN)

Hearing feedback; making changes

Today, about 400 participants exercise in TIME each week in over 50 community centres across the country.

"The uptake of TIME is a reflection of the recognition of the importance of exercise in maintaining health, and the need to create more safe, inclusive and accessible local opportunities," says Cathy Irwin, Senior Manager, Business Development at Toronto Rehab.

"We have tried to make it as easy as possible for community centres to successfully establish a TIME program, through our step-by-step, how-to toolkit. We really wouldn't have experienced such incredible growth without the many dedicated champions here at Toronto Rehab and in communities across Canada."

The program is not only a natural extension of the care Toronto Rehab provides, but an example of one of its strategic goals put into motion. 

"We are committed to building capacity for exercise and social engagement, close to our patients' homes and away from hospital settings," says Susan Jewell, Senior Vice President and Executive Lead for Toronto Rehab.

"Through close collaboration with community and patient partners, we can yield the most optimal programs to meet the needs of people recovering from illness, injury or managing the effects of aging most effectively."

Research reveals that participation in the program is time well spent. In fact, a qualitative study of people with stroke and MS, as well as their caregivers, has demonstrated improvements in function, social participation, and decreased need for caregiver assistance.

While the functional elements of TIME have remained intact, the program continues to evolve with feedback from the community.

The TIME program consists of a circuit, and for the first several years, participants traveled to 9 separate stations, individually.

As it became more and more evident that participants came to socialize as much as exercise, the format underwent a facelift. Now, participants are divided by their level of ability into groups of four, and travel between three stations.

Admission criteria has also changed.

"When we first launched, participation was limited to just three health conditions," says Jo-Anne. "But we soon learned from our community partners that a better mandate was to be more inclusive."

In turn, TIME started accepting anyone with any kind of chronic condition that would result in a balance or mobility deficit. Criteria is now extended to people living with neurological or orthopaedic conditions; the effects of aging; or weakness after surgery or extended hospital stay.

The future of TIME includes welcoming individuals with other levels of ability into the program, such as wheelchair users, and participants who are ready to leave a sheltered exercise program, but may not be ready to participate in a regular fitness class.

With the anticipated increasing seniors demographic, and prevalence of musculoskeletal and neurological conditions, the need for specialized programming has never been so strong.

"We are committed to continuing to grow and evolve TIME to support this need, by serving as a post-rehab exercise leader and knowledge broker for our community partners," says Cathy.

"We are excited about the future of TIME and what it offers the health care system."

Learn more about TIME, or find a program in your community.

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