Beverly Rehab Moves to Strength Training.

Using specially designed Nautilus equipment, Beverly Rehabilitation aims to give frail elderly a new lease on life

The frail elderly need not decline from cane to walker to wheelchair. In fact, they can now, in many cases, reverse that order of dependency, as illustrated by a program called "Freedom Through Functionality," a Nautilus equipment-based exercise regimen derived from research by Wayne Westcott, PhD, and adopted recently by Beverly Rehabilitation.

Dr. Westcott, research director for Nautilus Corporation and author of several books on senior fitness, conducted his research for Nautilus at John Knox Village in Orange City, Florida, focusing on 19 very frail elderly ranging in age from 80 to 90 years. Most of the participants were wheelchair-bound, while others had limited ambulation. The goal of strength/resistance training in these tests was to restore muscle strength, which research has shown can trigger other positive physical events: better gastrointestinal transit speed that aids digestion and reduces the risk of colon cancer; improved glucose utilization to benefit people with diabetes; and reduction in osteoarthritis pain.

"There were two important objectives for this research," Dr. Westcott explains. "The primary goal was to improve posture to allow residents to straighten up to promote better breathing and swallowing, while a subsequent goal was to strengthen key muscle groups involved in ambulation."

Using five Nautilus machines twice a week, the John Knox residents performed one set of 8 to 12 repetitions per session. Each session took about 7-1/2 minutes, which totaled 15 minutes of actual strength training per week. "My role was to evaluate, assess and measure each participant's fitness in a variety of parameters, including muscular strength, flexibility and body composition," said Dr. Westcott. "The medical staff evaluated walking ability and functional independence and tracked the number of falls."

After 14 weeks, the residents' leg strength improved by 80%. As Dr. Westcott points out, "Results are dramatic because these individuals were so far from their potential that their weak and atrophied muscles responded in functional improvement more than in any other age group."

According to Cindy Susienka, president of Beverly Rehabilitation, there are nine pilot programs using this approach: six in Beverly nursing homes and three in non-Beverly facilities. Non-Beverly institutions contract with Beverly Rehabilitation to provide rehabilitation service. The five Nautilus machines are standard equipment that has been specially adapted for this population (see photos). These machines fit into an area of 320 sq. ft. and can be leased over a 7-year period for affordability.

Says Jim Teatum, president of Nautilus, "We provide handouts to residents that ask the question, 'Why should I strength train?' Nautilus provides the answer in layman's terms: It's safe, relatively undemanding and very effective in restoring strength and functionality." Nautilus also provides training for the therapists, either on-site or at Dr. Westcott's facility.

"Results have been exciting," says Beverly's Susienka. "The program is customized to individual needs. Seniors like the equipment. It has adaptations for security and seat size. The resident is comfortable. Residents do make progress with traditional therapy, but once they begin using the Nautilus equipment, they begin to feel the progress themselves. The progress they see and feel energizes them to do more."

Leg press exercises increase the strength of hips, thighs and calves to help the resident rise from a seated position. To further help with the sit-to-stand movement, a resident will do a set of reps on the Nautilus triceps press. By pushing on the handles of the device, the arms, upper body and shoulders gain strength, enabling the resident to push off from a seated position.

Because it is not uncommon to see nursing home residents sitting slumped over, simply because they lack the strength to sit erect, part of the exercise program is a workout on a neck extension device. This helps residents to hold their heads up higher and to optimize their speaking, eating and breathing.

The rowing/pulling machine focuses attention on the upper back muscles, while Nautilus's low-back machine is designed to build up the lumbar spine and strengthen the back muscles that contribute to improved posture.

"One interesting side note," says Dr. Westcott, "was that the combination of exercises added an average of 4 pounds of muscle, which was desperately needed. Although we were not trying to have the residents lose weight, the added muscle helped to stimulate the metabolism. Thus, there was an approximate loss of 3 pounds of body fat, but an overall 7-pound change in body composition."

Staff interest and enthusiasm is necessary for program success, adds Gary Reinl, a consultant to Beverly Rehab and Nautilus. "If the therapy team and nursing team understand the value of using these tools with their resident populations, you are virtually guaranteed success. If staff isn't integrated and educated about the program, it might not work at all."

Not all residents adapt quickly to the idea. One, recalls Reinl, resisted the whole concept of strength training. It took a while but the nursing staff discovered that the resident and janitor talked each evening, during which the custodian talked about his negative, painful physical therapy. Naturally, the resident put more credence in his "friend's" tale than in his therapist's advice. After some encouragement, the resident did participate in strength training and encouraged other residents to join.

Consultant Reinl offers an interesting parallel in describing the status of strength training in nursing homes. "Looking back at 1965, it was not unusual for skin ulcers to advance to the point of amputation. Today, this would be an outrage resulting in lawsuits, license revocation, survey failures and more. In 1965, nursing homes knew what to do to prevent the condition, but just weren't doing it; now wound care protocols are standard. The musculoskeletal system should not be allowed to disintegrate either, but often it happens because it is an invisible deterioration, unlike skin ulcers." Nevertheless, Reinl predicts that, within five years, nursing homes will have protocols in place to deal with musculoskeletal deterioration.

According to Reinl, thousands of nursing homes across the country have residents who could hold the weight of their bodies upright and, thereby, improve their eating, breathing and swallowing functions. The care, reimbursement and desire are there, along with available training and technology. "And there is nothing complicated about this program when you have trained therapists and enthusiastic staff involved in supporting the resident."