Exercise is medicine: working with physical challenges.

Abstract

As we grow older, daily tasks become more difficult. Imagine what it is like for those with physical challenges. Exercise can be the medicine needed to assist those who are physically challenged. Fortunately, the fitness industry is beginning to lean more towards "functional" fitness, which targets movements that mimic daily activities. Therefore, exercise programs can be geared towards strengthening both the cardiovascular and muscular system to make everyday tasks much easier. Four people have taken advantage of exercise to assist them with their physical challenge all with a similar goal in mind. Teaching does not always have to be in the classroom. It happens in the fitness center everyday. Explore how exercise has opened up doors for these individuals. Exercise truly is medicine.

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When people hear the word exercise, the concept of "no pain, no gain" comes to mind. Exercise does not always have to be blood, sweat and tears in order to achieve results. Fortunately, the fitness industry has taken a turn for a more "functional" approach meaning that workouts now incorporate exercises that simulate everyday living. As "teachers" in the fitness industry, it is our job to make fitness an enjoyable experience as well as applicable to daily living unless there is another goal in the mind of our client. For example, our Senior Balance class takes advantage of Swiss Therapy Balls (also known as "Resist-a-BallsR) often used in physical therapy for rehabilitation. Exercises are performed both on, off and with the balls to add light resistance to strengthen the muscles needed for daily activities. Emphasis is placed on proper lifting techniques, throwing and just basic sitting on the ball for posture purposes. Participants have seen results not only through making daily activities easier to perform, but also through fall prevention. Since we had such success working with apparently healthy older individuals, we wanted to spread the good news and offered classes, seminars and articles to the public not only on the benefits of balance training, but the rewards of exercise. As a result, we had several phone calls from those with physical challenges such as Parkinson's disease, Multiple Sclerosis, Arthritis and Cancer who wanted to take advantage of exercise.

Regular physical activity has been proven time and time again to have several long-term health benefits. Research has proven that exercise can reduce blood pressure, decrease the risk of coronary artery disease, decrease some types of cancer, decrease body fat and reduce the risk of osteoporosis.(1, 2, 7) To date, there have been few studies performed on individuals with disabilities to determine whether the long-term affects of regular exercise can also apply to persons with disabilities. However, according to the American College of Sports Medicine, the article, "Physical Activity among Persons with Disabilities", states that a condition can be worse for a physically challenged individual if they are inactive. Inactivity may actually exacerbate their condition or contribute to a premature death (5). With this in mind, exercise may not be the "cure-all" for those physically challenged, but exercise can help them gain some improvement with general stamina, flexibility and strength needed to increase their quality of life.

Andy, who is 81, has been working out for over 3 years. He is challenged by Parkinson's disease. With this challenge, an imbalance in brain chemicals can cause a lack of movement coordination that often appears as tremors, stiff muscles and joints, and difficulty moving (6). There are drugs available that can assist with this condition. However, from a fitness standpoint, research has shown that an exercise program created for individuals with "slow progressive diseases" showed "... a 25% improvement in both maximal and submaximal work capacities ...". The main component of this exercise program was strength training (5). As a result, an exercise program was created for Andy with his condition in mind. Strength training would be a major component along with balance training and regular stretching (6). Andy visits the fitness center at least 3 days a week and religiously performs the exercises recommended by the exercise physiologist. He is a driven individual who is very enthusiastic and dedicated to his exercise program. "... I could see my muscles getting bigger, my posture was starting to improve, I could walk faster, get up and down stairs easier and get out of a chair better," claims Andy. As a result, he has been able to keep his condition under control and can still perform a majority of daily functions independently. In Andy's case, learning the importance of exercise enhanced his ability to take more control of his physical challenge.

Chris, a 34-year-old member who is currently a high school teacher, has been battling Multiple Sclerosis since college. Fortunately, his type of MS is not progressive, but he still has difficulty performing daily tasks and maintaining his balance. Unfortunately, there is no cure for Multiple Sclerosis, but exercise has been proven beneficial. In a 10-week study, multiple sclerosis patients participated in a moderate exercise aquatics program. The results showed a significant increase in both upper and lower body work capacities (5). Research has also shown improvements in both walking speed and distance from a 3-4 week walking study (5). After being encouraged and shown the facts of the benefits of exercise, by a former high school student who is now an exercise physiologist, Chris finally made a visit to the fitness center. He first started off 5 minutes each on the recumbent bike and the Nu-StepR (similar to a StairmasterR in the recumbent position) to build up his cardiovascular system since Multiple Sclerosis can cause fatigue and breathlessness. After 2 weeks, he progressed to strength training to battle muscle weakness and balance training to stabilize his lack of coordination (6). Today, Chris comes to the fitness center 2-3 days a week and is performing 20-30 minutes of aerobic exercise along with 2 sets of 10-12 repetitions for his strength training routine. His balance has improved not only from utilizing free weights, which stimulate neuromuscular mechanisms and supporting muscle groups, but also from using the Resist-a-BallR at least once a week to improve his balance for daily functions such as getting in and out of a chair. "I thought ... why not give exercise a try", claimed Chris. "I knew that my program was working when I was able to move the garbage cans from the garage to the street without my cane." It may sound like a small feat, but learning about exercise just made his life a little easier.

Joy, a 67-year-old retired Junior High School teacher, has been challenged by both rheumatoid arthritis and osteoarthritis for several years. "A doctor told me I would be in a wheel chair in 10 years.... that was 15 years ago!" Joy sometimes has difficulty walking since she's had 7 knee surgeries, but she is religious about working out at least 4-5 days a week. Again, research proved that moderate intensity exercise has been shown to possibly reduce the symptoms of arthritis (3, 5, 6). She does both cardiovascular exercises for about 20-30 minutes and then performs 2-3 sets of 12-15 repetitions on the weights. She is proof that physical activity has improved her joint strength and flexibility. "Some days I may hurt more than others, but if I don't use it, I'm gonna lose it!", claimed Joy. She enjoyed the benefits of exercise so much she has become an IFPA certified Personal trainer and is also certified through the Arthritis Foundation as a PACE instructor. She is a motivating individual and a perfect instructor for the arthritis class since she understands the challenges and limitations of arthritis. She is living proof that exercise has encouraged her movement both in and out of the fitness center. A teacher becomes a student to improve her quality of life.

Mary, 73 years old, was diagnosed with a brain tumor over a year ago. Since her surgery for the removal of the tumor, Mary has started a regular exercise program. Although she needs assistance once in awhile since her short term memory was affected by the surgery, she visits the fitness center at least 3 days a week. Recent research has shown that a regular exercise program can enhance a cancer patient's lifestyle, physical capacity and life expectancy. Exercise can also improve the immune system and enhance an individual's ability to enjoy life by participating in daily activities (4). Mary walks on the treadmill, rides the bike and exercises on the Nu-StepR for a total of 30 minutes. After that she performs 2 sets of 15 repetitions with strength machines. To complete her program, she performs some flexibility and balance exercises on the Resist-a-BallR. Mary has come a long way from when she started. She can perform daily activities a little easier since her surgery and is less dependent on her family for assistance. Mary had to learn how to operate cardiovascular machines and lift weights for strength training. She had knowledgeable teachers who gave her guidance and the information she needed to improve her quality of life.

Exercise does not always have to be related to sweat and tears. However, that depends on the individual's goal. The goal may be just to be able to walk up and down the stairs easily and without falling. "I know that if it wasn't for the balance class, I would have fallen down the stairs," claimed a member. If the goal is weight loss or training for a competition, the exercise program may be more intense. (It is always best to consult a physician in either case before starting an exercise program.) But the previous four individuals took advantage of their resources and learned a new "subject". They are physically challenged and they weren't ready to give up. They had well-informed teachers who made exercise a positive, safe and effective experience. Exercise may be the "medicine" needed to enhance their lifestyle. Everyone has different exercise goals; it just depends on how high the mountain is that one is willing to climb.

References

1) ACSM. ACSM's Guidelines for Exercise Testing and Prescription. 6th edition. Baltimore, MD: Williams & Wilkins. 2000.

2) Brooks, Douglas. Program Design for Personal Trainers. Champaign, IL: Human Kinetics. 1998.

3) Clark, Janie. 1997. "Programming for Adults with Age-Related Health Challenges". ACE Certified News. Vol. 3 No. 5. pp. 4-6.

4) Durak, Eric. 2001. "The Use of Exercise in the Cancer Recovery Process". ACSM's Health & Fitness Journal. Vol. 5, No. 1. pp. 6-10.

5) Heath, Gregory W. and Fentem, Peter H. 1997. "Physical Activity among Persons with Disabilities--A Public Health Perspective". ACSM Exercise and Sport Science Reviews. Vo. 25. pp. 195-234.

6) Rimmer, James H. 1997. "Designing Programs for Special Medical Populations". IDEA Today. May 1997. pp. 24-36.

7) Wilmore, Jack and Costill, David. Physiology of Sport and Exercise. Champaign, IL: Human Kinetics. 1999.

Schmidt is an Exercise Specialist for the Department of Fitness, Wellness and Health, and a guest lecturer for Bachelors degree in Fitness Management.