Fitness

Building a Model for Lifelong Fitness

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A “pay-for-use” post-therapy facility allows clients access to specialized equipment, therapy bands, balls, and beyond

Like many rehabilitation hospitals, Good Shepherd Rehabilitation Network, Allentown, Pa, has recognized the frequent situations in which health insurance limits physical therapy and can leave patients with few options. Initially, a “pay-for-use” program was developed to allow patients to continue to work out at the rehabilitation fitness facility when their insurance reached maximum benefit, maintain their progress, and avoid regression. Strong interest in using the facility post-therapy led to the development of a fully separate center, Optimal Fitness, for former patients in 2006. This advance continues as Good Shepherd’s medical model fitness facility opens to the general public.

Two key draws of the program are the availability of a specially trained exercise physiologist and the specialized adaptive equipment to accommodate various medical conditions. These features allow individuals with varying levels of ability to pursue a regular exercise routine.

Personal Programs 

The exercise physiologist offers an extensive new member orientation that includes a medical history review, verification of a clearance note from the member’s physician, and an assessment of the best fitness strategy for each person. In the case of a former patient, the exercise physiologist can supervise a home exercise program established by a physical therapist. After the introduction, former patients and public members may choose to pay for one-on-one sessions as needed, with some securing a regular time slot each week. The exercise physiologist is on the gym floor during regularly set hours to offer supervision and assistance to those exercising on their own.

Specific training items are popular during personal sessions with the exercise physiologist. The free mat space is outfitted with TheraBand tubing and bands by Akron, Ohio-based Thera-Band/Performance Health, stability trainers, exercise balls, and an Airex mat, available through companies that include Magister Corporation, Chattanooga, Tenn, and Libertyville, Ill-based SPRI.

Standard exercises can be modified on the mat with tubes and bands, such as those offered by Stretchwell, headquartered in Warminster, Pa, to improve hip rotator strength and enhance lower body training. They are also an integral component of strengthening for the upper body, including the rotator cuff and for general strength and maintenance of flexibility. The Airex balance pad is added to programs for individuals that require stability and balance training. Members with a history of stroke, multiple sclerosis, and other neurological conditions benefit from this device. Additionally, members with a history of orthopedic lower-body injuries use the Airex pad with weight or band challenges to further improve their stability.

Gymnastic balls, common in many gyms for abdominal strengthening, are used to improve balance for members who are post stroke or have other neurological conditions. The member may perform seated balance exercises such as reaching and twisting, or weight. A full set of free weights and medicine balls round out the non-machine gym space; and in addition to serving the specific medical conditions noted above, are commonly used by general fitness seekers. Manufacturers that market medicine balls include OPTP, Minneapolis, and Longmont, Colo-based Ball Dynamics International LLC.

Specialized, Adaptive Equipment

The second key element of the medical model facility is the specialized, adaptable equipment. The Nautilus and Apex stationary weight machines in Good Shepherd’s Optimal Fitness gym are designed for members of all abilities. The “swing-out” seats allow easy wheelchair access. Harbinger lifting hooks are available for members who have limited grip abilities.

The technology of the AlterG Antigravity Treadmill, from AlterG, Fremont, Calif, reduces body weight by 20% to 100%, allowing a cardio workout with greatly reduced impact on joints and ligaments. This treadmill is used by members with ongoing chronic conditions such as osteoarthritis or those with periodic weight-bearing restrictions.

The MOTOmed bike is a dual arm and leg bike. The bike, available through the Betzenweiler, Germany-based RECK Company, is motor-assisted and allows for passive or active assistive exercise. It is often used by MS and post-stroke clients as well as members with other neurological conditions.

The NuStep TRS 4000 recumbent seated elliptical machine, by NuStep Inc, Ann Arbor, Mich, has earned a spot on Good Shepherd’s fitness floor. It suits a variety of members as it is easy to use, assists in maintaining range of motion, and may be used for a cardiovascular workout that doesn’t require a lot of strength. Foot straps and customized gloves are available to increase the adaptability of this machine to members with less grip and lower body strength.

As part of a comprehensive program, the Functional Electrical Stimulation (FES) ERGYS motorized, electrical node-equipped bike is critical to have on-site for members with spinal cord injuries (SCIs). This device from Therapeutic Alliances Inc, Fairborn, Ohio, is highly utilized and integral to a specialized fitness center.

Machines that may also complement a specialized fitness center while integrating the use of pulleys, circuit weight training, and accessibility for wheelchair users include Pinellas Park, Fla-based Endorphin’s 360 Pro Gym, which can allow for strength building of the upper and lower body. Among its features are a low pulley and leg extension/standing leg curl station. The leg station assembly is designed to pivot out of the way to provide wheelchair accessibility. Another source for pulley systems is Cardon Rehabilitation & Medical Equipment Ltd, Burlington, Ontario, Canada, which markets equipment built to allow consistent resistance throughout the prescribed movement.

Optimal Fitness gym members who use a wheelchair can also benefit from the standing frames in the fitness center. The standing position allows gravity to elongate muscles and tendons that experience shortening throughout the day. The weight-bearing opportunity helps to maintain bone density that may diminish in non-weight-bearing individuals. The gym features an EasyStand and a more dynamic EasyStand Glider, from Altimate Medical Inc, Morton, Minn. The Glider offers moveable handles that generate reciprocal foot pedal movement. This facilitates both range of motion and strengthening.

The EasyStand Glider has moveable handles that generate reciprocal foot pedal movement. Good Shepherd’s Optimal Fitness Center uses the glider to increase the client’s range of motion and strength. Pictured: Cynthia Bauer, PT, DPT, OCS, and Optimal Fitness client Ruth Aragon.

The EasyStand Glider has moveable handles that generate reciprocal foot pedal movement. Good Shepherd’s Optimal Fitness Center uses the glider to increase the client’s range of motion and strength. Pictured: Cynthia Bauer, PT, DPT, OCS, and Optimal Fitness client Ruth Aragon.

Hausmann Parallel Bars, marketed by Northvale, NJ-based  company Hausmann Industries Inc, were added to the facility for individuals who require support when walking. Past patients with multiple sclerosis, general ataxia, and incomplete SCI frequently use the parallel bars to maintain endurance and balance. Members may assist in elevating their body weight onto a step placed in the parallel bars or perform more advanced balance exercises. Parallel bars are available on the market through a range of companies, including Bailey Manufacturing Co, Lodi, Ohio.

In addition to the adaptive equipment, Good Shepherd’s facility also offers a full set of dumbbells, bikes, treadmills, and elliptical machines for members without current or past medical conditions. Sources for this type of equipment include Exertools, Petaluma, Calif, as well as Bolingbrook, Ill-based Advantage Medical. Optimal Fitness also offers aquatic programming in the warm water indoor therapy pool. It is adjacent to the gym facility, and access may be added to a fitness membership. Cardio options in the pool include an underwater treadmill from HydroWorx, Middleton, Pa, Angola, Ind-based Hudson Aquatic Systems LLC’s AquaGaiter treadmill, five HydroRider bikes available through Biscayne Park, Fla, based-HydroRider, and a set of underwater parallel bars.

All are popular for members with chronic pain conditions including fibromyalgia, rheumatoid- and osteoarthritis, post- stroke, past total joint recipients, and other diagnoses that benefit from reduced weight-bearing when exercising. The pool offers multiple depths and lifts for entry and exit; allowing people with a variety of conditions to access the equipment or simply swim freely.

Community Response

The medical community has been responsive and supportive of the program. Physicians seeking to direct their patients to continue and maintain progress after therapy have an opportunity for their patients to use safe, effective, appropriate, and accessible equipment under professional supervision. The medical model facility can be a demonstration of support for people at any stage of illness or recovery, as well as community residents who want to continue their commitment to lifelong fitness. PTP

Cynthia Bauer, PT, DPT, OCS, is director of outpatient musculoskeletal services for Good Shepherd Rehabilitation Network, Allentown, Pa. Bauer received her master’s of science degree in physical therapy from Arcadia University and her doctorate in physical therapy from Temple University. For more information, contact PTPEditor@nullallied360.com.