Chronic health conditions and mobility challenges: Applied exercise for solutions
To highlight just why one might consider an exercise physiologist/kinesiologist as a part of a healthcare management solution, let me run through some of my cases (names and other identifying aspects are altered). Either privately or with funding from various insurance providers, these clients typically worked with me over at least 3 months, twice a week for one hour each session.
Ben, age 34, a first aid instructor, was in a major car accident. That very day the cardiologist reports Ben having up to 5 heart attacks. My job, through Ben's insurance providers, was to essentially improve his circulation and general aerobic fitness, to be measured using blood pressure and aerobic fitness markers. I would take him for mostly walks and a program of light and moderate intensity exercises--to bring his blood pressure down. This we did over several weeks, gradually increasing either the intensity of the walks or the duration. We would start and finish our sessions in Ben's apartment complex gym (and, this is where I took his blood pressure readings). Both in the gym and outside, we also did light calisthenic movements, and some rubber tube and light hand weight exercises. I taught him proper stretching and whole body weight exercises using very conservative positioning of whatever was available (both in the gym, and outside using park benches, bars, steps, etc). Of course, all this activity, waist and blood pressure measure were recorded and reported in detail for all the interested parties (Occupational therapy, physiotherapy, family doctor, cardiologist, car insurers, Ben's work insurers, lawyers, etc.). We met two times a week for three months, and his blood pressure improved significantly, as did all of his general fitness markers, and his mobility.
Doreen, age 36, a private client, with a preexisting blood clot in the leg (making air travel perilous), was 6 months pregnant (her fourth) when I first met her in a gym setting. The pregnancy became very complicated, and she was prematurely hospitalized and inactive until the delivery. She became pre-diabetic and was now very overweight. For one year, the challenge was to increase her fitness safely. Sessions were held in her house, using mostly simple body weight exercises using chairs, counters, stairs, the floor, etc. Walking was encouraged, mostly on her own during her times taking the baby out in a carriage and later a stroller. A lot of discussion revolved around food guidance. By the year end, Doreen was doing circuits at the park involving speed walking and intervals of body weight resistance exercises. She had regained her figure and was making public singing performances.
Eric, age 63, was virtually shut into his apartment, having undergone back surgery. He was unable to go down the stairs in an old apartment that was not up to current code, having become rather de-conditioned over the preceding months. The bulk of his early weeks involved lying on his back or supporting himself face down on all fours in bed; pushing and pulling rubber tubes, and being manually stretched by myself. He progressed to include exercising from a chair, and then gradually added more conventional body weight exercises from different heights including getting down on the floor. On a limited budget, his twice a week session, for three months resulted in being able to walk, shop and visit in and around town again.
Sylvia, a challenging ICBC motor vehicle accident case involving complicated pain tolerance, went from the warm water pool to the clinic “gym” for over a year. Sylvia might be an example of what we call a 'poor-to-non responder', and at the same time, supervising such a client involves making sure there is a response (i.e., some/enough stimulation and targeted teasing of muscle, nerve, energy reserves, hormone activation, etc). As she progressed from seemingly simple approaches, her exercise program was eventually more and more conventional--and even sophisticated--looking. Sylvia ended up using TRX (gymnastics-type rings) exercises and various athletic squats. She successfully finished and settled her claim.
Bob, an ICBC motor vehicle accident client, could barely walk or sit in and out of a chair when he first started. Eight months of continuous exercise sessions (twice a week) resulted in being a much-enlightened fitness enthusiast, having returned to work with considerable changes in body composition (i.e., lost fast, gained muscle), at age 67.
Shiro, an ICBC motor vehicle accident client, went from barely shuffling 5 meters to, 10 months into the active rehab, apparently new levels of athletic competition (he is both a table tennis competitor and a professional coach)! Shiro told me he had not received any prior conditioning or personal training in his life—and, really, it showed--and so the fitness and mobility changes today are quite significant/profound. He could readily take up any number of sports now and become quite proficient.
Gloria, a private client with terminal cancer, has been going to the gym for over two years and hopes to come back after some unfortunate complications this past spring—at which time she wrote “Thank you for your concern. I am so sorry that I have missed so many sessions and I always enjoy them…In fact it is the high light of my week.” Gloria’s customized program involved walking, step climbing, and both flexibility and strengthening exercises of all the major joints. She also did a Tai Chi like calisthenic routine that served as a part of her warm-up. A major goal for her was to keep her mobility for around the house and out and about town.
Each client had different levels of fitness and mobility. Each had one or more significant health or mobility challenge.
Customization was a given.
And common to all these cases:
Overall and specific fitness considerations, and an expectation to do somewhat complete workouts along with the 'problem at hand'.
Selected exercises were expected to be done as well as possible in terms of mechanical positioning (biomechanics), and proper intensities, duration and frequencies
Specific exercises, adaptations, variations, progressions--to address specific weaknesses or areas of concern
Supervision and direction was critical for the eventual fitness and mobility progress. Real time monitoring and adjustments are made accordingly. What exercise and activities, and the amounts, not to mention the sequencing...all affected outcomes. You can imagine how much energy some of the above clients had due to there conditions, and yet their energies improved significantly with specific supervision.
A ‘workbook was used, by those inclined, as both a learning guide and an information resource. The same workbook served as both a 'scope of practice' regarding the Exercise Specialist, and a survey learning book/understanding to reveal the clients knowledge and abilities as they progressed.
Significant and even profound changes can occur, even for the most challenged clients, especially when involving supervised applications, as described some, above. And, having a chance to work with the client for at least two sessions a week for three or even more months makes all the difference (actually, the more months the more consistently dramatic the positive results).
Now imagine less complicated persons who simply wish to be very fit and mobile. Or, persons who wish to perform with their bodies optimally...same basic approaches.
