Shut out of the gym

Health: Millions with physical limitations are denied the benefits of regular exercise.

Life After 50

October 21, 2001|By Jane E. Allen | Jane E. Allen,Special to the Sun

We are constantly reminded that 30 minutes of exercise several times a week is crucial to good health and long life.

But what happens if you're one of the millions of older Americans who suffer from arthritis, Alzheimer's disease, diabetes, osteoporosis or some other physically limiting condition? You may be trapped at home, shut out of traditional gyms and health clubs, too discouraged or too depressed to challenge yourself with movement.

"They're the forgotten people," said Karl G. Knopf, president of the Fitness Educators of Older Adults Association. He's among a growing number of patient advocates and fitness professionals who worry that the one-size-fits-all fitness world has left behind the very people who may need exercise the most.

The numbers are striking. An estimated 54 million Americans have disabling or chronic illnesses such as asthma and diabetes. Two-thirds of them are older than 60. Almost all could benefit from physical activity.

Exercise has been shown to lower blood pressure and cholesterol, improve sugar metabolism, and boost mood and concentration. It also helps muscle tone, endurance, motor skills and balance. The health benefits, along with the psychological boost of social interaction, can increase independence, staving off some of the deterioration that chronic illness can bring.

Without exercise, the chronically ill risk the setbacks of deconditioning, said Dr. Jeffrey L. Cummings, director of the Alzheimer's Disease Center at the University of California, Los Angeles. "If you let people sit in bed, they cannot get up again. You have to maximize your physical activity to reverse [deconditioning] to the extent you can."

But that's easier said than done. Only a few facilities can accommodate people with physical limitations. Tailored programs are scarce, and transportation is sometimes a problem.

And even if an appropriate program is available, health-insurance plans generally won't cover it. Only a few sick or elderly can afford to pay out of pocket.

Victor Suhr, for example, a 61-year-old former locksmith with post-polio syndrome, can barely scrape together the money for a weekly water class.

When he was still working, he swam 50 laps each day at a YMCA. But now, cool pool temperatures make his limbs cramp. He lacks the stamina to walk more than a couple of blocks.

Because Medicare won't pay for warm-water therapy, he cobbles together his one-third share for the class sponsored by the Arthritis Foundation and nearby St. Francis Medical Center. It isn't enough, but it's the best he can do.

Insurers an obstacle

Insurance poses another impediment, experts say. Many health plans don't provide physical therapy for chronic conditions. Some have trimmed rehabilitation benefits.

Exercise professionals say none of this will change until health plans and the federal Medicare program make exercise a priority.

"It's going to take some kind of a legislative mandate that would allow Medicare to fund fitness center memberships," said James H. Rimmer, head of the National Center on Physical Activity and Disability.

Access to exercise for those with special needs is often intertwined with -- and as a result, often hindered by -- the medical system. Doctors may not know what to recommend, and insurers aren't aware of its value. Because doctors generally receive limited training in exercise's benefits, they're less likely to know how and where to steer patients.

Some recommend physical therapy, although it is usually a very limited proposition -- often just a handful of sessions to get someone through the acute phase of an illness or postoperative period.

"At some point they will be discharged. That's where we see regression, and people lose the strides they make," said Janie Clark, president of the American Senior Fitness Association in New Smyrna Beach, Fla.

Exercise experts say physical therapy needs to be better melded with personal training, with patients perhaps stretching their half-dozen sessions by having trainers work with them until they hit a plateau or obstacle that requires a therapist's intervention.

Proof of benefits sought

Researchers, meanwhile, are seeking the scientific evidence that could move health insurers to make the benefits more widely available. Already, a few Medicare HMOs incorporate exercise into their wellness programs, but they're the exception. The impact of exercise on the nation's healthy population is indisputable, but specific research has only just begun in the ill and elderly.

"What we are now trying to do as scientists in rehabilitation is prove the evidence," said LaDora Thompson, an associate professor of physical medicine and rehabilitation at the University of Minnesota. Health insurers are "not going to reimburse for anything that does not have an actual proven research study that said it is truly effective."

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