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Fitness for the forgotten: older Americans with chronic conditions

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

But what if you're one of the millions of older Americans who suffer from arthritis, Alzheimer's, 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 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 over age 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 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. Programs tailored to special needs are scarce, and transportation is sometimes a problem.

And even if an appropriate fitness program is available, health-insurance plans generally won't cover it.

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 Rimmer, head of the National Center on Physical Activity and Disability.

Prove the evidence

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."

A former physical therapist who now does laboratory research on exercise and cell function, Thompson is among those working to provide proof on a fundamental level.

Researchers are trying to pinpoint what constitutes healthy exercise for people with special needs, so that, for example, someone with severe arthritis doesn't become injured following the standard 30-minutes-a-day prescription for walking.

Some people can improve their fitness with something as simple as tuning into a national public-television program, "Sit and Be Fit" — shown locally at 9 a.m. weekdays on KBTC.

The host, registered nurse Mary Ann Wilson, provides safe routines to improve strength, flexibility and coordination. Wilson also has developed specialized videotape routines for particular conditions.

For those who can maneuver outside the home, fitness professionals advise pursuing all local avenues. YMCAs, hospital outpatient-exercise programs and community colleges often offer specialized exercise classes.

Backyard water park

Even people with progressive disorders can benefit from physical activity. UCLA's Cummings said one Parkinson's patient demonstrates just how much physical progress can be made — with the right accommodations.

Tichi Wilkerson Kassel, the former owner and publisher of the Hollywood Reporter, was diagnosed with the progressive, degenerative disorder in 1988.

To get her to exercise, her husband, Arthur Kassel, said he "started building what I believed would be the best state-of-the-art pool for a handicapped person."

The result is a kind of backyard water park with a heated free-form pool and a Jacuzzi his wife can walk into from the pool. The pool has stainless-steel grab-bars for poolside stretching and stability, an overhead rope for hand-over-hand maneuvers and a 20-foot sloped entrance that gives his wife "an opportunity to develop a gait."

On good days, "she can get into the pool on her own foot power," holding rust-proof rails fashioned from bow rails used on yachts. On days when her body is more rigid, she can roll into the water in her submersible wheelchair.

"The most important thing you could ever do is empower somebody, to take charge of their own life and own movements," Arthur Kassel said.

With her illness at an advanced stage, Tichi Kassel's face sometimes becomes frozen and expressionless. But when she dunks her head in the warm pool water, "the Parkinson's mask slips away," and she smiles, her husband said recently as his wife demonstrated her progress to her neurologist.

"There's no doubt you're talking about several more years of survival" as a result of her water exercise, Cummings said.