Sweat Equity

The first thing people learn when they come through the doors of Birmingham’s Lakeshore Foundation is that a disability—physical, mental, or emotional—doesn’t translate into an inability to exercise.

That goes for everyone, from injured military veterans to visually impaired children, and people who have lost limbs to individuals with spinal cord injury, stroke, Parkinson’s disease, and other conditions.

“People tend to equate disability with not being healthy, and that’s not the case,” says Jeff Underwood, Lakeshore’s president and chief executive officer. “One of the biggest barriers is that some people, including some physicians and members of the fitness industry, don’t think exercise is appropriate for people with disability unless it’s medically supervised. They say you shouldn’t do it, you don’t want to hurt yourself, you don’t want to overdo it.” Consequently, many individuals with disability face challenges in meeting the Centers for Disease Control and Prevention’s (CDC) goal of 150 minutes of moderate physical activity per week. In turn, the lack of exercise can contribute to higher rates of obesity, depression, fatigue, and pain, according to a recent CDC report.

The UAB/Lakeshore Research Collaborative intends to change those attitudes toward exercise, along with the physical, social, and economic barriers that people with disability face in starting and sustaining fitness programs. The pairing brings together the scientists in UAB’s School of Health Professions with the adapted-fitness experts at Lakeshore, a nonprofit organization that has helped individuals with disability to improve physical fitness for 40 years. The combination of knowledge and resources is unlike anything else in the nation, Underwood says, and it has the potential to improve quality of life for people everywhere.

Lakeshore’s recreation center provides the setting for the breakthroughs—both research-related and personal. There, Underwood and his colleagues encourage people of all ages and abilities to increase their activity levels in a safe, accessible, and user-friendly environment. Using a technique known as “motivational interviewing,” they help individuals identify personal goals for working out, which can help them overcome initial reluctance to exercise and make it more likely that they will continue to do so.

Physical activity isn’t marathons or bust, Underwood says. For some people, the fitness goals are fairly basic: Get up, and get moving. Others prefer to spend time in the Lakeshore pool or walk around their neighborhoods. The Lakeshore staff helps individuals develop fitness plans that can be used at home, outside, or at other facilities if they can’t travel to the recreation center on a regular basis. “The trick is to find the right exercise program,” Underwood says—one that is simultaneously manageable and enjoyable.

James Rimmer, Ph.D., has a goal of his own: to prove that health and wellness programs are effective in helping people with disability to improve their physical and mental well-being. He has pursued that mission for more than 30 years. Now, as the Lakeshore Foundation Endowed Chair in Health Promotion and Rehabilitation Sciences in the UAB Department of Occupational Therapy, and as Lakeshore Foundation’s director of research, he leads the UAB/Lakeshore Research Collaborative and two national research centers dedicated to the cause. Rimmer also serves on the Scientific Board of the President’s Council on Fitness, Sports, and Nutrition—the first researcher with a focus on the health and fitness of people with disability to be appointed—which helps to advise the U.S. Secretary of Health and Human Services.

Rimmer’s CDC-funded National Center on Health, Physical Activity, and Disability seeks to develop solutions to prevent or reduce secondary health conditions—such as pain, fatigue, obesity, social isolation, and depression—that can accompany disability. “They have spiraling, interactive effects,” Rimmer says.

Determining how much exercise is required to benefit individuals is one major project. Currently, Lakeshore and UAB are examining how certain types and “doses” of exercise could reduce the impact of secondary conditions. The question hasn’t yet been answered, Rimmer says, because it’s difficult to find enough people with disability in a specific area to enroll in a study. Lakeshore and UAB have a model to change that by asking all new Lakeshore members to participate in the study, as well as people in the community who are interested in learning more about their health.

Through the Rehabilitation Engineering Research Center on Exercise and Recreational Technologies and Exercise Physiology for People with Disabilities (RecTech), made possible by a $6-million grant from the National Institute of Disability and Rehabilitation Research, Rimmer and UAB researchers are adapting technologies to make physical activity more inclusive. Currently, they are helping to build Lakeshore’s telehealth capacity. Internet-linked video monitors would connect fitness trainers to individuals from underserved communities and those who can’t regularly travel to the facility, helping them to stay active and motivated.

Simple modifications to a fitness program are often all that it takes to help many people with disability increase their activity levels. Others, however, may require more support—and UAB ingenuity. Alan Eberhardt, Ph.D., associate dean for the UAB School of Engineering, and his biomedical engineering students have been developing devices to aid individuals with disability since 1996, when Eberhardt received his first grant from the National Science Foundation to design adapted equipment.

“The goal is to combine engineering with rehabilitation and exercise medicine to improve outcomes for people with all kinds of disability, which include spinal cord injury, stroke, congenital conditions, and so on,” says Eberhardt, a RecTech collaborator. “For some people, coming up with a solution that lets them walk, stand, or even climb stairs is a major accomplishment.” Cost is another factor; Eberhardt notes that many people with disability say that devices currently on the market are too expensive and don’t work well.

Some of the student designs are prototypes created with one person specifically in mind. Other devices, however, have broader applications, bringing opportunities for commercialization and widespread use. Earlier this year, a UAB-designed wheelchair that toddlers can control with a joystick won the international student Da Vinci award, which recognizes innovation in assistive and adaptive technology. Another UAB finalist was an affordable home wheelchair scale that helps people monitor their weight; Lakeshore has already put it to use.

Eberhardt and his students also are collaborating with Rimmer on solutions to make working out more enjoyable, in turn increasing the chances that someone will continue exercising. Currently, they are tapping into Xbox Kinect technology with a goal of creating “exer-games” to help individuals with disability improve balance, strength, and cardiovascular endurance. Future projects include the development of interactive video “tours” for fitness machines, giving people a choice of virtual routes to walk, run, or cycle through as they exercise. “Some of these exercises get very boring, and no one wants to do it for very long,” Eberhardt says. “So we want to create scenarios where you feel like you’re moving down a trail, exploring the Grand Canyon, or visiting the Louvre.”

All of the sweat, science, and brainstorming in the UAB/Lakeshore Research Collaborative are dedicated to providing inclusive opportunities for high-quality physical activity programs. “Our understanding of the health of people with disability has been transformed in the last 30 years,” says Rimmer. “They’re no longer seen as people who have illnesses, but as people who can be as healthy as anyone else if they’re provided with access to health and fitness.”

• Learn more about the work of the UAB/Lakeshore Research Collaborative.

• Give something and change everything for research into fitness for people with disability.