Technical Report AMI-MU-003:

Cardiopulmonary Exercise Equipment

Authors: Lora Mielcarek, B.B.E., Elizabeth Omiatek, B.B.E.

Coordinating Editors: Jack Winters, Ph.D., Jill Winters, Ph.D., R.N.

Location: Medical Device Accessibility & Usability Laboratory

Current Version: 1.0 (June 2005) [past: Version 0.1 (8/04)]

Table of Contents

Executive Summary

At first glance, the field rehabilitation appears best equipped to fulfill the requirements of accessible medical instrumentation, as practitioners specialize in serving individuals with special needs. But this does not always hold true for the devices used in therapy. For individuals with sensory and physical impairments (the primary focus of this report), the rehabilitation process plays an integral role to improving their overall quality of life [3]. This process is accomplished using various techniques such as stretching, strengthening and endurance training.

This report focuses on features of cardiovascular endurance training equipment, especially as related to accessibility. Many health clubs are not equipped with cardiopulmonary exercise machines that are accessible to all clients regardless of ability or limitation, and the lower-cost home market has even greater challenges. While some of this relates to a need for more knowledge by consumers of features of what is available and features to look for, it also falls back to the manufacturers of universal cardiovascular exercise equipment. The product survey that has been conducted found a lack of accessories and options that would better assist users with impairments. Removable seats, access to weights, ergonomic pins, cuffs, supports and safety devices have all been identified as desirable features for universal equipment, yet most of the products found have been targeted for the younger, unimpaired population [4]. In part there is simply a need for use of universal design principles that help keep the user’s comfort, safety and dignity in perspective. There is also a need for customized features that proactively enable persons with certain types of impairments, abilities and needs to actively stay fit. This study provides an overview of 98 current products in this category, using 60 columns of features for devices classified into 5 categories: bikes, ellipticals, steppers, treadmills, and wheelchair cyclers. Hopefully, it will be helpful to consumers desiring to purchase such products and manufacturers desiring to improve the accessibility of their products. to determine additional design requirements of.

Background

The Surgeon General’s report on Physical Activity and Health published in 1996 asserted that “Physical activity of the type that improves cardiovascular endurance reduces the risk of developing or dying from cardiovascular disease, hypertension, colon cancer, and type 2 diabetes and improves mental health. Other findings are suggestive that endurance-type physical activity may reduce the risk of developing obesity, osteoporosis, and depression and may improve psychological well-being and quality of life [1]. Therapeutic exercise is an important aspect of regaining range of motion and strength after the onset of an impairment or injury. This training may include stretching exercises, strength training and cardiovascular endurance training [2]. The report focuses on the latter area, and in particular low- and moderate-cost products that may work their way into use within homes and local exercise facilities.

This report will not address the important accessibility issues related to the built environment, as these are addressed elsewhere. The North Carolina Office on Disability as well as The Center for Universal Design collaborated to identify aspects of universal design and common problems faced in athletic facilities, and have disseminated a published report [x]. Suggestions made by the North Carolina Office on Disability and Health include extra space at the end of a row of exercise equipment and extra chairs to accommodate persons who would like to participate in aerobics while seated. The RERC on Recreational Technologies, directed by Dr. James Rimmer (an RERC-AMI advisor), also has interests in this area. Their extensive research has shown, for instance, that most health club facilities and weight lifting companies have a target aim of those between the ages of nineteen and thirty, which represents only 7% of the population,. These groups emphasize the necessity to improve athletic facilities to encompass the large portion of society that is aging, impaired, or disabled. This includes modifications to the buildings, arrangement of the equipment, accessibility of the equipment, training staff in assisting clients, as well as added safety precautions.

Product Table

For an overiew and instructions on how to navigate within the product table click here.

Product Survey

Table 1 illustrates 98 of the current universal cardiopulmonary exercise equipment available. Key features have been illustrated to show the differences between each machine and its capabilities. In all there are 60 columns.

Each product name and manufacturer contains a hyperlink to the respective web site. Subsequent columns indicate whether it is manually operated or powered by an outside source, and specific equipment dimensions (e.g., the height, length, and width). Also addressed is what can be adjusted or measured on the machine. Some equipment can be adjusted to fit a user’s height while others can be adjusted to fit a user’s exercise level.

A conceptual tool such as the RERC-AMI’s evolving Access-RIM model or the R3 Accessibility Metric project may be useful to help understand the role of the equipment in participating with the user in the sequence of acts that enables the therapeutic exercise task to be completed. For now, the target aim has been determined using a one to three rating system, with:

The ease of adjustment of a particular piece of equipment is also rated on a similar scale, with:

The user abilities column describes impairments that are anticipated to prohibit someone from using the product. For example, someone who does not have the ability to stand cannot use certain devices as parts may be out of reach or there may not be enough room for the client in a wheelchair to slide onto the machine. A list of expanded abbreviations may be found in Appendix A. The cost presented does not include the additional accessories, weights or safety devices.

The comments include additional information found within the product advertisements that may set that machine apart from others within the group. Some products advertisements contained more information than others; therefore information not available has been left with a dash.

Product Evaluation

From the information presented in the product survey, it is clear that much more can be done to better accommodate individuals of varying ability. This was part of the motivation behind the inclusion of exercise ergometers within the D2.2 Senior Design competition for the 2004-2005 academic year.

When evaluating the usability of a product there are key features to look for, such as the mobility of the seat. If the seat can swing away or be removed it allows wheelchair users to perform the exercise without the need to transfer. If the seat is not removable, it should be located in an open area for easy transfer from a wheelchair. Wider seats also provide for added stability and comfort for larger users.

Some guidelines for selecting cardiovascular equipment are offering different types of exercise bikes, looking at equipment that provides exercise for both arms and legs, either at the same time or separately. For instance, offering an upper arm ergometer for individuals with temporary or long term leg disability can be beneficial [4]. This observation shows that use of Universal Design principles alone is likely not enough; modular approaches with options for specific augmentative devices will sometimes be needed.

Another suggestion is for consumers to make sure that a treadmill of interest has a low MPH setting, so that it can start off slow for users with balance problems and/or with limited cardiopulmonary capacity.

Simple and inexpensive adaptations can be made to equipment to make them usable for a wider range of ability levels. For instance, to increase grip strength one can use cuffs, mitts, or splints. To stabilize limbs or feet, a strap or clip can be used to secure a person’s foot to a pedal of an exercise bike [5]. Other solutions to problems such as balance would be to put a strap around the torso to secure person to equipment and provide a better base of support. Additional safety features are also desirable to keep the user both comfortable and safe. Leg and arm straps should be available for individuals with limited postural control, or who are not confident in their balance on the machine. It is also important to make sure that there is sufficient padding on the machine to help prevent uncomfortable pressure or rubbing.

Finally, many of the exercise monitors for display and control leave much to be desired. Such monitors generally serve two purposes: the control and select settings, and to display ongoing performance. This is a target for our D2.2 demonstration project that universal remote console (V2) standard to demonstrate possibilities for how displays and controls within exercise ergometer monitors could be designed in the future around the abilities and preferences of users.

Acknowledgment

This work is supported by the Rehabilitation Engineering Research Center on Accessible Medical Instrumentation, funded by the National Institute on Disability and Rehabilitation Research, U.S. Department of Education Grant #H133E020729. All opinions are those of the authors.

References

[1] Chakravarthy, M., Booth, F. (2003) Exercise. Philadelphia, PA: Hanley & Belfus.

[2] Hall, C., Brody, L. (1999). Therapeutic Exercise: Moving Toward Function. Philadelphia, PA.: Lippincott Williams & Wilkins

[3] McCown, K., Martin, J., Forest, S., Carter, M. (2004) Exercise and Fitness for Adults with Developmental Disabilites: Case Report of a Group Intervention. Arlington: Therapeutic Recreational Journal

[4] North Carolina Office on Disability and Health. (2002). Removing Barriers to Health Clubs and Fitness Facilities. North Carolina. North Carolina Office on Disability and Health

[5] The Coleman Institute for Cognitive Disabilities (2003). RehabilitationEngineeringResearchCenter on Recreational Technologies and Exercise Physiology Benifiting Person with Disabilities. University of Colorado

Appendix – Coding for Table

User Abilities (Impairments) Reference:

Cognitive – CG

Vision, blind – VB

Vision, partial – VP

Hearing, deaf – HD

Hearing, partial – HP

Reaching (forward, above head, or over shoulder) – R

Standing – ST

Manipulation of hand – MH

Manipulation of feet – MF

Postural control of head – PH

Postural control of arms – PA

Postural control of legs – PL

Postural control of torso – PT

Walking/mobility – MO

Ease of Adjustment Reference:

Tonal Reference:

Y1- Y=Yes and 1= tone

Y2- Y=Yes and 2= cue, for example heart rate displays a symbol of a heart along with a tone with it

N- No

Target Aims Reference:

Training Required Reference: