Motivated to move
Meet Manitobans who are working to improve their health
|Laura Cowie says she joined the Reh-Fit Centre after undergoing hip surgery.
BY GERALD FLOOD
Winnipeg Health Region
Wave, November / December 2016
Laura Cowie is “getting back into life” one small crank at a time on an exercise bike at the Reh-Fit Centre in south Winnipeg.
And it’s making her happy. Very happy.
“It’s only been weeks, but I feel an improvement in my stamina already,” she enthuses. “I walked my dog in St. Vital Park for the first time in three years. He was happy, and so was I.
“I feel a euphoria that comes from trying,” the single-parent librarian beams.
Cowie started getting back into life, as she says, when she reached a tipping point last summer – was her future going to be sedentary like her recent past, was she going to remain overweight and out of breath, or was she going to be more active and robust again?
She found that it wasn’t a difficult choice.
“I wanted to stop identifying with my limitations, with thinking of myself as a broken person,” she says.
It’s not that Cowie, 58, was ever an athlete, or had any interest in being one – she says she was born “big boned and klutzy” and was raised in an academic household where the emphasis was on exercising the mind, not the body.
“I can’t remember my father ever once asking us to play baseball,” she notes.
All the same, Cowie maintained a reasonably active, reasonably healthy lifestyle until it literally started grinding to a halt as advancing osteoarthritis made movement difficult, with the result that she gained weight, which in turn exacerbated her pain and fuelled more inactivity.
Four years ago, she found she no longer could keep up with other people.
Then two years ago, her joint problems – which made a walk from her car to her office “excruciating” both to perform and to witness – finally rendered her incapable of doing her job as a school division library services manager.
She went on disability leave and started a course of surgeries to replace first one knee, then the other, and then a hip.
Six months after the hip surgery, Cowie was largely free of pain, but she realized this spring that “my life had just shrunk and shrunk and shrunk.”
She also realized that she could do something about it. Her mother, whom she lived with and cared for, had died; her two daughters were still at home but in their twenties and self-sufficient; and Cowie was becoming mobile again.
“I just had this yearning, this feeling that my life could be bigger.”
Cowie visited the Reh-Fit Centre and joined up.
• • •
There are only two certified “medical fitness centres” in Canada. They are both in Winnipeg – the Reh-Fit Centre on Taylor Avenue in south Winnipeg, and the Wellness Institute at Seven Oaks General Hospital on Leila Avenue in north Winnipeg.
“It’s wonderful for Winnipeg,” says Sue Boreskie, CEO of Reh-Fit. “It’s something we should brag about.”
While both facilities welcome memberships from anyone interested in using their state-of-the-art equipment, their real specialty is in helping people to manage chronic diseases and conditions or to recover from and prevent heart attacks and strokes. They do this by tailoring physical activity and diet to the unique needs and “risks” of the individuals who are either referred to them or who apply for such help.
Of the two facilities, the Reh-Fit has been around longer, opening in 1979. But it really began several years earlier in a small lab at St. Boniface Hospital where Dr. David Mymin began putting heart patients on exercise regimes.
Mymin, like medical researchers across the continent, was rediscovering what the ancient Greeks knew thousands of years ago – that diet and exercise, not pills and potions – is the best prescription for good health.
“Some people thought he was taking great risks,” says Boreskie, who was mentored by Mymin. “In those days people thought, ‘Why would you exercise people who just had a heart attack?’ Now we don’t just exercise after surgery, we exercise before. When you’re waiting for surgery, you don’t want to be sitting at home getting stressed and more sedentary.”
Meanwhile, the Wellness Institute, the slightly larger of the two centres, is celebrating its 20th anniversary this year.
Owned and operated by Seven Oaks General Hospital, the Wellness Institute was developed as part of an effort to fully integrate disease prevention and management in a hospital setting. It offers a range of hospital and community wellness services, including pulmonary rehabilitation programming and diabetes care. As a result, Seven Oaks has been designated as a centre of excellence for treating chronic diseases and conditions, ranging from diabetes to kidney disease.
“We see our role as preventing illness as well as supporting people with chronic conditions such as diabetes, cancer, and heart, kidney and lung disease to stay well with lifestyle change so they don’t end up back in hospital,” says Casie Nishi, Executive Director of the Wellness Institute.
It is also quick to pick up on the needs of its clients. For example, it has a babysitting service so that parents (or other caregivers such as grandparents) do not have to forgo exercise in order to care for children. And, like the Reh-Fit Centre, it also has private showers and change rooms for both men and women who might avoid exercise because they have self-consciousness issues. The Wellness Institute also built a warm water pool that allows larger members to “aqua-size” without risk to joints and muscles.
Today, the two facilities have a combined membership of about 11,000 paying members, and about that many individuals again who take courses and training but apply them elsewhere. The average age of members is about 55, which makes sense given the tie-ins with chronic health issues, but members include children and people in their 90s.
“We have a niche,” Boreskie says. “Other centres focus on family, for example. We all work well together. It’s not a competition. Our worst competitors are televisions and computers.”
• • •
Cowie did not know that she would fit into the Reh-Fit’s age and health demographics when she first went there after friends told her how much it had changed their lives.
But she very quickly realized that the facility offered everything she wanted and, more importantly, everything she needed to achieve her first basic goal – “to change from being someone who is inactive to someone who regularly is active.”
Her first surprise came when she received the results of the required health and fitness tests. They were better than she dreamed.
“I was terrified,” she says. “I thought they’d say why not just jump off a cliff. But my triglycerides are excellent and I’ve basically got more (cardiovascular endurance) than I would have imagined. My cholesterol was good. That was really exciting. I now feel very positive about the health that I do have. You can build from there.”
Cowie was impressed by the range of program and wellness options – yoga, aerobics, massage therapy, dietary instruction, and on and on – and she was eager to try things she had never before considered – like working out on resistance machines or lifting weights.
She hopes to one day “try dragon boat racing” but knows that in the here-and-now she first had to start – and slowly.
“I can’t do track, but I can do the bike,” she says.
The bigger surprise, however, was how easily she fit in and how encouraging Reh-Fit staff and members could be.
She says in the past there were times when she felt self-conscious about her fitness and weight. “But here, it’s just assumed that you are trying to be better, to do what you need to do.”
Like most people familiar with the Reh-Fit and the Wellness Institute, Cowie also discovered that the most inspirational members are not the hard-bodied athletes doing reps on resistance machines or sprinting down the track, as admirable as their athleticism might be.
Instead, the people regularly cited as inspirational are the ones that might be described as being in the worst shape: the ones exercising from wheelchairs; the ones doing laps with a walker; the ones overcoming limitations caused by strokes or obesity; the ones working out with an oxygen bottle in a wheeled carrier at their feet.
“You meet everyone here, from the super-fit to the non-fit,” Cowie says. “But it’s the ones who are just trying that impress. You get that sense of life and health and energy from being with them.”
She says one woman in particular had told her that when she first joined she could not complete a single lap on the track, but that she now walks miles just to get to the Reh-Fit.
“She said, ‘Don’t give up. Keep coming and you’ll see changes, just like I did.’”
Other Reh-Fit members feel the same way. Manitoba Appeal Court Justice Freda Steel, for example, says one of the first things she noticed was the diversity of members and the range of their abilities.
“You go around and you see people who are much older, with canes and walkers and you think, ‘If they can come here and try, I can try, too.’
“I’ve seen people in their 90s who are in better shape than me,” Steel says, laughing.
• • •
It is paradoxical that North Americans have never been less healthy, and have never lived longer.
Longer lives are the result of myriad advances in disease control, according to Dr. Paul Komenda, Director of Research at Seven Oaks General Hospital.
Clean drinking water, a safe food supply, vaccinations, advanced cardio-vascular treatment, advanced chronic disease care, cancer care and other developments have combined to add years and years to average life expectancies, he explains.
At the same time, however, the way society is organized makes it increasingly unnecessary to exercise and increasingly affordable to eat convenience food rather than nutritious food. The result is that obesity rates have skyrocketed and threaten the affordability of heath care because the longer sedentary people live, the more likely they are to develop chronic conditions, which fuel ever more demand for expensive treatment.
Most Canadians know this, Komenda says, and most Canadians do nothing about it.
A recent Statistics Canada study of sports participation rates, for example, found that not only are Canadians mostly inactive, they are becoming more so. Between 1992 and 2010, overall sports participation rates by Canadians fell by 17 per cent, General Social Survey time-use data shows. The sports participation rate for women is one in six (for men, one in three) and just 17 per cent of adults 55 and older participate in sports.
But as gloomy as most of the news on the “wellness” front is, Komenda believes that it is outdated, that the trends are reversing faster than research can reflect.
He believes that we are at a point not much different than the hugely successful smoking-cessation movement was decades ago. “I’m optimistic we’re seeing a tectonic shift to people again recognizing that physical fitness is very important,” he says. “I think that’s evidenced, maybe not by hard science but by the economics around it.”
For example, he points to the astonishing growth of pay-per-use mega-gym facilities, the growth in participation in such events as the Manitoba Marathon, the growing emphasis on bicycle commuting, the push for walkable neighbourhoods, even the growing demand from patients for non-medical solutions to conditions such as high blood pressure.
But the clincher, he believes, might be that health-care insurers in the United States have seen that it is more profitable in the long run to reward clients with rebates and reduced premiums if they join fitness centres than it is to pay to treat them for obesity and inactivity.
“So some of that is rethinking how to make it easy to be active and difficult to be inactive,” he says. The operative word here might be “easy.”
Surveys find that most inactive people explain their inactivity is a result of a lack of time.
Komenda, however, explains that research has found that the optimal effort/reward ratio occurs when people engage in just 30 minutes of moderately intense exercise three or four times a week.
“There doesn’t seem to be any incremental benefit after that,” he says.
• • •
Cowie, meanwhile, returned to work at the start of the school year in September.
She says her experiences over recent years, and the discovery of the benefits of even modest amounts of exercise, have engendered an “incredible sympathy” for people with untreatable mobility issues.
“I never really realized how difficult it can be,” she says. “I have a lot of gratitude that I had this opportunity and that I’m getting better even by small steps.”
Gerald Flood is a Winnipeg writer.
Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.
Read the November / December 2016 issue of Wave