Helping Underserved Populations With Neurological Disabilities Continue to Exercise After Rehab

For patients with disabilities resulting from a neurological condition, the recommendation after completing a formal rehabilitation program is to continue to exercise on their own to sustain their gains. But a range of logistical, behavioral and practical barriers to regular exercise participation can make that easier said than done, especially for individuals with limited means.

In April 2024, Cleveland Clinic launched a free exercise and wellness program to address these barriers. The six-month program, designed for patients in underserved communities with disabilities due to conditions such as stroke or multiple sclerosis (MS), is offered three days a week for an hour at The Langston Hughes Center, a Cleveland Clinic community health and education center.

“There’s a huge gap in rehab once people are done with their formal rehab and you recommend they continue to exercise,” says program leader Susan Linder, DPT, PhD, Director of Clinical Research for Cleveland Clinic’s Department of Physical Medicine and Rehabilitation. “When you don’t have access to exercise equipment or the ability to adapt equipment designed for able-bodied people to the disabled population, that’s a huge barrier. The result can be high levels of physical inactivity.”

Combining exercise with lifestyle modification education

Dr. Linder is partnering with a neurologically trained physical therapist, a sports medicine physician and a wellness physician to run the program, which is funded by an internal Cleveland Clinic grant that pools philanthropic donations to support targeted programs to address unmet clinical and research needs.

The seven patients enrolled in the initial cohort are divided into two back-to-back hourlong sessions three days a week and use exercise equipment in the gym at The Langston Hughes Center. The program also purchased specialized equipment that allows exercise to be adapted for people with disabilities, including a free-standing harness system for positioning over a treadmill.

Exercise physiologists, physical therapists and/or residents in physical medicine and rehabilitation are available to patients during the sessions.

“They help adapt the intervention or the machine to each person’s abilities, to address barriers that we know can exist for this population,” Dr. Linder explains. For example, people who have had a stroke resulting in one-sided weakness may need help adapting weightlifting exercises so the hand on that side maintains contact on the grip of the bar.

The providers also monitor each participant’s heart rate and blood pressure, ensuring they have an appropriate response to the exercise. In addition, the team presents educational talks on various wellness and lifestyle modification topics every two weeks.

Extending the continuum of care

Dr. Linder says similar post-rehab group exercise and wellness programs have been offered at other Cleveland Clinic locations for a couple of decades now, but they involve a monthly fee for participants. “People on a fixed income with a disability often can’t afford that,” she says.

Supporting community-based programs such as this for people with disabilities is important, she notes, particularly in socioeconomically disadvantaged areas where barriers to exercise disproportionately affect Black residents, further widening racial gaps in general health and quality of life. The Langston Hughes Center serves residents of East Cleveland, many of whom have chronic medical conditions and lack resources to effectively manage them.

“These are our patients,” says Dr. Linder. “The program is a cost-efficient way to provide wellness so that they stay healthier while also remaining within our system so their health can be monitored. If something comes up, we notice it and can intervene sooner.” For example, one patient in the program had a fall, and the team was able to address it.

“This extends the continuum of care we can provide our patients,” Dr. Linder says.

Measuring outcomes, expanding the program

The program builds on Dr. Linder’s previous work as a neurologically trained research physical therapist. “We have spent over a decade investigating the benefits of aerobic exercise in people with stroke and MS,” she says. “We’ve demonstrated that, with the guidance of skilled therapists, these individuals can safely and effectively participate in training that meets recommendations.”

She and her colleagues will collect outcomes from participants related to:

• Level of physical activity measured by a wearable fitness tracker
• Strength through isokinetic testing
• Cardiopulmonary fitness via graded exercise testing
• Quality of life and social interaction as measured by the PROMIS-29 physical, mental and social health tool

The team plans to conduct a focus group to gather more information and hopes to eventually publish a case series report. They also envision expanding the program to other Cleveland Clinic locations with fitness centers in underserved communities.

If early input from participants is any indication, that goal is worth pursuing. “The patients are raving about not just the physical benefits but also the emotional benefits of being in a what basically amounts to a support group environment,” Dr. Linder concludes. “And they appreciate the supervision, assistance and guidance the staff are providing them. It’s a feel-good story all around.”