Saving lives the next step in your PT career?
By building on your PT role to become an exercise physiologist, you can find yourself literally training clients to save their lives, writes Chris Dounis.
It was around 9am when my phone rang, not an altogether unusual thing given that it tends to ring non-stop – or at least feels that way. What was unusual was that I didn’t recognise the number. I was training a client at the time, so naturally I didn’t answer and waited until the session was completed to listen to the voice mail. My suspicions were immediately aroused when I heard the voice of the wife of one of my older clients: receiving an unexpected call from a partner or carer is rarely a good thing. Perhaps though, she was simply calling to reschedule our session due to another appointment that her husband, Rob, had forgotten about. At 91 years of age I can forgive him for occasionally getting confused.
‘Chris, it’s Moira. Rob had a fall last night and has broken his arm. He’s at St Vincent’s. I don’t think you’ll be seeing him today. Give me a call when you can’.
It was the type of message that, in my role as an exercise physiologist working with older people, I dread receiving. At 91, any fall could be deadly, and even though Rob had only suffered a broken arm, he was certainly not out of the woods yet. You may find it hard to understand why a broken arm could be a life-threatening injury, but there are a number of reasons why this was a disaster – especially for Rob. I knew that he was now going to spend a number of days in bed with little-to-no movement at all. I also knew that, because of his other health issues, this was going to give him a very poor recovery prognosis. As his lower body mobility was already very restricted – due in no small part to several hip and knee replacements – he really couldn’t afford to spend the volume of time that I knew lay ahead of him being immobile. But it was what it was, so to speak, and I knew that if Rob made it to rehab I’d have my work cut out for me. Not just to keep Rob mobile and out of a wheelchair, but to simply keep him alive.
Broken arm? Work on leg strength
After speaking with Moira I found out that Rob had woken in the night to use the toilet. On his way he had lost his balance and fallen sideways, breaking his humerus about mid-way up the middle of the shaft. It was decided that they would not operate, as the likelihood of surviving the surgery was not good, so they placed the arm in a sling in the hope that traction and support would allow it to recover. The arm itself was not actually my specific concern: I just knew that if Rob was ever going to walk again and be in a position to get back home, we had to get him moving – and quickly. The challenge, given that Rob uses a 4-wheel walker or walking stick to ambulate, was that using either of those devices was going to be impossible while his arm was in a sling.
I won’t elaborate on the details of the sessions I conducted with Rob at the facility he was sent to for rehab, suffice to say that for the first few weeks of seeing him, we focused heavily on just getting him to weight bear on his legs as much as possible. After the best part of a week in hospital he was barely able to stand at all when I finally got to see him. It is always striking to see just how much strength and balance is lost when something like this happens, and a very timely reminder of just how devastating a fall like this can be for someone of Rob’s years.
From around the age of 60 we start to lose muscle mass, power and strength, so we need to be vigilant with exercise and strength training in order to reduce the amount we lose. These losses really accelerate once we get to 80 and beyond, so it was no surprise to see that Rob had lost almost 100% of his lower body strength in just a week of bed rest.
Where there’s a will
In the midst of this undeniably dispiriting scenario, however, it was heartening to see just how much Rob wanted to improve. I began to sense, after being told by all of the health professionals involved in his management that he had no chance of ever returning home, that we actually might just be able to get him there. One of the most difficult parts of working with clients at Rob’s stage of life is that they can quickly and easily lose all hope, and the thought of exercising every day, along with the loss of dignity that often accompanies such an accident, can lead to depression setting in very quickly. But as the weeks progressed and Rob could start to see progress, he began to believe that returning home was a real possibility. He clung on to this hope, and performed his exercises with perfect regularity with the strong desire to one day return home.
From not even being able to get up and out of his chair when I first went to see him, we managed to get Rob to a point where he could not only stand himself up and walk with his 4-wheel walker up and down the corridor, but also perform all of his daily tasks without assistance. The process was difficult, but by using the basic principles of graded exercise, the same principles that we’d use with our younger clients, we were able to see small improvements day on day and week on week. These small wins gave Rob the encouragement and motivation to keep going when, at times, it seemed like all hope was lost.
Training for prevention
Rob’s story is an example of the amazing benefits of doing the type of work that I get to do. As fitness professionals we all work with clients who want to lose weight, look good and feel better, and I enjoy working with these people as much as I enjoy working with people like Rob. However, it isn’t often that we get to work in a situation where you are literally trying to save someone’s life. That might seem like a dramatic statement, given that Rob had only suffered a broken arm, but this is what was at stake in this case. It gave me a huge sense of pride and achievement to be able to help Rob in the way that I did – a sense of achievement that I could never feel in helping someone to lose 10kg. Not that I don’t get a huge sense of achievement from that either – and, in some ways, that’s an even harder challenge than helping Rob to walk again was!
Rob’ssituation also speaks more broadly to the benefits that my other older client’s get from their exercise physiology sessions. The saying that prevention is better than cure could not be more pertinent than when dealing with people that are well into their 80’s and 90’s. My sessions usually involve fairly simply exercises and ensuring my client’s ability to maintain their independence through improved strength and balance, almost exclusively focusing on the lower body. Aside from my role in keeping them at home, safe and physically comfortable, I might be the only person that they see on a weekly basis, so my visits also have a large psychological and social impact on their lives. Sometimes, I wonder if the benefits that some of my clients get are more social than physical. Thankfully I see the huge importance of this, and I know that for a lot of my clients our sessions are the highlight of their day, which makes me feel as good as it probably does them.
Working with this demographic
This type of work is not going to be available to you unless you are a physiotherapist or Accredited Exercise Physiologist. I never had any intention of becoming a physiotherapist, but I realised from a very early point in my career as a fitness professional that I wanted to be able to help people from as many different physical and social positions as I could. So I went to university while continuing to work in the fitness industry and got my qualifications, even completing a Masters once my undergraduate study was done. The great thing about the fitness industry is that our work hours tend to be at the extremes of the day, leaving the middle of the day free to do other work, study and upskill. It took a lot of discipline, but it turned out to be one of the best decisions I ever made, and the stress of combining full time work with full time study was well worth it. It has opened the door to me for a different revenue stream that would not be available otherwise and has meant, even though I still start work at 5:15am and finish at 8pm, that I wouldn’t have to work at those extreme times of the day if I chose not to.
Rob’s story is just one of many of people that I have helped over the years. The qualifications that I have allow me to do what, I believe, is the best job in the world. I sincerely would not do any other type of work, and as such I’m always happy to talk to anyone in the industry about career and options. If you work as a PT and are considering how to expand your role, please feel free and I’ll gladly talk you through the best pathway for you and how I might be able to help.
Chris Dounis is an Accredited Exercise Physiologist with Exercise and Sports Science Australia. He holds a Bachelors in Health and Exercise Science and a Masters in Clinical Exercise Physiology, as well as further qualifications in the areas of strength and conditioning, health and behavioural psychology, nutrition and exercise rehabilitation. As the owner of CD Exercise Physiology he has worked in the health and fitness industry for over 10 years, working with clients ranging from elite athletes to those with chronic disease.