Faces of Public Health: James Rimmer, PHD

Dec 17, 2012, 2:44 PM

file James Rimmer, PHD

Last year, a new center to help promote physical activity among individuals with disabilities opened at the University of Alabama at Birmingham. NewPublicHealth spoke with James Rimmer, PhD, the center’s director, who has spent decades promoting the importance of people who are disabled engaging in physical activity for both their health and for fun.

NewPublicHealth: Tell us about the new center.

Rimmer: When I moved here from the University of Illinois/Chicago, there was a large donation made to support the needs of people with disabilities in all areas of physical activity, sport and recreation, by the Lakeshore Foundation, a non-profit organization that provides health and fitness services to people with disabilities. They brought me in to build an enterprise between the University of Alabama at Birmingham and the foundation, which is called the UAB Lakeshore Research Collaborative. Subsumed under that are two national centers that have been funded by the Centers for Disease Control and Prevention and the National Institute on Disability and Rehabilitation Research. The first center is the National Center Health, Physical Activity and Disability. The second center is the Rehabilitation Engineering Research Center.

NPH: You have been working in this field for decades. What will be new about your initiatives and efforts in 2013?

Rimmer: While NCPAD was created years ago, the Rehabilitation Engineering Research Center, where we’re building new systems and products to promote health and well-being among people disabilities, was new last year. What’s so different about this center is we’ve got a core of engineers and rehabilitation scientists and exercise scientists working at the intersection of the problems that people with disabilities experience when trying to become physically active. And so the amalgamation or the synergy between rehab engineers, exercise scientists and engineers in general is to build a platform—a research platform and a development platform—to develop new products that are universally designed for people with disabilities, in addition to creating innovative projects that will allow people to exercise together. We’re calling that a virtual exercise unit that will allow people from different parts of the country to actually exercise together on a platform in front of a screen in their home where they’re actually talking to each other and interacting in a natural environment.

People with disabilities have a tremendous lack of connectivity to communities because of the issues of transportation. So the major barriers—if you’re in a wheelchair or you have a cognitive disability—you can’t get to places unless either A) the transportation is available and accessible, or B) you have someone take you there. So we’re trying build, through information communication technologies, almost like a Twitter system, where people will sign up. They can volunteer to be drivers to help people with disabilities get to different locations, different fitness centers.

But the other big problem is when they do get to a fitness center, if they do have the opportunity, when you look at the contour of an exercise facility, the structure of it, in most cases, for people who use wheelchairs I would say less than 15 percent to 20 percent of the facility is accessible. They’ve got issues with lockers and locker rooms and there’s no privacy. If you have a personal assistant of the opposite sex, you can’t change in the same locker room. Equipment is generally inaccessible. If you can’t transfer onto weight training equipment, how do you use it? So you get to use very small amounts of equipment. Exercise adherence is hard for everybody, and it’s even more difficult if you’ve got less opportunity and fewer options.

NPH: What are you hoping will happen as a result of the center’s taking initiative on the issues?

Rimmer: I think this is the first opportunity where people with disabilities can carry the flag and be at the front of the line. So if we raise the floor for everyone, I think older populations are really going to benefit from this as well. Older populations do have disabilities and as they get older they have more and more of those disabilities, both cognitive and physical and even sensory. So we’re going to carry the flag on this one in the disabled community, and by that what I mean is get fitness centers to a higher level of consciousness about how there’s a trans-generational market out there that needs their services—not only services from a standpoint of making a locker room accessible, but to take a different approach in order to recruit people who are older and people with disabilities.

Right now, the percentage of people who have a disability or are seniors who are members of a fitness center is probably less than 5 percent, and that’s just unacceptable because these are people who need it more than those who don’t have these extensive limitations. Without disabilities, they can go out and run, they can ride a bike on the weekends with their buddies, they can deal with inclement weather, they can get places, and yet—ironically—the people who use them the most are the people who need them the least.

NPH: Tell us a bit more about the project for people with disabilities to exercise in their homes?

Rimmer: There are many reasons this is so important, but one reason is that we have about 730,000 people every year in this country who have a stroke. Many of those are significant. Most go through this very minimal amount of rehabilitation. They’re going to give you three or four days, you’ll get a chance to walk through parallel bars, you’ll lift a couple of weights, and then you’ll go home. That is way less than a person with a newly acquired disability needs to get back to health, and the way to begin that is really in the home. Telling someone “here’s a $600 membership, go to a gym that only has 5 percent to 20 percent of the equipment accessible” is not going to work. But if you get them to exercise at home, you continue that rehab through some kind of virtual exercise where they can actually co-locate, get on their computer, and continue on their rehabilitation with a piece of exercise equipment that’s creating cardiovascular work, maybe some strengthening, maybe some range of motion. Then they can interact via a system such as Skype, but instead of just interacting in a sedentary nature, they could actually be choosing to walk along the Boulder Creek Path or Yellowstone National Park.  If we can get those images—which is what we’re doing in this one study—interfaced with having access to this machine, the video gets sort of transported into the machine and then the person is only able to navigate those virtual environments by mobilizing the machine. And we’d we able to link people so that they could exercise together and rehabilitate together across the country.

NPH: What kind of funding are you getting for this?

Rimmer: We’re getting funding from the National Institute on Disability Rehabilitation Research. It’s a $4.75 million grant over five years.

NPH: How do you disseminate the information?

Rimmer: We’re trying to build what we call inclusive health coalitions, and we’re just starting the process now. This is a three-year grant where we’re partnering with Easter Seals to work with their affiliates to begin to develop a culture of health among the disability organizations in that community. Take any community and you’ll typically find multiple disability organizations providing services to people with disabilities. And then there are organizations that are providing services to people who are aging, and we think if we can get these groups to work together and then tie in the facilities we could now start to develop a coalition within the community to focus on health promotion for people with disabilities. It would start from the top. A doctor would have something available on his website. A patient comes in with a disability, they’re depressed or they don’t have any access to health promotion and activities. He presses a button on his computer and sends it to one of our study coordinators who coaches them on the phone and gets them involved in some sort of activity. I’m hoping a year from now we’ll have a prototype of the product. We’re building an actual device that interfaces with the computer or the television.

NPH: What sort of fitness facility for people with disabilities do you have at the university?

Rimmer: It is the benchmark and the gold standard. Everything at this Lakeshore Foundation Health and Fitness Facility is accessible—from the wide benches for changing, to private family changing areas, to all the knobs in the showers being low enough for a wheelchair user to take a shower. All exercise equipment is accessible. You can swing away the seat, and a wheelchair user can get in there. We have a staff with a high level of knowledge on training for people with disabilities.

We’ve got to get older people and people with disabilities out into fitness centers. They’re wonderful places and there’s a lot of downtime in them. You know, if you go to a fitness center, from 6 a.m. to about 8 a.m. they’re packed. After 8 a.m., everybody’s at work. And then they get real busy from 11:30 a.m. to 1 p.m., and then everybody goes back to work. And then they get real busy after work. But what about those 7 or 8 hours during the day when there’s a lot of downtime? We should be bringing people with disabilities and older people into the center then.

This commentary originally appeared on the RWJF New Public Health blog.