Home Versus Fitness Facility program

I am often asked whether a client should join a gym. It depends on that individual's needs and personality and on the gym's accessibility, among other factors. Many people join health clubs each year and quit going to them within a few weeks. Before joining a health club, I suggest you answer a few questions:

1. Do you like to exercise with other people around?
2. Is the health club easily accessible? (Consider both its distance from your house and its hours of operation.)
3. Does the equipment suit your needs? Is it adjustable, and does the weight go low enough for you? (I have never heard of a patient who complained because the weight would not go high enough.)
4. How crowded is the facility during the hours when you plan to exercise?
5. Is there someone qualified to supervise a program for an individual with special needs such as yours?

Some of the better health clubs allow a trial membership, which lets you find out whether you will truly enjoy working out in that facility. After his preliminary rehabilitation program after knee surgery, my father went to a local health club that offered short-term (about 3 months) memberships. He discovered that there were special hours for seniors only, which were less crowded and during which a nurse with specialized rehabilitation training was available. Many health clubs that are associated with hospitals have special classes and equipment for individuals with arthritis. The variety of equipment available at most health facilities is a positive factor, and allows you greater creativity in designing your program. For some people, having paid a membership fee can be an added incentive to help them stick with a program.

What if you wish to improve strength but work out at home? You can devise an effective resistance-training program using your body weight, small handheld or cuff weights, or rubber tubing. As I noted earlier, you can reduce the resistance for body weight exercises by using a support or modifying the position. For example, an effective exercise for increasing quadriceps (front thigh muscle) strength is a squat; however, traditional squats can increase the stress to the knee joint. A modification that reduces the stress to the knee and helps to support your body weight is doing a wall squat. With your back to a wall, take two to three steps away from the wall and then put your back against the wall, lowering your body slightly. The angle of your bent knees should not go below 90 degrees. With the wall supporting you, you can hold this position for 30 to 60 seconds, which you probably could not do without the wall support or modification to the knee position (see figure 4.2).

Another way to modify this exercise is to put a large ball between you and the wall. The ball allows you to glide up and down, making it possible to perform repetitions of the exercise rather than a prolonged hold (make sure that you are stable if you do this sort of modification).

Employing rubber tubing or small handheld weights offers a way to build resistance while giving greater variety to your home program. Exercise tubing is available in several thicknesses; you can start with lightweight anywhere. Many therapists use elastic tubing for rehabilitation programs because they can give it to patients to take home. One potential problem with tubing is that it wears out with repeated use and can then break, especially if you perform your exercises vigorously.

Figure 4.2 Wall Squat

You can set up an effective home program with minimal financial output by selecting some cuff weights and a few dumbbells. Some of the new brands of equipment have adjustable weights, often using water or sand to fill the weight. However, you may find that you are only able to progress to a certain level, after which you are unable to increase the resistance without additional equipment. Obvious benefits of a home program are the reduced cost, lack of a crowd, and no need to travel.