Reviving connection, adventure and wellness for adults outdoors.
Introduction
Demographics show indisputably that our population is aging. Strategies to keep older adults healthy and maintain their quality of life will be increasingly important in the coming decades. As a physiotherapist for the last 10 years at the Banff Mineral Springs Hospital (MSH), I have worked with Acute Care (AC) patients and Long-term Care (LTC) residents. I have been inspired by my older adult population to develop a unique community bike program called the Big Red Ride. This program is a collaboration between three community organizations and the use of a four-person, fully adaptive e-bike imported from Holland.
How was I inspired?
Witnessing LTC residents live a mostly sedentary life did not resonate well with me. I saw the effects repeatedly — deteriorating functionality and simple lack of satisfaction with daily living. Some would beg me to take them outside, and once out there, they would lament that they were no longer able to walk around and enjoy their surroundings. I realized that despite their age and often severe disabilities, they still craved opportunities to be active outdoors.
In 2015, I attended the Exercise Prescription and Aging conference where I learned some hard data about Canada’s fast-growing aging demographic. While many Canadians are living healthier into their later years, there is also an increasing number of older adults living with “frailty”. Frailty comes with more complex health challenges. Both social connectivity and physical activity are necessary components for healthy aging for any adult over 65 years, whether they are frail or not. Based on Statistics Canada data, the number of 85-year-olds will more than double, between 2016 and 2036.1 By 2036, 62% of all healthcare dollars will be spent on those over 65.2 Several keynote speakers challenged the physiotherapists at Exercise Prescription and Aging to become “influencers” by creating innovative solutions to respond to this situation.
Cycling for long-term care residents
At MSH, our team has been using cycle ergometers in our physiotherapy gym since 2012, mainly for AC patients. Physical activity as a treatment intervention for disease prevention and maintenance is a best practice amongst physiotherapists. Through use by some LTC residents, an interesting phenomenon occurred. Despite their poor quality gait and inability to walk very far, the high quality of their lower extremity motion while pedaling was astounding. Not only that, the residents loved it!
Our team started residents on a gentle, low-dose program, as recommended by the World Health Organization, of 10 minutes for three times per week. Disabilities ranged from Parkinson’s disease, chronic obstructive pulmonary disease, generalized and severe osteoarthritis, supranuclear palsy, severe hemiplegia with aphasia, types 1 and 2 diabetes, coronary artery disease, high blood pressure, dementia, osteoporosis, post pelvic fracture, post fall, and many other comorbidities.
Word spread quickly among our LTC residents, and our team often had wheelchair line-ups waiting to use the three ergometers. Within three months, some residents were biking for 45 minutes or more and would complain when their time was up for the day. An average dose for most was 20–30 minutes of gentle to moderate biking, 2–3 times per week. Our team saw improvement in their ability to perform functional activities of daily living, particularly their sit-to-stand motion, and they wanted to come back for more. Most of these residents were over 85 years of age.
After attending the 2015 Exercise Prescription and Aging conference and watching the residents joyfully bike in the gym, I was inspired to do something more to support them. I read a CBC article about an innovative Dementia Care Village in Holland called “Hogeway”,3 and through this, I identified the perfect bike — a fully adaptive e-bike that seats 3 people plus a pilot. E-bikes have recently been recognized to have positive health benefits.4 Use of an e-bike would not only provide more residents with an opportunity to bike outdoors at one time, but would also promote social connectivity and physical activity.5,6
My co-worker, Glenn Matthews, and I scoured the Internet until we found one. By the end of January 2016, our team raised $28,000 through generous donations from the Pauw Foundation, Banff Canmore Community Foundation, Mineral Springs Hospital Auxiliary, Banff Seniors Centre, IODE, and Albert Naffin Estate. By March 30, 2016, we ordered the bike from Holland.
Community and interprofessional collaboration
Prior to the bike’s arrival, I began to think about the day-to-day operations. The bike would require storage and maintenance. At the same time, there was a need to know who we could share this bike with to maximize its use, who would help us service it, and what would happen when we get a flat tire while out riding with a fully loaded bike?
According to the Canadian Frailty Network (CFN), there are 1.2 million Canadians who are 65+ living with frailty, and along with them, 2.5 million Canadians who are their caregivers and hundreds of thousands more in our healthcare workforce.7 The CFN’s guiding framework and approach to improving the care of older adults living with frailty includes educating the next generation of care providers and by engaging with other adults and caregivers. Interprofessional collaboration is an efficient way of promoting this approach.
A collaboration between our MSH Rehabilitation Team, the Town of Banff (TOB) Municipality and Bow Valley Primary Care Network (PCN) was created, and Big Red Ride was born. The TOB agreed to store the bike and coordinate volunteers; the PCN would use the bike as one of their active living programs; and our MSH Rehabilitation team would use the bike several mornings per week for the LTC and AC residents and patients.
Bactrax Bike Shop in Banff kindly stepped up to perform regular bike maintenance and help bail us out in an emergency. Thankfully, we have only had one emergency: a tire puncture when the bike was fully loaded. A group of Banff’s Assisted Living Community older adults were rescued by the Fire Chief. He drove them home with the sirens on and made their day. Many exciting conversations ensued over their dinner that night.