The Humble Staircase

It is a relief to witness the increasing awareness towards health and fitness in the current times. Courtesy to TV advertisements and social media, individuals are at least aware of healthy diet, lifestyle, and the importance of exercise. There is an effort to include movement and exercise via regular walking, Yoga, gym, and many more activities.

On the other hand, we miss out on small but frequent opportunities to exercise our body. In the frenzy of completing endless tasks in a day, we attempt to save time by taking the elevator, parking the car close to our destination, and ordering stuff rather than walking to pick up our food even if it is a nearby eatery. These are valuable short duration exercises that are so crucial for fitness, but ironically lost to us.

For the metropolitan dweller who lives in high-rise buildings, taking the stairs is something that needs to be consciously remembered. In my recent clinical experience, it was a surprise that some children were not used to stair-climbing on a routine basis.

There are many benefits of negotiating stairs—

· Improved leg strength, particularly the knee and hip extensor strength that are among the strongest muscle groups in the body.

· Increases balance.

· Reinforces alternate reciprocal movement patterns of the legs, similar to cycling, thus improving bilateral coordination.

· Enhances cardiopulmonary capacity.

On starting to negotiate 1-2 flights of stairs on a daily basis, I have observed clinical improvements in many children in terms of reduced clumsiness, increased balance, and reduced genu recurvatum (knees pushed back abnormally due to quadriceps weakness).

My advice to parents of young children is to climb 2 flights of stairs twice per day.

To adults, try to climb 2-3 floors before you take the elevator to your apartment on higher floors.

Having grown up in Mumbai during the 70s and 80s, I remember people climbing 4 flights of stairs well into their 50s and 60s. One may argue that they had no option since there were hardly elevators in 4- storey buildings constructed at the time. My perspective is different - they did not give up their daily habit of negotiating stairs. The same habit contributed to their health and fitness.

So why should we give up on climbing stairs at a much earlier age? Remember ‘use it or lose it’? Prior to Covid, it was heartening to hear from an adult that his office staff had decided to avoid using the elevator as much as possible for health and environmental benefits. While working in a New Jersey hospital 30 years ago, we would make it a habit to take stairs rather than an elevator.  

However, no exercise should be overdone. An example would be one of my patients who climbed 16 floors daily in an attempt to lose weight. Within 10 days he developed knee pain and required physiotherapy intervention. Negotiating 2-3 flights, in moderation, if you are not suffering from current injury should be fine. Always check with your doctor or a physiotherapist who is aware of your health conditions of the heart and the joints of your lower body.

So next time you see an elevator anywhere, take the stairs with your child for 1-2 floors. It is good for you, good for your child, and good for the environment. Take advantage of that small but crucial physical activity. Remember ‘use it or lose it’!

Relearning to Cycle

It is believed that one does not forget certain skills such as swimming, driving, and cycling.  This did not apply to me when I decided to start riding a bicycle after a gap of almost 2 decades. Needless to say but important to remember that I am heavier, older, and less agile.  The fear of falling was so profound when I first mounted the new bicycle. On attempting to peddle, I froze with fear when the feet needed to be lifted off the ground. It was difficult to find my footing with the second pedal while one foot was on one of them.  Feeling very much scared, I yelled at my husband when he verbally instructed me in an attempt to help me. The experience reminded of gravitational insecurity that I observe in young children as a clinician.

I felt as if I had no balance since I was perched on a very narrow base of support that a bicycle offers. My eyes were glued to the handle. Steering the handle and balancing on the bike seemed like an unachievable task during the first few rides. I would hold my breath while balancing and consciously remind myself to breathe. It took many rides of practice just to take off, pedal, and keep my balance.

While looking at something far away while cycling, I felt a loss of balance that increased my heartrate. On a quiet street, cycling by a pedestrian or a parked car increased my anxiety (open environment). And making turns was a totally different challenge that took weeks to learn.

Coming up the slope made me realize how decreased were my strength and endurance although I do lead an active lifestyle.  I now cycle on a relatively busy street; but with low confidence, and very well understand that it will take much more practice and effort on my part.

 

So why am I sharing this experience of relearning a skill that I was pretty good at?

Relearning to cycle has been a great experience from an adult perspective, albeit filled with fear and anxiety. It confirms what children experience while balancing and engaging in challenging movement tasks during physical therapy sessions. My personal experience of cycling after many years can be extrapolated to special needs’ children learning to pedal.

Learning the skill of riding a tricycle, and later a bicycle with training wheels is a perennial issue seen in children with special needs.  Cycling requires the following components-

•         ability to sit upright and balance
•        pedal the wheels that needs good strength of the muscles of the leg and the lower trunk
•         the alternate reciprocal movement of the legs requires bilateral coordination between the two legs.
•         maintain the balance while the cycle moves forward (dynamic balance)
•         steering the handle to make turns
•         looking sideways or far away while riding

 All of these components are further challenged when the child graduates to a bicycle with training wheels because the base of support narrows drastically from a tricycle to a bicycle.

Many children receiving physical or occupational therapy, although having achieved the ability to walk, still present with abnormal muscle tone, deficits in balance and vision-perception, gravitational insecurity, and weakness. Most of them have learned to sit and walk at a much later age than typically expected. Therefore, it should follow that higher gross motor skills such as cycling and jumping are going to be delayed. 

Children with special needs should be provided more time and increased practice to learn cycling. Ample patience is warranted from parents and therapists alike.  It helps if learning to pedal is practiced on a stationary bike such as a peddler or a floor bike.

http://sensoryintegrationbangalore.blogspot.com/2016/03/peddler-in-pediatric-therapy.html

Most children at our center have learnt to cycle by practicing on a peddler during therapy sessions. The age range of these children has been 4 years and above, whereas developmentally a child may learn to ride a tricycle much earlier. The time taken to learn cycling has taken anywhere between 1  to 6 months of practice with the peddler. Motor learning of any skill requires repetitive practice of 100s of times.

It is a joy for the parent and a liberation for the child once cycling is learnt. The cycle provides physical exercise, movement, balance, bilateral coordination, and becomes a sensory motor activity. 

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