What Is Exercise Therapy and How Can It Ward Off Dementia?

Today SevenPonds speaks with William Smith, an exercise therapist and account manager at Atlantic Corporate Health, a nationally recognized health care system based in New Jersey. Educated in exercise science, today Mr. Smith works with employers, fitness professionals, and healthcare organizations to develop targeted exercise programs for various patient populations, including those suffering from or at risk for dementia and other neurocognitive disorders such as Parkinson’s disease. He is also an accomplished author, whose books include “Exercises for Better Balance,” “Exercises for Stroke,” and “Exercises for Brain Health.”

Editor’s note: This interview has been edited for length and clarity.

Kathleen Clohessy: Hi, Will. Thanks for speaking with me today. Can I start by asking you to explain a little bit about what exercise therapy is? It’s different from physical therapy, correct?

William Smith: That’s right. Physical therapy is used for rehabilitation — treating or managing an illness or injury after it occurs. For instance, PT might be prescribed for a patient after a stroke or a fractured hip. The focus of exercise therapy is the prevention of injuries and maintenance of optimal function. You might call it “prehab.” 

Kathleen: That’s something of a novel concept, isn’t it?

William: Here in the United States it is, although it is becoming far less so over the past eight to 10 years. Unlike European countries, the U.S. for many decades has employed a “sick model” of healthcare that focused on treating illnesses and injuries after they occur. Now we are seeing a greater emphasis on prevention, with a focus on community-based care such as the programs I manage at Atlantic Corporate Health.

Kathleen: I may be showing my ignorance here, but what is Atlantic Corporate Health?

William: Atlantic Health System is the largest healthcare system in New Jersey, and one of the largest in the Northeastern United States. It has a huge network of hospitals and specialty clinics, including one of the largest departments of cardiovascular surgery in the northeast at Morristown Medical Center in Morristown, New Jersey.

Atlantic Corporate Health is a part of Atlantic Health System that focuses on working with employers to reduce healthcare costs by promoting healthy living initiatives such as diet, exercise and smoking cessation programs. We work with employers to identify target populations — for example, people with Type 2 diabetes or arthritis — and design programs to help them develop healthier habits, including more nutritious eating and targeted exercise. These, in turn, help reduce the employer’s health insurance costs.

Kathleen: Speaking of insurance: Does health insurance typically cover exercise therapy? I know a lot of insurers pay for some aspects of integrative therapy, like acupuncture and chiropractic. But I haven’t heard of them covering exercise therapy before. 

William: I’m glad you asked that. Some insurers will actually approve exercise therapy if it is prescribed by the person’s primary care physician to manage a specific health condition. The doctor needs to write a letter to the insurer specifying what the condition is and how exercise therapy can be of benefit. Then it’s up to the insurer whether to approve it or not.

Exercise therapy may also be considered a qualified medical expense under an employer’s “cafeteria” plan (also known as IRS code 125.) Again, the patient would need to get a letter from his or her primary care physician specifying their underlying condition and how exercise therapy can be of benefit and submit it to the insurer. 

Lastly, if a person has a high-deductible health plan and a health savings account, they may be able to use their HSA dollars to pay for exercise therapy. But, again, it needs to be ordered by a physician to treat a specific health condition and approved by an insurer as a qualified medical expense. 

Will Smith and his three boys

Kathleen: What sort of conditions might exercise therapy be used to treat? 

William: Exercise is beneficial for everyone! But exercise therapy is a more targeted approach that is tailored to each individual’s needs. So, for someone with knee arthritis, we would design a program to strengthen the muscles in the leg that support the joint. Someone with gait issues due to Parkinson’s disease would have a different set of exercises to help them with balance and fall prevention. It’s a very individualized approach with specific therapeutic goals.

Kathleen: And it also promotes brain health and helps prevent neurocognitive decline? 

William: Yes, absolutely. Exercise improves blood flow and oxygen and nutrient delivery to the brain, which promotes healthy brain function. It also enhances neuroplasticity, actually rewiring the brain and encouraging the development of new neural pathways. The more targeted the approach, the better the results.

Kathleen: Your background is in exercise science, and you’re a Certified Strength and Conditioning Specialist — a specialty that focuses on athletic performance for the most part. How did you become interested in working with people with neurocognitive challenges like Alzheimer’s, dementia and Parkinson’s disease?

William: I have actually been interested in this aspect of health and wellness since I was an undergrad at Western Michigan University. Part of the impetus was my experience with my Aunt Peg, who had Alzheimer’s disease. She started developing symptoms when she was quite young — in her late 50s or early 60s. So by the time she was in her 70s she was pretty much out of touch with her surroundings and hallucinating quite a bit. She kept telling us she saw John Gotti (the Mafia guy) in the room with her! I wanted to help but there was nothing I could do.

Then, some of my earliest clients were people who had neurocognitive disorders. There was one in particular that I recall, a man in his 70s named Ken who had Parkinson’s disease. He had all of the hallmark symptoms — tremors, an abnormal gait, a mask-like facial expression. Yet he benefited so much from a targeted exercise program that his grandson could not stop thanking me. That was gratifying, to say the least.

Kathleen: I’m sure! Is that what got you started writing books? 

William: To some extent, yes. I have always loved writing, and I have always wanted to help people to be their best selves. Being an author allowed me to do what I love to do and use my knowledge and expertise to help a lot of people at once. So it’s a great side gig for me.

This concludes Part One of our interview with William Smith. Please come back next week when we talk with Will about some of the ways that targeted exercise therapy can improve brain health and help people with various forms of dementia.