"Find your own way to do things," insists Grant, "a way that works and makes you feel good at the same time. When it comes to choosing exercise equipment, for example, think smart and never settle for second-best. I needed to choose devices that are suited to my specific needs. I can't run on a treadmill because it would make my leg too sore. But I can sit comfortably on a Biodex BioStep® for an hour or more and pedal away to improve my cardiovascular system and leg muscles.  Better still, the BioStep lets me work my arms at the same time - meaning I can work virtually my entire body in each session."

The BioStep pedaling motion feels smooth and its semi-recumbent positioning is easy on my back. It takes hardly any effort to overcome the initial inertia, and the swivel seat makes it easy to get on and off.

All of these aspects make the BioStep a great device for me to use. It's a smart choice and that's what you have to be in this situation, smart.

Below-the-knee amputee, John Grant

"The Biodex BioStep Semi-Recumbent Elliptical is one of the best investments I have made for my practice. It is so versatile; it can be used with almost any patient situation. I use it with people who suffer from strokes, multiple sclerosis, and Parkinson's disease, as well as orthopedic injuries. I also use it with my women's health patients, having them do core stabilization while working out on the BioStep. Because the BioStep is non-weight-bearing, I can also start working with total joint replacement patients much sooner than on a stationary bike.

One of the top BioStep features is how easily patients can get on and off of it, since the seat swivels to each side. Patients also like that the BioStep appears non-threatening.  Even patients with back problems find the recumbent seated positioning and chair shape to be very comfortable.

In my clinic, we average 55 patients per week, and about 85% of them use the BioStep at some point. I start patients with an easy work pace and increase resistance as they progress. I have used the system for a couple of years now and would recommend it to other facilities. If you need a single piece of equipment that can satisfy a lot of needs, the BioStep is certainly worth considering."

Pamela Buttram, P.T., D.P.T. Functional Improvements Physical Therapy Lilburn, GA

Semi-Recumbent Elliptical
Product review of a new exercise modality for cardiac rehabilitation

Barry A. Franklin, PhD
Director, Cardiac Rehabilitation and Exercise Laboratories
William Beaumont Hospital, Royal Oak, Michigan

REPRINT from recent white paper with permissions

Exercise training plays an important role in primary and secondary prevention of coronary artery disease. Epidemiological studies suggest that sedentary individuals, compared with their physically active counterparts, are nearly twice as likely to develop coronary disease. Moreover, a low level of aerobic fitness (< 5 metabolic equivalents) appears to be an independent risk factor for all-cause and cardiovascular mortality. Increased functional capacity, symptomatic relief of angina pectoris, decreased cardiovascular and all-cause-cause mortality, favorable risk factor reduction, enhanced psychologic status, and improved quality of life appear to be sufficient end points to justify the recommendation for physical conditioning in apparently healthy persons and those with known coronary disease.

It is often recommended that patients with known coronary disease participate in a supervised cardiac rehabilitation program. The goal of cardiac rehabilitation is to help the patient return to the highest level of function and independence possible, while improving the overall quality of life - physically, emotionally, and socially.

Safe and effective exercise is an important component of the cardiac rehabilitation process. Exercise is often prescribed on traditional exercise machines such as stationary cycles, treadmills, and upper body cycles. New exercise modalities often appear on the market and the cardiac rehabilitation specialists must evaluate each new modality to determine its effectiveness for the cardiac rehabilitation population.

Important aspects should be considered when determining the effectiveness of an exercise modality.
They include, but are not limited to:

Comfort: The exercise machine should be considered comfortable while in use for a period of up to 30 min. The seat should accommodate a patient population of small to large.

Usability: The product should allow for many muscle groups to be incorporated into the exercise motion thereby spreading out the work load in an effort to avoid prematurely fatiguing any one muscle group. This spreading out of the workload often reduces the patients RPE at a given HR, allowing the patient to exercise longer. Exercise products that accommodate a “shifting” of the workload between muscle groups allow patients to reduce the work of the fatiguing muscle group. The patient can continue maintaining target heart rates by having the less fatigued muscles provide a greater degree of effort.

Safety: To avoid overuse injuries often associated with repetitive motions, the exercise modality should provide for biomechanically safe positioning, reduced lower back stress and avoidance of high impact/jarring types of forces (low impact). The product should not require a great degree of coordination or balance to operate or during entry and exit. The heart rate response at a given energy expenditure should not be disproportionately elevated.

The purpose of this paper is to evaluate a new exercise modality that has recently appeared on the market and determine its suitability for use in cardiac rehabilitation programs.

A semi–recumbent elliptical cross trainer called the BioStep (Biodex, Shirley, NY) is currently in use at the Beaumont Health Center, Cardiac Rehabilitation Program, Royal Oak, Michigan. The BioStep provides for the popular elliptical motion, seen in the well-received upright exercise machines, to be accomplished in the seated (semi recumbent) position. The addition of arm levers dependently attached to the foot levers classify the BioStep as a total body “Cross Trainer” incorporating the major muscle groups of both the upper and lower body.

Most patients are capable of maintaining exercise at their prescribed levels; do so comfortably, and at a low RPE when compared with other exercise modalities. Blood pressures are easily monitored, as one arm can be released from the arm lever, while the remaining three limbs continue the pedaling motion. The positioning is well tolerated and considered comfortable by most patients. The large seat and extended backrest offer good lower back support. The elliptical motion provides a no-impact striding action that allows patients to avoid the starting and stopping motion often associated with many linear steppers.

In summary, the new Semi Recumbent Elliptical Cross Trainer, BioStep by Biodex, meets the criteria of safety, comfort and usability as discussed above. The BioStep appears to be an effective and welcomed addition to the growing selection of aerobic training devices available to cardiac rehab specialists and their patients. Our future research studies will be designed to assess the measured oxygen consumption and RPE on the BioStep, at a given submaximal heart rate (~ 70-80% HRmax), and compare these data (at matched heart rates) with other exercise devices currently employed in contemporary cardiac rehabilitation programs.