Wheelchairs 101: Understanding Wheelchair Options, Coverage and the Acquisition Process

Written By: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist

Owner: Healthy Aging Physical Therapy

As a physical therapist, I have had the privilege of working with many individuals who rely on wheelchairs to maintain their independence and quality of life.  The reasons for needing a wheelchair are as diverse as wheelchair users themselves, and a well-matched chair can make a world of difference. From those with new spinal cord injuries who require an agile, lightweight manual chair to take the place of walking in the setting of traumatic paralysis, to the patient who has had a stroke and now needs a specialized ‘hemi-chair’ designed for propulsion with one side of the body, each journey is unique.

While many people initially see a wheelchair as a step back, I often see it as a step forward. A wheelchair can open doors to independence, freedom of mobility, and a reduced reliance on caregivers. Although I sometimes encounter hesitation or pushback when bringing up the idea of a wheelchair, I frequently find that once the process is complete, my patients experience newfound freedom and vastly improved quality of life.

In my current practice, I most often work with patients with neurodegenerative diseases, like multiple sclerosis (MS) or Parkinson’s Disease, who can still ambulate part of the time but may need a wheelchair with custom features, like the ability to tilt-in-space, elevate seat height or powered mobility, to manage fatigue, enable longer-distance mobility, support posture in the presence of kyphosis and scoliosis and maintain independence in their daily tasks. Most recently, I had the opportunity to help my own mother obtain a custom power wheelchair. After living with Parkinson’s disease (PD) for 20 years, her postural impairments began affecting her ability to breathe, function, and manage back pain. The chair provided her with much-needed relief and now allows her to access her facility’s dining room even during periods when walking is too difficult due to ‘off times’ and back pain.

(PS: You’ll see some pictures from my mom’s assessment and fitting throughout the blog - special thanks to Derek Logan, PT, ATP from REQ for your help with this process!)

No two reasons for needing a wheelchair are the same. This is why a thorough assessment by a knowledgeable therapist, in collaboration with a skilled vendor, is essential to finding the best solution for each individual’s needs. At Healthy Aging Physical Therapy, we frequently provide wheelchair assessment training in conjunction with a variety of local vendors and I’d like to take this opportunity to shed some light on what this typically entails.

Wheelchairs, Scooters and Powered Mobility Options

When it comes to mobility devices, there are many options to consider. The choice between a standard wheelchair, a custom manual or power chair, or a scooter depends on the user’s specific functional and medical needs. Each type of mobility aid comes with its own set of features, costs, and considerations.

Scooters

Scooters are three - or four-wheeled motorized devices for individuals who can sit upright and operate controls but require assistance for longer distances due to weakness or cardiopulmonary conditions. Scooters are an excellent choice for those with some mobility but who experience fatigue with walking. They are often not covered by insurance and usually require an out-of-pocket investment ranging from $800 to $3,000. Many scooters can break down or fold up for transportation and can be tried at local durable medical equipment vendors and pharmacies.

PS: The above image is from the movie Thelma. If you haven’t seen it yet, stop reading and go watch it:)

Transport Wheelchairs

Transport wheelchairs are often purchased online or at medical supply stores and are the lightest, most easily transportable wheelchairs available. They typically have small wheels and limited seat and lumbar support; this enables them to be light enough to transport easily in and out of the car, but are also not designed for long term use as they do not provide adequate postural support for the user. Transport wheelchairs are not typically covered by insurance (unless you meet the criteria for a standard chair, but cannot self-propel and have a 24/7 caregiver who can assist) and cost anywhere from $100-$300 typically. 

Standard Manual Wheelchairs

Standard manual wheelchairs are the most basic option covered by insurance, and are often used for short-term needs or rental purposes. These chairs are manually propelled and typically cost between $100 and $500. They are ideal for individuals who do not require specialized features and need a temporary mobility solution. Medicare and other insurance plans may cover standard wheelchairs if they are deemed medically necessary, and are often issued during hospital stays in a ‘rent to own’ manner in which the Medicare beneficiary pays a small amount a month for thirteen months and then ‘owns’ the wheelchair.

Custom Manual Wheelchairs

Custom manual wheelchairs are tailored to the user’s specific dimensions and functional requirements. These chairs may include lightweight frames, adjustable seating, and positioning supports to enhance comfort and postural alignment. They are commonly used by individuals with conditions such as spinal cord injuries or neurological disorders. Custom manual wheelchairs generally cost between $1,500 and $5,000, depending on the materials and features. Custom manual wheelchair acquisition requires a wheelchair assessment by a therapist and vendor team, a visit with a doctor who will provide documentation to certify medical necessity, and insurance coverage often requires detailed documentation to justify the need for customization.

Power Wheelchairs

Power wheelchairs are motorized devices designed for individuals who have limited upper body strength or severe postural issues. These chairs can include advanced features such as recline, tilt-in-space, and elevation to address complex needs. Power wheelchairs are best suited for individuals with conditions like MS, Parkinson’s disease, or other impairments that significantly limit strength and mobility. The cost of a power wheelchair can range from $2,000 to over $20,000, depending on the level of customization and technology. Medicare typically covers power wheelchairs, but only after a thorough assessment to establish medical necessity. These assessments need to be provided by a therapist and vendor team, and the individual will also need to visit with their doctor who will need to complete additional paperwork (‘Face to Face’ visit) to support the medical necessity of this device.

Fun Fact: The average custom power chair weighs between 200 and 300 pounds. And, no, you cannot lift it into the trunk of your car!

Beyond Mobility: Other Important Reasons to Consider a Wheelchair

While mobility is often the primary reason for a wheelchair, there are several other important considerations that influence the need for a specific type of chair.

Preventing Skin Breakdown and Pressure Ulcers

For individuals who spend long hours in their wheelchairs, proper seating and support are critical to prevent skin breakdown and pressure ulcers. Specialized cushions, adjustable seat angles, and recline and tilt-in-space features can help individuals redistribute pressure and protect vulnerable areas, ensuring comfort and long-term skin health.

Providing Postural Support

Postural support is essential for individuals with trunk weakness or structural deformities. A well-designed wheelchair can enhance alignment, improving not only comfort but also critical functions like breathing and digestion. For example, we might choose to increase the seat angle (aka ‘seat dump’) and use a contoured seat back to improve pelvic alignment and maintain a healthy posture throughout the day, reducing pain and fatigue.

Enhancing Functional Abilities

Wheelchairs with advanced features can improve functional abilities in daily life. Elevating seat mechanisms, for instance, allow users to reach higher surfaces such as kitchen counters and cabinets, enabling tasks like cooking and cleaning. Additionally, alternative drive options like head controls or adapted joysticks can enable mobility even in users with limited hand function.

Reducing Caregiver Reliance

By addressing mobility and functional needs comprehensively, a wheelchair can reduce reliance on caregivers. This increased independence not only improves the user’s quality of life but also eases the burden on family members and care teams and can improve family dynamics considerably. 

How do I get a Custom Wheelchair?

Acquiring the right wheelchair is a multi-step process that involves collaboration between the patient, therapist, and vendor. Here is what to expect:

1. Initial Wheelchair Assessment: Your therapist and vendor team will conduct a comprehensive assessment of the individual’s mobility, strength, posture, and functional needs. This evaluation helps determine the type of wheelchair that will best meet the user’s requirements. These can be done in a Wheelchair Clinic or at-home with a provider like Healthy Aging Physical Therapy. You will have the opportunity to trial a chair similar to the one you will likely end up with to see if it would be a good fit.

2. Therapist/Vendor Collaboration: The therapist works closely with the wheelchair vendor to determine the best type of wheelchair for you, and identifies any necessary modifications or adaptations to meet your needs. They then work together to fill out the necessary paperwork and complete a Letter of Medical Necessity.

3. Documentation Submission: The prescribing physician, therapist and vendor provide detailed paperwork, including the assessment findings and justification for medical necessity. This documentation is submitted to Medicare or other insurance providers for approval.

4. Approval and Order Placement: Once the paperwork is approved, the vendor places the order for the wheelchair. Once approved, the equipment is ordered and the wheelchair is prepared for you. For custom manual or power chairs, this step may involve further adjustments and fittings.

5. Delivery and Fitting: Once the wheelchair is ready, your vendor and therapist will meet with you again to deliver the chair and provide any additional modification that may be needed. Things like the arm rest height and head rest position will need to be set for you specificically to ensure the best fit. If there are any larger issues, your vendor may take pieces of the chair back to be adapted as needed. 

6. Wheelchair Training: Now the fun begins! Just like learning to drive a car, learning to drive your new wheelchair will take some practice. Your therapist will work with you to learn to drive it forward, backwards and to turn so you can safely and efficiently navigate your home and community. 

7. Timeline for Custom Chairs: The entire process, from evaluation to delivery, can take anywhere from 6 to 12 weeks if everything goes smoothly. This timeline depends on the complexity of the chair and the speed of approval from insurance providers and can take up to 6 months at times if there are delays along the way.

Will Medicare Pay for my Wheelchair?

Medicare provides coverage for wheelchairs under its Part B Durable Medical Equipment (DME) benefit, but specific criteria must be met. Most commercial plans also have a DME benefit that is typically based on, or similar to, Medicare standards. Coverage is available when a physician prescribes a wheelchair for use in the home due to a medical condition that limits mobility. Here’s an overview of how this coverage typically works:

• Eligibility Requirements: Once you meet with your therapist and vendor team to trial your wheelchair and determine your needs, a physician must then conduct a face-to-face assessment and document the medical necessity of the wheelchair. This documentation is then submitted to Medicare for review.

• Types of Wheelchairs Covered: Medicare covers basic manual chairs (rent to own), custom manual chairs, and power wheelchairs if the features are medically justified.

• Scooters: Medicare may cover scooters in limited circumstances, such as when mobility is restricted both inside and outside the home, but this coverage is less common.

• Costs: For approved devices, Medicare typically covers 80% of the cost, leaving the user responsible for the remaining 20%, either out-of-pocket or through supplemental insurance.

• Modification and Replacement: Generally speaking, Medicare expects your custom chair to last at least 5 years. Should your chair require modifications or repair within that five year time frame, you will need to work with your vendor to fix your current chair in most situations. If modifications are required due to a change in your medical status, they may be covered by medicare, but repairs due to wear and tear may be an out of pocket cost. After five years is up, you may be eligible for a new chair should you demonstrate medical necessity for a new chair at that time. 

Choosing the right wheelchair is a collaborative process that requires a deep understanding of the individual’s needs and goals. By working closely with a skilled therapist and an experienced vendor, users can find a solution that not only meets their medical requirements but also improves their quality of life. Whether it’s a lightweight manual chair for someone with a spinal cord injury or a custom power chair for postural support, the right match makes all the difference. 

At Healthy Aging Physical Therapy, we are proud to offer custom wheelchair assessments in the comfort of your home. This approach can be incredibly beneficial, not only for individuals who may find it difficult to access a clinic but also for tailoring recommendations to fit seamlessly into your living environment. By evaluating how a wheelchair will work within your home - from navigating doorways to accessing essential spaces - we can ensure the best possible outcome for your mobility and independence. If you or someone you know could benefit from an in-home wheelchair assessment, we encourage you to reach out to learn more about how we can help.

Join the Healthy Aging Physical Therapy Team

Okay, time for some real talk.

The healthcare world right now? Let’s call it what it is: a bit of a disaster. Therapists are overworked, underpaid, and often put in situations where they can’t do their best work. Add inflation and Medicare cuts to the mix, and it’s not just clinicians who are struggling - practice owners are feeling the squeeze too.

But what if there’s a better way? What if there’s a practice out there committed to addressing these issues head-on? That’s what we’ve built at Healthy Aging Physical Therapy.

Why Healthy Aging Physical Therapy is Different

1. Beating Burnout

We’ve worked hard to create an environment that supports our therapists. Our full-time caseload is only six patient visits a day. That’s it. This allows you to actually breathe during your day and deliver the high-quality care your patients deserve.

We’ve also streamlined documentation with thorough but efficient systems, using elaborate quick texts and templates. These tools save time without sacrificing quality. We’re equally focused on patient and therapist satisfaction because, honestly, you can’t have one without the other. Happy therapists = happy patients - and we take happiness seriously around here.

2. Support and Collaboration

At Healthy Aging PT, you’re not alone. Our team thrives on collaboration, celebrating victories together and supporting one another through challenges. Whether it’s mentorship, ongoing education, certification opportunities, or equipment - we’ve got your back. Our number one goal is to help you grow and thrive.

3. Financial Stability and Growth

We’re realistic about the financial challenges in healthcare, but we’re also forward-thinking. We’ve diversified our income streams with our Wellness 365 program, a cash-based service that not only provides incredible value to our patients but also offsets the decline in insurance reimbursements. This approach ensures sustainability for our practice and sets us apart as a leader in innovative care.

For our staff, we’ve reimagined compensation. Instead of the small, insignificant 1-2% annual raises typically offered in healthcare, we share the profits. Each team member receives a percentage of our profits based on hours worked. When we work hard and grow together, we all share in the rewards.

The Result? One Incredible Team

Our approach has created an amazing team culture. Our therapists love what they do, and it shows in both their satisfaction and our patient experience. (Just check out our 59 Five Star Google reviews!)

What Do We Need Now? YOU.

We’re growing, our waitlists are long, and we need exceptional therapists to help us meet the demand. Here’s who we’re looking for:

• Physical Therapists + Occupational Therapists for the Medford/Melrose/Stoneham/Wakefield area.

• Personal Trainers + Massage Therapists opportunities available across all our our service areas!

We need people with the right mix of experience, compassion for the patient experience, and passion for their work. If you’re someone who values ownership of your time, wants better work/life balance, craves true meaning in your work, and loves being part of a supportive team - we want to hear from you.

Our Hiring Process

We take hiring seriously because finding the right fit matters. Here’s how it works:

1. Phone Chat: We’ll schedule a time to chat, so you can be clear from the outset on what what working at Healthy Aging is like, and what the role requires.

2. Shadow Day: Come spend a day with us to see how we work and how you fit with our team.

3. Open Book Policy: I’ll tell you how much I love working here, but clearly, I’m a bit biased;) To make sure you have all the info you need to make the best decision, I’m always happy to connect you with current or even past employees so you can ask the questions you may not feel comfortable asking in the interview.

If you, or someone you know, fits the bill, please reach out. We’re excited to grow our team and provide opportunities for therapists to thrive while making a real impact in our communities and in our patients’ lives.

Ready to chat?

Send your resume and cover letter to Katie@HealthyAgingPT.com and I’ll be in touch soon!

Reflections on my Goldman Sachs 10,000 Small Businesses Program Journey

Written by: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist and Owner of Healthy Aging PT

This past fall, I had the incredible opportunity to participate in the Goldman Sachs 10,000 Small Businesses program (10KSB). If you're not familiar, 10KSB is a nationwide initiative funded by Goldman Sachs, taught by Babson College professors, and designed to help small business owners grow their businesses through education, mentorship, and access to resources. The program is application-based, tuition-free, and brings together business owners from diverse industries to learn about the financial management, growth opportunity assessment, and leadership involved with business growth and development. (Curious? You can learn more about the 10KSB Program here.) Over the course of the past several months, I dove deep into every corner of my own business, from financial forecasting to marketing and new product development, and emerged not just a better business owner, but a more confident leader. Here are the five biggest lessons I learned.

1. Being a Business Owner is Actually Really Cool - and More Important Than I Thought

When I started Healthy Aging Physical Therapy, it was all about me—not in a selfish way, but because it was literally just me. It was a way to keep working during the pandemic while balancing homeschooling my two young kids. I started with zip, zero, NO formal business education, no plan, and a lot of trial and error. Over time, I realized that I wasn’t just filling a need for myself - I was meeting a huge unmet need in our community and decided to grow.

But what I learned through 10KSB is that small business owners are a rare breed. Did you know that according to the U.S. Small Business Administration's Office of Advocacy, only about 20% of small businesses survive their first five years? Or that small businesses make up 99.9% of all businesses in the U.S. and employ nearly half of the nation’s workforce? Additionally, 81% of small businesses have no employees, while only 19% employ staff, and of those, about 15% have between 1-10 employees. Healthy Aging Physical Therapy currently has a staff of EIGHTEEN (and looking to hire more!) Those aren’t just statistics - they represent real people, real jobs, and real impact.

Today, Healthy Aging Physical Therapy isn’t just about me anymore. We’re an employer, employing therapists, personal trainers and office management staff who love what they do and have the flexibility for real work-life balance. Walking into 10KSB, I felt like a therapist who happened to own a business. Walking out, I see myself as an entrepreneur, and I’m proud to be contributing to my local economy.

2. It's REALLY Important to Understand Your Numbers

Numbers used to intimidate me. For the first few years, I was in reactive mode - looking at financial data after the fact and making educated guesses about what to do next. The 10KSB program has changed that completely.

Now, I not only understand our financial foundations, but I’ve developed a forecasting model that allows me to proactively adjust factors like our service mix and staffing. Instead of anxiously riding financial waves, I feel confident and in control. I have back up plans, and a rainy day fund. I can spot trends in real time, understand what’s driving them, and take action before problems snowball.

Even more importantly, I’ve learned how our practice fits into the larger healthcare ecosystem. From policy changes to Medicare reimbursement cuts (Medicare reimbursement rates are going down another 2.8% as of 1/1/2025!), I now have the tools to navigate these challenges strategically rather than reactively.

3. I Feel Stronger Than Ever in My Vision for Healthy Aging

The first five years of practice ownership were about experimenting - trying new things, seeing what worked, and learning from what didn’t. Now, I have a clear roadmap for growth.

I’ve learned that being a good therapist isn’t enough. While growth is great, it’s more important for me to find ways to ensure the way we practice stays consistent with my values. To do so, I need to teach these principles effectively to my staff, create systems that ensure consistency, and build structures that support scaling and growth. I’ve gained confidence not only in my mentorship skills but also in my ability to scale without compromising our mission and core values.

While my goal as a therapist has always been to help as many people as I can, this practice has given me the voice and venue to MULTIPLY this in a way I never expected. The 10KSB has given me both confidence and the tools to scale my practice without losing the attention to care, compassion and evidenced-based practice that are so critically important to patient success. 

4. I’ve Learned I’m Not Alone

Running a business can feel incredibly lonely, especially when you didn’t set out to be a business owner in the first place. The stress, anxiety, and excitement of entrepreneurship are hard to describe to anyone who hasn’t lived it. I recently came across a meme that said “Being a business owner is great - you get to choose which 80 hours a week you work!” I laughed out loud because truer words have never been spoken - or meme’d about!

But in my cohort of 44 other business owners (shout-out to Group 2-2-2!), I found my people. We came from vastly different industries - there were water filtration experts, ice cream creators, restaurant owners, marketing experts, and more - but despite our different paths to entrepreneurship, we all share the same struggles - and now we get to celebrate our wins, together.  

Beyond our cohort, I’m now part of a nationwide network of over 14,000 10KSB alumni. That’s an incredible community of support, collaboration, and wisdom that I can lean on for years to come.

5. I Can Do Anything I Set My Mind To

This program was intense. Adding 15+ hours a week of coursework to an already jam-packed schedule was exhausting. But I did it - and have officially earned my Certificate of Entrepreneurship.

Running a private practice in today’s healthcare landscape isn’t easy. The constant threat of Medicare cuts, rising supply costs, and workforce shortages has made me second guess my plan many times over. But I’ve learned that the garden you tend is the garden that grows - it’s a simple analogy, but it’s true.

More importantly, this lesson extends beyond business. It’s about balance - something I’ll be the first to admit I haven’t mastered yet. Behind the business owner who seems to have it all together, there’s also a mom trying to find time to connect with her kids who are too-quickly growing their way out of her house, a wife trying to carve out quality time with her husband, and a human being who needs time for her own health and well-being (which has been largely ignored since August…).

If I could sum up my biggest takeaway from 10KSB, it’s this: I am in control. I can control my time, my business, and my priorities. I do NOT need to live in the ‘reactive’ anymore. The year ahead, and all the years after that, are full of potential - not just for Healthy Aging Physical Therapy, but for me, my family, my health, and my own peace of mind.

Looking Ahead 

This program wasn’t easy, but it was transformative. I’m heading into 2025 with a solid business foundation, a clear plan for growth, and a renewed commitment to balance and well-being.

To my team, my family, and everyone who’s supported me, and been patient with me, along this journey: thank you. And to any small business owners reading this - keep this program in mind. It's a heavy lift, but it’s worthwhile. Here’s to a purposeful and pleasant year ahead - for me, my team, my practice and my family.

Unlocking Cognitive Fitness: 6 Steps to Optimize Brain Health

Written by: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist, Owner of Healthy Aging PT

As we age, it’s natural to notice changes in cognitive function—whether it’s misplacing your keys or taking longer to process information. While these changes can feel concerning, there’s plenty you can do to maintain and even improve your brain health. By focusing on building cognitive reserve, you can safeguard your mind and maintain your independence as you age. Think of cognitive reserve as a savings account for your brain. The more reserve you build, the more resilient you are to cognitive challenges.

The great news? Building cognitive fitness is possible at any stage of life, and it starts with these six proven steps.

1. Exercise for Brain Health

Exercise isn’t just for physical fitness—it’s for cognitive fitness, too! Regular physical activity stimulates neurotrophin release, enhances hippocampal neurogenesis, and improves blood flow to the brain, all of which help maintain cognitive function.

• The Science: A National Institute on Aging study found that individuals who exercise 1–4 times weekly reduce their risk of memory decline by 33%.

• Action Step: Engage in moderate-to-vigorous physical activity for at least 150 minutes weekly. Activities like brisk walking, resistance training, or swimming boost brain health and physical well-being. You can check out our list of curated exercise videos for some great (and free!) workouts you can do at home. 

2. Nutrition for Cognitive Health

Your diet plays a critical role in cognitive fitness. Whole-food diets like DASH, Mediterranean, and MIND reduce inflammation and support brain function.

• The Science: According to NIH research, diets rich in fruits, vegetables, and lean proteins are linked to better cognitive outcomes and reduced risk of Alzheimer’s disease.

• Action Step: Prioritize unprocessed, whole foods. Incorporate brain-boosting foods such as leafy greens, berries, nuts, and omega-3-rich fish. For more information about evidenced-based dietary patterns that support cognitive health, I suggest checking out the Harvard School of Public Health’s ‘Nutrition Source’ page. 

3. Sleep and Brain Function

Sleep is essential for brain health, supporting memory consolidation and overall cognitive function.

• The Science: Studies reveal that individuals sleeping 6–8 hours nightly maintain greater grey matter volume, which is crucial for cognitive fitness. Both insufficient and excessive sleep can harm brain health.

• Action Step: Create a sleep-friendly environment by keeping your bedroom cool, dark, and free from screens. Aim for a consistent 6–8 hours each night. For some more information, you can download this free E-Book from the NIH about Sleep for Older Adults. We keep these on hand and ready for any of our patients who need help getting their zzzz’s and it is our go-to resource.  

4. Stress Management for Healthy Aging

Chronic stress can damage the brain, but reframing how we view stress makes a big difference. A positive mindset can reduce the negative impact of stress on cognitive health.

• The Science: Research shows that reframing stress reduces its physiological effects, helping maintain cognitive resilience.

• Action Step: Practice stress management techniques such as mindfulness, journaling, or meditation. Reframing challenges as opportunities for growth supports both cognitive and emotional well-being. Looking for more? The Free Mindfulness Project has an awesome library of guided meditation and mindfulness exercises available for everyone.  

5. Social Connections and Brain Health

Meaningful social interactions aren’t just good for the soul—they’re essential for cognitive fitness.

• The Science: NIH studies show that loneliness increases the risk of dementia by up to 40%, while maintaining social connections helps preserve brain health.

• Action Step: Strengthen your social network by joining group activities, such as Wellness365, that combine fitness and fun with community-building. Want to hit two birds with one stone? Check out our in-person Group Fitness Classes to get your exercise in while engaging with like-minded peers for the added bonus social connection.

6. Lifelong Learning and Brain Health

Your brain thrives on novelty. Learning new skills, trying different hobbies, and exposing yourself to new experiences keep your mind sharp.

• The Science: NIH-supported studies highlight that engaging in novel activities throughout life helps maintain cognitive reserve and delay decline.

• Action Step: Get curious and commit to trying one new activity each month, whether it’s taking a class, visiting a new place, or trying a new hobby. We are lucky to live in a great area - with the city, the mountains, or the beach all with in an hours drive, there is always a new adventure you can try. Looking for something closer to home? Check out your local Senior Center and Library calendars to see if they have any lectures or workshops that might pique your interest. I’ve linked my hometown’s centers above, but check out the centers closest to you!

Building a Brain-Healthy Lifestyle

Cognitive fitness isn’t a one-time achievement; it’s a lifelong commitment. By incorporating exercise, nutrition, quality sleep, stress management, social engagement, and novelty into your routine, you can boost your cognitive reserve and maintain your independence. Through our Wellness365 program, Healthy Aging Physical Therapy provides tailored support to help you achieve these goals. Our program is always individualized to meet your needs, but can include things like supported fitness to build up your physical resilience and support your brain health, nutrition guidance to enhance your cognitive and physical wellness and education about stress management strategies to maximize your emotional balance.

Your journey to better cognitive fitness begins today. Want to take Let’s the first step together? If you live in one our service areas, we’d love to help! Check out out Wellness365 Page for more information and to get signed up today!

References

1. Augusto-Oliveira, M., et al. (2023). Exercise Reshapes the Brain: Molecular, Cellular, and Structural Changes Associated with Cognitive Improvements. Molecular Neurobiology, 60(12), 6950-6974.

2. Puri, S., et al. (2023). Nutrition and Cognitive Health: A Life Course Approach. Frontiers in Public Health, 11.

3. Tai, X.Y., et al. (2022). Impact of Sleep Duration on Executive Function and Brain Structure. Communications Biology, 5(201).

4. Seward, B.L. (2017). Managing Stress: Principles and Strategies for Health and Well-Being. Jones & Bartlett Learning.

5. Sutin, A.R., et al. (2020). Loneliness and Risk of Dementia. The Journals of Gerontology: Series B, 75(7), 1414–1422.

6. Karsazi, H., et al. (2024). Which Intellectual Activities Are Related to Cognitive Reserve? Psychological Research.

7. National Institute on Aging (NIA). Brain Health and Cognitive Reserve. (Available at: https://www.nia.nih.gov)

8. Harvard Health Publishing (n.d.). Cognitive Health and Aging: How Exercise and Nutrition Protect the Brain. (Available at: https://www.health.harvard.edu)

The Overflowing Cup and Your Nervous System

By: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist, Owner: Healthy Aging Physical Therapy

I went to yoga this morning, in an attempt to regulate nervous system after a week of solo parenting while my husband was out of town. Normally, I can balance all the regular demands of my life, which as a mother, caregiver, business owner, and home owner, are many. But with him away, the balance shifts. Suddenly, it’s double the drives to the pool for swim team, only one man on deck for the morning routine, and each meal and clean up falls to yours truly. By the end of the week, my metaphorical ‘nervous system cup’ was overflowing; while I meet all the needs of my business, my kids and my home on weeks like this, I frequently deprioritize my own needs, failing to get enough water, proper nutrition, exercise or rest. While I know the cycle well, it’s still hard for me to maintain a good balance when something like this tips the scales. During my much-needed yoga session this morning, I got thinking about how interesting it is that while this phenomenon, and the resulting impact on our bodies and nervous systems is so universal, the triggers and manifestations differ from person to person. The good news is that while our own experiences of stress, overwhelm and exhaustion may differ, the ‘treatment’ is relatively simple, evidenced-based, and enjoyable. The first step is understanding your nervous system:

The Overflowing Cup Metaphor

Think of your nervous system as a cup. When it’s half full, it has room to absorb life’s stressors or give more to those around you. But when your cup is full—due to stress, pain, life’s demands or a physiologic change like an illness—even a small addition of water overflows it. As I mentioned, our individual manifestations are varied, but often lead to symptoms like fatigue, brain fog, or heightened emotional responses. Dysregulation activates the body’s "fight or flight" mode, flooding it with cortisol.

Chronic elevations of cortisol have wide-ranging effects on health. Prolonged stress and high cortisol levels can lead to systemic inflammation, insulin resistance, hypertension, and impaired immune function, ultimately increasing the risk of chronic diseases such as cardiovascular disease, diabetes, and autoimmune disorders. There is no lack of evidence in this area. Research published in Frontiers in Endocrinology emphasizes the connection between chronic stress and metabolic disorders, while findings from the National Institute on Aging highlight the role of cortisol in neurodegenerative diseases, such as Alzheimer’s.

Even if you’re "managing" well and the impacts of dysregulation haven’t yet caused physiological change, a dysregulated nervous system simply feels crappy. It leaves you less efficient in your work, less present in your relationships, and unable to be the best version of yourself. When your nervous system is dysregulated, it’s harder to focus, connect, and enjoy the things that matter most. Prioritizing nervous system regulation is not just about avoiding future health issues; it’s about improving your day-to-day experience of life. It’s about creating more space in your cup so you can thrive, not just survive.

Dysregulation in Chronic Pain, Fear of Falling, and Parkinson’s Disease

Many of the patients we see in our practice experience nervous system dysregulation, often as part of a broader health condition. These patients show patterns of heightened stress response that exacerbate their primary symptoms. Whether it’s chronic pain, fear of falling, or neurological conditions like Parkinson’s disease, the effects of dysregulation can significantly worsen their quality of life. Below are some specific examples and approaches for nervous system regulation in these populations.

Chronic Pain

Patients with chronic pain often live with a nervous system in overdrive. Long-term exposure to pain can cause the brain to become hypersensitized, interpreting even minor stimuli as significant threats. This constant activation of the sympathetic nervous system amplifies pain and perpetuates a cycle of stress and physical discomfort. Gentle movement, mindfulness-based stress reduction, and diaphragmatic breathing can help calm this cycle, retraining the brain to regulate pain responses more effectively.

Fear of Falling

In older adults, the fear of falling is not just psychological—it’s a full-body response that often keeps patients trapped in a state of hypervigilance. This fear increases muscle tension, disrupts balance, and raises the risk of further falls. Patients in this state frequently withdraw from physical activity, which only worsens functional decline. Interventions such as balance training, slow-paced walking, and grounding techniques can help mitigate these responses and restore confidence.

Parkinson’s Disease

For individuals with Parkinson’s, nervous system dysregulation exacerbates motor and non-motor symptoms, including tremors, freezing, and cognitive challenges. Stress often worsens these symptoms, creating a feedback loop that further destabilizes the nervous system. In these patients, incorporating aerobic exercise, yoga, and social connection into their routines can help regulate the nervous system and improve both physical and mental outcomes.

Evidence-Based Tools for Regulating the Nervous System

Nervous system regulation is key to maintaining physical, mental, and emotional balance. The key to regulating your nervous system isn’t always about eliminating stressors—because often, we can’t. We can’t always reduce our demands, get rid of our chronic diseases, or eliminate every source of stress. Instead, it’s about building a bigger cup. When we do things that increase our capacity, the same amount of water—the same stressors—can fit without overflowing. By expanding our nervous system’s capacity (otherwise known as our resilience), we can absorb more challenges without triggering the negative effects of dysregulation. Below is a list of simple, easy-to-incorporate strategies that are backed by research. These practices can help you expand your capacity, regulate your nervous system, and create more balance in your life.

1. Breathwork

Breathwork practices such as diaphragmatic breathing, box breathing, or the 4-7-8 method stimulate the vagus nerve and activate the parasympathetic nervous system. These techniques reduce heart rate, lower blood pressure, and counteract the effects of the "fight or flight" response. Controlled breathing has been shown to significantly reduce stress by shifting the autonomic balance to favor parasympathetic activity. For some easy-to-follow videos and tips on breathwork, check out the resources on our website here.

2. Mindfulness and Meditation

Mindfulness meditation helps bring attention to the present moment and reduces stress hormones like cortisol. Techniques like the 5-4-3-2-1 grounding method are particularly effective during acute stress. Studies, including those supported by the NIH, show that mindfulness can lower inflammation, improve emotional regulation, and enhance the nervous system's ability to adapt to stress. For a step-by-step guide to the 5-4-3-2-1 method, check out our resources here.

3. Physical Activity

Exercise, particularly rhythmic and moderate-intensity activities such as yoga, walking, or swimming, helps regulate the nervous system by releasing endorphins and improving brain plasticity. It also enhances heart rate variability (HRV), a key marker of parasympathetic activation. Research from the National Institute on Aging highlights that consistent physical activity supports the body’s stress recovery mechanisms, making it a powerful tool for nervous system balance.

4. Quality Sleep

Sleep is essential for nervous system health, allowing the brain to consolidate memories, process emotions, and clear out metabolic waste. Poor sleep disrupts the balance between the sympathetic and parasympathetic systems, exacerbating stress. Adopting sleep hygiene practices—consistent bedtimes, reducing screen exposure, and creating a restful environment—improves sleep quality and nervous system regulation. For comprehensive sleep hygiene tips, you can refer to the National Institute on Aging's guide here.

5. Nature Connection

Spending time outdoors in natural settings promotes grounding and nervous system regulation. Nature exposure has been shown to reduce cortisol levels and increase parasympathetic activity. A 2020 review in Frontiers in Psychology reported that "forest bathing" or similar nature-based activities improve mood, lower blood pressure, and enhance mental clarity. How easy is that? Feeling overwhelmed? Just go outside.

6. Socialization

Strong social connections play a critical role in nervous system regulation. Meaningful interactions with trusted friends or family members activate the parasympathetic system and promote emotional resilience. Research from the National Institute on Aging indicates that loneliness and social isolation are linked to heightened sympathetic nervous system activity and increased inflammation. In contrast, social bonds lower stress markers like cortisol and improve overall well-being. Group activities such as exercise classes or support groups are particularly effective in this regard. For this reason and many more, Healthy Aging loves teaching our group fitness classes. You can see where we teach on our Group Fitness page here.

Moving Forward: Make Nervous System Regulation a Priority

While we know these strategies sound simple, in reality, it’s the consistency that makes the difference—and that’s often the hardest part. The key is to start small and meet yourself where you are. Focus on adding just one thing at a time. Whether it’s five minutes of deep breathing, a short walk outside, or a single restorative yoga pose, small, consistent steps can begin to regulate your nervous system and create more room in your cup over time. Progress doesn’t have to be perfect; it just needs to start.

References

1. Frontiers in Psychology (2018)
   Study Title: The Effects of Controlled Breathing on Stress and Autonomic Function
   Annotation: This study highlights how breathwork techniques like diaphragmatic breathing and the 4-7-8 method can activate the parasympathetic nervous system and reduce stress-related symptoms.
   Link: Frontiers in Psychology

2. National Institute on Aging
   Resource Title: Getting a Good Night's Sleep
   Annotation: A comprehensive guide to sleep hygiene, detailing practical strategies to improve sleep quality and regulate the nervous system.
   Link: National Institute on Aging

3. National Institute of Neurological Disorders and Stroke (NINDS)
   Research Title: Deep Phenotyping of Neurologic Post-Acute Sequelae of SARS-CoV-2 Infection
   Annotation: Explores the biological mechanisms of nervous system dysfunction, including the impact of autonomic dysregulation and immune response.
   Link: NINDS

4. Therapist Aid
   Resource Title: Grounding Techniques (5-4-3-2-1 Method)
   Annotation: A clear, actionable guide for using the 5-4-3-2-1 grounding method to manage acute stress and promote mindfulness.
   Link: Therapist Aid

5. National Institutes of Health (NIH)
   Resource Title: Long COVID and Autonomic Dysfunction
   Annotation: Details autonomic nervous system regulation and strategies for improving resilience against stress-related symptoms.
   Link: NIH

6. Frontiers in Endocrinology
   Study Title: Chronic Stress and Metabolic Disorders: Insights from Recent Research
   Annotation: Discusses the long-term health effects of elevated cortisol, including systemic inflammation and increased risk for chronic disease.
   Link: Frontiers in Endocrinology