The Endorphin 355 series unit.

When most people think about aerobic exercise machines, they think of treadmills, stationary bikes, and elliptical machines. These popular machines require significant lower-body involvement. For people who are unable to use their lower extremities—whether due to injury or a long-term illness, it can be frustrating to find an effective method of performing cardiovascular exercise. The solution for these people as well as those injury-free individuals is the upper-body ergometer (UBE).

UBEs are widely used in physical therapy. Targeted to meet the aerobic needs of individuals who cannot use their legs for physical activity, these machines offer a great cardio workout that uses the upper body instead. UBEs can be used for individuals who need a low-impact exercise program; those who are recovering from foot or leg injury and have clearance to continue working out; and those with spinal cord injuries, multiple sclerosis, or lower-body disabilities.

The UBE is designed to bring all the benefits of lower-limb cycle ergometers to the upper body with even greater versatility. The UBE's wide range of exercise speeds, work rates, and anatomical range of motion, combined with isokinetic accommodation resistance, make it ideal for athletic training, physical therapy, performance training, and cardiovascular conditioning.

The UBE's range-of-motion adjustments provide complete control over the musculature and joint structures involved in the exercise plus the extent of that involvement. This feature allows exercise to range from limited arm/shoulder involvement to full elbow, shoulder girdle, and torso rotation range of motion. In rehabilitation cases, injuries from the wrist to the trunk may be exercised in this manner, and the musculoskeletal forces, range of motion, and work rate may be precisely controlled and progressively increased based on treatment goals and individual tolerances.

The major feature of the UBE is that it is isokinetic (constant velocity) and offers the proven benefits of controlled speed and accommodation resistance.

UBEs work like a bicycle for your arms. On some UBEs, you sit on a comfortable seat with a supportive back and grasp handles in front of you, "pedaling" with your arms in a circular motion. Some models offer dual passive movement for the legs, which is controlled by your arms. Using the upper body for cardio is an effective method for elevating your heart rate to an aerobic level.

Using a UBE involves nearly every upper-body muscle group with particular emphasis on the arms and shoulders. Historically, upper-body ergometry has been almost exclusively used by paraplegics, since they could remove the seat from the machine and perform the arm cranking from their wheelchair. Oftentimes, the only people who regularly use an UBE are paraplegics and triathletes.

The proper body position for the UBE with a seat option is to first set the seat height so that your shoulders are at the same level as the axis of rotation of the crank. Second, the seat should be moved horizontally so that when your arms are farthest from your body in the cranking cycle, they are not quite fully extended (maybe a 5° to 10° bend at the elbow). The most comfortable hand position typically is a neutral grip (palms facing).

The initial intensity and duration will be significantly less than what you would do on a stationary bike or elliptical machine. This is due to the fact that the upper-body musculature is so much smaller, weaker, and less efficient (mechanically) compared with the lower body. However, once the upper body is trained aerobically, improvements will be made just as with any other progressive overload routine with resistance or aerobic exercise.

A UBE engages virtually every muscle in the upper body, in a similar fashion to an exercise bike for the lower body. As a cardiovascular apparatus, it offers similar benefits to a cycle. As a warm-up for resistance training, it provides better activation of the upper torso than the traditional alternatives.

When used in the standing position, the UBE engages all core muscles of the midsection. It also is widely used as an aid to the rehabilitation of many injuries and as a general exercise apparatus for those in wheelchairs.

UBE CASE STUDY

We use UBEs as a warmup for patients with wrist, elbow, shoulder, cervical, hip, and/or thoracic injuries. A recent patient presented the following case. After suffering from an injury to his right hip, he was limited to upper-body workouts. While his upper-body strength increased with resistance training, he complained of frustration with his inability to perform cardio exercises in his therapy program.

Left: The SciFit PRO1 model. Right: The Med-Fit Systems UBE174 unit.

His PT incorporated the use of a UBE into his therapy program. It provided an optimal method of warming up muscles before moving on to his usual resistance exercises using free weights. To build his aerobic fitness, 20- to 30-minute sessions on the UBE were prescribed. The goal was to perform two 30-minute sessions per week for a full aerobic workout.

On alternative days, the UBE was used to warm up before exercising with free weights. The program provided the patient with upper-body strength as well as endurance improvement.

THE SETUP

UBEs vary widely in design and features. Some are small machines that sit on a tabletop, others involve standing or sitting in a wheelchair, and some are large machines that can be operated while sitting or standing. Described below are a few UBEs on the market today.

Biodex Inc (www.biodex.com), Shirley, NY, features its new Upper Body Cycle, a self-powered and self-charging UBE. The Upper Body Cycle offers two universally accepted resistance modes: Constant Power (effort level control) for cardiovascular and general aerobic exercise, and Isokinetic (speed control) for building strength through resistance throughout the user's range of motion for the duration of the exercise period. It features a large rotating seat that accommodates wheelchair transfers and patients with ambulatory difficulties. EZ-Grip™ handgrips allow people with hand-control limitations to hold onto crank handles.

Cat-Eye Fitness (www.cateyefitness.com), Dallas, offers upright and recumbent ergometers. The EC-C400 is a highly versatile ergometer that is mechanically designed for high-use "unsupervised" commercial settings. It features Cat-Eye's patented belt drive Eddy current Electromagnetic Disk Brake resistance system. The EC-3600 recumbent ergometer provides a complete workout. An onboard computer provides five different programs and six different readouts.

Endorphin Corp (www.endorphin.net), Pinellas Park, Fla, offers its 300, 355, and 370 Series products for upper-body conditioning. The 300 Series features a magnetic belt drive resistance that provides smooth movement in both forward and reverse rotation. It can be attached to the 355 Series platform if crank arm height adjustability is required. The 355 Series unit can be used in a seated or standing position, and the crank arm on the e-resistance system can be adjusted from 36 feet to 50 feet from the floor. The 370 Series unit is an upper- and lower-body exercise platform that provides a height-adjustable upper e-system resistance module.

Med-Fit Systems Inc (www.medfitsystems.com), Fallbrook, Calif, offers its UBE174. It features a height-adjustable, removable seat with full back support. The height-adjustable mechanism allows for use in a sitting, standing, or overhead position. The crank arms are length adjustable. The ergometer's nine-gauge steel construction allows for a 500-pound capacity. The LCD displays elapsed time, time remaining, watts, resistance level, RPM, MPH heart rate, and target heart rate with an optional HR transmitter.

SciFit (www.scifit.com), Tulsa, Okla, offers its PRO1 and PRO1 Sport upper-body exercisers. The PRO1 model provides a traditional seated upper-body workout, while the PRO1 Sport allows users to work overhead or standing. An adjustable console accommodates users at all angles, and the crank arm is adjustable and reversible for rotary rowing motion. The systems allow for bidirectional movement and resistance for increased versatility. The PRO1 unit features removable two-position footrests and wheelchair tie-downs.

Kelly Parish, PT, is a staff PT at Endurance Physical Therapy in Seattle. For more information, contact .