August 25, 2017

Does your bathroom routine drain your battery? How effort and exercise shape community participation

A bathroom with a shower chair and a grab bar in the shower.

Shower chairs and grab bars are some of the adaptive bathroom equipment used in this study. Photo from Healthy Community Living (

What do showering, brushing your teeth, and “visiting the porcelain throne” have to do with energy levels and community participation? More than you might think, especially for people with mobility impairments.

Effort Capacity and Choice, a current research project at RTC:Rural led by Andrew Myers, is working to better understand how what happens in the bathroom impacts what happens outside of the bathroom. The project is a collaboration between the RTC:Rural, the University of Montana Bureau of Business and Economic Research, and the New Directions program within the Department of Physical Therapy and Rehabilitation Science at the University of Montana.

Previous RTC:Rural research has shown that many people who use mobility equipment live in homes that do not meet their needs, specifically in regards to the accessibility of their bathrooms and the entrances to their homes. 56% live in homes with inaccessible bathrooms, and 57% live in homes with a stepped entrance.

This is especially troubling as the need for affordable, accessible housing is only going to increase in the next few decades with an aging American population. In rural areas, where people are already more likely to be unemployed, living in poverty, elderly, and have a disability, this housing need will be especially severe.

RTC:Rural analysis of the American Time Use Survey has also shown that people with mobility impairments bathe less often, and when they do bathe they spend more time doing so. The Effort Capacity and Choice project builds on this information by investigating whether the amount of effort a person thinks they must exert affects their choices to be active at home and in their community.

Each person has a finite amount of energy to spend doing the things they need and want to do each day. One metaphor to explain this is the cell phone theory, which compares the amount of energy a person has to the battery life of a cell phone. Some cell phones have fully functional batteries, but others have batteries that no longer hold a full charge, which requires the user to make decisions about how to spend that limited battery power. Do they use the phone minimally to save power only for important phone calls, or do they start taking a lot of pictures and posting on the internet, which will use up their battery in a couple hours? Essentially, a person has a limited amount of energy each day, and if they use up a big percentage of that energy on bathing they then have less energy for other things, leaving  their battery drained.

This is where Myers and his team come in. They’re asking, in essence, how to give people more battery life. They do this by comparing two different strategies: by installing assistive bathroom equipment (therefore reducing the effort needed to bathe), or by providing regular physical activity (increasing the person’s capacity to use their existing bathroom).

A bathroom with no visible adaptive equipment.

Our “Effort Capacity and Choice” project hopes to figure out which is more effective: adding adaptive bathroom equipment or increasing a person’s ability to use their current bathroom. Photo from Healthy Community Living (

The second part of the study is then finding out what people choose to do with that extra battery life. The idea is that if people have more energy, they’ll spend that energy participating in their communities. Community participation covers a wide range of activities, but includes working, shopping, volunteering, and socializing, all things that benefit both individuals and their communities.

The study is currently in the process of collecting data. Over 200 people from the city of Missoula, Montana have completed surveys, and 45 have participated in one of the two interventions. If all goes as planned over the next two years, the researchers aim to collect 600 surveys and have 160 people participate in the interventions. Since participants are given the option to keep the installed bathroom equipment or to continue exercising at New Directions after the duration of the study, they are likely to see long term benefits from their participation.

Beyond the individuals who are helped by this research project, the findings could have real implications for practices that positively affect people with disabilities.

About 78 million people, or 25% of the U.S. population, live in a household with at least one person with a disability. While this includes all impairment types, not just mobility difficulty, this is still a significant portion of the American population. Many of those (40 million) are people without disabilities themselves who live in households with at least one person with a disability. Policies and programs that help make homes more accessible will not only improve quality of life for the person with the mobility impairment, but also reduce the amount of caretaking responsibility assumed by other household members. If it requires less energy or exertion to perform daily activities, like bathing, will people with disabilities—and their caregivers—have more energy for community participation, such as employment?

It’s not realistic to think that there will be a sudden increase of affordable, accessible housing in rural areas just because there is an increased need for it. However, the Effort Capacity and Choice study will provide both a model and empirical data to support easy, affordable ways to make people’s homes more accessible and to help them live more easily in existing housing, which will in turn allow them more choices about how to spend their time and energy.