More than walking: What does movement cost the patient?
By Nisha Jacob Savanhu
Updated 2:58 PM CDT, Tue October 27, 2026
When we talk about mobility, we often make it sound binary. A patient is mobile or immobile. Walking or bedbound. Independent or dependent. But there is a very large space between those categories – and that is often where home medical equipment (HME) has the greatest opportunity to help.One question I have learned to ask is not only, “Can this patient make the movement?” but also, “What does that movement cost them?”
A patient may technically be able to walk with a rollator, but that tells us very little about the effort involved. Can they grip and operate the brakes comfortably? Do they have the finger and arm strength to control the device? If they need to stop, can they turn, sit and stand again safely? How much pain or fatigue follows a short trip across the room?
The same issue arises with wheelchair mobility. A person who is newly relying on a wheelchair may suddenly ask the shoulders, arms, hands and trunk to perform work that used to be shared by the legs. They may be capable of propelling the chair, but capability does not tell us how tiring the movement is, whether it causes pain, or whether they can repeat it throughout the day.
That is why movement should not be measured only in steps. Sometimes it is measured in inches: shifting weight, turning to one side, repositioning the legs, changing the angle of a recliner, or moving from a flatter position to a supported upright posture.
Those small changes can matter more than pressure and comfort. Body position can also influence pulmonary function. A systematic review comparing different positions found that respiratory measures were often better in more erect positions across many populations, although the optimal position varied by diagnosis. The point is not that every patient should simply be sat upright. It is that posture is not physiologically neutral.
For a person with limited mobility, a small position change may alter the relationship between the diaphragm, chest wall and gravity. It may also create an opportunity for a few deeper breaths, a pressure shift, or a more comfortable posture. But even that “small” movement may require effort, assistance or recovery time. What looks minor to an observer may feel very different to the person doing it.
Small movements also change where pressure is carried. A weight shift, a change in recline angle or repositioning in bed changes the relationship between the body and the support surface. The mattress, cushion or seating surface influences how that load is distributed, but the surface does not eliminate the need to think about movement and repositioning. The equipment and the movement work together.
This is where HME providers can look beyond product categories. A bed, recliner, wheelchair, rollator, mattress, cushion or transfer device becomes part of the patient’s movement environment. The more useful question is not only what the equipment is, but what it allows the person to do – and how much effort it requires them to do it.
Instead of asking only whether a patient can walk, transfer, propel, stand, sit or reposition, consider asking: How much effort does this require? What hurts during or after the movement? Can the patient stop and rest safely? Can they repeat the movement several times a day? Can they change posture when they become uncomfortable? Does the equipment make repositioning and supported breathing easier or harder?
More movement is not automatically better, and HME providers are not prescribing therapy. Mobility and positioning still need to reflect the patient’s diagnosis, pain, skin tolerance, fall risk, cardiovascular and neurologic status, goals of care and the recommendations of the clinical team.
But HME professionals can help change the question. Instead of asking only, “Where will this patient spend most of the day?” we can also ask, “How will this patient move and breathe throughout the day – and what will that movement cost them?”
For some patients, meaningful movement will be measured in steps. For others, it may be measured in inches – a weight shift, a change in posture, a transfer or a position that makes a deeper breath more comfortable. Either way, the patient’s effort, pain, fatigue, comfort and ability to repeat that movement deserve to be part of the conversation.
Nisha Jacob Savanhu, MD, MBA, is clinical solutions manager at Graham-Field, where her work spans clinical education, product strategy, customer insights and health care workflow. She writes about the practical intersection of clinical evidence, equipment, mobility, comfort and the care environment, with a focus on asking better questions that help health care professionals see patient needs more clearly.
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