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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

Focus on Fitness Focus on Fitness

Don't Be a Wheelchair Potato!

May 04, 2014

By Paulette Chandler M.D.

Brigham and Women's Hospital

Are you a wheelchair potato, or a competitive sports wheeler? A variety of conditions such as stroke, arthritis and multiple sclerosis may result in a person being restricted to a wheelchair. Exercise is an important tactic in the game of coping with a chronic disease or recovering from injury.

Plenty of exercise options are available no matter what your level of ability — wheelchair basketball and water aerobics, to name two. Just as with anyone who wants to begin an exercise program, people with disabilities need self-confidence, perseverance, and motivation to get out and try new activities and maintain healthy activity levels. It is common for people who use wheelchairs to avoid physical activity out of concern over finding the best and safe forms of exercise.

Why Exercise?

One of the most important aspects of life with a disability is maintaining emotional health. People with disabilities may feel overwhelmed just with getting through the usual daily necessities of living. So the idea of adding regular exercise might seem impossible. But regular exercise actually is a great remedy for what I call "soul fatigue." There are multiple physical and emotional benefits:

  • Enhancing your independence
  • Increasing your mobility
  • Combating muscle atrophy and joint stiffness
  • Maintaining body weight, and maybe even losing a few pounds

Exercising with friends and family is a way to stay motivated and at the same time maintain those personal connections. People who share time and thoughts and laughter with kindred souls have lower rates of death and illness.

Exercise combats not only depression but also muscle atrophy, joint stiffness, weight gain and pressure sores, as cells are regenerated and nourished through activity.

So, what's the best form of exercise? All forms. A combination of aerobics, strength training, stretching for flexibility, and balance techniques is optimal. Focus on your breathing during all exercises. Breathe from your diaphragm, allowing your belly to protrude when you inhale.

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Aerobic Activities

Aerobic activities naturally promote deep breathing, which energizes the body. Aerobic activity, such as propelling yourself in the wheelchair with your feet, strengthens your heart and lungs, boosting endurance. Stationary bike or water routines are other aerobic options.

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Strength Training

Strength training such as stretching rubber tubing with your arms can quickly increase your upper-body power, making every-day activities such as lifting groceries or turning wheels on your wheelchair easier. Rubber tubing is an inexpensive and convenient way to work against resistance. Spasticity (involuntary tightening of muscles) is common in patients with conditions such as stroke or multiple sclerosis. Strength training can aid in reducing muscle spasticity and decreasing limb pain. Splints or orthotic devices may help to control muscle tone and prevent injury and pain in limbs. Strengthening the muscles around a joint also puts less pressure on the joint, resulting in decreased pain. Begin each exercise in a sitting position to minimize injury. Always work at a safe pace with guards in place to prevent falling.

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Flexibility exercises should be done daily. Be sure to stretch all major muscles in your upper body, shoulder, arms and back. Nonfunctional or disabled muscles and joints need to be stretched just like their functional counterparts. If you can't engage in active movement, then limbs may be passively moved by you or a family member who has learned the proper techniques.

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Posture and Balance

Balance exercises help to improve posture and muscle tone. Balance exercises may be done with a large ball. People confined to wheelchairs often have compromised posture such as stooping or slouching. Slouching stresses the ligaments and muscles in your lower back, creating pain and impairing deep diaphragmatic breathing. Keep blood flowing freely by aligning ears, shoulders and hips. Keep feet flat on floor and knees bent at 90 degrees. Keep back straight and supported to keep it in a neutral position. Postures held for long periods of time compromise blood flow. Try to change positions at least every hour.

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Tailor Your Regimen to Your Needs

Finally, if you've never attempted exercise, your first step is to visit your doctor and physical therapist or fitness professional for guidance in selecting appropriate exercises. Any wheelchair-fitness program must be tailored to a person's health, level of fitness and motor skills. You may not be ready for the wheelchair marathon, but the most important thing is to start moving.

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Paulette Chandler, M.D., M.P.H. is a clinical instructor of medicine at Harvard Medical School and an attending physician at Brigham and Women's Hospital.

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