The following excerpt is taken from Chapter
4 of Life on Wheels: For the Active Wheelchair User, by Gary Karp,
copyright 1999, published by O'Reilly & Associates, Inc.
To order, or get more information about Gary's book, call
(800) 998-9938. Permission is granted to print and
distribute this excerpt for noncommercial use as long
as the above source is included. The information in this
article is meant to educate and should not be used as an
alternative for professional medical care.
If you use your body, you will live longer and more happily. It is
especially important for chair riders to exercise to the degree possible. An
inactive, sedentary lifestyle is an invitation to a variety of undesirable
- Weak muscles. The parts of the body you can control need exercise to
stay strong and vibrant.
- Cardiovascular loss. Your ability to function depends on the heart's
ability to get healthy blood out to your muscles. A weak heart means early
fatigue and long-term decline in your level of activity and independence.
- Osteoporosis. Your bones lose density from lack of use.
- Weight gain. Calories turn to fat when you don't burn them off with
activity. The heavier you get, the harder it is to exercise and so to lose
weight. Extra weight adds to the strain on your heart and muscles.
You don't have to be a bodybuilder to maintain strength. Muscle strength is
as much a matter of softness and elasticity as it is of bulk. Flexible muscles
can travel further when they contract, which translates to additional
Whatever muscles you have voluntary control of can be exercised and kept at
an optimal level of mass and elasticity. You can do this without an extreme
amount of exertion. It is a myth that to exercise a muscle you have to strain
it to exhaustion. Gentle and slow repetitions with little weight will maintain
muscle tone, at least, and gradually build strength, at best. Exercising
moderately two or three times a week will take you a long way toward attaining
the strength, stamina, and general health you desire.
I find that a very simple routine of exercising doing push-ups in my
wheelchair, using moderate free weights, and other resistance types of workout
really makes a big difference. Once after an extended illness I lost some of
that tone and really noticed the change in strength.
Heart disease is a widespread problem in Western culture. Heart disease is a
greater risk to many whose mobility is limited. In the mid 1990s, heart disease
accounted for almost 20 percent of deaths following spinal cord injury. Persons
with cerebral palsy are at somewhat greater risk of cardiopulmonary dysfunction
than the general population, accounting for the majority of deaths of adults
Difficult as exercise may be for some people with a disability, it benefits
your quality of life. Aerobic exercise has a number of important benefits:
- It makes the heart stronger and improves circulatory efficiency. The heart
is, after all, a muscle too.
- It helps reduce blood pressure and heart rate.
- It helps control your weight.
- It increases endurance for physical activity by helping more blood and
oxygen to reach muscles.
Only some manual chair riders are active enough that pushing the chair alone
is adequate aerobic exercise to benefit the heart and general fitness. Most
manual wheelers do not push enough in the course of an average day to provide
for optimal health, nor do they work up a sweat or increase their heart rate in
the process, indicators of productive aerobic exercise.
Unfortunately, medical schools do not teach much about exercise physiology
or the preventive values of exercise. Your doctor will encourage you to be
active to the degree you are able, and might refer you to physical therapy, but
usually for practical purposes like activities of daily living. You should
directly ask your doctor and therapists to develop an exercise program specific
to your needs. Exercise needs to be a continuing program--not just short-term
Keeping to an exercise program might seem like an unwanted burden on top of
everything else required of you by your disability. But even small amounts of
regular exercise make a remarkable difference in a short period of time and
more than compensate for whatever inconvenience the exercise entails.
After extensive exercise and training in rehab, this person noticed a
decrease in physical abilities as he exercised less:
I became very busy with my new business out of an office at home. This meant
that I was not wheeling around the place where I used to work, not commuting
back and forth, and not traveling or going to meetings as I used to. I think
all of that physical activity helped keep me in shape. I especially noticed
that it was becoming more difficult to transfer into and out of my chair.
Suddenly I seemed to be throwing my body more than lifting it. So I started
doing simple upper body exercises a few times each week for about fifteen or
twenty minutes, and was amazed by how quickly I started to feel the difference.
Now my exercise routine is important to me because I know it really
The type and duration of exercise appropriate for you is a matter of
experimentation and building endurance. You will need to design a program for
yourself working with the best qualified doctor and therapist you can find. Any
professional who develops an exercise plan for you must clearly understand the
physiology of your disability as well as your personal experience. For example,
people with MS are sensitive to being overheated and must not let body
temperature rise much. People with paraplegia need to take care not to
overstrain their shoulders. For people with post-polio syndrome, certain types
of exercise can be exactly the wrong thing to do.
For a long time I pushed and forced myself to exercise, to use a stationary
bike, etc., to help my respiratory system and to get myself "fit"
after my daughter was born. I didn't know it then, but that was the worst thing
that I could have done. Yes, I did need exercise, but I was modeling my
exercise program on one that healthy people use. I overtaxed my respiratory
system. I made the muscles that had taken over for those that were atrophied
work even harder.
Even if you are a high quadriplegic or experience fatigue easily, you can be
physically active in ways that benefit your general fitness. Aerobic exercise
is very good for the heart, but just being outside enjoying even modest
activity is worthwhile. It helps you maintain a more positive attitude and
An exercise program doesn't have to mean lifting weights, pulling on rubber
straps, or using some exercise machine. There is a tremendous array of athletic
options available. Almost anyone can participate in some form of sport. Many
can swim or exercise in water. Bowling, shooting, or archery can be performed
by even high quadriplegics with the use of newly developed adaptive devices.
Those with higher degrees of function can participate in sports like wheelchair
basketball or quad rugby.
Of the vast number of health facilities, few are well equipped for
wheelchair access, and staff is rarely trained in issues that relate to
disability. Most weight trainers come from a body-building point of view. They
are interested in building muscle mass to give your body a bulkier, sculpted
look. Building muscle mass is generally not appropriate for a wheelchair user,
although those wheelchair users involved in weight lifting or certain other
wheelchair sports can benefit from this approach.
Ask whether your physical therapist can visit the health facility with you.
She can review the various exercise machines, discuss whether swimming would be
an option and how you would actually do it, and help you prepare a program.
Asking for such consultation is not an unreasonable request on your part.
Therapists are often given approval to make such visits. Your needs are
specialized, and health club staff who offer personal training services are
unlikely to be able to determine what is right for you. It is especially
important that your program is balanced among the various muscle groups.
Some people go to health clubs to show off their bodies, their strength, and
to check other people out. As a wheelchair user, you might find yourself
uncomfortably conspicuous at first.
I'd really like to go someplace where I can swim and use the exercise
equipment, but it's important to me to have a place to dress and shower in
private. I'd rather not be in public with my skinny legs or revealing my
catheter. A few newer places are starting to include private dressing rooms
with showers, but nothing close enough to where I live at the moment.
The weight room in my building is all men. For the first six months I took the
free weights into the hallway. All these men are grunting and I'm lifting these
four-pound weights. But I got over that. I loved it. I saw the change in my
body right away.
Two health risks of wheelchair users are softer leg bones and poorer
circulation. When legs do not have to carry the weight of the upper body, they
begin to lose calcium and become soft. Bones then break more easily on heavy
The act of walking is a pumping action that moves blood through the body.
Legs that are inactive have less efficient circulation since their muscles are
not helping the process. Always sitting also limits circulation to the legs
because of the angles that veins and arteries must pass at the hips and knees.
Standing lets gravity help circulation, as blood passes straight down the body
without having to turn corners. Circulation is also a matter of hydraulics--the
assistance of gravity to bring blood down to your legs also helps it flow
upward in the closed pressure system of the body.
The risks of softer leg bones and poorer circulation can be addressed with
standing frames, which comprise a growing segment of the medical supply
industry. There are three types of standing frames:
- Fixed. The frame remains in one place, and does not have a seated
- Movable. The frame includes wheels within reach, linked by a chain
or belt to smaller wheels at the bottom so you can move within a room. Some
frames are motorized and move by means of a joystick control like a power
- Integrated. Another kind of product is a wheelchair with the
capacity to transform into a standing frame. Such a frame is intended for
people at work, such as a mechanic who would need to stand beneath an elevated
car, or for situations where an extended reach is needed, such as at a
supermarket. There are both manual and power models.
Other benefits of standing frames pointed to by manufacturers are reduction
of spasms and muscle shortening, less chance of pressure sores, and improved
urinary and bowel function since the colon and intestines are constrained in
the sitting position (although some physicians do not subscribe to this view).
If you have shortened muscles from sitting for many years, a standing frame can
be a means of getting your body straightened out again. A product which is able
to be set at intermediate angles can allow you to therapeutically stretch in
the frame and gradually lengthen your muscles out to a normal posture.
Getting into the standing position is achieved in various ways with
different products. Some products have a well-engineered leverage system that
allows you to manually lift your own body weight into the standing position
with minimal effort. Some products are motorized. Still others may require you
to have assistance, particularly if you have insufficient arm strength.
Standing frames support you with a surface behind you which generally
contacts the buttocks and might extend as far as down to behind the knees or as
far up as the lower back. While it is true that there is still some pressure on
the buttocks, it is much less than if you were sitting directly on them. The
knees are braced in front, and another support is generally located at the
abdomen. All supports are padded for the prevention of pressure sores. Since
there will be continual contact while standing, you would need to limit the
time spent in any one standing session. Some frames include adjustable
footplates. Frames are available with various options, such as a desk platform
for writing or reading, storage compartments, and drink holders. Some come in a
range of colors.
People with very brittle bones, cardiac disorders, or significant shortening
of hip and knee flexor muscles might need to avoid standing frames, but might
be able to work their way toward using them with stretching and therapy. You
may require a prescription to purchase one.