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Physical fitness and trying to stay in shape is a concern to all of us. Research has shown that the body seems to suffer from inactivity. While many people with disabilities may have an active lifestyle, it is often difficult to exercise when a disability presents physical limitations. We are just beginning to address this issue. We hope to encourage people with disabilities to discover strategies for reaching their maximum levels of fitness within their physical limitations. We have provided a few websites that offer information about health and fitness programs for people with disabilities. Some of the websites also offer information about adaptive equipment companies.
Exercise and physical activity can be done to improve or maintain fitness or for the joy of it as play. Despite calls for higher levels of physical activity, the majority of people, including those with disabilities, do not get the recommended amount of physical activity needed to maintain health benefits and prevent secondary conditions associated with a sedentary lifestyle such as heart disease, obesity, and osteoporosis. For persons with a neuromuscular condition or other disabilities, reduced function, weakness, fatigue, lack of mobility, inability to exercise, pain, and problems with weight can make exercising difficult and lead to reduced physical activity.
People with limited physical abilities are more likely to be at a long-term risk for coronary artery disease, obesity, osteoporosis, anxiety and depression. Recent research studies suggest that promoting physical activity and exercise for people with disabilities is especially important since they have a substantially greater risk of developing secondary conditions such as heart disease and diabetes due to inactivity. For people in wheelchairs with physical limitations, a more sedentary lifestyle can make exercising more difficult for some.
It is known that adopting a healthier lifestyle, including regular physical activity, can modify the risk factors for these conditions, and improved physical activity is likely to contribute directly to quality of life, community integration, and to improved ability to participate in a variety of activities. Furthermore, exercise can boost the mood of people and make people feel better all-around.
Exercise is different than physical activity. Exercise is a planned, structured and repetitive body movement whereas physical activity is the movement you do throughout the day. One benefit of exercise can be an improved ability to take part in ongoing daily physical activity. Whether you have a planned exercise program or simply rely on day-to-day physical activity, the message is to stay as active as possible. New knowledge and research tells us that no matter what the level of disability is, we should be encouraged to value exercise and come up with a customized plan that fits our physical ability.
Barriers may make it difficult for some people with disabilities to participate in physical activities. Architectural barriers such as buildings, walkways, doorways, restrooms may discourage disabled people from getting involved in physical activities. Limited transportation may be a barrier to just getting to the activity. Economic barriers such as the low-income levels associated with disability are considered to be a major problem to participating in physical activities.
Exercise Training Guidelines for Persons with Physical Disabilities
1.
Gather recent medical literature on your disability to determine
the latest information and recommendation for developing an exercise
program.
2. Educate yourself on how your disability may interact with a
training program.
3. You can seek professional help from your physician or physical
therapist to work with you and get you started. You may also work
with an exercise physiologist. With the assistance of your physician,
determine which muscle groups are still functional and which muscle
groups are either weak or paralyzed. This will help you in finding
an exercise that works and in learning what could be harmful for
you.
4. You will want to start slowly and increase your time gradually.
Recognize limitation along the way, make adjustments, and keep
going.
5. You may want to focus on muscle groups that are essential for
performing activities of daily living.
6. Make sure that your blood pressure and heart rate remain in
safe ranges.
Types of Exercises:
Stretching
and Range of Motion Exercise:
Stretching muscles and joints is important to maximize and maintain
function whether you can do it yourself or need the assistance
of another person. Arm circles, for example, can help maintain
function in the shoulders, which makes it easier for you to reach
for something or to move something out of the way. Also, stretching
muscles prevents tightness and can help you maximize your ability.
Yoga movements are another form of exercise.
If you are unable to exercise yourself because of physical limitations, stretching and range of motion exercises will help keep your muscles flexible. Range of motion exercises include arm circles, wrist circles, shoulder shrugs, calf stretching, lifting the knee up towards the chest, bending and extending the knee, back stretch and ankle circles.
Cardiovascular
Exercise
Cardiovascular exercise, which is also known as aerobic exercise,
increases your heart rate and blood flow, and makes you breathe
a little more heavily than you would when performing your daily
tasks. There are numerous benefits, some you may notice, and some
you may not. The benefits you may notice include increased ease
of accomplishing your activities of daily living such as getting
in and out of the car, going from place to place, or an improved
mood. Benefits you may not notice include lower blood pressure
levels, improved blood cholesterol levels, and lower blood sugar
levels to name a few.
Swimming, biking, and walking are examples of cardiovascular exercise. Stair climbing and rowing machines are useful for cardiovascular or aerobic exercises. If you have access to a pool and enjoy swimming, swimming may be the best exercise for many individuals with neuromuscular conditions because it minimizes mechanical stress on the body. Do what you enjoy, what feels good, and what is accessible.
The intensity of aerobic exercise varies depending on the person. In general, health professionals will recommend a moderate or low intensity workout. This means that you should be exercising at a level where your heart rate increases and you are breathing heavier than you would normally. If you cannot easily carry on a conversation, slow it down!
Department
of Neurology, Mount Sinai School of Medicine
Division of Neuromuscular Diseases
5 East 98th Street, 7th Floor, Box 1139
New York, NY 10029
212-241-8674
http://www.mssm.edu/neurology/neuromuscular/als/care.shtml
Strength
(Resistance) Training
Strength training, also known as resistance training,
improves muscle strength. Any exercise that involves hand-held
weights, weight machines, stretch bands, or even balls is usually
a strength exercise. These types of exercise, like stretching
exercises, can involve any muscle in your body. Exercising with
a friend and sharing the experience can be fun and motivating.
Joining or starting a wellness program may also help and be a
fun experience.
Usually, it is a good idea to find two or more exercises that you can vary, exercising different muscles on alternate days. For example, walking or exercising the lower extremities one day and exercising the upper extremities the next day gives a good workout. This kind of schedule provides a period of rest for each muscle group and variation that keeps the overall exercise program challenging and enjoyable.
You can exercise anywhere, in your house, at a gym, at a swimming pool, or outdoors. It is important to do what works best for you according to what your body is telling you and/or what a professional recommends. Pick an exercise you enjoy, whether it is walking, stretching, or any other exercise, and begin slowly before you gradually increase to longer periods of time. In addition, make sure you rest long enough between times to fully recover after the exercise; otherwise, you may remain in a constant state of pain which can have negative effects on functioning.
Exercising in a warm pool is a great way to work out because of the buoyancy and support of water; it allows people to move in ways they cannot move on land. For weak limbs, inflatable cuffs can be used to float an extremity. For other limbs, water resistance provides a workout that can be fine-tuned to each person's strength. The principal disadvantages of water therapy are that the temperature may not suit one's body and it may be difficult to find pools that have lifts, if needed. In addition, the surfaces around pools tend to be slippery and dangerous for anyone who has a tendency to fall.
It is very important to listen to your body. Avoid pain, fatigue, and weakness. These symptoms are signals that your muscles are overworked. A brief period of fatigue and minor muscle pain for 15-30 minutes after exercising is usually normal. However, symptoms that last longer than 30-60 minutes reflect muscle overwork and possible injury. If this occurs, the exercise should be reduced or stopped. If you experience any additional weakness and/or pain, you should discontinue the exercise and consult your physician.
National Center on
Physical Activity and Disability
University of Illinois, Chicago (NCPAD)
The NCPAD encourages persons with disabilities to participate
in regular physical activity as a means of promoting healthy lifestyles
and preventing development of secondary conditions. The slogan
of NCPAD is “Exercise is for everybody and every person
can gain some health benefit from being more physically active.”
They gather, organize, evaluate, synthesize, and disseminate information
on the state of the science in physical activity and disability.
In addition, they offer a variety of resources for persons with
disabilities, fitness and exercise professionals, health professionals,
and researchers interested in disability and physical activity.
Some of their resources include leisure activities, health & exercise
programs, other resources listed by state, equipment adaptations,
and applied products listed by company.
1640
W. Roosevelt Road
Chicago, IL 60608-6904
800-900-8086 (V & TTY)
http://www.ncpad.org
Resource List: Wellness,
Self-Care, Exercise, and Aging with Disability This is a resource
list put together by June Isaacson Kailes, Disability Policy Consultant
from the Rehabilitation Research and Training Center on Aging
with Disability. The website provides information about available
books and videos regarding wellness, self-care, exercise, and
aging with disability. On the website Kailes provides recommendations
for various books and videos that would be helpful for specific
disabilities or specific interests regarding exercise and disability.
To get this information off the website scroll down to the "table
of contents", click on "subject index", and scroll down to "exercise".
http://www.usc.edu/dept/gero/RRTConAging/paper1.html
Exercise: When,
How, And Why
This talk was presented at a conference sponsored by the Rehabilitation
Research and Training Center on Aging at Rancho Los Amigos Medical
Center in Downey California in conjunction with Southern California
Post-Polio Network and Stroke Association. This talk is presented
by Jacquelin Perry, M.D., Chief, Pathokinesiology Services at
Rancho Los Amigos Medical Center and Professor of Orthopedics,
Biokinesiology and Physical Therapy at USC School of Medicine.
http://codi.buffalo.edu/graph_based/.aging/.conf/
http://codi.buffalo.edu/graph_based/.aging/.conf/.exercise
Adaptive Aerobics
This website has tips for integrating people with disabilities
into aerobics classes. Topics under "Getting Started" include
To Sit Or Not To Sit, Modifications For Standing Athletes, and
Positioning Tips For Adaptive Aerobics Instructors. Topics under
"Advanced Topics" include Muscles Used In Seated Aerobics, Movement
In Seated Aerobics, and more.
http://www.turnstep.com/Adaptive
AXIS
Dance Company
The AXIS Dance Company has created an exciting body of
work developed by dancers with and without disabilities. They
are developing a physically integrated dance form. They have performed
at their home base in the San Francisco Bay area and abroad. Axis Dance Company
also maintains an extensive community education and outreach program.
Dance Access and its youth component Dance Access/Kids! offers
an on-going program of classes for adults and youth of all abilities.
1428 Alice Street, Suite 201
Oakland, CA 94612
510-625-0110
http://www.axisdance.org
American
Dance Therapy Association (ADA)
The ADA provides Dance/Movement Therapists who are graduates
of masters degree programs. They are able to integrate a dancers'
special knowledge of body, movement and expressive spirit with
the healing skills of counseling, psychotherapy and rehabilitation.
They help a wide range of people, from autistic children to seniors,
from the mentally ill to people without disabilities who have
lost touch with their inner truth, from people with spinal cord
injuries to people who just have never felt quite at home in their
bodies. In addition, they offer classes across the nation…see
this website for more information as well as how to contact them.
http://www.adta.org
Publications on Neuromuscular Diseases and Physical Exercising
Physical activity and disability is a large area of research. If you are interested in recent research in this area, a few examples are listed below that primarily emphasize the effect of physical exercising on individuals with neuromuscular disabilities. In addition, you can visit PubMed Central (PMC) at http://www.pubmedcentral.nih.gov, which is the U.S. National Library of Medicine’s digital archive of life sciences journal articles. This website has a list of journals that you can click on to review their current and past issues. At the same time, you can search by specific topic, author, or title using the different search options.
1. Seaman, Janet A., “Physical Activity and Fitness for Persons with Disabilities,” July 2, 2002.
The article focuses on the importance of physical activity in promoting healthy, active lifestyles for people with disabilities. Health and social benefits are derived from activity and fitness yet there are challenges impeding the progress of physical activity for disabled persons. Furthermore, the article lists a group of professional organization with contact information for interested people.
IFI: The Center
for Discovery
Box 840 Benmosche Road
Harris, NY 12742-0840
845-794-1400
2. Aitkens SG, McCrory MA, Kilmer DD, Bernauer EM. “Moderate resistance exercise program: its effect in slowly progressive neuromuscular disease.” Archive of Physical Medicine and Rehabilitation. (1993). July; 74 (7): 711-715.
In this study, the focus was to determine the safety and efficiency of a 12-week moderate resistance exercise program in persons with slowly progressive neuromuscular disease. The results indicated that the 12-week strength-training program is achievable, practical, and safe in slowly progressive NMD and produces moderate improvement in muscle strength.
3. McDonald, Craig M., MD. “Physical Activity, Health Impairments, and Disability in Neuromuscular Disease.” American Journal of Physical Medicine and Rehabilitation. (2002); 81 (suppl): S 108-120.
This article reviews
the effect of reduced physical activity on health, fitness and quality
of life. Using individuals with Duchenne muscular dystrophy, the relationship
between the disease physiology, impairment, functional limitation, and
social limitation in the community is discussed.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12409816
