• Strength-building exercise
  
• Aerobic exercise
  
• Exercise programs
  
• Health clubs
  
• Standing frames
  

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 results:

• 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.

Strength-building exercise

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 strength.

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.

Aerobic exercise

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 with CP.

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.

Exercise programs

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 therapy.

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 works.

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 higher spirit.

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.

Health clubs

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.

Standing frames

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 impact.

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 position.
• 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 wheelchair.
• 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.