Other Physical Impairments

• Varying degrees of muscle tone and range of movement about a joint will require you to work within your own limits.
• A sway of the lower back or a curvature of the spine, as well as bowed legs can result in back pain and difficulty walking. Try bike riding, it is great for strengthening your leg muscles and is suitable for those with bowed legs.
• Isometric exercises (where you hold your body in one position e.g. the plank) are useful to strengthen the muscles around your joints.
• Try Swimming, it reduces the strain and impact that is placed on your joints during many other traditional forms of exercise but still provides a great aerobic workout.
• Exercises that involve smoother movements are better than those that involve a lot of jumping and impact on your joints. Care should therefore be taken to avoid impact activities such as trampolining and gymnastics.

• Exercise can help improve strength and fitness and therefore help you to manage your fatigue.
• A blunted heart rate and blood pressure response to exercise can occur due to irregular autonomic nervous system (ANS) functioning. Use the rating of Perceived Exertion (RPE) scale to monitor training intensity.
• Ensure you take regular rest intervals, both between exercise sets and between training sessions.
• Know your limits and don’t be afraid to tell your exercise partner, coach or fitness instructor about how much you can do.
• Following a relapse, do not try to exercise until after your symptoms have ‘levelled out’ and you have completed any prescribed course of medication or steroid treatment.
• Your exercise programme should be reviewed if your individual needs change.

• Exercise cannot change how your condition progresses but it will help to maintain your muscles’ existing strength.
• Discuss the influence of spinal deformities, respiratory problems and/or cardiovascular complications with your doctor prior to beginning a new exercise programme.
• If you experience muscle weakness or atrophy, consider using a brace or splint.
• If walking or weight-bearing activities are difficult try Swimming or other water-based exercises.
• Ensure you take regular rest intervals, both between exercise sets and between training sessions.
• Your exercise programme should be reviewed regularly as your individual needs change.

• Perform a full range of exercises for unaffected muscles but exercise caution and only perform short-term exercise for affected muscles showing no signs of weakness. It is not recommended to exercise severely weakened muscles.
• Heavy or intense resistive exercise and weightlifting using polio-affected muscles may be counterproductive, as this can further weaken rather than strengthen these muscles.
• Aerobic training can therefore be more effective than strength training for maintaining overall fitness, especially if you pace your session well and allow for frequent rest periods. You should focus on the duration rather than intensity of each session to help improve fitness without inducing undue fatigue.
• Stop immediately if you experience undue fatigue, weakness or discomfort. This usually means you are doing too much!

If you experience irregular body temperature or heat sensitivity, consider the following:

• Ensure you wear appropriate clothing for the temperature of your exercise environment. In cold environments, wear extra layers and consider using hot drinks to hydrate.
• Drink sufficient fluids to remain hydrated.
• Take frequent breaks to prevent overheating.
• In warm/hot environments, try to exercise in the cooler periods of the day and in well-ventilated environments. Try using a fan, cold flannel or water spray to aid cooling.

• Get inventive! Consider alternative positions or support (wall, stable object, exercise partner) to allow you to perform specific stretches safely.
• Consider performing strength exercises in a seated position or lying on a bench, possibly making use of seat belts/wraps or stretch bands to keep your body stable and in the correct position.
• In a gym environment, try using the fixed resistance machines which will help stabilise your body and guide the direction of movement.

• If you find simultaneous bilateral movements hard (e.g. moving both arms at the same time during a bicep curl) then try exercising each side of your body separately.
• Train with a partner for support and take your time to assume the correct position.
• The use of therabands, suspension cables or towels can help you perform exercises more easily because they complement any individuality in actions.
• If you are taking part in an exercise class, ask the instructor to run through some of the movements and techniques required prior to starting the session.

• To help prevent injury, avoid using passive stretches where someone else moves your limbs.
• If you find it hard to grip weights or cables, you can use gripping aids such as flexion mitts or straps to help you perform these exercises safely and effectively.

As a wheelchair user it is quite common to experience postural problems due to slumping and/or you may have a rounded posture caused by tightness in your chest and front shoulder muscles, which can sometimes lead to shoulder problems. Flexibility training that focuses on the shoulder region along with strengthening exercises for your back muscles can help to prevent this.

If you spend the majority of your day in a sitting position this can cause tight and weakened hip flexors (the muscles that are designed to move your thigh towards your trunk). It is therefore good practice to stretch the muscles around your trunk, hips and knees on a regular basis.

A great deal of strength is required in your shoulder, arm and trunk muscles to perform daily activities such as transferring in and out of your chair. Strength training can be extremely useful in making these tasks feel easier. When performing exercises using cable machines, free weights (dumbbells) or therabands ensure you secure your brakes prior to starting.

It is important to note that strength exercises should try to use the full range of motion/flexibility that you possess as this will enhance functionality. Increased range without increased strength will not produce much benefit and conversely, increased strength in a shortened range may exacerbate issues of function.

• Pressure areas may be prone to ulceration so check your skin and reposition yourself regularly. Perform regular wheelchair push-ups to relieve pressure. You could set a reminder to do this every 15-30 minutes.
• If your level of weight-bearing activity is low you may be susceptible to osteoporosis. Taking part in physical activity will help to prevent this however, if the bones of your legs do become weak this increases your risk of a fracture if you fall. Hence, your safety and stability during any exercise is of utmost importance.