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wheelchair exercise

I was recently asked to write an article for our friends at the Long Term Living Magazine on the topic of patient care and exercise for mobility challenged patients. It’s an interesting topic and something that deserves focus. Exercise remains a critical component of our lives, no matter what our age or capability. Most all of us are capable of doing some sort of exercise and just might need to think creatively to find the right solution for more challenging cases. Below is the article that was published in the Long Term Living Magazine 5/29/2014. Please enjoy!

Long-term care (LTC) residents who rely on wheelchairs for mobility run a greater risk of diminished mental
acuity and depression, as well as complicated health issues, including Type 2 diabetes, high blood pressure
and coronary heart disease. Pressure sores may develop on those who are confined to a wheelchair, and
excess weight gained from a sedentary life adds strain on the joints of the musculoskeletal system,
contributing to osteoarthritis.

A Journal of the American Geriatric Society study shows that inactive women at age 65 have a life expectancy of 12.7 years, whereas active, nonsmoking women at 65 have a life expectancy of 18.4 years. Other studies have shown that strength training was as effective as medication in reducing depression in older adults.
For residents in wheelchairs, physical exercise is essential for increasing blood circulation, spine stability, posture and
flexibility. Exercise generates endorphins, body awareness and muscle strength while relieving stress and enhancing self esteem for a healthier and happier life. What’s more, exercise improves a resident’s ability to achieve a deeper and more restful sleep, which is essential for preserving emotional and physical health.

For some residents, medical conditions may exclude certain chair exercises. Also, for those just starting exercise regimens, it is imperative that each person discusses his or her individual exercise plan with a physician, who can offer some suggestions or prohibit chair exercises that may be either too strenuous or too likely to aggravate an existing medical condition.

HELPING LTC RESIDENTS HELP THEMSELVES
Regardless of the resident’s age, physical condition or whether he or she ever has exercised in the past, several techniques can help a resident overcome his or her mobility issues. Be sure to consult with a physician to determine what exercises are appropriate for each resident. Any type of exercise will benefit a person’s health but, in general, clinicians should aim to incorporate these important types of exercise into the wheelchair user’s routine:

Basic leg crosses. Leg crosses are good options for seniors who have at least mid-range leg strength. The goal is to simply get the muscles working.

  • Have the patient carefully kick his or her leg out.
  • Have the person cross the legs and then alternate.
  • Repeat this task a number of times.
  • Finish up the exercises with ankle circles.

Cardiovascular. A series of seated, repetitive movements will raise the resident’s heart rate and help to burn calories.

  • Wrap a lightweight resistance band under the wheelchair and have the resident perform resistance exercises, such as chest presses, for a count of one second up and two seconds down. Have him or her try several different exercises to start, with 20 to 30 reps per exercise, and gradually increase the number of exercises, reps and total workout time as endurance improves.
  • Have the resident punch the air with or without hand weights.

Strength training. If the resident has limited mobility in his or her legs, focus on building upper body strength.

  • Have the individual sit straight up in the wheelchair and lift up both arms toward the ceiling, and then slowly move them back down. Alternate the movement by lifting up one arm while the other is stretched out toward the ground, similar to picking apples off a tree. Repeat these movements eight times.
  • Have him or her perform exercises such as shoulder presses, bicep curls and triceps extensions using light weights. Aim for two to three sets of 8 to 12 repetitions for each exercise, adding weight and more exercises as strength improves.
  • Resistance bands can be attached to furniture, a doorknob or the wheelchair. They can be used for pull-downs,shoulder rotations and arm and leg-extensions.

Flexibility. Flexibility is important for enhancing range of motion, preventing injury and reducing pain and stiffness. Even with limited mobility in the legs, a resident still can benefit from stretches and flexibility exercises to prevent or delay further muscle atrophy.

  • Stretching can be performed by having the resident use the floor or his or her body weight to provide resistance to the muscle group being stretched. An occupational therapist should be on hand to help target musclesand joints by helping the person stretch beyond his or her usual range of motion.

Chair Chi. This exercise program is based on the principals of Tai Chi and Qi Gong but designed for residents in LTC
environments. Chair Chi requires no special equipment but can be used to help people receive the benefits of traditional Tai

Chi and Qi Gong.
Most movement in Chair Chi begins and ends with the muscles and back, and can include any number of poses. Motion
remains mostly slow—the slower, the better the results. Working against gravity, the body weight provides resistance as
great as some weight-bearing activities and, according to the Mayo Clinic, Chair Chi is a zero-impact exercise.
Yoga. Most yoga poses can be modified or adapted depending on the resident’s physical condition, weight, age, medical
condition and any injury or disability. Wheelchair yoga is an exceptional option for residents with chronic obstructive
pulmonary disease or multiple sclerosis.
Exercising is equally important for wheelchair users as it is for able-bodied LTC residents, and perhaps even more important given their susceptibility to other conditions. Despite the mobility restrictions wheelchair users face, wheelchair exercise can be a rewarding way of maintaining good health and mental ability. As a group activity, exercise for wheelchair users also can serve as a fun social activity that can be integrated into a daily and weekly schedule.
Getting wheelchair users on a consistent exercise routine tailored to their needs and abilities will help them attain better flexibility and range of motion, greater strength and energy, relief from pain and increased tranquility. It can also help improve breathing capacity for residents with asthma and emphysema, while burning fat and calories, lowering cholesterol and helping to alleviate symptoms of osteoporosis, osteoarthritis, arthritis, bursitis, tendonitis, fibro/polymyalgia and neuropathy.

wheelchair exercise for the elderly

Nursing home residents are physically frail, and possibly approaching the end of their lives. So what’s the point of exercise, especially for someone in a wheelchair?  Too often, I believe, professionals and staff in long-term care environments accept this defeatist attitude.

Unfortunately, this then passes on to the resident and becomes a self-fulfilling prophecy: Long-term care residents in wheelchairs avoid exercise and decline further.

Lack of activity leads to joint degeneration, heart problems, stroke, congestive heart failure, diabetes, and a range of other chronic medical conditions including blood clots and painful, persistent pressure sores.

On the other hand, study after study lately has shown that exercise, even by frail elders, improves cardiovascular health, cognition, and overall quality of life. The Centers for Disease Control and Prevention says that exercise benefits people with arthritis by reducing pain, delaying disability, and improving mobility, function, and mood. Other studies have shown that strength training was as effective as medication in reducing depression in older adults. It can help improve breathing for residents with asthma and emphysema, while burning fat and calories, lowering cholesterol, and helping to alleviate symptoms of osteoporosis, osteoarthritis, arthritis, bursitis, tendonitis, fibro/polymyalgia, and neuropathy.

 

Obviously, nursing home residents in wheelchairs are as prone as anyone to sedentary living. One of the most common consequences of using a wheelchair is weight gain, resulting from a more sedentary lifestyle. Yet even for this population, physical exercise is essential for increasing blood circulation, spine stability, posture, and flexibility.

Exercise generates endorphins, body awareness, and muscle strength, while relieving stress and enhancing self-esteem. What’s more, exercise improves a patient’s ability to achieve a deeper and more restful sleep, which is essential for preserving emotional and physical health.

For some residents, medical conditions may exclude certain chair exercises. Also, for those just starting out their exercise regimens, it is imperative to discuss any exercise plan with a physician. Yet in my years as a rehabilitation specialist caring for individuals recovering from strokes and traumatic brain injury, and now as a supplier of wheelchairs to people needing them, I have concluded that, regardless of the resident’s age, physical condition, or whether or not the person exercised in the past, there are a number of techniques for helping a chair-bound individual overcome mobility issues.

Exercises for Wheelchair Users

Any type of exercise will benefit wheelchair-bound residents’ health, but in general, clinicians should aim to incorporate these important types of exercise into their routines:

Basic Leg Crosses — These are good options for seniors who have at least mid-range leg strength. The goal is to simply get the muscles working.

  • Have the patient carefully kick one leg out, cross the legs, and then alternate. Repeat this task a number of times. Finish up the exercises with ankle circles.

Cardiovascular – A series of seated repetitive movements will raise the patient’s heart rate and help the person burn calories.

  • Wrap a lightweight resistance band under the wheel chair and have the resident perform resistance exercises, such as chest presses, for a count of one second up and two seconds down. Have the person try several different exercises to start, with 20 to 30 reps per exercise, and gradually increase the number of exercises, reps, and total workout time as endurance improves.
  • Have the wheelchair bound resident punch the air with or without hand weights.

Strength Training – If the resident has limited mobility in his or her legs, focus on building upper body strength.

  • Have the person sit straight in the wheelchair and lift both arms toward the ceiling and then slowly bring them back down. Have them alternate the movement by lifting up one arm while the other is stretched out toward the ground, similar to picking apples off a tree. Repeat these movements 8 times each.
  • Have the person do shoulder presses, bicep curls, and triceps extensions using light weights. Aim for 2 to 3 sets of 8 to 12 repetitions for each exercise, adding weight and more exercises as strength improves.
  • Instead of weights, resistance bands can be attached to furniture, a doorknob, or the wheelchair. They can be used for pull-downs, shoulder rotations, and arm and leg-extensions.

Flexibility is important for enhancing range of motion, preventing injury, and reducing pain and stiffness. Even with limited mobility in the legs, a resident can delay further muscle atrophy by stretching. Stretching can be performed by having the resident use the floor or their body weight to provide resistance to the muscle group being stretched. An occupational therapist should be on hand to help them target muscles and joints and to stretch beyond their usual range of motion.

 

  • Chair Chi is an exercise program based on the principals of Tai Chi and Qi Gong, tailored to people in long-term care environments. Requiring no special equipment, the movements are circular and never forced; the muscles are relaxed rather than tensed; and the joints are not fully extended or bent. Motion remains mostly slow – the slower, the better. Working against the body’s weight provides resistance as great as some weight lifting, with zero impact.

 

  • Yoga poses can be modified or adapted to the resident’s physical condition, weight, age, medical condition, and any injury or disability. Wheelchair yoga is an exceptional option for residents with chronic obstructive pulmonary disease or multiple sclerosis.

 

Exercising is just as important, and perhaps even more important, for wheelchair users as for able-bodied long-term care residents. Despite mobility restrictions, wheelchair users can find exercise a rewarding way of maintaining good health and mental ability. As a group activity, wheelchair exercise also can serve as a social activity in the weekly schedule.

 

Better flexibility and range of motion, greater strength and energy, improved breathing capacity, relief from pain, increased tranquility—who would want to deny any of that to a person just because he or she is sitting in a wheelchair?

 

About the Author

Craig Hood is executive vice president of Allegro Medical, a supplier of home medical supplies and equipment. He has worked as a rehabilitation specialist caring for individuals recovering from strokes and traumatic brain injury. He formed Allegro Medical to supply products for post-acute care and the treatment of chronic conditions.

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