PUSH IT: When people tell me they walk or push their wheelchair daily, that's great, but I follow up by asking if they are walking at an intensity that constitutes exercise, and if not, that needs to be a new goal.

Exercise: It's All About Intensity

If you have a disability, it is even more important to get enough exercise because your ability to move throughout the day while doing daily activities is limited, which increases your risk for heart disease and diabetes.

I'm sure you've heard about the importance of incorporating exercise into your life, but do you do it? If you have a disability, it is even more important to get enough exercise because your ability to move throughout the day while doing daily activities is limited, which increases your risk for heart disease and diabetes. If you are a caregiver, it can be difficult to set aside time for yourself, but it is important to get exercise to stay healthy, and prevent injury.

Rehabilitation therapies are very important for people in any stage of their recovery from an injury or living with a disability. As a physical therapist, I know the value in getting as much therapy as you can. However, therapy sessions rarely focus on improving your cardiovascular fitness. There are a number of reasons for this, but mainly if therapists have limited time to spend with you individually, that time is best spent working on the activities you need their skills to improve. Unfortunately, many therapists often skip the important discussion of incorporating an exercise routine outside of your therapy sessions. Should you have any questions about if you're safe to exercise, how to exercise and options of where to exercise, make an appointment with your physical therapist.

WHAT IS EXERCISE?

The definition of exercise is "physical activity that is planned, structured and repetitive for the purpose of conditioning any part of the body. Exercise is used to improve health, maintain fitness and is important as a means of physical rehabilitation." The reason this is important is because exercise goes above and beyond your daily activities. Doing housework or yard work is physical activity, but it's not exercise. And the difference can often be clarified by considering the intensity at which you feel like you're working. Let's focus on cardiovascular exercise, also known as aerobic exercise. This is your walking, jogging, wheelchair pushing, swimming, cycling, dancing, etc. It's activity that can be sustained and improves your endurance. Aerobic exercise enhances glucose regulation (i.e. helps manage or prevent diabetes,) improves blood pressure and improves arterial function. It can also help improve your memory, and decrease depression and anxiety.

Heart rate is one way to monitor your intensity, however there are a number of factors that can impact your heart rate's response to exercise. There are medications that may impact heart rate; if you have a diagnosis that impacts your autonomic system, your heart rate response may not be reliable; etc. Rather than getting a heart rate monitor, there is a simple 1-10 scale that you can use.

As your fitness improves, it'll take more work to get to the same intensity. That's great! It means you're getting stronger and reaping the benefits of your work. But it also means you can't get complacent with your exercise routine, and you'll need to step it up.

When I ask people what their exercise routines consist of, I often hear their physical therapy schedule, which we have already discussed and it is different than exercise. Or I hear that they walk or push their wheelchair daily, which is great. But I follow up by asking if they are walking at an intensity that constitutes exercise, and if not, that needs to be a new goal.

Also, if you use a wheelchair, consider exercises that use different muscles than the ones you're using all day to push your chair and transfer. This can exacerbate shoulder pain. Think about exercise that use more of the muscles in the back of your shoulders and include pulling rather than pushing. Trying different sports is a great way to push the intensity.

"As your fitness improves, it'll take more work to get to the same intensity. That's great!"

It's recommended you get 30 minutes of "As your fitness improves, it'll take more work to get to the same intensity. That's great!" aerobic exercise five days per week. If you can't sustain an activity for 30 minutes, you can break that activity down into three intervals of 10 minutes and take rest breaks. Again, if you have any questions about whether you're safe to exercise, how to exer cise safely and/or how to increase the intensity, make an appointment with your physical therapist. •

THE FITNESS PRIORITY

Kristin McNealus, PT, DPT, ATP received her Masters in Physical Therapy from Boston University then went on to earn her Doctorate in Physical Therapy from MGH Institute of Health Professions. She has been a staff physical therapist on inpatient rehabilitation for people with spinal cord injuries at a number of hospitals in Southern California, as well as Director of a community adaptive gym for people with neurological injuries. She is a member of the International Network Spinal Cord Injury Physiotherapists, and has contributed to the APTA Guidelines for Exercising with a SCI. She has completed 3 marathons, and 25 triathlons, including the Ironman! SCI Total Fitness is designed to promote health and wellness for people with physical disabilities.