SCI and Exercise
For the last 2 years I have been attending the gym at my local council leisure centre in order to improve my strength and fitness. I was prompted to start exercising more partly because of the episode of cancer that I experienced in 2012. Exercise has been shown to reduce the chance of cancer returning (1, 2), as well as having other beneficial health effects.
The Collingwood Leisure Centre had recently been renovated to make the swimming pool and changing rooms fully wheelchair accessible (I also go swimming there but I will write about that in another post). Nothing had been done to upgrade access to the gym area, but fortunately the gym is still not too bad as far as access goes. I did however have to cross a few hurdles in order to properly gain access to the gym equipment.
"I found that the gym instructors were very helpful in assisting me to use the weights and other equipment..."
I found that the gym instructors were very helpful in assisting me to use the weights and other equipment, but eventually the gym management complained that I was using many more free one-on-one sessions with the instructors than was allowed under the conditions of my membership. I am a member of the Disability Advisory Committee (DAC) for the City of Yarra, and through them I was able to lobby successfully for dedicated twice-weekly sessions for people with disabilities to obtain extra help in the gym.
The next step was to find splints or gripping-aids that would help me connect to the equipment effectively. The gym did have some straps that were barely serviceable for strapping my hands to the machines, but by asking advice from the Austin Health physios I was able to find ideal gripping aids called Active Hands (http://abilityinmotion.com.au/products/active-hands). These were designed by a quadriplegic guy in the UK for his own use and then he went into business making them. I persuaded the gym to purchase them for my use, and for the use of others. The gym instructors are very impressed at how well they work.
I attend the gym twice a week for about 40 minutes, and I start each session with a “warm up” on the hand cycle, although in reality this is my main cardio-vascular exercise, and I am really huffing and puffing by the end of it. The remaining exercises are strength-building, using weights, cable machines and the ‘Max Rack’ which is shown in the photo.
At home I also try to stay active by pushing my manual wheelchair in the morning, doing at least two “laps” of my house and garden every 20 minutes. Before my morning attendant carer leaves, I get them to help me transfer to my power wheelchair so that I can go anywhere independently for the rest of the day. When I am in my power wheelchair I have a timer that goes off every 30 minutes to remind me to exercise for 3 minutes using a ‘theraband’ I have connected to my study door, although in reality I often ignore the timer’s alarm.
"I attend the gym twice a week for about 40 minutes, and I start each session with a “warm up” on the hand cycle... At home I also try to stay active by pushing my manual wheelchair in the morning, doing at least two “laps” of my house and garden every 20 minutes..."
"The subject of exercise can be a complex one; how much exercise is best, what type, when and, for people with a SCI, what exercise is possible? The answers to all of these questions also depend on what outcomes you are trying to achieve."
The subject of exercise can be a complex one; how much exercise is best, what type, when and, for people with a SCI, what exercise is possible? The answers to all of these questions also depend on what outcomes you are trying to achieve. In this post, I have mainly been talking about how I use exercise in an everyday way to help reduce the risk of developing some of the health problems that can occur following a SCI. For people with a SCI, there is a much higher risk of developing type 2 diabetes and cardio-vascular disease, for instance, and developing it earlier in life than people without a SCI (4, 5). There are many reasons for this, but a large part of the risk is due to the changes that happen to the metabolism when a person suddenly becomes less active following their injury (4).
Most of the evidence now supports the idea that even people who do a few intense workouts in a week may not be as fit as they think (6, 7), and that it is really long periods of inactivity that have the most negative impact on health (8). The theory goes that a trip to the gym or other intense exercise is similar to running away from a predator or chasing after a meal back when we were living as hunter-gatherers (9). However, we also evolved to be able to walk vast distances every day in search of food, and this may partly explain why we need some light activity throughout the day to stay healthy, as many researchers argue (9). This is especially relevant information for people with SCI because, for many of us, there are large parts of our day spent without much movement at all.
"Most of the evidence now supports the idea that even people who do a few intense workouts in a week may not be as fit as they think (6, 7), and that it is really long periods of inactivity that have the most negative impact on health."
It is also good news in a way because it means that even if you don’t have access to a gym like I do now, you can still achieve health benefits by doing simple things at home. In fact, the evidence suggests that for someone in a situation similar to mine, in a wheelchair but with some upper body movement, any type of upper body movement every 15-20 minutes breaks the sedentary pattern and leads to better health (7).
"Although the topic of exercise can be complex and also physically difficult for some people with SCI, the idea itself seems relatively simple: just try and find some ways to incorporate a little bit of exercise into each part of the day and you’ll be much better off."
The new Australian Nation Physical Activity Guidelines published last year recommends minimising the amount of time spent being inactive as well as getting 150 minutes of moderate or 75 minutes of high intensity physical activity per week. It also recommends including muscle strengthening exercises 2 times per week (10).
Although the topic of exercise can be complex and also physically difficult for some people with SCI, the idea itself seems relatively simple: just try and find some ways to incorporate a little bit of exercise into each part of the day and you’ll be much better off.
- Speed-Andrews AE, Courneya KS. Effects of exercise on quality of life and prognosis in cancer survivors. Current sports medicine reports. 2009;8(4):176-81.
- Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, et al. Exercise interventions on health-related quality of life for cancer survivors. The Cochrane database of systematic reviews. 2012;8:Cd007566.
- Hicks AL, Martin Ginis KA, Pelletier CA, Ditor DS, Foulon B, Wolfe DL. The effects of exercise training on physical capacity, strength, body composition and functional performance among adults with spinal cord injury: a systematic review. Spinal cord. 2011;49(11):1103-27.
- Gorgey AS, Dolbow DR, Dolbow JD, Khalil RK, Castillo C, Gater DR. Effects of spinal cord injury on body composition and metabolic profile - Part I. The journal of spinal cord medicine. 2014.
- Collins HL, Rodenbaugh DW, DiCarlo SE. Spinal cord injury alters cardiac electrophysiology and increases the susceptibility to ventricular arrhythmias. Progress in brain research. 2006;152:275-88.
- Hamilton MT, Hamilton DG, Zderic TW. Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes. 2007;56(11):2655-67.
- Manns PJ, Dunstan DW, Owen N, Healy GN. Addressing the nonexercise part of the activity continuum: a more realistic and achievable approach to activity programming for adults with mobility disability? Physical therapy. 2012;92(4):614-25.
- Power A. Reducing risk through physical activity. Perspectives in public health. 2012;132(6):269-70.
- Charansonney OL, Despres JP. Disease prevention--should we target obesity or sedentary lifestyle? Nature reviews Cardiology. 2010;7(8):468-72.
- The, Department, of, Health. Australia's Physical Activity and Sendentary Behaviour Guidelines www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines [cited 2015].