SCI Forum Reports
Leisure and Fitness Activities
November 2, 1999
We all know that regular exercise is good for us. For people with spinal cord injuries, exercise is especially important, yielding such benefits as improved muscle strength, endurance, and coordination; improved cardiovascular physical fitness; prevention of heart disease; better regulation of blood pressure; reduced pain; and weight control. Yet many people do not exercise regularly due to lack of time, motivation, information about how much or what kind of exercise is best for them, or access to opportunities. For people with SCI, the obstacles can be especially challenging.
"Finding a good exercise regimen is the hardest thing to do," said Dave Tostenrude, Recreation Therapy Manager at the Veterans Affairs Puget Sound Health Care System, so he recommends that people choose activities that can be easily integrated into their current lifestyles. "Look at what you're doing day-to-day and see what you can increase in order to increase the exercise benefits." he said. Many activities that we don't necessarily think of as exercise, such as house cleaning, gardening, or throwing a Frisbee to the dog, can provide physical benefits. Any time you lift your arms above your head, you're raising your heart rate, he said. "And if you're raising your heart rate for a period of time, that's exercise."
Tostenrude also advises people to choose activities that they know they already like. "If it's something you have no interest in, you're more likely to drop it after a while." If you enjoyed skiing or cycling before your injury, and you can't afford your own adapted skis or handcycles, "look into programs such as Disabled Sports USA and Skiforall ." Sometimes insurance companies will pay for equipment if a physician can write a medical and therapeutic justification for its purchase, he said.
YMCAs and community centers can offer low cost alternatives to expensive health club memberships.If a facility has little in the way of accessible exercise equipment, Tostenrude encourages people to suggest equipment purchases to facility directors. In Seattle, people can contact the city's Parks and Recreation Department and ask for the individual in charge of special populations. Tostenrude recommended Don Krebs' Access to Recreationcatalogue of adaptive exercise equipment for those who want to purchase their own.
Tostenrude also suggested varying the location or type of activity to avoid boredom with an exercise routine. When the weather gets bad, fitness routines may have to move indoors. All of the malls have walking clubs that welcome people using wheelchairs or handcycles, he said.
Tostenrude passed around samples of simple, low-cost products that can provide exercise benefits if used properly. Hand-held squeeze balls, often sold as stress-reducers in drug stores for under $2, can "actually give a workout and build up hand strength that can work up to hand feeding," he said. Stretch bands, which come in different strengths and cost about 15 cents a foot, are often used during rehabilitation to increase range of motion, "but they can also increase your heart rate."
To provide benefit, an exercise program should consist of an activity that uses a large muscle group continuously and rhymthically for 20-60 minutes, 3-5 times a week, and raises the heart rate to 50-85% of maximum. Because people with spinal cord injuries have decreased muscle mass, altered blood flow redistribution, and altered body temperature regulation, they should consult their doctors before starting any new fitness program to determine a safe level of exercise. Exercise testing may be able to detect problems such as a drop in blood pressure during exercise or silent angina in people with high-level injuries. Your practitioner can review with you your risks for autonomic dysreflexia and problems regarding temperature regulation and over-heating during exercise.
Gardening can be a healthful, satisfying, and therapeutic activity for anyone, perhaps especially for people with disabilities, according to Kathy Morse of the Kitsap County Master Gardener Program. "The world of gardening is enormous - it can stretch your mind," she said. The history of gardening for people with disabilities dates back to World War II, when programs were begun for veterans. In the 1950s the horticultural therapy movement emerged, which recognized the therapeutic benefits of gardening for people with disabilities and chronic illnesses.
Gardening is accessible to people with disabilities through the use of various specialized structures and tools, many of which are extremely simple. Raised beds at table height and vertical gardening on lattice structures allow gardeners in wheelchairs to work easily with soil and plants. Simple terraced bookshelves can hold containers in which vegetables, flowers, and herbs can flourish within reach. Adapted tools can often be fashioned from standard garden or kitchen tools, and specially designed tools can be purchased from suppliers such as Charley's Greenhouses in Mt. Vernon, Washington (800-322-4707).
While enjoying the pleasures of gardening, "make sure you have shade in your work area, take plenty of breaks, and drink plenty of water," Morse said.
An excellent resource for people with disabilities who would like to start gardening is The Enabling Gardener, by Gene Rothert, who has paraplegia. One internet resource is the American Horticultural Therapy Association..The NW Chapter contact for the American Horticultural Association is Jerry Anderson, 1636 Ash St., Forest Grove, OR 98116.
The Master Gardener Foundation of Kitsap County is developing an adaptive garden as part of the Master Gardener North End Demonstration Garden at the Northwest College of Art in Poulsbo, Washington. Scheduled for completion in the summer of 2000, this garden will demonstrate methods for creating barrier-free gardens as well as adapted tools and plantings that make gardening easier. Call the Kitsap Master Gardener Program at 360-337-7157 for more information.
Bitten Duggan became involved in the arts following a traumatic brain injury. "The arts enabled me to express things that words couldn't express." She is now the Adult Program Director for VSA Arts of Washington (formerly Very Special Arts), an organization offering a variety of art classes and activities for adults with disabilities.
"We now offer eight classes in the area, primarily in visual arts, which teach different techniques for different hand strengths," she said. Artists with insufficient hand function are fitted with helmets with paintbrushes attached. For photography classes, cameras mounted on wheelchairs require only a pull of a string to take the photo.
Other VSA Arts programs include an artist residency program in the schools, arts education conferences, festivals, a directory of artists with disabilities, an annual art exhibit, and a gallery. For information, a class list, and a calendar of events, call VSA Arts of Washington at 206-443-1843.
"I like to get my exercise doing things I enjoy," said Charlene Curtiss, a dancer with paraplegia whose wheelchair dance company, Light Motion, offers performances and workshops for people with and without disabilities. Her style of dance has come to be known as integrated dance, "which I like to call crips and standups," she said. It uses the contact improvisation method, involving touch, weight-sharing, and counterbalance between and among dancers. "You can get a lot of exercise and enjoy it without going professional," she said. "The thing I like about improvisation is you can create movement with a person in an original way."
Curtiss does not view severe disability as a hindrance to dance. "You can create a dance regardless of disability," she said. "We created a dance with a man on a respirator."
Curtiss, who has performed internationally and conducted VSA Arts-sponsored residency programs in Washington state, offers a monthly dance workshop and "jam" in Seattle for disabled and non-disabled dancers. Call her at 206-328-0818 for information.