Fitness for People in Wheelchairs


In 2018, Nikki Walsh’s life took a sudden turn when she woke up in a hospital bed, paralyzed from the chest down from a car accident. Despite her challenges, a new purpose emerged from her limited mobility. Walsh, a 33-year-old certified personal trainer with a degree in kinesiology and exercise science from Penn State University, helps people in the wheelchair community, including herself, harness the power of fitness. 

A year after that near-deadly accident, Walsh decided to shift her focus from trying to walk again to rebuilding her overall strength, focusing on the muscles she uses most: her upper body and core. 

She felt nervous about going to the gym solo, a barrier faced by many wheelchair users, she says, so she asked a friend and fellow personal trainer for support. Since then, “exercise has been my saving grace,” Walsh says. “I feel like myself again.” 

Stronger muscles can help you transfer in and out of your wheelchair. But exercising around people gives Walsh a sense of community and an outlet to ease stress and anxiety.  “When you’re just sitting around alone thinking about your disability, you’re way more likely to be in a down mood,” she says. 

Exercise can be a challenge if you have limited mobility, but it’s important to get enough of it. Regular physical activity can lower your odds of getting health problems that stem from inactivity and long-term wheelchair use. 

The good news is, “there’s adaptive everything at this point,” Walsh says. “No matter your abilities, you’ll be able to find something that works for you.” 

According to Frank Greco, a certified inclusive fitness trainer at Northwestern Medicine Marianjoy Rehabilitation Hospital near Chicago, all adults, including people who use wheelchairs, should aim for at least 150 minutes of aerobic exercise each week along with 2 to 3 days of strengthtraining, if possible.

But everyone’s starting fitness levels and abilities are different. While you should still try to exercise at least 3 to 5 days a week, “you can start at the bare minimum,” Greco says, “and then adjust your goals as you go along.” 

In general, wheelchair users should target endurance and strength in the upper body, Greco says, especially the muscles in your shoulders, wrists and hands, rotator cuff, triceps, and trunk – the muscles in your lower back, upper back, chest, and abs. And don’t forget to stretch. 

By improving your overall fitness, upper body strength, and flexibility, Greco says, you’re less likely to get overuse injuries and muscular imbalances that are common among people in wheelchairs. Regular exercise can also go a long way to boost your quality of life, self-esteem, and self-reliance.

Independence getting it back or maintaining it  is a huge goal for many wheelchair users when it comes to fitness. And a strong upper body and core can give you the confidence and power to go from your wheelchair “into your bed, onto the couch, into a car, or onto the toilet,” Walsh says, “without constantly relying on a caregiver, friend, or family member.” 

Other benefits of regular exercise for wheelchair users include: 

  • Better upper body posture
  • Less risk of falling out of your chair during everyday tasks
  • Less fatigue and depression
  • The ability to go to work
  • Lower risk of health problems like heart disease and obesity

Sue Lephew, 55, a client who works with Greco, is a big believer in the benefits of exercise for wheelchair users. Lephew hasn’t been able to walk since her spinal cord injury at the age of 17. She’s developed back and nerve problems after 38 years of sitting, but regular exercise helps ease some of that pain. 

Increased strength and stability have also lessened her fear of falling when she transfers and prevents pressure sores. “You can lift yourself a lot longer and do a better job of shifting your weight,” Lephew says. 

There isn’t one type of physical activity that’s best for everyone. It depends on your abilities, fitness goals, and what you want to do with your body every day. But there are three types of exercises to focus on: cardiovascular, strengthening, and flexibility. 

Flexibility exercises include things like adapted yoga or simple 5 to 10-minute stretches you do before or after a workout or during the day. Lephew stretches every day, sometimes “for hours.” 

When it comes to strength-training exercises for people who use wheelchairs, Greco recommends using weights or resistance bands to do a variety of things that target your big and little muscles, such as: 

  • Shoulder presses
  • Lateral raises
  • Reverse grip flies
  • Tricep extensions
  • Bicep curls

Trunk exercises are also key. “Including what we call the Pallof press,” Greco says, which is when you pull a weighted cable or resistance band toward the center of your chest while using your ab and back muscles to stabilize your core.

To further strengthen your belly, back, and upper body, Greco says, you can do the following: 

  • Abdominal twists or crunches with resistance bands
  • Variations on rows and pull-downs
  • Chest presses 
  • Modified push-ups

Any movement is better than none. But try to do aerobic exercises for at least 25 to 30 minutes most days of the week, if possible. What kind of cardio is best for people who use wheelchairs? “Really anything that’s going to get your heart rate up,” Greco says. 

Examples of aerobic exercises for people in wheelchairs include: 

  • A seated stroll around your neighborhood
  • Adaptive or modified cycles or bicycles 
  • Wheelchair-accessible rowing machines 
  • Swimming
  • Wheelchair sprinting
  • Basketball, tennis, softball, soccer, or other wheelchair sports 
  • Adaptive skiing, dancing, or sailing 

Lephew’s go-to for cardio is a tabletop arm bike. She uses it at home for 40 minutes a day, at least five days a week. She sometimes leads a small dumbbell workout class at the Marianjoy fitness center. “Arms by Sue, we call it,” Greco says. 

If you have access to a safe space, you can exercise outside or inside your home. Check out the YouTube channel for the National Center on Health, Physical Activity and Disability (NCHPAD) if you’re looking for free exercise-from-home videos. 

But rehabilitation centers and some mainstream gyms offer adaptive fitness classes and accessible exercise equipment, including weight-lifting machines that let you move the seat out of the way, so you don’t have to transfer out of your wheelchair.

If you’re new to exercise, ask your doctor to refer you to a fitness trainer or physical therapist who works with people who use a wheelchair. These exercise experts can create an at-home workout plan or teach you how to use free weights or adaptive equipment with or without a trainer at a gym. 

“There’s always an initial run through when someone first comes in (to the fitness center),” Greco says. “You don’t want someone sitting at a machine wondering: How the heck do I get this thing to move? How do I adjust the seat or turn myself?”

You might feel more comfortable working with an adaptive fitness trainer or athlete coach who has limited mobility themselves, like Walsh, who offers virtual or in-person workout sessions for people of all ability levels. “Many of my clients come to me saying they’re happy they found a wheelchair user who gets it,” Walsh says.   

What if you meet with a physical therapist or trainer and you don’t click? “Keep searching,” Lephew says. “There’s going to be someone out there who understands you and your needs.”

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