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.