Get Fit

By Michael Hayden

Most people have little exercise experience. Many of these same people have a burning desire to try. This article is directed at you! Perhaps you have been sedentary most of your life, yet you want and need to exercise to remain healthy and to maintain the degree of self-sufficiency you currently enjoy.

Any individual, especially one who has a disability, may find himself or herself faced with a few hurdles. The most commonly asked questions are: What type of fitness professional do I need? Do I have to go to a gym? Does my type of disability matter? These questions are important and should be clarified before beginning any exercise program.

There are dozens of exercise principles and thousands of exercises out there to choose from. You can’t expect your physician to be up to snuff on each one. However, you should always seek approval from a family doctor before starting any exercise program. Many of the top physiotherapists and fitness professionals have extensive referral networks going on with medical professionals, so ask your doctor if he or she recommends someone.

The primary step when choosing an exercise professional is, personally or with help, to figure out your functional goals and needs. I would suggest that the first criterion for choosing your exercise program is that the prospective "trainer" includes this type of screening in his or her consultation. During the screening, the professional should be able to answer all your exercise questions, and should have a network in existence where he or she can refer you if he or she is unable to work with you, e.g. if you are not physically fit enough to begin exercising.

The screening is for you as well. Ask if the trainer is insured in case of mishap and whether he or she has current CPR skills. Ask your prospective trainer about his or her education and certifications. Preferably he or she has a degree in kinesiology, but experience with clientele who have disabilities is more important. Find out if the trainer is certified by a well-respected, recognized body, such as the American Council on Exercise (ACE), YM/YWCA, Canadian Society of Exercise Physiology (CSEP) or National Strength and Conditioning Association (in the U.S.A.) -- and, most importantly, if he or she is certified in adaptive fitness.

A balanced exercise program includes effective aerobic, strength and flexibility components. Your "trainer" should be able to design a program that addresses each of these. Hire the type of trainer who offers one-on-one instruction -- who will evaluate and monitor your progress, not just write you out a program and then send you on your way.

Knowledge is the key to success, so book just one session to see if the two of you are compatible. (A single session usually costs anywhere from $20 to $50, depending on your area of need.) If you are not looking forward to working with this individual because he or she does not have enough to offer, or you simply don’t like him or her, the greater the chance you are going to give it all up. Exercise should be fun, first and foremost.

Secondly, choose a trainer who will evaluate and monitor your progress. A proper exercise professional should be able to teach you, motivate you, accommodate your needs and understand and work around obstacles you thought insurmountable.

Don’t let a trainer tell you that you need to go to a gym if you do not want to. An in-home program can address all your fitness goals and can save you the cost of a membership if you are on a tight budget. You do not need expensive, high-quality treadmills or variable-resistance strength machines. You can still derive benefits using inexpensive accessories such as dumbbells, dynabands, straps, Swiss balls, bean bags and canned goods. Many trainers take equipment to you, in order to turn your home into a temporary gym. If you have some equipment, the trainer should be able to incorporate it into your program.

The most important aspect of any in-gym or in-home program is improving the strength and range of motion of the body parts used throughout common daily activity, for example, transferring to the tub, toilet or bed, dressing, walking (whether assisted or not), gripping objects and balancing. Also, your trainer should have knowledge of rehabilitation exercises for overuse injuries commonly experienced by people with disabilities. Bursitis and tendonitis of the shoulder and elbow are just two of the common injuries I deal with. The exercises prescribed should work to strengthen and stretch these muscles and joints, by mimicking their movements.

If you want to be more social, then a gym is a great place to meet people. But scrutinize the facility carefully first. Is it accessible? Are the machines accessible? Is there a trainer qualified in adaptive fitness on staff? If not, will they allow an outside trainer in with the expertise needed? The choice of exercises is the same as the in-home program. The advantage is that you have a wide variety of equipment to use.

A healthy weight-management and cardiopulmonary component of each program is very important. It is essential in helping people make a lifestyle change from a sedentary to a more energetic one, which will help them steer clear of health risks. Herein lies our biggest challenge. Most people with disabilities such as spinal cord injury, multiple sclerosis or cerebral palsy will not be able to use some aerobic equipment or elevate their heart rates for long enough. This is because many clients with disabilities cannot use the large musculature of the lower extremities usually applied during aerobic activities such as biking or jogging. Modifications such as braces for balance, a hand-crank ergometer and rowing machines can be used to achieve aerobic needs. However, when using the hand-crank ergometer or rowing machine, the weaker, smaller upper-body muscles will usually fatigue long before duration goals are achieved.

An experienced trainer will be able to use an adapted heart-rate formula to measure and monitor your heart rate to allow you to work in the proper zone for your age and required goal. The recommended duration of aerobic exercise is 15 to 60 minutes of continuous activity. Your trainer will also be able to use alternate exercise principles such as interval training, which is a work/rest period training to equal these time goals.

Most importantly, the trainer should have specific knowledge associated with certain disabilities that can pose extraordinary exercise problems which you, the client, may not even know about. For instance, people with spina bifida can often have an allergic reaction to the latex found in dynabands and surgical elastic. Cloth-covered bungie cords should be substituted. Many wheelchair users exhibit overuse injuries in shoulder joints and tight anterior musculature. As well, people with cerebral palsy may have high tonality muscles. Both these groups require excessive static stretching before beginning to exercise.

The trainer should also screen for any medication that you may be taking and understand and work around any adverse side effects. For example, some people with spina bifida or spinal cord injuries commonly experience urinary tract infections. Certain antibiotics, such as floxcillans and sulfamits, have been found to cause weakening of the connective tissue around the joints. Call your local pharmacist for a list of possible side effects of any medications you are taking.

Don’t ignore the responsibility of learning about the specifics of your disability yourself. Come armed with as much information as possible. The time wasted fine-tuning your program because of exercise complications will cost you money.

A proper fitness professional should be a motivator, teacher, coach and friend. Let him or her help you make a lifestyle change. Remember, a lack of motivation and training can lead to your giving up or getting bored. A trainer can keep things interesting and fun.

(Michael Hayden, B.A., YM/YWCA, ACE, CSEP, OASES, is Vice-President of Top Shape Inc. For more information, contact him or Peter Morel at (613) 730-8035, or e-mail: topshape@webruler.com or pmorel@shoc.ca. To locate a fitness professional in your area, contact the Canadian Society of Exercise Physiology at (613) 234-3755.)