More MS news articles for February 2000

Pace yourself

It's the best way for the disabled to gain the benefits of exercise

Tuesday, February 15, 2000

By Patti Murphy

Wanna work out?

Then go for it. But go slowly. When your body's compromised, pacing yourself beats pushing yourself.

Disabilities rarely mean that you can't exercise. Don't fret if you're not athletic. It's OK to focus on stretching, light lifting or doing a partial aerobic workout. Exercise can be helpful whether it's for a few 10-minute intervals every day or an hour three times a week.

Becoming limber can be liberating. If you're consistent, exercise improves stamina and complements your ability to perform daily activities. It reduces medical complications for people in wheelchairs and allows those with progressive disorders to maintain a high level of functioning, say physical therapists Kevin F. Lockette and Ann M. Keyes in "Conditioning with Physical Disabilities," their well-known adaptive fitness manual (Human Kinetics, 1994).

Exercise is good for your self image.

"There's a certain kind of contentment that you feel," said Mark Major, a quadriplegic, wheelchair athlete and founder of the Exercise Center for the Physically Challenged, which opened in October near San Francisco. "You persevere through the day much easier. When you learn to move more smoothly, you become more independent."

But, he said, folks often leave rehab programs unprepared to stay fit. Insurance covers just so much therapy and it's hard to find
disability-friendly fitness clubs or classes, Major said.

What do you do when you're on your own?

For safety, discuss your workout plans with your doctor. The scope of your workout and your performance will have a lot to do with whether your disability is static or dynamic, say Lockette and Keyes.

With static conditions, such as a spinal cord injury or some amputations, exercise has no remarkable affect on your physical state as it does with dynamic conditions, such as multiple sclerosis, cerebral palsy, a head injury or stroke. Abnormal muscle tone from cerebral palsy, for instance, may increase with temperature changes, fatigue or emotional stress and limit your fitness efforts.

Medical clearance is critical; you may need a doctor's approval even when all you want to do is stretch. Lockette and Keyes, who based their book on a conditioning and strengthening program they developed at the Rehabilitation Institute of Chicago, say to avoid stretching without consulting a doctor if you have: joint deformities, osteoporosis, a history of joint laxity or dislocation, tissue or joint abnormalities from surgery, surgically placed materials to stabilize fractures or pain that limits movement or has not been evaluated by a professional. Ditto for an infection, swelling or open wound in the area you want to stretch.

After your doctor gives the OK, follow these strategies:

1) Know your range of motion and limitations before you choose exercises. If you need the support of your arms to rise from a chair, for example, pick movements to strengthen the legs. If it's taxing to turn your upper body to reach behind you or your main activity is pushing a wheelchair, work your shoulders to promote flexibility and prevent rotator cuff injuries.

If you're an amputee, your back and abdominal muscles need attention. If one side of your body is paralyzed, strengthen the limbs you can use.

2) Keep your body's symmetry in mind. Alternate an upper-body exercise with a lower-body exercise or movements on the left and right side of your body, if you can. Bilateral exercises help with balance and coordination. If your body has a weaker side, do more repetitions on it.

"If we get strong in one movement and forget about the antagonist movement, we're asking for problems," said Ted Cibik, an adaptive fitness trainer in Leechburg. "If you don't have that balance ... your daily activities suffer."

3) Take breaks, but rest wisely. Too much or too little rest will render your workout ineffective. Lockette and Keyes recommend rest periods of 2 to 4 minutes during general strength training, 2 minutes or less for muscle endurance activities such as wheelchair road races, swimming and long distance walking. The length of your rest periods should stay the same as you increase the duration or intensity of your workout.

Another sensible habit: Exercise on alternate days or do a split routine where you work different muscle groups (shoulders and back or chest and arms, for example) on alternate days.

Get used to saying "enough" and starting over.

"Have the wisdom and the insight to back off to let your body heal," said Cibik, who's had asthma since childhood. You may have to curb or stop exercise, for instance, when symptoms of a disorder such as multiple sclerosis or muscular dystrophy exacerbate. The same goes for when you're recovering from a cold or flu, which can put you out of commission longer the average person if you have a chronic condition, Cibik said.

Patti Murphy writes a monthly column on disabilities. You can e-mail her at