Incorporating Activity into Life

Posted by Nurse Linda in Life After Paralysis on December 30, 2020 # Health, Mobility

Activity is an essential fuel for the body. Movement can enhance flexibility and increase your mental health. Your body responds positively to movement if you sense it or not. For those with decreased sensation, the body still responds to movement if done actively or passively. There is evidence that activity or movement of the body assists in regeneration of the nervous system in addition to helping with joint flexibility, muscle effectiveness, blood circulation, reduction of edema, and improvement in skin, bladder, and bowel function. wheelchair on track

So, who does not want activity in their life? Well, most of the entire population. Getting people to exercise with or without movement challenges is difficult. People see the benefit but fail to carry it through. This is the time of New Year's resolutions. Many people resolve to increase exercise in their life. They join gyms. By mid-January or at least by February, this resolution will be in the rear-view mirror for most. Adding mobility challenges and incorporating exercise into life becomes even more trying.

You can use some strategies to help you toward the goal of activity/movement/exercise. The first is to think about the activity in realistic terms. When people say they are going to start an exercise program, they immediately think of an Olympic style of movement—working all day on activity, gaining strength quickly, and reaching the pinnacle of success.

There are people who accomplish this goal with and without neurological injury. That is fabulous and congratulations to them. We all wish them much success. However, most individuals do not have this mindset, although we probably would all like to have it. People often jump to the endpoint of a challenge, not thinking about the hard work to get to such a goal.

Instead, think about what can be done simply. It might not be easy but think about the simplest movement task to complete using your body skills. It might be doing going from sitting to standing three to five times in a row if your abilities allow standing. It might be rolling in bed from side to side a few times, either on your own or with assistance. It could even be someone passively moving body parts that are difficult for you to move on your own. These are some ideas. You will think of others.

Many of you will already be doing some activity with your body above your level of injury but think about what you can do below where your body is getting little input. Moving your body includes all of it, even the challenging parts.

Exercise is a repetitive movement. Your daily transfers, pressure releases, and body propulsion are movements but typically not completed in repetitions needed to be exercised. You can add some reps to your daily activities that help, but exercise is a much more focused process.

Once you decide what you would like to do, check with your healthcare professional to start an exercise program within your individual health status ability. Your body needs to be ready to avoid complications such as moving blood clots, heart and respiratory challenges, and bone fractures.

Some diagnoses put a person at increased risk with exercise due to cardiac or respiratory function, muscle wasting diseases, and blood clots. Be sure to get an opinion from your healthcare professional to make sure you are healthy enough to begin your exercise program.

Tell your thoughts about your exercise plan to your healthcare professional. They will be able to tell you if the movement is safe for you as an individual. They can also tell you if you can and should do more, perhaps starting with a more aggressive plan or building up to additional movement. They may enlist the help of a physical therapist to guide you through the process.

If you are just beginning to add movement, think about how long it has been since you did the physical exercise to your body, especially below the level of injury. If you have had a stroke or brain injury, it might be how long since you have moved a side or a part of your body. If it has been a while, you will definitely want to begin slowly. Move your body gently. Aggressive movement can harm muscles, joints, and bones that are not accustomed to the activity.

Set limits to the amount of time spent exercising. You can slowly build as you become used to your routines. It is easy to begin 'gung-ho,' but your body is not ready for that level of movement. Even if you cannot feel exercise trauma or fatigue of muscles, your body will.

When adding activity to areas of your body with decreased sensation, you might not feel damage to your body, but your body will still respond to it. You might notice swelling, redness, or warmth over an area. These are indications that something is wrong. You might not receive the message that you have overstretched or over-exercised your body. Your body will be sending messages of pain, but you might not receive that message. Instead, you might have increased spasticity. You can develop autonomic dysreflexia (AD) or increases in AD episodes. If you have a lower-level injury, you might see swelling or an enlarged joint from inflammation.

As a person moves, heat is generated from within the body. After spinal cord injury, temperature regulation can be affected. Sweating below the level of injury might be affected by the neurological injury. Monitor yourself for overheating when moving. You may need to exercise in a cooler environment or use cool towels to help regulate your body temperature. Others, such as those with Multiple Sclerosis (MS), may need to use a cooling vest. If in a pool, cold water can trigger issues such as temperature dysregulation toward hypothermia. The pressure of water in a pool setting can also trigger AD.

Blood pressure management can be an issue with exercise. Following SCI, blood pressure naturally lowers. Circulation from the legs may be slow in returning to the heart leading to orthostatic hypotension (OA) or low blood pressure, especially when changing positions or exercising. The use of elastic stockings, abdominal binder, and good hydration can help this issue.

When exercising, the muscles in the abdomen can be stimulated. This can lead to an unplanned bowel movement or an increase in urine output. Plan to exercise after a bowel program if this becomes an issue and check your leg bag frequently.

Once you have worked through the above preparation and planning, it is time to begin movement or exercise. Starting your exercise program gradually with gentle movements in a time-controlled situation can help avoid some of these issues. Your mind might be thinking you can do more, but your body will still respond to over-exercise. It is better to be cautious before moving forward.

These sites contain the amounts and types of exercises that should be performed. It will show you how much exercise and what types of exercise after SCI have been researched. These are guidelines. You might need to work toward meeting the guideline as opposed to just starting at the suggested performance standard. There are other guidelines for activity as well. Your healthcare professional may have one that they think will best fit your needs.

The Christopher and Dana Reeve Paralysis Foundation

SCIRE (Spinal Cord Injury Research Evidence) Community

MSKTC (Model System Knowledge Translation Center)

University of Washington Northwest Regional Spinal Cord Injury System

Locations for exercise or activity can be as simple as in your own home. You may want to branch out to an adapted exercise center, a local gym, or a public pool. If you do any exercise anywhere, be sure the equipment is in good order and that there are protections in place for your safety and needs. Make sure a person with experience is helping you. They have worked with individuals with spinal cord injury or other diagnoses before. That person should be equipped to assess and supply first aid or other healthcare initiatives.

It is not advised to begin a new exercise program in a public area right now. When it is safe to do so, check the establishment carefully. Do not assume things are happening just because you are told they are. In these days of COVID-19 and other contagious bacteria and viruses, note the cleanliness of the facility. Check to make sure the equipment you are using is cleaned between individuals. Make sure safety precautions are actively used.

Keeping to your resolution to add movement to your life can be a commitment. If you start slowly, you will be more likely to continue. Nurse Linda

Pediatric Consideration:

Providing exercise for your child is sometimes easier because of the size of the child. It is easier to lift and move smaller limbs and bodies. However, exercise can be a challenge due to spasticity, autonomic dysreflexia (AD), or orthostatic hypotension (OA).

You have spent time with your child in the rehabilitation center, so you might already be aware of some activities. It is essential that you begin by talking with your child's healthcare professional about their individual needs.

Some guidelines for exercise with children can be found at various web sites, from their healthcare professional or from your child's discharge instructions. Your local SCI center for pediatrics will have some as well. This is one site that has pediatric guidelines:

CS Mott Children's Hospital, Michigan

Local resources are a great start for the pediatric community. Use the Near Me app on the Christopher and Dana Reeve Paralysis website to find locations near you. If there is nothing specific to SCI and children, try other diagnostic groups and organizations in your area. Teachers and school physical therapists are also great resources of local availabilities. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.