Long-term care (LTC) residents who rely on wheelchairs for mobility run a greater risk of diminished mental acuity and depression, as well as complicated health issues, including Type 2 diabetes, high blood pressure and coronary heart disease. Pressure sores may develop on those who are confined to a wheelchair, and excess weight gained from a sedentary life adds strain on the joints of the musculoskeletal system, contributing to osteoarthritis.
A Journal of the American Geriatric Society study shows that inactive women at age 65 have a life expectancy of 12.7 years, whereas active, nonsmoking women at 65 have a life expectancy of 18.4 years. Other studies have shown that strength training was as effective as medication in reducing depression in older adults.
For residents in wheelchairs, 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 for a healthier and happier life. What’s more, exercise improves a resident’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 exercise regimens, it is imperative that each person discusses his or her individual exercise plan with a physician, who can offer some suggestions or prohibit chair exercises that may be either too strenuous or too likely to aggravate an existing medical condition.
HELPING LTC RESIDENTS HELP THEMSELVES
Regardless of the resident’s age, physical condition or whether he or she ever has exercised in the past, several techniques can help a resident overcome his or her mobility issues. Be sure to consult with a physician to determine what exercises are appropriate for each resident. Any type of exercise will benefit a person’s health but, in general, clinicians should aim to incorporate these important types of exercise into the wheelchair user’s routine:
Basic leg crosses. Leg crosses 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 his or her leg out.
- Have the person 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 resident’s heart rate and help to burn calories.
- Wrap a lightweight resistance band under the wheelchair and have the resident perform resistance exercises, such as chest presses, for a count of one second up and two seconds down. Have him or her 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 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 individual sit straight up in the wheelchair and lift up both arms toward the ceiling, and then slowly move them back down. 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 eight times.
- Have him or her perform exercises such as shoulder presses, bicep curls and triceps extensions using light weights. Aim for two to three sets of 8 to 12 repetitions for each exercise, adding weight and more exercises as strength improves.
- 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. Flexibility is important for enhancing range of motion, preventing injury and reducing pain and stiffness. Even with limited mobility in the legs, a resident still can benefit from stretches and flexibility exercises to prevent or delay further muscle atrophy.
- Stretching can be performed by having the resident use the floor or his or her body weight to provide resistance to the muscle group being stretched. An occupational therapist should be on hand to help target muscles and joints by helping the person stretch beyond his or her usual range of motion.
Chair Chi. This exercise program is based on the principals of Tai Chi and Qi Gong but designed for residents in LTC environments. Chair Chi requires no special equipment but can be used to help people receive the benefits of traditional Tai Chi and Qi Gong.
Most movement in Chair Chi begins and ends with the muscles and back, and can include any number of poses. Motion remains mostly slow—the slower, the better the results. Working against gravity, the body weight provides resistance as great as some weight-bearing activities and, according to the Mayo Clinic, Chair Chi is a zero-impact exercise.
Yoga. Most yoga poses can be modified or adapted depending on 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.