Bladder Health Week, November 16-22, 2008
In honor of Bladder Health Week we are posting information on bladder care during exercise. Today we will focus on those with Spinal Cord Injuries. Wednesday’s focus is for those with Multiple Sclerosis and Thursdays focus will be Resistance Training for those with physical disabilites. As posted at: National Center on Physical Activity and Disability
• Prevents secondary conditions such as cardiovascular disease, diabetes, pressure sores, carpal tunnel syndrome, chronic obstructive pulmonary disease, hypertension, urinary tract infections, and respiratory disease.
• Prevents deconditioning and obesity
• Provides psychological and/or recreational benefits
Best Exercises for Persons with SCI
• Aerobic exercise to maintain cardiovascular health
• Strength training to maintain the ability to perform activities of daily living and mobility, as well as to prevent injury through muscular balance
• Flexibility training to improve range of motion and reduce spasticity
Important Considerations When Exercising
• Incontinence (flaccid or neurogenic bowel/bladder) - Individuals with lesions above the sacral level experience a loss of control with their bowel or bladder.KEY: Monitor urinary cycle, be sure to empty your bowel and bladder before starting exercise.
• Spasticity - This condition is characterized by high muscle tone and hyperactive stretch reflexes. It typically occurs in the muscles below the site of injury and is exacerbated by exposure to cold air, urinary tract infections and physical exercise.KEY: You should stretch spastic muscle groups and avoid exercises that cause excessive spasticity. When you are at home you should extend your legs as often as possible.
• Autonomic Dysreflexia - A sudden rise in blood pressure resulting from an exaggerated autonomic nervous system response to noxious stimuli below the level of injury, usually due to bladder/bowel overdistension or blocked catheter. Symptoms include profuse sweating, sudden elevation in blood pressure, flushing, shivering, headache, and nausea.KEY: Seek medical attention immediately when it occurs.
• Orthostatic hypotension - A drop in blood pressure (greater than 20 mmHg for systolic blood pressure and greater than 10 mmHg for diastolic blood pressure). It occurs in upright postures, especially moving from supine to upright sitting/standing/head-up tilt. Symptoms include nausea, dizziness and light-headedness.KEY: Monitor blood pressure throughout exercise, avoid quick movements, perform orthostatic training (if available), maintain proper hydration, and use compression stockings and an abdominal binder. If orthostatic hypotension occurs, lie in a supine position with your feet elevated.
• Thermoregulation - Irregular body temperatures are often experienced by individuals with SCI.KEY: Wear appropriate clothing, drink plenty of fluids and take precautions in certain environments; in warm environments, a fan and water spray will aid in cooling, and in cold environments, wear extra layers.
• Pressure sores (decubitus ulcers) - Damage to the skin or underlying tissue caused by prolonged sitting, using old wheelchair cushions, sitting on hard surfaces, shear forces or as a result of a fall.KEY: Check skin regularly and perform wheelchair push-ups. (See strength training section for protocol.)
• Transfers - Be sure to follow appropriate guidelines.
• Balance - Use straps or other physical assistance to hold the trunk in position during upright exercise.
Cardiovascular Training Guidelines
The American College of Sports Medicine (ACSM) recommends performing 20 to 60 minutes of continuous aerobic exercise or multiple sessions of short duration (approximately 10 minutes) for three to five sessions per week. For individuals just starting an exercise program, a circuit training program is effective.
Aerobic exercise can be monitored using an individual’s maximal heart rate (MHR) or rating of perceived exertion (RPE). MHR for individuals with SCI is significantly lower than for individuals without SCI while RPE should be moderate to somewhat strong. See NCPAD’s General Exercise Instructions factsheet for more information.
Quadriplegia
MHR typically does not exceed 100 to 125 bpm, and training intensity should be between 50% and 70% maximal heart rate. Therefore, an average target heart rate (THR) falls between 65 and 91 bpm.
Arm ergometry is a preferred type of exercise training for individuals with quadriplegia. Be sure the wheelchair is locked, the hands are secured to the equipment (straps can be used for stability and balance) and the ergometer is in a fixed position.
Paraplegia
The MHR of individuals with a lesion T1 to T6 is suppressed; however, for lesions below T6, the MHR is closer to the age-predicted maximum. Training intensity should not go above 70%.
Types of cardiovascular training that benefit individuals with paraplegia are wheelchair ergometry, upper-body calisthenics, rowing machine, sports: (basketball, track, swimming, quad rugby), and functional electrical stimulation-leg cycle ergometer (FES-LCE).
Strength Training Guidelines
• Training sessions should be held three days per week.
• Refrain from training the same muscle groups on consecutive days.
• Upper-body pushing and pressing exercises (bench press, overhead press) will help transfers and wheeling, while pulling/rowing exercises will help prevent shoulder overuse injuries and improve sitting posture.
• Perform wheelchair push-ups every 10 to 30 minutes and hold for 30 to 60 seconds. When doing wheelchair push-ups, be sure to bend the elbows slightly.
• Use straps or a partner for stabilization and balance.
• Vary exercises to reduce over-use injuries and emphasize muscle groups that are still functional.
Types of strength training that benefit individuals with SCI are free weights, weight machines (Nautilus, for example), medicine ball, wall pulley, and theraband.
Flexibility Training Guidelines
Flexibility training is important to prevent contractures (permanently shortened muscles). Paralyzed muscles should be passively stretched by an exercise specialist; specifically, the hamstrings, adductors, hip flexors, plantar flexors, and lumbar extensors.
Types of flexibility training are:
• Passive resistance
• Theraband
• Standing in a standing frame (if not medically contraindicated).
Important Safety Considerations
• Get physician consent.
• Regularly monitor blood pressure, heart rate, RPE, and symptoms.
• Stop exercising if you feel pain or discomfort.
• Don’t exercise if you are ill (i.e., cold, flu, bladder infection, pressure ulcer, unusual spasticity).
• Check medications and their effect on exercise tolerance.
• Extended periods of inactivity may cause osteoporosis.
Special thanks to Dr. Steven Figoni and Bridget Collins.
Note
The information provided here is offered as a service only. The National Center on Physical Activity and Disability, University of Illinois at Chicago, the National Center on Accessibility, and the Rehabilitation Institute of Chicago do not formally recommend or endorse the equipment listed. As with any products or services, consumers should investigate and determine on their own which equipment best fits their needs and budget.
National Center on Physical Activity and Disabilityhttp://www.ncpad.orgncpad@uic.edu(800) 900-8086 (voice and TTY)(312) 355-4058 (facsimile)
As posted at: National Center on Physical Activity and Disability