Introduction: Strength & Fitness Exercises for People With Disabilities

About: Appreciate what you've got, every day will bring something new.

I volunteer with an organisation called AccesSports which takes activites that the most agile of athletes find challenging and brings these sports to children and adults with disabilities. The exhilaration inherent to each sport is just a part of the experience which fosters positive change in function and fitness as well as attitude and expectation for a life lived with a disability. Programs are designed to promote each person's highest physical and athletic potential while cultivating social and emotional well being. We seek to create a community where differences are diminished, blurred and often erased. Our programs are designed to build a community of relationships that last a lifetime.  This video gives an overview of the some of the activities athletes participate in.

However, before the exciting sports activities can start, a stretch and fitness work-out happens first. We use games to engage our athletes - for example, heading soccer balls, doing oblique crunches or finishing song phrases before coming up from a squat. Then we work on aerobic conditioning using options like obstacle courses or other movement drills, often with soccer balls. The point is to safely elevate the heart rate of our athletes for a few minutes. Even if the athlete is in a power chair we might emphasize something like raising their leg or arm or rocking while moving in the chair. Next we teach a soccer skill - for example, trapping the ball, learning to pass with the inside of the foot or a move. This is the last half hour of class; the focus eventually is to use the skill in a game in the last 10-15 minutes. Again, the drills are fun and driven by team competition. The drills can be relay races, juggling contests or even soccer bowling (kicking balls off cones). The final game is small sided so everyone gets a chance for many touches of the ball. Each session ends with a cheer.

Step 1: Exercises: Leg Presses & Abductors

With the athlete on his/her back and feet straight up in the air. We do leg presses with a trainer leaning on 1 or 2 of the athletes feet. We prefer close chain exercises (i.e. squats) but often get better form with trainer's body weight. After a set we go right to either 1 or 2 legged bridges. We generally avoid reps here and hold for 20 seconds instead.

With athletes with high tone and extremely tight hamstrings, we do either lying abductor splits or standing weight shifts.

Lying abductors is where with the athlete on his/her back the trainer sits by the athlete's feet and put their hands under the feet to provide resistance or to be a gliding aid as the athlete tries to work on abduction. We make sure the feet stay on our hands on the ground so hip flexors cannot be a part of the exercise. The legs have to stay straight through as well.

The weight shift exercise is demonstrated in the following two videos

3 sets of leg presses and 3 of bridges or abduction.

Step 2: Excercises: Pushups

Trunk stability is the aim and we target the inner/outer obliques as well as the tranverse abdominals. Next we move to push ups, with more physically involved athletes, we'll do push up in which a trainer is over the athlete using hand pressure guiding them through the motion. With the less involved we give the command "bottoms up" in which they wiggle or push anyway the can until the are on all fours with the "bottom" high in the air. We straighten out and perform a negative rep in which they slowly lower themselves back to the floor. We repeat for 10 -20 reps. Sometimes we do push-ups against the wall. With the same amount of repetitions. Elbows in and down on these as we're trying to avoid a pectoral imbalance. If an athlete lives with paraplegia then we double these upper
sets while the others work on lower body.

We switch to sitting up with a trainer facing each athlete. We work on the opposing muscles to the push ups and perform low rows in a cross handed hand shake with the trainer offering enough resistance for fatigue and not failure. With athletes who have high tone (i.e. elbow flexion from Cerebral palsy or stroke) this exercise is done with light resistance and very slowly. This way the exercise doesn't contribute to negative bicep tone. 3 sets of each.

Step 3: Exercises: Oblique Crunches

We encounter many athletes who have issues with hip flexion that is counter to hip abduction and a stable stance/gait, we avoid straight crunches or sit ups. Instead we use side planks, straight planks, oblique crunches and side bends with resistance. We perform the exercises in a group circled around on mats. The group performing the exercise at the same time generally brings about total compliance from all of the athletes.

Step 4: Exercises: Aerobic Drills, Walking

After the core work - we start run/walking for 15 minutes. Sometimes with a soccer ball and sometimes over an obstacle course, we make the drill appropriate to the cognitive levels present. With athletes working on gait, we try to work on form and spend the time doing weight shifting in place while being held up, side walking, backwards walking, and knee drive walking -often with trainer manipulation. It's good to have extra volunteers here to
double up on these athletes. Whenever possible, a full body, weight bearing work-out will elicit better conditioning results than just pushing a wheelchair. Of course many athletes are simply great at pushing their chair through courses and games without the ability to stand. But whenever possible we aim for weight bearing.

We try not to reinforce bad habits or form in ambulating so we don't send athletes out running for the sake of running until we can accommodate better form.

Walking - Supported

Step 5: Steps

We often adapt parts of the environment to aid in the physical exercise required for individuals.  In this examples, stairs are used as a way to exercise thigh muscles flex at the hip. These include Illiacus, Psoas Major, Sartorius and Rectus Femoris.

Stairs are a challenge for many athletes and tackling them in a controlled & supportive environment improved cognition and confidence.

Step 6: Conclusion

If you can practice some of these exercises 3-5 times/week then you can hope for a level higher in function that will result in better physical, emotional, and cognitive being.

We've seen our athletes who work out 1 time/week see a change in perception (that our athlete begins to see themselves as just that - an athlete), some physical improvement, emotional, and cognitive gains. The work-outs are designed in concert with therapies which are current to each athlete.

The "carrot" we hold out for each athlete is the game of soccer and incorporate soccer drills and games into most of our sessions. We begin with core routines and then move to 4 compound exercises for opposing muscle groups of upper and lower extremities.

We try to perform 20+ repetitions with each exercise. Many of the physically involved athletes have lost slow twitch muscle tone/strength. Low weight/high repetition is more appropriate and safer regardless.

We spend the last half hour doing soccer drills. Often these are adapted to support our training goals - such as an outside kick for someone working on abduction or a head ball to the side with someone working on trunk control.

We finish with a game - usually we break the group into smaller teams so everyone gets a lot of touches.

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