Universal Fitness Innovation & Transformation
She is 29 years old and lives with her fiancé. Diane uses a manual wheelchair full time for mobility. She has been using a wheelchair for most of life as Diane was diagnosed with spina bifida when she was born. Diane is pretty independent and has proficient wheelchair skills, however, she experiences shoulder pain from over use as she wheels to and from work every day. Diane is also concerned about developing pressure sores as is looking for strategies to avoid these painful skin conditions.
He is 45 years old and uses a wheelchair mostly for mobility (for example, if he was going shopping Tomas would use a wheelchair to go around the mall). However, he can transfer independently and is able to stand for short periods of time. He is hoping to build up his strength and endurance to improve his overall mobility (most likely with the wheelchair- he’s not trying to get rid of it!) and reduce his fatigue (right now he feels tired all the time). Tomas has was diagnosed with MS about 7 years ago and recently he has noticed that he is relying on the use of his wheelchair more and more.
Mobility is “the ability to move the body from one place to another or the ability to move the body or body components within space” (CSEP, 2002, p.II 2). This includes locomotor movements such as running, jumping, and skipping, and body movements including the head, neck and trunk.
A mobility aid is equipment or an assistive device that is designed to improve walking or mobility for someone with an impairment. Examples of common mobility aids are wheelchairs (power or manual), walkers, canes, or crutches. For the purpose of this resource, we will focus on wheelchairs as mobility aids, however, you are likely to encounter people with a range of impairments using a variety of mobility aids. The use of and equipment itself may change depending on the day and activity. The best thing to do is to talk about mobility aids during the consultation to gather more information from the participant.
Exercise is important for everyone! For people who use mobility aids, the benefits of regular exercise include:
Given the individual nature of how people experience disability and impairment, this section will highlight the importance of the consultation phase. Many staff are nervous about their first meeting and this section will hopefully make them feel a little more comfortable and better prepared to manage this first step.
Use the consultation as an opportunity to get to know the participant. In addition to gathering medical information and fitness/ physical activity experience, you will also focus on goal setting and learning about participant preferences. In addition to discussing the exercises themselves, ask the participant about how they will get to the fitness centre, and the level of support they need (if any) to access the locker room, and prepare for exercise.
You want to support the participant to be as independent as possible. Depending on the individual, this may change over time as they become more familiar with the setting and feel more confident and capable. Some participants may choose to include task-specific training as part of their goal setting (e.g., movements to help with getting out of bed, stopping and changing directions, or wheeling more efficiently).
When someone using a wheelchair comes in for their consultation think about the following:
The following safety issues are important to consider when planning and supporting exercise for people using wheelchairs
Plan ahead to ensure the wheelchair doesn’t tip over! How do you do this?
Check out NCHPAD’s resource: Discover Accessible Fitness: A wheelchair user’s guide for using fitness equipment for great tips and suggestions to improve stability during exercise (http://incfit.org/files/Discover%20Accessible%20Fitness_FINAL.pdf)
Don’t overload the wheelchair! How do you avoid this?
Assistance with Transferring
As a health club, you may want to discuss whether you will assist people with transferring from their wheelchair. Depending on the individual, transfers can range from offering a hand as the person stands on their own, to working with another person to physically perform a 2-person transfer. Different organizations may adopt different policies depending on the availability of training (if you decide to assist with transferring, proper training is strongly recommended!) and the comfort level with staff and management. There are benefits and risks associated with this decision that each club should consider – for example, how do you make a decision on a person-to-person basis? Should you have an official policy in place? What are the health risks to fitness professionals? Will you consider a weight limit for persons that are being transferred? How else can you offer assistance or support? There is no right answer to this issue- it is worth taking some time to consider how you will address it before jumping in and offering help- remember, you need to provide a safe space for both participants and staff!
Stuff you should know:
Pressure sores are caused by prolonged sitting. These can progress from slight discomfort or a small break in the skin to a full on ulcer at a risk of infection without proper attention. People who use wheelchairs are typically aware of their risk of pressure sores and may be managing one at any given time. Exercise helps to increase circulation which is good, but it also may lead to increased sweat and moisture which can make a pressure sore worse. If a participant mentions that they have a pressure sore, ask if they need anything. Remind them to shift their weight or move around every so often to decrease the pressure. This is one more reason to eat a healthy, balanced diet. Check to see how accessible your change rooms and showers are- washing after exercise and applying talc powder is a great tip. If it’s not accessible- see if there are small things you can do to make a difference.
Every person is like every other person, like some other person, and like no other person.
It’s really important that people who are new to exercise learn how to monitor and describe how they are feeling or their response to exercise. One helpful way to do this is to introduce the Rate of Perceived Exertion (RPE) scale. The smiley face RPE Scale or the OMNI scale (see below for examples of both) may be more suitable for participants with various disabilities than the age-predicted maximal heart rate (220 – age) (Stanish & Aucoin, 2007).
In the beginning, it is also recommended that participants measure their heart rate (using wearable technology such as a heart rate monitor may make this easier!). This information will help the trainer and participant to work together to learn about how the participant perceives their exertion during exercise and may help to inform programming strategies. For example, a trainer may encourage the participant to work towards a specific level of RPE, which can be complemented with information from the HR monitor to measure exercise intensity. Monitoring HR may also be useful in the event that participants are exercising at a level beyond the recommended intensity, which may happen if the participant is very engaged in the activity or trying to make a positive impression on the trainer.
Smiley Face Relative Perceived Exertion Scale
The tips and strategies found within the inclusive TIMES section will help you to create an environment that will support your participant’s participation in physical activity as independently as possible. It is important that you involve the participant whenever possible, along the way to ensure the program that you design will meet their needs physically, as well as emotionally and socially. Introducing a few simple strategies such as offering visual images of the participant’s program will help them to be more independent in completing their fitness programme. Ultimately, they will gain confidence and belief in their abilities (increasing self-efficacy) and experience self-determination (sense of control over their own destiny). This is key to establishing healthy habits that will be adopted for the long term.
National Centre on Health Physical Activity and Disability (NCHPAD). (2014). Discover Accessible Fitness: A wheelchair user’s guide for using fitness equipment.
Canadian Society for Exercise Physiology (CSEP). Canadian Physical Activity Guidelines for People with MS. Available at (Accessed 20th April 2017):
Canadian Society for Exercise Physiology (CSEP) (2002). Inclusive Fitness and Lifestyle Services for All disAbilities.
Exercise is Medicine, ‘Your Prescription for Health Series’, available at: http://exerciseismedicine.org/assets/page_documents/YPH_All.pdf [accessed 6th April 2016]
Harvard School of Public Health, ‘Healthy Eating Plate & Healthy Eating Pyramid’, available at: https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/ [accessed 9th May 2016]
Martin Ginis, K. A., Evans, M. B., Mortenson, W. B., & Noreau,, L. M. (2017). Broadening the conceptualization of ‘participation’ of persons with physical disabilities: A configurative review and recommendations. Archives of Physical Medicine and Rehabilitation, 98(2), 395-402. doi: 10.1016/j.apmr.2016.04.017.
Moore, G., Durstine, L., and Painter, P., eds. (2016) American College of Sports Medicine: Exercise Management for Persons with Chronic Diseases and Disabilities, 5th Edition, Human Kinetics, Champaign
O’Connor, F., Casa, D., Davis, B., Pierre, P., Sallis, R. and Wilder, R., (2013), ACSM Sports Medicine: A Comprehensive Review, Lippincott Williams and Williams, China
Pescatello, L., Arena, R., Riebe, D., Thompson, P., eds. (2014), ACSM’s guidelines for exercise testing and prescription, 9th Edition, Baltimore: Lippincott Williams & Wilkins
Swain, D., Brawner, C., Chambliss, H., Nagelkirk, P., Paternostro Bayles, M. and Swank, A., eds. (2014), ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription, 7th Edition, Baltimore: Lippincott Williams & Wilkins
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