How people with disabilities can overcome barriers to physical activity

Five years ago, Sheila Goble, a 49-year-old retired teacher, wife, and mother of two, suddenly lost control of the right side of her body and collapsed on her bedroom floor. A ruptured blood vessel was bleeding into the surrounding regions of her brain.

“One minute, I was getting dressed to go for a morning walk, and the next minute, I was on the ground,” Goble, now 54, recalls.

In September 2017, Goble suffered a hemorrhagic stroke, which accounts for approximately 13 percent of all strokes in the United States, according to the American Stroke Association. Without immediate medical attention, the risk of permanent disability and brain damage increases significantly.

Racing against the clock, she was rushed to a nearby hospital in Michigan, where doctors determined that her stroke occurred in the basal ganglia and the internal capsule—brain regions responsible for coordination and movement. Goble lost feeling and was paralyzed on the right side of her body.

No longer able to walk on her own, she relied on a wheelchair to get around and needed help performing the most basic tasks, such as using the bathroom, bathing, and brushing her teeth. For years, Goble had advocated for disabled people as a special education teacher, and now found herself with a disability of her own.

Goble was referred to the Shirley Ryan AbilityLab, a Chicago-based physical medicine and rehabilitation hospital that specializes in traumatic brain and spinal cord injuries, neurological disorders, stroke, and amputation.

As she passed through the facility’s sliding glass doors, she was greeted by a large, bright mural that read, “The soul moves first.” For Goble, this message hit home.

“I don’t know where my recovery’s going to be,” she recalls thinking. “There’s no certainty in this. I could be using a wheelchair for the rest of my life. I could learn to walk again. We don’t know. There’s no guarantee." Goble admits feeling frightened but also grateful to be alive.

Determined to continue living a healthy life with her disability, Goble began working out several times a week with an exercise physiologist, who helped her adapt exercises to focus on what she could do, rather than what she couldn’t.

Adapting to increased physical activity

Whether people are born with a disability or develop one, like Goble, due to an illness, injury or chronic condition, regular physical activity can help improve quality of life and reduce the risk for other health issues or complications.

Researchers have examined the benefits of regular exercise among diverse groups of people with disabilities stemming from trauma and chronic conditions, including:

• Stroke
• Spinal cord injuries
• Parkinson’s disease
• Muscular dystrophy
• Cerebral palsy
• Amputation
• Alzheimer’s disease

Studies show that physical activity offers a range of notable health benefits. These include improved heart and muscle fitness, brain health, and ability to perform routine daily tasks.

“When you see a person fully engaged in a consistent exercise program, you start seeing a drive to become better and stronger,” says Aleksandra Gebska, lead exercise physiologist at the Shirley Ryan AbilityLab’s Adaptive Sports and Fitness Center. “We see people have more stamina, more self-confidence… Their attitude toward life changes as they find ways to overcome their challenges and ways to do things differently.”

The amount of exercise experts recommend for adults with disabilities is the same for those without disabilities. Disabilities may mean you have serious difficulty:

• Walking or climbing stairs
• Hearing
• Seeing
• Concentrating, remembering, or making decisions

For some people, their level of ability or the severity of their condition may affect their physical activity. But overall, most adults who are able should get at least 150 minutes (2 hours and 30 minutes) of moderate-intensity physical activity each week, or at least 75 minutes (1 hour and 15 minutes) of vigorous-intensity physical activity. In addition to aerobic activity, adults who are able should also aim to engage in muscle-strengthening activities that involve all major muscle groups at least two days per week.

But only 38 percent of adults with disabilities get the recommended amount of aerobic activity, compared to 54 percent of adults without disabilities. This makes them three times more likely to develop diabetes, heart disease, stroke, cancer, and other chronic conditions. Only 14 percent of disabled adults meet the recommended guidelines for both aerobic and muscle-strengthening exercise, compared to 23 percent of abled adults, based on data from the American College of Sports Medicine.

People with disabilities who are not able to meet federal exercise recommendations should do as much as they can and avoid inactivity.

It’s important for anyone starting a new exercise program or adapting to a disability to work with their healthcare provider (HCP) or a trained exercise specialist to learn what types of activity are safe and appropriate for them. Some possible examples of aerobic activities for those with physical limitations include:

• Walking with assistive devices
• Aquajogging or water aerobics
• Hand-crank/arm bicycling
• Portable pedal machines
• Rower-cycling
• Seated basketball, football, tennis, softball, or volleyball
• Swimming
• Propelling oneself in their wheelchair

People in wheelchairs may be able to do certain arm-muscle strengthening exercises while seated, such as shoulder presses, bicep curls, or lateral raises with dumbbells. Stretching while lying down or in a seated position, along with certain yoga or tai chi moves, can also improve mobility and flexibility.

Small steps can turn into miles

Exercise can seem daunting for people with disabilities, especially when their strength, endurance, balance, and coordination are affected. But Gebska believes that small changes can lead to big results.

In fact, research shows that exercise doesn’t have to be done in lengthy sessions to provide notable health benefits. Small bouts of activity have benefits, which can add up over time.

People who have been sedentary may start with 10 minutes of exercise a day, Gebska explains. They can gradually increase their activity by adding short exercise sessions done throughout the day. For example, to reach their goal for the day, people in assistive devices can split up their activity into multiple “mini workouts” such as:

• 5 minutes of walking with their walkers or propelling in a wheelchair
• 5 minutes of resistance band work in the afternoon
• 5 minutes of stretching in the evening

In her practice, Gebska has seen a transformation in many of the people she has helped, noting they are often initially frustrated over what they can’t do because of their disability. But over time they shift their focus to what they can do. In many cases her patients exceed their own expectations—doing much more than they thought they were capable of doing.

“Especially when you go through some tragic event, people often focus on what they cannot do and on their limitations,” Gebska says. “That's what's clouding the whole future of getting fit. We really show them that—through resources and the way we work with them—the sky is the limit of what a person with disability can do.”

Finding resources to reach your goals

While it can be intimidating starting a new fitness regimen, health experts recommend the following tips:

• Write down your goals, thoughts, and ideas in a journal.
• If you have access to a gym, make sure it's compliant with Americans with Disabilities Act Standards.
• If possible, work with an exercise physiologist or physical therapist to modify hobbies and activities that you enjoy.
• Join an adaptive sports league available through various nationwide organizations.
• Find home fitness apps and online videos or classes for virtual workouts.
• Consult an HCP before starting a fitness regimen to develop a workout plan that is safe for you.

Fitness is a never-ending journey

Through intensive training and physical therapy, Goble was able to regain more movement in her right arm and leg. Her goal was to be able to walk on the beach again with her family and friends.

To help retrain her muscles, one of her exercises included walking in a gait harness over bean bags to simulate the uneven beach terrain. Her consistency paid off. Five years after her stroke, Goble is able to walk on the beach unassisted. The recovery from her stroke is ongoing and her gait can be unsteady at times, but she continues to stay active outdoors and takes virtual workout sessions through the Shirley Ryan AbilityLab’s tele-fitness program.

She knows physical fitness is a lifestyle—not a destination. She is determined to do what she can to stay active and keep her brain and heart healthy.

“I've learned to have faith in the human body [and] how our bodies can adapt and get stronger—even in the littlest of ways, no matter our age or our abilities,” Goble says. “Exercise, for me, has not just been my way of getting stronger. It's been my confidence booster. It's been my outlet for frustrations. It's been my way to live a healthy lifestyle in order for me to live a long life with my husband, adult children, and close family and friends.”