The health benefits and constraints of exercise therapy for wheelchair users: A clinical commentary

Abstract

BackgroundThere are approximately 1 billion people living with chronic lower limb disability, many of whom are wheelchair users.ObjectivesReview cardiometabolic and neuromuscular risk profiles of wheelchair users, benefits of regular exercise and the causes of neuromuscular upper limb and hip injuries that hinder regular adherence.MethodLiterature published between 2013 and 2017 was adopted according to the standard practices for systematic reviews (PRISMA) through Crossref Metadata and Google Scholar searches. Individual paper quality was evaluated using a modified Downs and Black Appraisal Scale.ResultsThe literature search identified 16 600 papers which were excluded if they were non-English, non-peer-reviewed or published before 2013. Finally, 25 papers were accepted, indicating that sedentary wheelchair users have poor cardiometabolic risk profiles (PCMRP) because of a lack of physical activity, limiting their quality of life, characterised by low self-esteem, social isolation and depression. Their predominant mode of physical activity is through upper limb exercises, which not only improves their cardiometabolic risk profiles but also precipitates neuromuscular upper limb overuse injuries. The primary cause of upper limb injuries was attributed to poor wheelchair propulsion related to incorrect chair setup and poor cardiorespiratory fitness.ConclusionWheelchair users have a high body mass index, body fat percentage and serum lipid, cholesterol and blood glucose concentrations. Empirical investigations illustrate exercise improves their PCMRP and cardiorespiratory fitness levels. Although literature encourages regular exercise, none discusses the need to individualise chair setup in order to eliminate wheelchair pathomechanics and upper limb neuromuscular injuries. Wheelchair users must be encouraged to consult a biokineticist or physiotherapist to review their wheelchair setup so as to eliminate possible incorrect manual wheelchair propulsion biomechanics and consequent overuse injuries.

Playful Interactive Systems to Support Physical Activity Among Wheelchair Users

“…The fact that the authors chose to use focus groups also caused some limitations, most importantly the fact that they could not distinguish individual's data from a group. Ellapen et al (2017) reported a summary of 25 papers that indicated that sedentary wheelchair users have poor cardiometabolic risk profiles (because of a lack of PA, limiting their quality of life, characterised by low self-esteem, social isolation and depression (Ellapen et al, 2017). Wadey and Day (2017) also identified 10 themes in their work examining barriers, facilitators, and benefits to PA for amputees (Wadey and Day, 2017).…”

“…Previous literature encourages wheelchair users to engage in PA; however, they do not describe the initial challenges that wheelchair users experience (Ellapen et al, 2017). Reasons for this include unique environmental, programmatic and attitudinal barriers e.g.…”

The benefits of hydrotherapy to patients with spinal cord injuries

“…A primary goal of exercising is to increase PWSCI’s energy expenditure, thereby improving their poor cardiometabolic risk profile (La Fountaine et al 2015 ). In order to increase energy expenditure, the rehabilitation programme’s frequency, intensity and duration are increased, so that in turn it often leads to more upper limb injuries (Ellapen et al 2017 ). Ellapen et al ( 2017 ) reported that habitual use of the same upper body exercises leads to overuse orthopaedic injuries and boredom, resulting in poor rehabilitative exercise adherence.…”

“…In order to increase energy expenditure, the rehabilitation programme’s frequency, intensity and duration are increased, so that in turn it often leads to more upper limb injuries (Ellapen et al 2017 ). Ellapen et al ( 2017 ) reported that habitual use of the same upper body exercises leads to overuse orthopaedic injuries and boredom, resulting in poor rehabilitative exercise adherence. Strydom et al ( 2009 ) reported that variation in habitual exercise and rehabilitative regimes increases patient adherence and subsequently is able to positively impact the realisation of the programme objectives.…”

Editorial

“…The manuscripts published in this special issue are within these research areas and provide examples of the most recent evidence guiding the wheelchair sector in less-resourced settings. The effects of wheelchair services through different service provision models (domains 1 & 2) are described in Bazant et al ( 2017 ), Shore ( 2017 ) and Ellapen et al ( 2017 ). Policies (domain 2) related to accessibility to building infrastructure and higher education in Africa are covered in Yarfi, Ashigbi and Nakua ( 2017 ) and Chiwandire and Vincent ( 2017 ), respectively.…”