This is a part of the Hot Topic podcast series from the Model Systems Knowledge Translation Center on Exercise and Fitness After Spinal Cord Injury. Lynn Worobey, PhD, DPT, ATP, researcher, discusses Things to Watch Out for When Starting an Exercise Routine.

So there are a lot of challenges that can come with being more physically active, too. So things like blisters. There’s a risk of injuries. So some people think, “I don’t want to be playing quad rugby. I don’t want to be knocked out of my chair. Like that seems dangerous.” Other people find that exciting. But I think that starting things in a safe way, so knowing kind of your body’s limitations. So after a spinal cord injury, there are sort of a different set of things to think about. So sometimes people might have a lower blood pressure. So thinking about how we get that and keep that up so it’s safe to exercise. Skin protection is another important thing. So making sure that if you’re in your chair, you have a good pressure relieving cushion. If you’re transferring to something else, that you skin is also protected as part of that activity.

Based on your level of injury, your heart rate and temperature responses might be different. So if your injury is T6 or above, you’re more susceptible to those kinds of not necessarily being regulated the same. So giving yourself a nice ample warmup and cooldown period. And then also measuring your exertion differently. So a lot of people think of “Well, I’m going to measure my heart rate, and that’s how I’m going to tell if I’m working hard.” But based on your injury level, that might be blunted, so you might not be seeing an increase in that. So a perceived level of exertion or something like a talking test where you’re kind of seeing — are you able to talk and still hold a conversation? Are you a little short of breath? Are you really winded and you can’t kind of talk? … are other ways that you can measure exertion.

Something to think about in terms of exercise with spinal cord injury is the risk of overuse injuries. So if somebody’s in a manual chair, they’re pushing their chair a lot in the same pattern. There’s a lot of risk for overuse. So part of what we can do to combat that is strengthen specific muscles. So strengthen the rotator cuff. Strengthen the muscles that support the shoulder blade. Get them in a good position. But also be mindful of overuse when you’re exercising. So doing the same thing every day is not good exercise. We want to work different muscle groups. We want to work muscle groups that are different than the ones that we’re using to push every day.

And a lot of this comes in terms of consequences. So there may be bigger consequences for overuse injuries for somebody that’s using a wheelchair than somebody who’s able-bodied. So getting shoulder surgery for somebody in a wheelchair is pretty devastating. So if you’re not weightbearing on that arm, you’re not pushing, you’re not transferring, your level of independence is completely out the window. And we also know that sometimes things like pain and limitations aren’t resolved even after surgery. So the more that we can do to be proactive and prevent these type of injuries, the better people will be.

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