This is our compilation of exercise routines and tips from various sources that can be helpful in promoting improved wellness and conditioning for everyone, including those persons with a disability or chronic condition. This compilation is provided for information purposes only to help you make informed wellness choices that you can discuss with your personal health professional(s).

Exercises For Disabled Military Veterans

From Military.com

by Stew Smith


This article is probably one of the most important articles I have done. I hope to help this disabled veteran and others with some creative ideas for fitness.

This is the email I received:

"I am a disabled veteran who subscribes to Military.com, and when catching up on old issues after my vacation, I found a reference to your Stretching Plan for use before starting any exercise plan."

"I find your articles very interesting, but there is one area I wish you could cover. There are a number of disabled veterans I know who subscribe to Military.com and they might also be interested in this. Many of us are permanently very physically limited due to our injuries and medical conditions."

"In spite of this we are still interested in keeping in shape as best we can, as well as keeping our weight in check. It is very difficult to find exercise plans that address this. Could you make a plan/article for us? Many of us are living on our disability checks and don't have gyms or other facilities available or the funds to pay for expensive plans, so I think it would really be appreciated. I know I would really appreciate it."

Thank you,
Disabled Vet

No - Thank YOU! I have written several articles already that may help you, but this one will focus on how I have helped disabled veterans and amputees with creative fitness ideas in the past. This article will focus on a variety of ways to perform many of the exercises you used to do in the military, or at least work the same muscle groups.

You may need some special equipment like dumbbells, rubber bands, or wrist and ankle weights, but they are inexpensive and can be found in most of your physical therapy clinics. The following link will give you access to my free "45 Day Beginner Program" (PDF) with pictures of all the stretches and exercises I discuss in this article.

For starters some related articles for you to check out are the following:

Fitness on a Budget
Fitness as We Age 
- Food Plan for Weight Loss
Lower Back Workout 
- Shoulder Workout 
- Circuit Training

Stretching Can Do it All

First of all, the stretching plan you asked about earlier is ideal for just about anyone. The stretches can be performed standing up, on the floor, or in a chair if needed. Holding stretches for 45-60 seconds can actually have an isometric effect on your muscles meaning you can actually work the muscle by stretching. The muscle actually contracts after nearly a minute of stretching it. That is one reason why people who do yoga look so toned. So when all else fails, do the stretching plan until your feel your muscles start to contract.

Upper Body Exercises:
Chest, Triceps, Biceps, Abs, Lower/Upper Back and Shoulders

Pushups

You know how to do them. But with certain injuries working your chest, triceps, and shoulders with this exercises maybe challenging. Many people have issues with their wrists not bending properly. What I would recommend in this case is to do a pushup on a set of hexagonal dumbbells where you can place the heel of your palm on the bar without bending your wrist. Another option is to do the pushups on your fists. Lay a towel under your hand unless you are a hardcore martial artist who likes to toughen up the fists. Here are some other alternatives:

Floor Bench Press

Other chest, triceps and shoulder alternatives can be done with wrist weights or dumbbells while lying on the floor on your back like you would do a bench press exercise. Shoot for as many as you can with the given weight you select for 3-4 sets.

Rubber Band Pushups

Wrap the center of the band around your upper back and grab the end of the bands in your hand and push away from yourself using the same motion as the pushup or bench press. You can do this sitting down or lying down. Depending on the tension, do as many as you can 3-4 times.

Military Press and Triceps Extensions

Using dumbbells, wrist weights, or elastic bands, these exercises can be done sitting in a chair or standing. Raise your hands over your head and then bend your elbows so your hands are behind your head. Repeat this motion for 10-15 times for at least 3-4 sets.

See the "The Best Shoulder Workout" article for an even better shoulder workout that can be done with dumbbells, wrist weights, or bands.

Chair Dips

Lift yourself out of your chair 10-15 times for 3-4 sets. See bench dip picture for details. This is a functional and challenging exercise for your triceps.

Torso Exercises:
Abs, Lower / Upper Back

Depending upon the severity of your injury, you may be able to do all or some of these exercises. It is best to try these while lying down on the floor, but you can do them in a chair if need be.

Crunches

By just lifting your shoulders off the floor you flex your abs. Now, you can also flex your abs by lifting your hips off the floor (reverse crunch), or you can flex your abs by doing a seated crunch as well. A seated crunch requires you to bend forward a few inches and flex your stomach muscles for ten seconds. Repeat ten times and you will feel this one! See the "Resting with Crunches" article for more ideas.

Try practicing rolling over on your back from your stomach ten times without stopping too. This is a great way to work the torso if having difficulty with crunches.

Lower Back Exercises

Pictured in the article above are also a torso balancing exercise I call Swimmers, where you lift your legs off the floor while lying on your stomach. This works the lower back, rump, and hamstrings. Sitting down performing this exercise requires a stretch and a flex combination. Bend forward in your chair taking your chest to your knees; then using your lower back muscles, sit upright again.

Upper Back Exercises

The reverse pushup, arm haulers, and birds that can be found in the lower back article listed above are great ways to lie down and work out your upper back muscles. You can also do these with rubber bands while sitting. Place the rubber bands around a pole or something sturdy, and pull with both hands so you bring your elbows past your shoulders flexing your upper back muscles. This is great for the posture and balances out your shoulder and chest muscles.

Lower Body Exercises

In the 45 Day Plan linked above, you will see pictures for squats, lunges, and heel raises. These maybe tough if you suffer from spinal injury or amputated limb. However, you can work your leg muscles while sitting down by doing leg extension or leg curls with ankle weights. You can even do one-legged squats if you can hold onto something for balance. See the pictures for the leg movements in the Circuit Training article. Though I am using weight machine in this picture, try it with rubber bands or ankle weights using the pictured motion.

I hope this article is helpful to those fellow veterans who gave so much for us. Feel free to email me if you have specific issues that did not get covered in this article.

Stew Smith is a former Navy SEAL and fitness author certified as a Strength and Conditioning Specialist (CSCS) with the National Strength and Conditioning Association. If you are interested in starting a workout program to create a healthy lifestyle - check out the Military.com Fitness eBook store and the Stew Smith article archive at Military.com. To contact Stew with your comments and questions, e-mail him at stew@stewsmith.com.











Adaptive Aerobics For The Disabled

From TurnStep.com By Mike Ross

TO SIT OR NOT TO SIT

To Sit or Not to Sit - this is a question for both the participant and the instructor in Adaptive Aerobics. While some athletes have no choice, being confined to wheelchairs or having mobility limitations that impair balance or coordination, those athletes able to stand in an aerobics or step class should be encouraged to do so.

Even if they cannot perform all the movements or if they cannot use the step, the fact that they can use the large muscle mass in the lower extremities to generate oxygen demand means that they will achieve a training effect much more easily than just using their upper body muscles. This is appropriate when integrating disabled athletes into the general population health club classes.

For example, if a prosthesis limits the ability of an athlete to perform a pivot turn step on the bench, demonstrate an alternative step sequence that moves and turns the athlete's orientation identically as your pivot turn step does in the same number of beats. You will find that the disabled athlete is not the only participant in your class who uses this alternative step sequence!

You, the aerobics instructor, when faced with a class of both seated and standing athletes, or when programming a class of exclusively seated athletes, are faced with the question of whether to teach from a seated or a standing position. There are adaptive aerobics videos that feature standing instructors and seated participants. I personally recommend that, when teaching a standing class, the instructor should stand and when teaching a seated class, the instructor should be seated. The problem in teaching a class with both standing and seated participants from one position or the other is communicating with the class what movements are primary and what movements are suggested adaptive movements. This is a similar problem in teaching a standing class with varying levels of fitness; when you demonstrate a low-impact alternative to a high-energy movement and the entire class follows you, even the aerobics monsters who don't need the alternative.

One suggestion for the combined classes is to team-teach. Several combinations of instruction can be used, the most common being both instructors at the from of the studio and one instructor demonstrating the standing aerobics, while the other is seated, demonstrating the adaptive movements. For a class with all standing participants, but with some balance-impaired or coordination-impaired, one instructor could teach the basic class, while the other demonstrates suggested modifications. Another combination would have one instructor in front of the studio with the other a "roving" instructor.

Again, I recommend that, when teaching an exclusively seated class, the instructor also be seated. This does not put a barrier between the class and the instructor. Also, the instructor is reminded that certain movements just can't be accomplished from a seated position. I also face the class, but this is partly because the classes I teach seated are not in mirrored aerobics studios and I can't watch the class in the mirrors.

This allows me to immediately identify anyone having problems with mastering any movement so that I can introduce a modification within the class sequence. It also directly communicates the proper form, since many of the movements are performed in front of you body and would be hidden if my back was presented to the class.

Movements to Include

Every instructor develops a style of instructing; some are good, some are ok, a few are poor. As an experienced aerobics group exercise leader, you already have a style. As a popular aerobics instructor at your facility, your style has gotten you compliments and increased attendance in your classes. My recommendation is not to change your style - it's successful and it is yours. Just adapt the movements that make up your style into another format - seated.

To begin developing your seated style, take an aerobics or step class while seated. See what movements and movement combinations are awkward and which are intense. Make certain that the class that you take is taught by an instructor who actually uses upper extremities in the choreography and doesn't just depend on intricate step patterns or footwork to raise the class' heart rate.... you know who you are! While you are taking this class, try to exercise with a restriction on motion to just one side, as if you were a stroke athlete. Vary the intensity by varying your lever length.

Don't assume that disabled athletes will know how to adapt the movements that you demonstrate (either in a studio class or in a seated class) to the most appropriate intensity, speed or location for them. Be the instructor, not just the person at the front of the room; before class, instruct them on modifications and include modified movements in the sequence of your choreography as instructive examples.

Examples of movements and movement patterns to consider incorporating into your seated choreography are:


MARCHES

Yes, the basic staple of Low-Impact Aerobics translates well into a seated format. It's more of a Marching Band March than the Parris Island style that we learned back in Basic Training. The Kinesologic Movement is Shoulder Flexion/Extension. Elbows are bent and the arms move in opposition. Almost all of the disabled athletes in a seated class can master this sequence. It is an effective warm-up, cool-down and place-keeper in between segments. For those seated athletes who have some leg movement control, they can lift legs in time with the march. Instructors should be on guard for seated athletes who turn this into a torso twist movement. Increase intensity by straightening out the elbow joint or by lifting the arms to a march in front of the torso. Decrease intensity by decreasing range of motion.


PRESSES

Presses are easily mastered by most seated athletes. These movements can recruit muscles of the shoulder girdle, the shoulder joint and the elbow. The combination of location, intensity variations and speed variations make this exercise very versatile. In fact, in the warm-up period, this is one of those exercise patterns that can be used to preview movement sequences in the aerobic exercise part of the program. Decrease intensity by not pressing above the shoulder level, decrease intensity by pressing in half-time to the music, decrease intensity by not using arm muscles. Increase intensity by doing the exercise to the beat, by using full arm range of motion and by exercising one sequence at or above shoulder level (for those athletes who can do it safely). Increase interest in your choreography by varying the location of the presses (front at the chest, side and down, side and out, etc.). Increase interest by doing one arm, then the other - balance can be maintained if the athletes steadies himself with the non-movement arm.


SHOULDER FLEXION/EXTENSION & ABDUCTION ADDUCTION

These shoulder lifts to the front and side are also versatile exercises, but you must take care not to overwork the anterior deltoid, which is the hip flexor of the upper body; it takes over when the other shoulder muscles are fatigued, much as the hip flexor takes over when you have fatigued the quadriceps & hamstring. So, set your choreography up to bracket these movements with arm movements. Vary the location; flexion/extension for eight counts, the abduction adduction for eight counts. Vary the intensity by varying the degree of flexion that you maintain in the elbow joint. Vary the intensity by varying the speed of the exercise, or by double-counting the movement. Cueing on this should always remind the athletes to watch their posture and sit up straight; in fact, one indication of fatigue is athletes slumping in their chairs. Again, one arm at a time is an appropriate variation for most populations, but unless you are confident of the balance and coordination of the group, I would stay away from the one arm flex/extend with the other arm abduct/adduct combination movement, although it is an option for populations that can handle it.


SHOULDER ROLL AND LIFTS (SHRUGS)

I use these mainly as warm-ups and cool-downs, but they are appropriate exercises for some populations that have limited arm movements. Vary the intensity by varying the speed. Try to work the shoulder through the full range of motion. Vary the interest by rolling or shrugging one shoulder at a time, then both together. Since you should not deviate from a seated, centered position and you are not introducing swinging movements of the arms, moving one shoulder at a time should not cause balance problems.


SWIM

The advantage of swimming motions is familiarity; not everybody knows intuitively when you spoken command is "PLIE" or "GRAPEVINE" or "U-STEP, RIGHT LEAD", but if your command is "BREAST-STROKE", most of the population knows the movement. Again, be careful of movements (like the backstroke) that lift arms overhead and be careful for the balance with one-arm full-extension movements. Don't forget all the swimming strokes - Crawl, Fly and, of course, Dog-Paddle.


ARM CURLS

These are exercises that involve movements at the elbow joint. Vary location (side, front, chest high, shoulder-high, shoulder-high front, etc.), vary intensity with the beat, and vary intensity with range of motion. Be careful, again, of asymmetrical movements, since alternating side curls could be a problem with athletes with impaired balance. Don't forget that movement at the elbow is for more muscles than just the Biceps Brachii!


COMBINATIONS

Don't be afraid to incorporate combinations into your choreography. As with combinations in your studio class or in your step class, have these well-rehearsed before you throw them at the class and preview these, either before the class begins or as part of the warm-up. Remember, some disabled athletes with cognitive impairment or with poor muscle coordination may not be able to follow even what you consider simple combinations and sequences. Before class, show them alternate movements and assure them that following your choreography is not a prerequisite to enjoyment of the class - the biggest benefits to your class are participation to the best that you can do.

Movements to Avoid

Just as with studio aerobics, seated aerobics have exercises that are "contraindicated". This term is somewhat overused and underutilized; it doesn't mean wrong, it just means that the specific exercise is inappropriate for either the general population or for the subject population. Again, this is not addressed to the needs of elite athletes who can benefit from these movements and not all disabled athletes will have problems with these movements, but enough of them will that I feel these have no place in a general seated population aerobics class.

As far as I'm concerned, the best synopsis that I've come across should be familiar to all of you certified by AFAA. The AFAA 5 Questions are:

  1. What muscle(s) are you attempting to stretch, limber or strengthen?
  2. Are you doing that?
  3. Is the back protected? Are there any other stress points?
  4. Can you isolate the muscle(s) and stay in alignment?
  5. Who is it appropriate for or inappropriate for?

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TORSIONAL MOVEMENTS

Transverse Rotation of the Trunk is controlled by the Internal and External Oblique Abdominals and by the muscles of the Erector Spinae group in the lower back.

These muscles may be unusable or only partly usable in athletes with spinal cord injuries. Spinal cord injury athletes may also have metal rods surgically implanted in their spinal cords to provide support and trunk stability. Stroke athletes may have impaired balance; twisting movements could lead to them losing their balance in a chair. For any athlete in a chair, the twisting movement could rub and lead to abrasion sores. Finally, these muscles are relatively small and don't produce a big oxygen demand, so you may not gain a large benefit from using them in aerobics.

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ASYMMETRICAL FULL-EXTENSION ARM MOVEMENTS

These are shoulder exercises in which the arms are extended and moved through motions not in concert and not directly in opposition. In other words, one arm is pressed down while the other is pressed sideways, or the arms are "windmilled."

This is an example where directly lifting the upper extremity movements from your step or aerobics class to a seated format may not be appropriate. Again, for those athletes with balance problems, this could tip them over. For athletes with coordination difficulties or with cognition problems, moving arms in opposing directions or in different motions is hard, requires more concentration and may result in frustration and cessation of exercise.

This does not mean that you are limited to moving both arms at a time; moving one arm singly is a good example of lowering the intensity level of an exercise. In that case, the athlete can use his other arm for balance or support if necessary.

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EXCESSIVE ARM MOVEMENTS ABOVE THE SHOULDERS

The intensity of the Pressor Response, which is the elevation of heartrate and blood pressure with extension of the upper extremities above the shoulder level, varies with every athlete. With athletes in poor cardiovascular condition, the changes can be immediate and dangerous. If you incorporate arm movements above the shoulders in your choreography, be certain to demonstrate alternative locations for these movements that won't produce an exaggerated Pressor Response.

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TRUNK EXTENSION AND FLEXION

Trunk Flexion is controlled by the Rectus Abdominus (the Abdominal muscles). Trunk Extension is controlled by the Erector Spinae (lower back muscles).

As with the torsional moves, spinal cord injury athletes may be unable to perform this movement, due to absence of control of these muscles or due to implanted spinal stiffening rods. Athletes with poor balance control may lose their balance and pitch forward. Athletes may lose their view of the leader when the bend forward. In all considerations, I would recommend against incorporating this movement into a seated class with disabled athletes.







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