Health Smarts

Reprinted from PN/Paraplegia News October 2015

When it comes to people with spinal-cord injury or disease exercising, what’s more important, endurance or strength training?

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Weights or Cardio?

When it comes to people with spinal-cord injury or disease exercising, what’s more important, endurance or strength training?
Strengthening refers to the exercise of increasing the muscular power and mass, which also improves the body’s metabolism. We need strength to perform our daily activities.
Improving strength requires muscles to be put under more strain than they’re accustomed to, which will stimulate protein growth inside the cells.

This tends to be done in shorter bouts of exercise with weights, and recovery is important. A day of rest after a day of strengthening exercise will help the muscles increase mass.
Endurance training, also called cardiovascular exercise, refers to using several groups of muscles to increase the heart rate for a prolonged period of time. Good examples are pushing your wheelchair, cycling, playing sports, etc.
These exercises promote oxygen delivery to the body, which keeps the muscles, nerves and brain healthy. They also improves heart and lung function.

Both Are Best

The answer to which form of exercise is more important is that both of them are key for good health.

Strengthening exercise helps maintain as much independence as possible. Weakness can impact the ability to transfer from a wheelchair or do basic activities independently.
Strength training is also a way to maintain your weight, as added pounds can certainly impact mobility. It also strengthens the muscles of the rotator cuffs to decrease overuse injuries of the shoulder and strengthens core muscles to decrease back pain — common occurrences among people using wheelchairs. Performing this type of exercise three times per week is recommended.
Cardiovascular exercise is important to decrease the risk of or manage health complications such as hypertension or diabetes, which can lead to strokes or heart attacks if not controlled.
The American Heart Association recommends 30 minutes of endurance training, six days per week.

The Right Effort

One way to monitor if you’re in the “strengthening zone” versus the “endurance zone” is monitoring your heart rate. You can manually take your pulse or purchase a heart rate monitor to wear on your wrist.
Calculate your maximum heart rate by subtracting your age from 220. For example, if you’re 50 years old, subtract 50 from 220 for a maximum heart rate of 170 beats per minute (bpm).
The strengthening zone is 80–90% of your maximum heart rate range, so a 50-year-old’s heart rate should be in the 136–153 bpm range. The endurance training zone should be 65–75% of your maximum heart rate, so 111–128 bpm for a 50-year-old.
A number of factors can affect the heart rate’s response to exercise. Medications can increase your resting heart rate or decrease the amount the heart rate can increase from resting.
If you have an injury that affects your autonomic system (this can be true for spinal injuries above T-4, multiple sclerosis or stroke), the heart rate may not be a reliable vital sign for the amount of effort you’re putting in.

Another way to monitor your effort level is using the rate of perceived exertion. This is a 1–10 scale for how hard you’re working, with 1 being “not at all,” and 10 being an “all-out effort” that can’t be sustained for very long. See a visual scale for the rate of perceived exertion above.
If you’re working on your triceps, you want that muscle to feel like it’s reaching the 8–9 level. You may not be out of breath, but the muscle is unable to keep working.
For cardiovascular training, you want to be in the 5–7 range. You feel like you’re putting forth effort, but it can be sustained. You may feel out of breath, but could carry on a conversation.

Exercise Caution

Remember that 
exercise is a form of stress on the body. You need to feel a little uncomfortable in order to get the benefits.
However, listen to your body. It’ll let you know if the stress is good or bad. There are some things to be cautious of 
when planning a workout.
n  Don’t exercise into pain.
n  Go slow. With strengthening exercises, be sure to perform the movements in a slow, controlled manner 
in all directions.
n  Know your medications. Have a good understanding of the medications you take 
and how they can affect your body’s 
response to exercise.
n  Have a plan for cooling down. Exercise will increase your temperature, so plan to work out in 
an air-conditioned environment, or have ice water 
readily available.
n  Watch your skin. Use padded equipment if you can. Keep an eye on any area of your body you can’t feel. And always check your skin after a workout. If you find any areas of redness, let it heal and find a way to prevent that during future workouts. 


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