 We all know how important it is to stay physically fit. And without regular exercise, our muscles will not perform to the best of their ability. Exercise ensures that we maintain good strength and endurance to lead full and active lives. In this video, we will guide you through a 25-minute aerobic exercise program and a series of resistance exercises. As you will see, the participants have varying levels of spinal cord injury. And if you choose, you may follow the person who most closely demonstrates your functional ability. When you incorporate exercise into your daily routine, you'll experience many benefits. You'll have improved self-esteem and self-confidence, it'll increase your ability to take care of your activities of daily living, it will decrease your LDL cholesterol, which is your bad cholesterol, and it will increase your HDL cholesterol, which is the good cholesterol, and it will provide for some social interaction. The American College of Sports Medicine recommends that you exercise three days a week at 50-80% of your max heart rate. To determine your max heart rate, you take 220, minus your age, and there you go. An alternative way to measure your exercise intensity is to use the Borg RPE scale, which can help you evaluate your rating of perceived exertion. This is a sliding scale where 6 is no exertion at all and 20 is maximal exertion. The target zone for aerobic exercise using this scale is between 9 and 14. If during the workout you feel that you are only at a 7 or an 8, that means that you're not working at your full potential. Try to use more of your body and pick up your speed if you can. If you feel like you're at a 14 or above and are exerting too much energy, slow down your movements and make your movement patterns smaller. One more way to measure your exercise intensity is by using the talk test. If you can carry on a conversation while exercising, you're doing just fine. But if you're having trouble talking while exercising, that means you're exercising a little bit too hard and you need to decrease your intensity by making your movement patterns a little bit smaller and maybe decrease your speed a little bit. So here's a few things you may want to think about before you start exercising. You may want to use a waist strap or a trunk strap to maintain good balance. And another thing, if you have a spinal cord injury at T6 or above, you may have problems regulating your body temperature. So have a spray bottle or a damp cloth close by to keep you cool. To prepare for exercise, have your resistance equipment close by. Have a water bottle on hand to stay hydrated. Secure any strapping devices you may use to maintain good posture. Lock your wheelchair brakes so your wheelchair doesn't roll. And if you have armrests on your wheelchair and your functional balance allows, take those armrests off. If at any time during the exercise session, you experience pain or discomfort, either modify your movement or stop altogether. And if the pain persists, you may want to consult with your physician. Hi, I'm Gina Beidermut, and I'm the Adaptive Sports Consultant at Kaiser Foundation Rehabilitation Center in Vallejo, California. And I'm joined here today with Sebastian, Cleveland, Mark, and Richie. And we're here to do an exercise program. So let's get started. We're going to slowly warm up your muscles before our aerobic workout. Sit up straight. If you need to wear a chest strap for balance, please do so. Take a nice big deep breath in and out. And again, breathe in and out. Now look over your right shoulder and to the left. Bring your head back to center. Tip your ear to your shoulder and to the other side. Bring your head back up to center. And let's do shoulder rolls, shrug them up, and roll them back. It's important to focus on rolling your shoulders back because your shoulders tend to roll forward from pushing your wheelchair. Now hang your right arm down to the side and circle it. Now hang your right arm down to the side and circle it. And the other direction. Now your left arm to the side and circle it. And the other direction. And do some nice big arm swings. And reach forward one arm at a time. Stretch it out as far as you can. If at any time during this exercise program you experience pain, stop and consult with your physician. Now shoulder press over the head. Reach one arm over your head. Extend it up as high as you can. And bicep curls arms together. Extend them down at your side. Flex your arms up so your hands are coming up shoulder height. And triceps hold your elbows up high. Push your hands back. If you have limited or no use of your triceps because of your level of spinal cord injury and need to modify it, extend your arms down and externally rotate your hands, locking your arms out. And lateral raises arms bent. And shoulder rolls shrug them up and roll them back. Bicep curls alternating. Roll raises arms straight and pulse it back. Shoulder shrugs shrug them up and down. You should be getting warmed up and ready for our aerobic part that's coming up. So take it into a jog. Remember to stay safe and exercise at your own pace and functional ability. And bounce your hands at the side. Nice and high. Make sure you're sitting up straight and bounce them forward and back. And cabbage patch. Circle it around. This may challenge your balance a little bit and circle the other direction. Do as much as you can. All of this will help with your overall conditioning. Now hold your elbows up high. Push those hands out to the side. And let's take it in some bicep curls alternating. And front rows extend the arms out in front of you. Pull them back and squeeze those shoulder blades together. If you need to modify this or any movement, modify it so you get as much on your movement pattern as you can while still maintaining good balance. And roll it. Reverse your direction. Roll raises arms bent. We're coming into our first intensity check. How are you doing? So take it into a jog. Remember that intensity scale? Where are you on that scale right now? Put some good energy into this. And jumping jacks. Extend those arms up as high as you can. Getting warmed up yet? Imagine like you're in a nice cool pool and swim it out breaststroke. And upper cuts. Cross it over and punch it. And tricep push backs. Again, if you need to modify this, go ahead. Make sure you get as much out of your movement. And shoulder press both arms up over the head. As high as you can go. And front reach. Reach it as far as you can. And bicep curls together. If you're getting tired, take it into a jog. Just keep yourself moving. And up, out to the side. And reverse it. Push those hands out. We're almost at our next intensity check. Keep it going just a few more. And take it into a jog. Here's your intensity check, how are you doing? And front rows. Reach forward, pull them back. And jumping jack. And upper cut. And take it into some high elbows. Push those hands out to the side. This will get easier the more you do it. Try and do some form of aerobic exercise at least three days a week. And take it into a jog. Remember, exercise is work. And you may experience a little discomfort and pain. But that's normal. But if it persists longer than a few days, consult with your physician. Front raises. Extend the arm out in front of you. Raise your hand up about shoulder height. And karate chops. Hold your elbows up nice and high. Extend those hands out in front. And alternate. And lateral raises, arms straight. You've been working really hard. You'll feel better as soon as we're done. You're doing great. And take it into some apple picking. Reach up and pull your hand down as if you're putting it in a pouch at your opposite side. And switch to the other side. Now arms open and close nice and fast. And take it in diagonal. It's important to do exercise on a regular basis. It will help increase your endurance and your ability to perform your activities of daily living. The easier it is to perform your activities of daily living, the more time you have to spend with family and friends. And single arms, swim it out to the side. And take it into a jog. This is our last intensity check. How are you doing? Did you reach your target number? Come on, keep it going up and down. That's it, keep it going. And we're going to start slowing it down now. Reach forward one arm at a time. Slow it down so your heart rate can come down a little bit. And lateral raises, arms bent. And bicep curls together. And bicep alternating. And pulse it back. Start slowing it down. And bounce your hands at the sides. Imagine those basketballs. Now forward and back. And now let's take it into some shoulder rolls. Oh, doesn't that feel good? Reach down to the side. Stretch. And to the other side. And back up to center, shoulder shrugs up and down. And bring your arm across your chest to stretch. Do some good deep breathing. Switch to the other side. Now put your hand on your opposite knee. Twist to the side and stretch. And over to the other side. Bring yourself back to center. And do a chest stretch. Lean back. Open up your chest. Feel that stretch. Bring it back. Nice, slow arm swings. And take a nice big deep breath in. And again, breathe in. And again, breathe in. You did a great job. If you do this a couple times a week, it'll get easier. And you'll feel the effects almost immediately. Hi, I'm Todd Tanner. I'm a physical therapist. And I work at Kaiser Foundation Rehabilitation Center in Vallejo, California. Strength and resistance training are vital to maintaining your musculature, allowing you to perform everyday activities. In this portion of the program, we're going to demonstrate strengthening and resistance exercises aimed at strengthening the shoulder, the trunk, the upper arm, depending on your level of injury. These exercises are very important to maintain symmetry of the body and hopefully hold off potential harmful muscle imbalances. We will show these exercises being performed with no weight, no cuff weights, free weights, or resistance tubing. The tubing is very good because you can vary your level of resistance depending on your recovery, and you can take it anywhere you need to go. The various colors of the tubing or bands identify the amount of resistance. There are four things to consider when you're doing an exercise program. The sets, the repetitions, the proper amount of weight, and the frequency by which you do the program. A set is a number of repetitions done in a row. Now remember, this is based upon your ability. If you're stronger, start at three sets of 10. But if you're not, do three sets of five and work your way up to it. Remember, in between each set, take a break to allow your body to recover and prepare for the next set. Repetitions are the number of times you perform an activity or an exercise. The number of repetitions is based upon your ability and is usually set by the physical therapist. It's important that when you're doing your exercises that they're slow, controlled, and using the appropriate musculature. Remember, it's more important to have quality than it is quantity. The amount of weight or resistance is usually expressed in pounds being moved. Again, it's important to pick a weight that allows you to be smooth and controlled through your available range of motion. This is true whether you're using no weight, cuff weights, free weights, or the exercise tubing. Finally, frequency is the number of times a day or a week you should do your exercise program. Research suggests three to five times a week is most effective. When you first start out, it's important to pick a weight or resistance that allows you to move through your available range of motion smoothly and slowly. If you're unable to do 10 repetitions this way, then the weight is too heavy. Use a weight or resistance that fatigues your muscles within 10 to 15 repetitions. Depending on your functional ability, you can try doing the exercises with both arms simultaneously, or you can have one hand stabilize while the other hand performs the exercise. To start, you want to bring your wheelchair onto a level surface. You want to lock your brakes. You want to sit up to the best of your ability. Remember to exhale when you're performing the exercise and inhale when you're returning back to the start position. In the beginning of the rehabilitation process, your strength may be diminished, and therefore you might not be able to use weight or resistance. Another reason why you might not use resistance is your level of injury. In these cases, just the weight of gravity itself will provide a training effect during the exercises. The purpose of resistance training is to strengthen and maintain the musculature of your shoulders, enabling you to do the activities of daily living. An important activity is to do a pressure relief off your backside to allow for circulation and maintain good skin integrity. You can do this by doing a push-up in your wheelchair. Secure your brakes and place your hands at your side, either on your wheels or on your arm rests. Position your head forward while tucking the chin to help maintain proper balance. And slowly push up, lifting your bottom off the seat cushion and hold it there. If you're unable to lift yourself up, you can perform pressure relief by leaning to one side, getting your weight off that side, and then switch and lean to the other side. You can also perform a pressure relief by leaning forward or backward. If you have a power chair that tilts back, then use that. All these positions distribute the weight, giving your pressure points relief. With time, these exercises will get easier, and you'll have a good foundation to build both strength and endurance. I hope you view this as a bridge in regaining your independence and incorporate some form of physical activity in your everyday life. Bicep curls target the muscles on the front side of your upper arm. To perform bicep curls with no resistance, extend your arm down at your side, bend at the elbow, bring your hand up to your shoulder, then return to the start position. It is important to keep your elbow close to your body during the movement. Depending on your balance, you can alternate each side or do the movement with both sides together. Elbow extensions work the tricep muscles, which are found on the back side of your upper arm. To perform this exercise with no resistance, hold your elbow high so that it points toward the ceiling. Extend, then drop your hand behind your head. The movement should be smooth and controlled in both directions. Lateral raises target the deltoid muscles which are found on the top of your shoulder. Lateral raises are performed by holding your arms down at your side, lifting them out and away from your body to shoulder height or above. The movement should be done smooth and controlled throughout the entire range of motion. Internal and external rotation target key muscles in the stabilization of your shoulder. Position yourself with assistance as needed in your bed on your side. Your knees and hips should be bent so that you do not roll during the exercise. Start with your top arm across your body, palm facing down, the elbow bent to 90 degrees, and your upper arm in contact with your side. Lift the back of your hand away from your body while maintaining the contact with your side. The motion should be smooth and controlled in both directions and in an arc. Your shoulder should maintain a stable position throughout the exercise. If the shoulder rolls out, then stop the exercise and reposition the shoulder before continuing. If you cannot maintain the shoulder, then you should skip this exercise. Save yourself extra work and stay in this position to do internal rotation of the bottom arm. Bend the arm approximately 90 degrees with the palm facing up, lift the hand up towards your stomach. The movement should be smooth and controlled in both directions. To perform this exercise on the other side, roll over and follow the same directions. Bicep curls target the muscles on the front side of your upper arm. To use tubing or band for bicep curls, firmly secure the tubing or band to a part of your wheelchair below your feet, or anchor to a stationary piece of furniture and position yourself so the direction of the pole is upward from the floor. Begin with your arm in your lap and bend your arm at the elbow, bringing your hand up to your shoulder. This exercise is best performed one side at a time. It's important to hold on with your other hand to stabilize your body. Elbow extensions work the tricep muscles, which are found on the back side of your upper arm. To perform the exercise, you must first secure the tubing above your head with assistance as needed to a door or other stationary object. Next, position yourself so your back is to the door and take hold of the tubing. Start with your elbows at shoulder height and extend your arm straight out. Then return to the starting position. The motion should be smooth and controlled in both directions. Lateral raises target the deltoid muscles which are found on the top of your shoulder. To perform the exercise with tubing or a band, first position the wheelchair on top of the tubing or the band. Hold the tubing or band in your hand with your arm fully extended at your side. With your palm down, lift up and away from your body to shoulder height or above. If you're unable to hold the tubing or the band, then perform the exercise with the tubing or the band at the crease of your elbow. Chest press targets the pectoralis muscles in your chest, the triceps in the arm, and the anterior deltoid muscles of the shoulder. To perform this exercise, first wrap the tubing around your back and underneath your armpits. Grasp the end of the tubing and simultaneously push forward extending both arms fully out in front of your body. Exhale as you push forward and inhale as you return to the start position. Front row targets the rhomboids in the middle trapezius which are the muscles of your upper back. It also works to posterior deltoids in the back of the shoulder as well as the biceps in the upper arm. Secure the tubing to a door or stationary object at shoulder height. Facing the tubing, start with your arms extended out in front of you. Pull back, bending at the elbow and squeezing your shoulder blades together. Ideally, your elbow should be at shoulder height but not above. If you cannot hold this posture, then modify your arm position to suit your abilities. While performing this exercise, wear a chest strap for safety. Internal and external rotation target key muscles in the stabilization of your shoulder. To perform this exercise with tubing, secure the tubing to a door or stationary object at elbow height. Position yourself on the side of the tubing making sure you lock your brakes. Sitting up as straight as possible, begin with your elbow tucked in close to your side with your forearm across your abdomen. Slowly move your hand out and away from your body while maintaining your elbow, contact with your side and return to the start position. This movement should be smooth and controlled in both directions. You can remain in this position to perform internal rotation. Bicep curls target the muscles on the front side of your upper arm. To perform bicep curls with resistance using a wrist cuff, wrap the cuff around your wrist and secure with the Velcro. Start the exercise with your arms extended down at your side, bend your arms at the elbow, bringing your hands up to your shoulder height, then return to the start position. Elbow extensions work the tricep muscles which are found on the back side of your upper arm. To perform this exercise using a wrist weight, secure the weight around your wrist. Raise your hand behind your head, bending at the elbow. Keeping your elbow close to your head, fully extend your arm up in the air, then return to the start position. The movement should be smooth and controlled in both directions. Lateral raises target the deltoid muscles which are found on the top of your shoulder. Secure the weight to your wrist. With your arms at your side and palms down, lift up and away from your body to shoulder height or above. The movement should be smooth and controlled in both directions. Internal and external rotation target key muscles in the stabilization of your shoulder. Position yourself with assistance as needed in your bed on your side. Your knees and hips should be bent so that you do not roll during the exercise. With the weight secured to your wrist, start with your top arm across your body, palm facing down, the elbow bent to 90 degrees. Your upper arm should be in contact with your side. Lift the back hand away from your body while maintaining contact with your side. The motion should be smooth and controlled in both directions and in an arc. Your shoulder should maintain a stable position throughout the exercise. If the shoulder rolls out, then stop the exercise and reposition the shoulder before continuing. If you cannot maintain the shoulder, then you should skip this exercise. Save yourself extra work and stay in this position to do internal rotation of the bottom arm. Bend the arm to approximately 90 degrees with the palm facing up. Lift the hand up towards your stomach. Movement should be smooth and controlled in both directions. To perform this exercise on the other side, roll over and follow the same directions. Bicep curls target the muscles on the front side of your upper arm. To perform bicep curls with free weights, hold the weight in your hand with your arm extended down at your side. Bend your arm at the elbow, bringing your hand up to your shoulder height and then returning to the start position. Elbow extensions work the tricep muscles, which are found on the backside of your upper arm. To perform this exercise using free weights, grasp the free weight, raise your hand up and behind your head, bending at the elbow, keeping your elbow close to your head and then fully extending your arm up in the air. Then return to the start position. The movement should be smooth and controlled in both directions. Lateral raises target the deltoid muscles which are found on the top of your shoulder. Grasp the weight with your hand. With your arms at your side and palms down, lift up and away from your body to shoulder height or above. The movement should be smooth and controlled in both directions. Depending on your functional ability, you can try doing the exercises with both arms simultaneously, or you can have one hand stabilize while the other hand performs the exercise. Internal and external rotation target key muscles in the stabilization of your shoulder. Position yourself with assistance as needed in your bed on your side. Your knees and hips should be bent so that you do not roll during the exercise. Hold the weight in your hand and start with your top arm across your body, palm facing down. The elbow bent to 90 degrees. Your upper arm should be in contact with your side. The motion should be smooth and controlled in both directions and in an arc. Your shoulder should maintain a stable position throughout the exercise. If the shoulder rolls out, then stop the exercise and reposition the shoulder before continuing. If you cannot maintain the shoulder, then you should skip this exercise. Save yourself extra work and stay in this position to do internal rotation of the bottom arm. Bend the arm to approximately 90 degrees with the palm facing up. Lift the hand up towards your stomach. Movement should be smooth and controlled in both directions. To perform this exercise on the other side, roll over and follow the same directions. The purpose of resistance training is to strengthen and maintain the musculature of your shoulders, enabling you to do the activities of daily living. An important activity is to do a pressure relief. Off your backside to allow for circulation and maintain good skin integrity. You can do this by doing a push-up in your wheelchair. To do this, secure your brakes and place your hands at your side, either on your wheels or on your arm rests. Position your head forward while tucking the chin to help maintain proper balance. And slowly, push-up lifting your bottom off the seat cushion and hold it there. If you're unable to lift yourself up, you can perform pressure relief by leaning to one side, getting your weight off that side. And then switch and lean to the other side. So perform a pressure relief by leaning forward or backward. If you have a power chair that tilts back, then use that. All these positions distribute the weight, giving your pressure points relief. With time, these exercises will get easier and you'll have a good foundation to build both strength and endurance. I hope you view this as a bridge in regaining your independence and incorporate some form of physical activity in your everyday life.