Updated: May 6

Important tips for improving your cardio vascular endurance in and out of a wheelchair after a spinal cord injury, stroke, or traumatic brain injury.

Cardiovascular fitness or endurance measures your ability to do exercises that involve your whole body at moderate to high intensity for an extended period of time. Improving your cardiovascular endurance can reduce your risk of diseases such as diabetes and heart disease. But how can you incorporate exercises that involve your whole body when you are living with partial paralysis or increased tone and spasticity?

Below are principles that I encourage all NMR clients to consider when making a plan to add more cardio into their workout routine.

Tip #1 - Do not push your wheelchair as a form of cardio

This one might be a little controversial, but let me explain. If you are a manual wheelchair user pushing your chair is something that you need to do to get from place to place. Depending on how much ground you cover in a given day, that can demand a lot from your shoulders. Because of its large range of motion, your shoulder joint is considerably less stable than some of the other joints in your body and is at increased risk of injury. For these reasons, I advise most manual wheelchair users to find other exercises as forms of cardio, keeping in mind that the daily task of pushing the chair is already accomplishing some of that.

An exception can be made for manual wheelchair users who compete in a sport or activity that requires them to sprint and turn in their chairs. Even then, the focus of that kind of sport specific cardio training should be on emphasizing proper form when turning or sprinting without compromising speed. Speaking to a trainer, physical, or occupational therapist may be helpful to receive coaching on proper pushing technique.

Tip #2 - Do not assume that strength is more important than cardio

Many clients that I have worked with prioritized strength training over cardio because they wanted to build more strength in order to complete their daily tasks easier. While strength training does accomplish this, improving your cardiovascular endurance can help you increase your ability to do those tasks longer and take less breaks. For example, you need strength in order to transfer in and out of your wheelchair but if you are exhausted after a few transfers you may need to improve your cardiovascular fitness or muscular endurance.

Tip #3 - Understand that cardio is about more than just weight loss

There is a common misconception that cardio is the best way to lose weight. It isn‘t. Put in simple terms, you will lose weight if the energy/calories burned from your daily activity is more than the energy provided by the food that you eat. Nutrition is a key element of overall fitness that cannot be ignored. Speaking to a nutritionist about your diet is a great way to get an accurate picture of what you are actually consuming in a day.

When it comes to burning calories during daily activity, planned exercise and non exercise related activities are two key things to consider. The exercises that burn the most calories are those that recruit the most muscles in your body and those that progressively challenge your muscular and cardiovascular system.

Cardio can help you lose weight, but it also strengthens your immune system, helps to reduce chronic pain, and aids in sleep among other things. Try to engage in cardiovascular exercise to take advantage of it’s many benefits, not just weight loss.

There is a common misconception that cardio is the best way to lose weight. It isn't.

Tip #4 - Prioritize whole body movements

Choose exercises that engage as many muscles as you can voluntarily contract and then try to complete them as many time as you can in about a minute or so. Can you roll over independently or with little help? Roll on the bed or on the floor in both directions for one minute on each side.

Can you stand? Perform as many sit to stands as you can in a minute or a minute and thirty seconds, then progressively try to increase that number. Maybe you have very limited strength and trunk control. Sit forward in your chair so you cannot use your backrest and lean as far as you can to one side while still being able to bring yourself back up to mid line. Do these lateral leans as many times as you can before you loose your balance then progressively increase that amount. Another way to make it harder is to increase the pace and depth of your lean.

Tip #5 - Switch it up

Cardio can be boring if you do the same exercises over and over again with no variety. If you primarily focus on one muscle group or one type of movement you may be neglecting another part of your body and you may get bored. If you primarily move forward when you do cardio, try moving side to side or backwards. If you push all day long, try pulling or twisting motions.

Find a friend or family member to do cardio with you. They can do their own exercises indoors or outdoors while you exercise and you can motivate one another.

Variety and Consistency are Key

Keep your cardio exercises relatively simple and add variety so you’ll be more likely to stick with them. If you would like more suggestions comment on this post or reach out through our Instagram page. Also, if you are a wheelchair user and you have any favorite forms of cardio, share it with us!

14 views0 comments
  • Lauren Natale

If you or a loved one has suffered a spinal cord injury (SCI) you may have questions about what spinal cord injury rehab is and how it differs from traditional inpatient or outpatient physical therapy. SCI rehab, sometimes called activity based therapy, is specialized physical training that helps individuals build strength and improve their functional fitness after they have completed traditional physical therapy. The goals of this type of rehab vary depending on the individual's lifestyle and the location of their injury. For example, someone with a cervical level SCI is more likely to have difficulty controlling their chest and abdominal muscles. Therefore, seated balance and posture exercises are important in order to build strength and improve their functional ability to sit up with little to no assistance. Someone with a thoracic level SCI is more likely to have voluntary control over their core muscles, but not their hip and leg muscles.

spinal cord injury anatomy
Spinal Cord Regions and Nerve Affected

After being discharged from the hospital and from traditional physical therapy, every SCI client that I have had the opportunity to work with still had physical and functional limitations that were difficult address on their own. Some wanted to increase their upper body and core strength in order to transfer in and out of their wheelchairs independently. Some wanted to begin an exercise program to improve their mental health, minimize chronic pain, and reduce the risk of osteoporosis. Because no two injuries are the same, planning exercise programs for SCI rehab requires creativity, consideration of client's desires, and extensive knowledge of the human body. At NeuMotion Rehab (NMR), we consider 4 main elements as we develop each exercise plan: Range of Motion (ROM), Core Strengthening and Engagement, Weight Bearing, & Strength and Conditioning.

Range of Motion

Range of motion refers to a limb or joint's ability to go through it's complete spectrum of movements. Each joint in the human body has different expected ranges in each direction. After a SCI, limitations in ROM are common in both the affected and unaffected body parts. At NMR, we combine active (client led) and passive (trainer led) ROM techniques to increase mobility and reduce unwanted stiffness in the body. Many of our SCI clients also live with increased tone and spasticity which results in involuntary muscle contractions that can be disruptive. Regular stretching and joint mobilization techniques have reduced that spasticity and improve the quality of our client's movements.

Core Strengthening

In SCI rehab, core strengthening is very different than a typical gym regimen of sit ups and crunches. For those who have voluntary control of their abdominal muscles, core exercises are geared toward correcting any imbalances that may be present as a result of compensatory patterns of movement following their injury. For those who cannot voluntarily engage all or portions of their core, exercises that increase their ability to maintain seated posture, sit up, roll over, and change positions in and out of their wheelchairs are important.

Weight Bearing

Individuals who have had an SCI are at higher risk for developing osteoporosis, a condition where bones become weak and brittle. Typically, mechanically loading bones during exercises like standing, kneeling, or walking stimulates the process of bone remodeling which keeps bones strong and healthy. Studies on the effect of weight bearing exercises in SCI rehab are inconsistent. Some studies show that it has little effect while some maintain that it increases bone density. At NMR we incorporate weight bearing exercises in an effort to decrease the risk of osteoporosis and to challenge our client's muscular and nervous systems in ways outside of what they can achieve seated in a wheelchair.

Strength and Conditioning

To meet our client's individual strength and conditioning needs NMR has a variety of adaptive equipment including: hand grip aids that enable anyone to use cable machine and dumbbells, medicine balls with accessible handles, a recumbent bicycle, and a harness system for increased safety while using a treadmill or other cardio equipment. Strength and conditioning exercises help our clients improve their quality of life and ability to complete daily tasks on their own.

SCI rehabilitation is often a long, unpredictable journey without guarantees. The journey, however, is also filled with important milestones and victories. Clients work closely with their therapist or trainer to create and work toward goals that will help them increase their fitness and self esteem. One of the most exciting things about working with SCI clients is seeing them develop and rediscover patterns of movement in ways that they did not know was possible. At NMR we think that life and fitness after a spinal cord injury has the potential to be full, engaging, and worthwhile. Our goal is to partner with our clients and to be a resource to help in any way that we can.


  1. SpinalCord.comTeam. “Spinal Cord Injury: Types of Spinal Cord Injuries.” Spinal Cord Injury | Types of Spinal Cord Injuries |, 2 Dec. 2020,

  2. Svircev, Jelena. “SCI Forum Report & Video.” Osteoporosis and Spinal Cord Injury - Northwest Regional Spinal Cord Injury System, 13 Nov. 2012,

  3. “Spinal Cord Injury.” Reeve Foundation,

32 views0 comments