Why fitness is important for people with disabilities

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Steven Peace became an expert on the value of fitness in the hardest way imaginable.

In 2006, he was a 32-year-old Navy lieutenant living alone in San Diego when he had a stroke. He was not discovered for 14 hours and spent the next several months recovering in a hospital. "I couldn't walk. I couldn't talk. I was just lying there in bed," he said.

His right side was paralyzed, and while his ability to think and speak improved slowly, after about six months, he realized he was never going to be the same. "And that was crushing," Peace said. But he told himself, "'You can sit around and do nothing, or you can get out there and do everything.' And I made the decision that I was going to get out there and do everything."

He pushed the limits on his activity level, becoming a para-cyclist who has won national and international competitions and competed in the 2012 Paralympic Games.

Beyond the medals, being active was essential to his recovery, Peace said. The difference between where he started and where he is now is "night and day. Completely."

Few could match Peace's athletic accomplishments, but experts say that simpler fitness goals are achievable – and essential – for people confronted with similar challenges from cardiovascular issues.

"We don't have to be Olympians to be healthy," said Dr. Marlís González-Fernández, an associate professor of physical medicine and rehabilitation as well as orthopedic surgery at Johns Hopkins University School of Medicine in Baltimore. "But we do have to move. Bed rest and inactivity are the enemy."

More than 70 million adults in the U.S. reported a disability as of 2022, according to the latest data from the Centers for Disease Control and Prevention.

The Physical Activity Guidelines for Americans state that adults with disabilities who are able should do at least 150 minutes a week of moderate-intensity aerobic activity or 75 minutes a week of vigorous-intensity aerobic physical activity. Those who are able should also do muscle-strengthening activities of at least moderate intensity on two or more days a week. People who can't meet those levels should engage in regular physical activity "according to their abilities and should avoid inactivity," the federal guidelines say.

American Heart Association and American Stroke Association guidelines recommend able stroke survivors get at least 10 minutes of moderate-intensity aerobic activity four times a week or at least 20 minutes of vigorous activity twice a week. For stroke survivors who sit for long periods of time, it may help to break up sedentary time with as few as three minutes of standing or light exercise every 30 minutes, the guidelines say.

"For all of us, cardiovascular health is really important," said Dr. Sangeetha Madhavan, a professor of physical therapy at the University of Illinois Chicago. But Madhavan, who runs the UIC Brain Plasticity Lab, said exercise becomes even more important for people recovering from a stroke.

For starters, people who've had a stroke can have a higher risk of experiencing another one or a heart attack, she said. Exercise can lower that risk.

The psychological benefits of exercise are also important. Depression and anxiety are common after stroke, Madhavan said, as people deal with a sudden loss of independence or adjust to the challenges of physical limitation.

Fitness is fundamental for physical or functional recovery after stroke, she said, because it contributes to the process of neuroplasticity, the brain's ability to reorganize and form new neural connections.

Some research has suggested, for example, that a stroke survivor could boost such connections to paralyzed limbs by exercising healthy ones – as in, a person with a paralyzed left hand could see gains by doing strength training with their right, Madhavan said.

González-Fernández said fitness is both important and challenging for people who have had amputations related to diabetes or peripheral artery disease. People with those health conditions tend to have been less active, and limb loss can make things even more difficult.

But after an amputation, people are encouraged to start being active even before they have been fitted for a prosthetic device, González-Fernández said. "Inactivity really is a risk factor for a lot of chronic conditions and for worse health outcomes," she said. Someone with an above-the-knee amputation who uses a prosthesis to walk may need to burn 100% more energy than someone who doesn't use one.

But according to the American College of Sports Medicine, only 14% of adults with disabilities meet both aerobic and muscle-strengthening guidelines for good health, compared to 23% of adults without disabilities.

González-Fernández said the biggest hurdle she sees for rehabilitation can be a person's inability to envision how they can meet their life's goals. "And the answer is, always, you can accomplish those goals," she said. "It just might be a bit different."

So being active might start by working with a professional to determine a reasonable goal, Madhavan said. "For some it might be like, 'I want to run a marathon,' or 'I want to walk a marathon.' For some, it might be, 'I just want to walk down the hallway without falling.' Fitness is about achieving the goal that you want to do."

A professional can help match goals with exercises and break it down into achievable steps, she said. "If I want to walk down the hallway without falling, I need to work on my balance and mobility first, and then I can increase my endurance."

Most people will begin with supervised activity, González-Fernández said, "starting to figure out ways to move around the house and doing activities within their own environments so they can become independent."

After that, Madhavan said, a fitness plan might include more movement, a little strength training or just getting their heart rate up by "going out for a walk, maybe getting on the treadmill or a bike."

A professional can help clarify what's possible and how to achieve it, she said.

Aerobic fitness can be important for brain plasticity, Madhavan said, and some recent research in stroke survivors suggests high-intensity exercise may be better than moderate-intensity. But even dancing has benefits, she said. "Maybe it's slow movements, and maybe you do it just once a week."

The point is, "anything is better than nothing," she said.

Initially, exercises for people with a physical impairment might involve simply standing, using a walker or doing arm exercises, González-Fernández said. Over time, people can graduate from supervised exercise programs to programs they can do at home or at a gym.

"Walking is our first recommendation for most folks," she said. Swimming works for many people, as do recumbent bikes. "The risk of fall is very low, and you are getting that cardiovascular conditioning" without stressing joints.

People who no longer have use of their legs can still use devices that let them use their hands to rotate pedals, Madhavan said. "There's a lot of adaptive equipment and adaptive fitness centers out there."

Peace said that people of all levels of ability have come to him for advice. Some have competed on bikes before; some have never ridden. He starts by asking, "Are you going to ride for competition, or are you going to ride for recreation?" He then works to match them with the type of equipment they'll need.

Peace's general advice to others is simple.

"Try everything," he said. "I tried cycling. I liked it. There was wheelchair basketball, there was wheelchair tennis, there's every imaginable sport." The Paralympic Games underway in Paris showcase others, like sitting volleyball and para-badminton. With some activities, you might say, "I'm not doing that again. And then you'll find some that are like, 'Hey, that was a pretty good time.'"

Being active, Peace said, "completely changes someone." And not just physically.

"When I first started riding the recumbent, I think I got more from the camaraderie," he said. Research has shown isolation can be a serious complication for stroke survivors.

Getting out and meeting people helped him find his voice, literally. Some people who've had a stroke, he said, "don't speak real well." But if you have to speak to the person next to you, "it will get better. And it all happens when you have to work with people."

Although he's no longer competing, he coaches and manages others. And he still rides five days a week – sometimes out on the street, sometimes on the training bike in his garage. He's grateful for the help he had and eager to help others.

Staying fit, he said, "has put me in a place where I feel better about myself and that's just – that's better than anything I could ask for."