I have a client who is paraplegic and confined to a wheelchair. What activity expends maximum calories for this person? He’s concerned about weight gain and how to calculate calorie expenditure during exercise so that he can adjust his calorie intake accordingly. Any charts, resources, books, exercise recommendations, etc. would be greatly appreciated.
It is difficult to recommend a specific activity that would be best for your client because each person will need individual modifications according to their abilities. The key is safe, challenging, unaccustomed stimuli. Even if there were a research article stating the best exercise for caloric expenditure, it would only be specific to that research group. Therefore, it is best to try various methods of activity, and figure out which is optimal for your client.
Various types of activities that will be helpful for your client include, but are not limited to, the following:
- Weight training – upper extremities
- Arm crank ergometry (perform cycling motion with arms on this machine)
- Have your client perform laps around a track/outdoors in his wheelchair (can include inclines if appropriate)
- Have a ball (basketball/football/baseball, etc.) toss with your client
- Set up cables for your client to perform continuous pushing motions (punching)
- Set up a boxing bag for your client to punch
- Aquatics – exercises in a pool
- Rowing (strap your clients legs to prevent falling)
- Manipulate acute variables (reps, speed, sets, rest, days per week)
Regarding calorie expenditure and fat loss, monitor your client’s body fat levels and diet. If he is maintaining a steady percentage of body fat, then you can speculate he is eating around the same amount of calories he is expending. If he is gaining body fat, then he is eating too much or not moving enough. Lastly, if he is losing body fat, then you can speculate his activity level and food intake are right on. However, monitor his energy levels and be sure he is not sluggish. If he is experiencing a lack of energy, increase his food intake.
For your client to achieve his goal, the energy in (food) must be less than the energy out (exercise). However, the energy intake must be optimal in nutritive value for your client to stay within his caloric allotment while feeling energetic. The energy output should be specific to your client’s goals and needs. The exercises should be fun, challenging, multi-planar and safe. A great reference for various populations is the book Exercise Prescription by Kamala Shankar, MD.