Beyond the Wheelchair: Staying Active for Better Health and Independence

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adaptive gym

Sedentary Behavior in Wheelchair Users: Understanding the Challenges and Taking Action to Reduce It

By Dre Murielle Grangeon, PhD, Kin, Admin.A.

Sedentary behavior has become a major public health concern. It is defined as a set of behaviors performed while sitting or lying down during waking hours that require very low energy expenditure. For people who use a wheelchair, this issue deserves special attention, as mobility constraints may result in extended periods spent sitting and fewer opportunities for movement.

However, using a wheelchair does not necessarily mean being physically inactive. Thanks to modern approaches in adapted physical activity, assistive technologies, and guidance from specialized professionals, it is possible to significantly reduce sedentary behaviors and their impact on health.

Understanding Sedentary Behavior in Wheelchair Users

It is important to distinguish between sedentary behavior and physical inactivity. A person may participate in exercise sessions several times a week while still being highly sedentary if they spend most of their day sitting without interruption.

For wheelchair users, reduced mobility opportunities, environmental barriers, and certain functional limitations can contribute to prolonged periods of inactivity. This situation is particularly concerning because insufficient movement affects multiple physiological systems.

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The Consequences of Sedentary Behavior

Prolonged sedentary behavior is associated with numerous negative health effects.

Cardiovascular and Metabolic Consequences

Extended periods of inactivity can lead to:

  • Reduced cardiorespiratory fitness
  • Increased risk of cardiovascular disease
  • Greater insulin resistance
  • Higher risk of type 2 diabetes
  • Increased cholesterol levels and certain inflammatory markers

For individuals with spinal cord injuries, these risks are often amplified due to a significant reduction in active muscle mass.

Musculoskeletal Consequences

Sedentary behavior also contributes to:

  • Loss of muscle mass
  • Reduced strength and endurance
  • Increased fatigue
  • Decreased bone density
  • Progressive physical deconditioning

This process can further limit independence in daily activities.

Psychological and Social Consequences

Lack of activity can have major effects on well-being, including:

  • Lower self-esteem
  • Symptoms of anxiety and depression
  • Social isolation
  • Reduced quality of life

Over time, these effects can become just as limiting as the physical consequences themselves.

Why Are Wheelchair Users at Greater Risk?

Sedentary behavior often results from a combination of factors.

Physical Limitations

Depending on the underlying medical condition, some individuals may experience:

  • Muscle weakness
  • Chronic pain
  • Significant fatigue
  • Difficulties with transfers
  • Cardiovascular limitations

Environmental Barriers

Insufficient accessibility remains a major obstacle:

  • Inaccessible infrastructure
  • Limited access to sports and recreation facilities
  • Transportation challenges
  • Lack of specialized equipment

Psychosocial Factors

Fear of injury, lack of confidence, limited social support, and lack of awareness about exercise opportunities can also contribute to maintaining sedentary habits.

The Benefits of a More Active Lifestyle

Reducing sedentary time provides significant benefits, even when increases in physical activity remain modest.
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Physical Benefits

  • Improved cardiovascular fitness
  • Better weight management
  • Increased muscle strength
  • Reduced cardiometabolic risk
  • Less physical deconditioning

Functional Benefits

  • Greater independence
  • Improved wheelchair mobility
  • Better transfer capabilities
  • Increased participation in activities of daily living

Psychological Benefits

  • Improved mood
  • Reduced anxiety
  • Increased self-esteem
  • Better quality of life

How Can Sedentary Behavior Be Reduced?

The goal is not only to participate in sports but also to reduce the amount of time spent inactive.

Break Up Periods of Inactivity Regularly

Even brief interruptions can provide meaningful health benefits.

It is recommended to:

  • Change positions regularly
  • Perform a few minutes of active wheelchair propulsion
  • Carry out arm and trunk mobility exercises
  • Engage in functional mobility activities whenever possible

Each interruption of sedentary behavior helps stimulate blood circulation and muscular activity.

Incorporate More Movement into Daily Life

Everyday activities can provide excellent opportunities to move:

  • Community mobility
  • Shopping and errands
  • Adapted household tasks
  • Recreational activities
  • Social participation

The accumulation of these movements can generate meaningful health benefits.

Participate in Adapted Physical Activity

The most commonly recommended activities include:

Cardiovascular Activities

  • Active wheelchair propulsion
  • Handcycling
  • Adapted swimming
  • Wheelchair basketball
  • Wheelchair rugby
  • Adapted dance, among others

Strength Training Exercises

New Technologies for Reducing Sedentary Behavior

Technological advances are opening new opportunities for wheelchair users. These innovations increase opportunities for movement, stimulate neuromuscular function, and enhance participation in exercise.

Digital Monitoring Tools

Smartwatches, mobile applications, and activity sensors can:

  • Measure sedentary time
  • Provide movement reminders
  • Set personalized goals
  • Promote self-management of physical fitness

These tools support the adoption of more active behaviors throughout the day.

activite physique adapte
Assistive Robotics and Rehabilitation Robotics
The use of robotic technologies is rapidly expanding in rehabilitation and adapted physical activity. Available technologies include:
  • Robotic exoskeletons
  • Robotic gait-training systems
  • Robotic devices for upper-limb rehabilitation
  • Assisted training platforms
These devices allow repetitive and intensive movements that would otherwise be impossible or difficult to achieve. For some individuals with spinal cord injuries or severe neurological conditions, assistive robotics also offers new opportunities for supported standing and assisted locomotion.

Functional Electrical Stimulation (FES): A Powerful Tool Against Sedentary Behavior

FES involves using electrical impulses to trigger muscle contractions when voluntary activation is impossible or insufficient.

Over the past several years, FES has emerged as one of the most promising interventions for combating the consequences of sedentary behavior in individuals with paralysis or neurological impairments.

Its key benefits include:

  • Activation of a large amount of muscle mass
  • Increased energy expenditure
  • Improved cardiovascular fitness
  • Preservation of muscle mass
  • Reduced metabolic complications
  • Enhanced blood circulation

FES can be integrated into various forms of activity:

  • FES-assisted cycling (FES bike)
  • FES-assisted rowing
  • Assisted cardiovascular training
  • Muscle strengthening programs
  • Stimulation-assisted and robotic-assisted walking
For many individuals with spinal cord injuries, FES provides one of the few opportunities to actively engage lower-limb muscles in structured physical exercise. As a result, it represents a particularly effective strategy for limiting the harmful effects of prolonged sedentary behavior.

The Essential Role of the Specialized Kinesiologist

Combating sedentary behavior requires much more than simply encouraging people to “move more.” It demands comprehensive assessment, individualized exercise prescription, and safe professional supervision.

A kinesiologist specialized in adapted physical activity, rehabilitation, or neurorehabilitation plays a central role in this process.

kinésiologue neuro

As such, kinesiologists are key members of modern interdisciplinary rehabilitation teams.

Conclusion

Sedentary behavior is a major health concern for wheelchair users, but effective solutions exist. By combining adapted physical activity, regular interruptions of inactivity, and innovative technologies such as Functional Electrical Stimulation (FES) and robotics, it is possible to significantly reduce its impact on health. However, these tools achieve their full potential when integrated into a personalized program supervised by a specialized kinesiologist. Through their expertise, they help transform opportunities for movement into meaningful gains in health, independence, and quality of life.

References

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