Exercise in Disability

The headline is that disabled adults should aim for the same targets as other adults: at least 150 minutes of moderate activity a week, or 75 minutes of vigorous activity, together with muscle strengthening on at least 2 days a week working all the major muscle groups. This is a population-level aspiration rather than a rigid individual prescription: any activity is beneficial, and the volume, intensity and type should reflect a person's health, function and impairment-specific risks. Activity can be adapted to the individual, and for a wheelchair user this includes wheeling, seated aerobic work, and resistance using bands or weights, with everyday tasks counting too. Because the target can feel out of reach for someone starting from very low activity, a useful behavioural step for disabled adults and people with long-term conditions is to build up in short bouts, for example aiming for 10 minutes at a time, as a stepping stone towards the guidelines.

A central task is to challenge the myth that activity is inherently harmful for disabled people, which is one of the biggest barriers. Activity should be built around what a person enjoys and can access, with attention to practical barriers such as transport, cost, accessible facilities and confidence. Starting at a low level and progressing gradually is the safest approach, and even small increases and reductions in sitting bring benefit. For a full-time wheelchair user, standing may not be possible and prolonged sitting is often unavoidable, so the emphasis is on adding active movement where possible; importantly, active wheeling and seated exercise are themselves physical activity rather than sedentary behaviour.

Activity after a limb amputation is a useful example of adapting rather than restricting. Activity does not all wait for the wound to heal: appropriate rehabilitation, transfers, seated exercise and training of the unaffected limbs can begin early, while prosthetic loading and impact activity depend on wound healing, surgical advice and rehabilitation assessment. A graded return to aerobic and strengthening activity supports cardiovascular health, weight management, bone health and confidence, and helps with prosthetic use and function. Programmes are tailored to the level and cause of amputation, and to comorbidities such as diabetes and vascular disease which are common in this group. Practical points include care of the residual limb and the intact limb, protecting the skin at the socket interface, and attention to balance and falls, since amputation increases fall risk. Swimming, hand-cycling, seated and adapted gym work, and para sport all provide options, and referral to prosthetic, rehabilitation and para sport pathways helps people progress.

Appropriate activity carries no major risk for disabled adults, but a few specific points matter. Some wheelchair users who do a lot of upper-limb or overhead activity are at risk of rotator cuff injury, so shoulder load should be managed and technique attended to. In people with spinal cord injury, skin integrity and pressure areas, autonomic dysreflexia, impaired thermoregulation, and cardiovascular and blood pressure responses such as orthostatic hypotension all matter; glucose control in those with diabetes, and the cardiovascular and vascular comorbidities common after amputation, also shape a safe programme. The SEM doctor's role is to individualise activity, manage these specific risks, dispel unhelpful myths, and refer to rehabilitation, prosthetic and para sport services where they add value.

• •Disabled adults should aim for the same targets: at least 150 minutes moderate or 75 minutes vigorous a week, plus strengthening on at least 2 days.
• •There is no reason to set a lower target by impairment type; appropriate activity is safe and beneficial.
• •Short bouts, such as 10 minutes, are a useful behavioural step; adapt activity to the individual.
• •Wheelchair users doing overhead or upper-limb work are at risk of rotator cuff injury.
• •After amputation, return graded once healed, mind residual-limb skin and falls, and address diabetes and vascular comorbidity.
• •Dispel the myth that activity is harmful, and refer to rehabilitation, prosthetic and para sport pathways.