We all have to be responsible and have to take care of our bodies, our fitness and our health but we have to achieve this within our budgets. Many medical aids and state facilities do not have the budget, or there sources, to provide enough medical care (or for as long as we think reasonably necessary) so often we land in the situation where we feel we haven't reached our full potential, that we could still benefit from further exercise and therapy or require more equipment.

So what then, and what if the healthcare centre is far away or there are no professionals nearby with the right facilities? What if we cannot afford the nearest gym or it is inaccessible to wheelchairs? So where do we start?

ALWAYS check with your GP, doctor or healthcare professional before starting on a new exercise regime. Your local clinic or practice can give you good advice regarding an exercise program for you to do at home.

Wheelchair Fit

If you want to get wheelchair fit then push your wheelchair! How about some wheelchair pushing in a different setting - along the beach front if you are lucky enough to live near the sea, at the local shopping mall (some of them have some decent ramps to try out), at the local athletics track or school?

PHOTOAA new venture has started in Pretoria at the Moreleta Kloof Nature Reserve. Agroup of wheelchair users and friends meet at 5pm every Tuesday and take a roll along an accessible track in the reserve. It's great to be in the bush with game and birds all around and then go back to Rademeyers, a restaurant in there serve, for some good old socialising. Entrance to the reserve is free so why not join Mathys Roets and Pieter Pretorius, keep fit and enjoy the fresh air?

If you are going to head out into the great outdoors you may want to invest in a Freewheel from Chairman Industries (R4800). Thisclips onto your standard wheelchair footplate, makes traversing over rough terrains much easier and is far cheaper than a hand cycle, road bike or offroad wheelchair. Chairman will also fit it to your Chairman Custom-Lite forfree!!

Shoulder Fit

Protect your shoulders from over-use syndromes like rotator cuff syndrome by strengthening the muscles behind the shoulder and around the shoulder blades. One simple way of doing this is by pushing your wheelchair backwards. Another way is to use an old inner tube from a bike or wheelchair tyre and slip it over your hands. Hold your arms at shoulder height and pull your arms apart against the "spring" of the tube.

Some people prefer strengthening exercises. One idea is to do those things that you find difficult to do over and over again until you become stronger. A lovely exercise for gorgeous shoulders is to lift yourself up out of your wheelchair whilst straightening your elbows. This strengthens the arms, helps for pressure relief and also helps to improve transfers.

Dumb-bells can be bought at Game and Sportsmans Warehouse and wristlets from Dischem, Sportsmans, Game and Dions. A quick and easy way to make weights is to fill plastic shopping bags with soil, gravel orpebbles or even a bag of rice or mielie meal. When the shopping bags are heavy enough seal them by tying the handles into a knot and then slip the handlesover your arms. Cold-drink cans and bottles can also be filled and their openings sealed. Old bike and wheelchair inner tubes can be used to give resistance like a Theraband.

Remember, when you are strengthening a muscle you need to stretch it as well otherwise, as it gets stronger, it will shorten. This ise specially important if you have a muscle imbalance as in one muscle that bends a joint but no muscle to straighten it.

Arm Fit

If you struggle to keep your elbows straight at night, or whilst exercising, there are various methods that can be employed to help. Thermoplastic splints can be made to fit your arms exactly. PHOTO1 These are expensive and can cause pressure sores if not monitored well. Other alternatives range from a pillow strapped on with a bandage PHOTO2 to a magazine (we used our Rolling Inspiration in the photos!!) and a bandage. PHOTOS 3&4 Acardboard cylinder can also be cut in half lengthwise to be used as a splint, just get the fit right and beware of pressure areas. PHOTO5 You can then proceed with your arm exercises without your elbows bending.

Do not leave a foreign object like this around yourarm for an extended time without rest periods as these may cause pressure soresand damage to the skin. If you don't have normal sensation in your skin you need to regularly check your skin; especially if you are using new equipment.

Standing Fit

There are many reasons why standing is good for you. Before standing (especially if you haven't stood in a while) please check with your doctor or physiotherapist that your leg bones are strong enough. If not,you may put yourself at risk of breaking bones, which could be very serious, if not deadly. People with osteoporosis should not attempt to stand.

Standing chairs range from about R200,000 for a fully electric one to R35,000 for a less automated, lighter chair. If you would like to stand but your knees do not remain straight, leg splints can help. They range from fitted callipers at R22,000 a pair with knee joints that bend sothat you can wear them under your clothes and whilst sitting; to back slabs(R14,000 to R1,600 a pair); to simple Plaster of Paris back slabs that can be made by your therapist; to a plank of wood covered with soft material like anold T shirt and fastened to the legs with bandages.

For assistance when standing you can use a tilt table or standing frame (±R9,000) or use a window! Park your chair against the wall, have your knees facing the wall and protected by a pillow. Place your feet onthe ground and pull yourself up into a standing position using the burglarbars. Please note: you must have the arm strength to do this. Always do it with someone nearby to assist if necessary.

PHOTO6 Should you want to use your leg splints to walk or stand, parallel bars can be made from poles of either wood or metal and secured to the ground using uprights. PHOTO6A If you walk with back slabs or other splints and find that your foot is dragging, thread a shoelace through the shoelace holes nearest to your toes and then up and around the leg strap. This helps to keep your foot up, preventing it from dragging andpossibly tripping you.

Transfer Fit

Many people think that a hoist is required to transfera person between bed, wheelchair and car but this is sometimes impractical ashoists do not fold up easily for travel. PHOTO7 A transfer board, if used correctly, canassist with transfers. No lifting is required if the correct techniques areused. A towel under the buttocks can also be used instead of a hoist ortransfer board.

Remember to stretch strong or spastic muscles tomaintain range, prevent stiffness and reduce spasm. Standing helps to reducespasm too.

Don't forget that your heart is a muscle too and needs regular exercise to keep strong and prevent complications like strokes andheart attacks. Cardiovascular exercise (where your heart rate goes up) is a good way to exercise your heart and improve your health.

Exercise is also a good way to reduce stress, manage weight and release endorphins, the feel-good hormones that reduce pain and makeyou feel good - we could all do with more of those I'm sure!

So, keep doing what you are doing, push a little harder, smile and make a difference!

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