Exercise With Spina Bifida: Building Strength, Mobility, and Independence

Spina bifida affects everyone differently—from those who walk independently to those who use wheelchairs full-time, and everywhere in between. But regardless of where you fall on this spectrum, exercise offers profound benefits for physical health, independence, and quality of life.

This guide provides practical exercise strategies for people with spina bifida across all mobility levels.

Why Exercise Matters for Spina Bifida

People with spina bifida face unique health challenges that exercise directly addresses:

Cardiovascular Health

Reduced mobility often means reduced cardio fitness. Heart disease risk increases when activity levels drop. Appropriate exercise maintains heart health regardless of mobility level.

Bone Density

Bones need stress to stay strong. When paralysis limits weight-bearing, bones weaken. Targeted exercise helps maintain bone density where possible.

Muscle Strength

Even with paralysis, maintaining strength in functioning muscles is critical for:

• Transfers and mobility
• Preventing overuse injuries
• Supporting joints
• Daily independence

Weight Management

Lower activity levels and reduced muscle mass affect metabolism. Regular exercise helps maintain healthy weight and body composition.

Mental Health

Depression and anxiety are more common in people with spina bifida. Exercise is a proven mood booster that also builds confidence and social connection.

Pressure Injury Prevention

Stronger muscles support better positioning and more effective weight shifts, reducing pressure injury risk.

Understanding Your Level of Function

Spina bifida creates different functional abilities depending on the lesion level:

High Lumbar (L1-L2)

• Typically use wheelchair full-time
• May have some hip flexor function
• Focus: upper body strength, wheelchair cardio, seated exercise

Mid-Lumbar (L3-L4)

• May walk with braces and aids
• May use wheelchair for longer distances
• Focus: maximize leg function, upper body strength, mixed approach

Low Lumbar/Sacral (L5-S1)

• Often ambulatory, possibly with minimal aids
• May have foot/ankle weakness
• Focus: gait strength, balance, general fitness

Your exercise approach should match your functional level while always including cardiovascular work, strength training, and flexibility.

Exercise for Wheelchair Users

Cardiovascular Fitness

Wheelchair propulsion training:

• Sustained wheeling on flat surfaces
• Interval training (push hard, recover, repeat)
• Build up to 20-30 minutes of continuous movement

Arm ergometer (hand bike):

• Excellent cardio option
• Adjustable resistance
• Can be used at gyms or purchased for home

Wheelchair sports:

• Basketball, tennis, racing
• High-intensity cardio plus social engagement
• Contact local adaptive sports programs

Swimming/water exercise:

• Full body cardio with no pressure points
• Requires accessible pool facilities
• May need assistance getting in/out

Strength Training

Upper body focus (critical for independence):

Pushing muscles (for transfers, pressure relief):

• Chest press
• Shoulder press
• Tricep exercises
• Push-ups (modified as needed)

Pulling muscles (for balance, posture):

• Rowing movements
• Lat pulldowns
• Bicep exercises
• Reverse flys

Core work:

• Seated trunk rotation
• Adapted planks
• Medicine ball exercises
• Work within your functional ability

Lower body (if any function exists):

• Passive and active range of motion
• Resistance exercises for any functioning muscles
• Aquatic therapy for supported movement

Flexibility

• Daily stretching prevents contractures
• Focus on hip flexors, hamstrings, shoulders
• Passive stretching for paralyzed areas
• May need assistance for some stretches

Exercise for Ambulatory Individuals

If you walk independently or with aids, you have more exercise options—but also different considerations.

Cardiovascular Fitness

Walking programs:

• Build up duration gradually
• Use aids as needed for safety
• Track distance and time for progression

Cycling (adapted if needed):

• Recumbent bikes offer stability
• Adaptive foot straps may help
• Builds leg strength and cardio

Swimming:

• Non-weight-bearing cardio
• Works entire body
• Reduces impact on joints

Elliptical trainers:

• Low impact
• May need handrail support
• Good cardio option

Strength Training

Focus areas:

Legs (maximize function):

• Squats (supported if needed)
• Leg press
• Step-ups (with rail)
• Ankle/foot exercises if functional

Core:

• Planks
• Bird-dogs
• Bridges
• Targeted exercises based on functional ability

Upper body:

• General strength work
• Don't neglect upper body even if ambulatory

Balance Training

Particularly important for ambulatory individuals:

• Single leg stance (with support nearby)
• Tandem walking
• Balance board work
• Perturbation training with supervision

Gait-Specific Training

Work with physical therapy to:

• Optimize walking pattern
• Strengthen gait muscles
• Improve endurance
• Reduce compensatory patterns

Managing Common Exercise Challenges

Skin Integrity

Pressure injury prevention:

• Do weight shifts during seated exercise
• Check skin before and after activity
• Use appropriate padding
• Avoid exercises that put prolonged pressure on vulnerable areas

Heat management:

• People with spina bifida may have impaired temperature sensation
• Monitor for overheating
• Take breaks in climate-controlled environments
• Stay hydrated

Bladder and Bowel Considerations

• Empty bladder before exercise
• Time exercise around bowel programs
• Know bathroom locations
• Carry supplies if needed
• Don't let management needs stop you from exercising

Shunt Awareness (Hydrocephalus)

Many people with spina bifida have VP shunts. During exercise:

• Avoid activities with high impact to the head
• Know your shunt malfunction symptoms
• Don't avoid exercise—shunts are generally durable
• Discuss with your neurosurgeon if concerned

Latex Allergy

Common in spina bifida population:

• Check exercise equipment for latex components
• Use non-latex resistance bands
• Alert gym staff
• Carry emergency medication if needed

Tethered Cord Concerns

If you have tethered cord symptoms:

• Discuss exercise with your neurosurgeon
• Some activities may be restricted
• Generally, appropriate exercise is still beneficial
• Monitor for new symptoms

Building Your Exercise Routine

Sample Week: Wheelchair User

Monday: Arm ergometer 20 min + upper body push exercises Tuesday: Wheelchair skills/propulsion training + stretching Wednesday: Upper body pull exercises + core work Thursday: Rest or gentle stretching Friday: Arm ergometer intervals + upper body push Saturday: Wheelchair sports or swimming Sunday: Rest, passive range of motion

Sample Week: Ambulatory Individual

Monday: 20-minute walk + lower body strength Tuesday: Upper body strength + stretching Wednesday: Swimming or cycling 25-30 min Thursday: Balance exercises + core work Friday: Lower body strength + walking 15 min Saturday: Recreational activity (hiking, sports) Sunday: Rest, gentle stretching

Progression Principles

• Start conservatively — especially if new to exercise
• Increase one variable at a time (duration OR intensity, not both)
• Track your workouts to see progress
• Expect plateaus — they're normal
• Celebrate consistency over perfection

Finding Adapted Exercise Resources

Adaptive Sports Programs

Many communities offer:

• Wheelchair basketball, tennis, rugby
• Handcycling clubs
• Adaptive swimming programs
• Sled hockey
• Track and field

Contact: Local parks and recreation, hospital rehab programs, or search for adaptive sports organizations in your area.

Gyms and Fitness Centers

Look for:

• Accessible facilities
• Staff trained in adaptive fitness
• Appropriate equipment (arm ergometers, accessible machines)
• Pool with lift access if interested in aquatics

Don't be afraid to ask for accommodations or modifications.

Physical Therapy

A physical therapist familiar with spina bifida can:

• Create a personalized exercise program
• Teach proper form and modifications
• Address specific functional goals
• Monitor for problems

Regular PT check-ins help optimize your independent exercise routine.

Exercise at Different Life Stages

Children and Adolescents

• Focus on fun and participation
• Develop exercise habits early
• Adapted sports build confidence and social skills
• Work with pediatric PT for appropriate activities
• Prevent secondary conditions through early fitness

Adults

• Maintain independence through strength and cardio
• Address weight management proactively
• Balance exercise with work and life demands
• Find sustainable routines you enjoy

Aging With Spina Bifida

• Fitness becomes even more important
• Focus on maintaining function
• Adapt exercises as needs change
• Address new mobility challenges proactively
• Stay active to maintain quality of life

Common Questions

Will exercise make my condition worse? Appropriate exercise does not worsen spina bifida. It helps maintain function, prevent complications, and improve quality of life.

What if I've never exercised? Start very gradually. Even 5-10 minutes of activity is a beginning. Progress slowly and celebrate consistency.

Can I build muscle with paralysis? You can absolutely strengthen functioning muscles. Focus on what you can control.

Is it safe to exercise with a shunt? Yes, with reasonable precautions. Avoid high-impact head trauma. Discuss specific concerns with your neurosurgeon.

Moving Forward

Spina bifida doesn't define your fitness potential—it shapes the approach you take. Whether you're a wheelchair athlete pushing competitive limits or someone just starting to incorporate movement into daily life, exercise offers benefits that extend far beyond physical fitness.

Work with healthcare providers who understand spina bifida, find activities you enjoy, build consistency over time, and celebrate every achievement. Your body has unique capabilities—exercise is how you maximize them.

The goal isn't to exercise despite spina bifida. It's to exercise in a way that works for your body, building the strength, endurance, and independence that support the life you want to live.