I was at the gym a few months ago and had to ask a guy to help me switch an attachment on the cable machine I was using. It was a guy I see there regularly, always working hard, always purposeful. I asked him if he was training for anything — as the town I live in is a mecca for outdoor sports. “Nope,” he said, “just trying to live and stay active for as long as I can.”

The episode popped to mind recently when I was reading Tim Gilmer’s 2007 story “Return of the Canary,” about his own experience with coronary artery disease and the symptoms and denial that preceded it.

For wheelchair users, especially younger ones, arterial health is one of those vague issues that most people don’t think about until they have to. But research has shown that wheelchair users are at much higher risk of having artery problems — whether the narrowing associated with coronary artery disease or the acute danger of blood clots.

Both issues respond well to a proactive mindset, a la gym guy. As Gilmer put it, “Coronary artery disease is all about risk factors. To successfully manage or prevent it in the first place, we must recognize and rein in the risk factors that are controllable — and learn not to worry about those that aren’t.”

Heart Health Risk Factors

Most of the research around arterial health in wheelchair users is done on people with spinal cord injuries. A recent meta-analysis of research tracking spinal cord injury and heart disease showed that people with SCI are over 1 1/2 times more likely to have cardiovascular diseases, including heart failure, stroke, myocardial infarction and atrial fibrillation. The reasons are complicated, but there are some we can control and some — including chronic inflammation, altered lipid levels and autonomic dysfunction — that are just part and parcel of living with a spinal cord injury. For more on SCI and cardiovascular risk, the paper “Diagnosis and Management of Cardiovascular Risk in Individuals with Spinal Cord Injury” has a lot of quality information and is relatively easy reading for a scientific paper.

The risk factors we can control are the same ones you’ve probably already heard about a million times. Excess weight, poor diet, tobacco use, lack of exercise, diabetes and high blood pressure elevate the risk of cardiovascular disease for everyone, disabled or not. Bob Vogel’s “Spinal Cord Injury and Cardiovascular Disease” has a full breakdown of risk factors and how to get your doctors to test for arterial damage before it becomes a life-threatening problem. Testing can be especially important for people with higher level injuries, as lack of sensation can mask some of the symptoms of acute heart problems, like chest or arm pain or shortness of breath.

The other major arterial risk for people with SCI is blood clots. Risk of forming blood clots, which can quickly become deadly if they migrate to the lungs or brain, is the highest immediately after SCI or any other kind of traumatic injury, even one as small as falling out of your chair and breaking a bone. Pregnancy can also increase your risk for clots, especially if you’ve already had a blood clot before. Lack of activity or a lot of downtime in bed are risk factors as well. In “Blood Clots and SCI — What to Watch For,” Gilmer explains it all and talks with wheelchair users who’ve dealt with recurrent blood clots about how they stay safe.

Nutrition Tip

“Eliminate trans fats. Trans fats are unnatural, man-made fats that increase shelf life of foods (e.g., hydrogenated oils). These fake fats can cause major clogging of arteries, are known to increase LDL and lower HDL, and can interfere with your body’s use of beneficial omega-3 fats. Avoid fast and junk food, which tend to be loaded with this unhealthy fat.”

-Joanne Smith, certified nutritionist

Lifestyle Changes and Preventative Medicine

If you’re concerned about your risk of coronary artery disease — and research shows if you have an SCI, you should be — the most effective preventive medicines are often lifestyle choices. The first is to exercise regularly. That can be easier said than done though, especially for higher level injuries, as Ian Ruder explains in his recent Bully Pulpit, “The Everlasting Saratoga Cycle,” about his decades-long attempts to love an arm ergometer. Heart-healthy exercise recommendations like “150 minutes a week of moderate aerobic activity” often don’t mean a whole lot for wheelchair users when examples are usually things like brisk walking, gardening or ballroom dancing.

Occupational therapist and wheelchair user Kerri Morgan is currently in the middle of a five-year, NIH-funded study to try and determine what constitutes enough exercise for wheelchair users to improve their health. Until those results are released, we have to go with the little bit of research we do have. Handcycles and arm ergometers have been shown to improve cardiovascular health. I have a handcycle set up on a trainer throughout the winter months and it’s one of the few activities that feels like a true cardio workout where I can feel my lungs working before my muscles give out. For those like Ruder who get bored while spinning your arms in circles and going nowhere, fear not. Modern “smart trainers” and apps like Zwift have gamified indoor cycling and made it a lot easier to stay motivated. Zwift even has a handcycle avatar to crank through your virtual rides. 

For those who don’t have enough function to crank an ergometer, push a wheelchair or otherwise get your heartrate up on your own, there is some research that functional electrical stimulation bikes can provide many of the same health benefits.

Other major lifestyle interventions include stopping smoking, limiting alcohol and changing your diet. Fortunately, for cardiovascular health, the diet recommendations are straightforward. Joanne Smith explains that a healthy cardio diet includes foods high in fiber, such as nuts and seeds; whole grains; plentiful fruits and vegetables; and healthy fats contained in cold water fish, such as salmon, herring and halibut; also, avoid processed foods.

For both coronary artery disease and blood clots, preventive medications can be effective depending on your risk factors. Baby aspirin is commonly prescribed for both blood clots and coronary artery disease; other blood thinners are common for clotting, as are statins for coronary artery disease. But even if your doctor doesn’t think you’re high enough risk for prescription medications, lifestyle modifications have an added benefit. They can improve other areas of your health, including mood, energy levels, and body composition.

As I wrote in a recent newsletter on weight loss, when you’re changing your lifestyle, don’t think about what you are losing (or trying to prevent), think of what you are trying to gain: years of better living.