Pathways to Prevention (P2P) Program

Can Physical Activity Improve the Health of Wheelchair Users?


The 2010 census estimated that 3.6 million Americans use a wheeled mobility device, such as a manual wheelchair, motorized wheelchair, or scooter. This number is projected to be four times higher by 2020. Individuals who use wheeled mobility devices often experience poorer health outcomes compared to the general population. There are some distinct health challenges related to the physical effects of long-term wheelchair use, such as shoulder overuse injuries, skin breakdown, and urinary tract disorders. Wheelchair users may also encounter barriers to accessing preventive health care and getting sufficient physical activity.

Physical activity is likely to have wide-ranging impacts on the overall health of people who use wheeled mobility devices. Previously studied outcomes of physical activity interventions include balance, falls, transfers, self-efficacy in self-ambulation, depression, physical fitness, and cardiovascular health. Interventions to increase physical activity could also play a role in improving the preventive health care of people who rely on wheeled mobility devices, as well as increasing their workforce participation, independence, and quality of life.

The Physical Activity Guidelines for Americans highlight the need for increased physical activity in the population living with disability and recommend a mix of strength training and aerobic exercise to promote wellness and prevent disease. However, both the first and second editions of the Guidelines have emphasized the need for more research to identify safe and effective types and doses of exercise.


The population of wheeled mobility device users is large, diverse, and not well defined. While several national surveys and datasets contain information about the extent of disability, few of these include data about whether a wheeled mobility device is used, the type of device, or the length or amount of use. Wheelchair use is often not reported in literature examining the effects of physical activity in populations that are likely wheelchair users. When wheelchair use is reported, much of the research focuses on alleviating the primary condition that has led to wheelchair use rather than the impact of wheelchair use on overall health. As a result, wheelchair use is an ever-present but under-studied aspect of the daily life of millions of Americans with mobility limitations.

Workshop Goals

This P2P workshop assessed the available scientific evidence to better understand the potential benefits of physical activity interventions for wheeled mobility device users. The following questions were addressed:

  1. What is the evidence base on physical activity interventions to prevent obesity, diabetes, and cardiovascular conditions, including evidence on harms of the interventions in people who are at risk for or currently using a wheeled mobility device?

  2. What are the benefits and harms of physical activity interventions for people who are at risk for or currently using a wheeled mobility device?
  3. What are the patient factors that may affect the benefits and harms of physical activity in patients who are at risk for or currently using a wheeled mobility device?
  4. What are methodological weaknesses or gaps that exist in the evidence to determine benefits and harms of physical activity in patients who are at risk for or currently using a wheeled mobility device?

Sponsoring NIH Institutes, Centers, and Offices

Continuing education credits are not offered for this workshop.

Last updated on November 15, 2022