The art of burning calories if you're disabled
Movement is difficult for many disabled people, so it's not easy to burn calories and stay at a healthy weight. Simone Illger is disabled, and has lost four stone in the past year, and this month shared her methods on Ouch's talk show.
In 2012 Simone Illger saw two friends undergo gastric bypass surgery. They were both Thalidomide-impaired like her and, also like her, they were overweight.
At 4ft 9in and 14 stone (93kg) she resolved that she did not want that to happen to her and decided to do something about it.
Illger started to monitor the food she was eating by tapping it all into a website which kept a count of her calories.
"At the moment I'm on 1100 calories a day," she says. "It's not a lot of calories but, depending on how you use them, you can still manage to eat quite a lot of food. And if you want more calories you have to exercise, go out and earn those calories so that's an incentive for me."
She quickly discovered that she didn't have to spend as much time exercising as she imagined she might have to. "Exercise as a disabled person burns more calories because of the [extra] effort you have to put into it," she says. "You may only be able to manage two minutes on the treadmill but you're likely to have burnt as many calories as the [non-disabled] person that was on there for half an hour."
She discovered this by using a heart monitoring device while training. "Heart rate can tell you how many calories you are losing," she says, and still uses the device now.
Two years later, Illger is 9st 10lb (62kg).
Paraplegic model Shannon Murray has been put off from exercising because she dislikes putting her non-standard body on show.
"The pool is accessible but it is a hoist not a ramp," she says. "It feels that with a ramp you can discreetly get in a pool. You can't discreetly get in a pool with a hoist. When you're a little bit conscious about your body anyway and getting into a pool full of able bodied users you know that they're staring and it's just not very appealing. It puts you off the idea when you're ready to go for a swim you know you've got to get through that first hurdle."
But it's not just the staring. Even though public gyms may declare themselves to be accessible, the reality can be different.
"On things like hand-bikes, which are a great cardiovascular workout for paraplegics, the saddle is tiny," she says - as well as pedalling she has to work out how she's going to cling on.
Illger sympathises and says she has similar difficulties being the wrong shape for many pieces of gym equipment. With short arms and short legs, she cannot use common gear like exercise bikes, rowing machines and cross trainers. But when a local gym offered a free session with a personal trainer, she took it up and learned about other equipment such as the stepping machine and the gym ball, as well as how to do stretches and twists. "He got me to do exercises with an elastic resistance band with handles on," she says. "I'd never exercised my arms before."
Illger has now set up a small gym in her garage with jigsaw rubber matting on the floor. She has borrowed a treadmill, and bought a wobble board and her own stretching bands. She exercises every morning.
Had she known she would feel so much better, she says, she would have started long ago. "My mobility has vastly improved. I use a wheelchair part-time but now if I'm stuck without the wheelchair I don't panic, I don't think, 'Oh my goodness, how far am I going to get before I collapse in a heap,' because I know that I can walk for 45 minutes on a treadmill at 2.7 miles per hour."
When she first started to exercise she could only do two-minute bursts before feeling that her heart would give out on her. It wasn't an easy beginning but she has almost reached her target weight. She knows that not all disabled people are the same, however, and that others may have many more difficulties achieving what she has done.
"I do realise that if you're tetraplegic or paraplegic you're going to be even more limited as to the types of exercise you can do," she says, "So that's where diet has to come first."
Other variables like prescription drugs can also confuse the picture further. Illger says it's important to keep a track of what you're putting into your body.
"If you can't move as much, or if you can't move at all, then sadly you have to eat even less." She says that ultimately the formula is a simple one: "Eat less, move more."
Discussions on weight loss and other subjects can be heard on this month's edition of Ouch, available as a podcast or to stream from the BBC News website. It's presented by Rob Crossan and Kate Monaghan.