Training important in recovery

     By Kim Springer
     View columnist
      More than 650,000 Americans are newly affected by stroke each year with more than 75 percent of the cases occurring in people older than 65.
      This statistic comes from the American Heart Association and calls attention to the fact strokes and heart attacks are still affecting Americans at an astonishing rate. Those that survive these episodes now have options to improve their lives and future health.
      Biomechanics Magazine notes that "traditionally, rehabilitation programs target patients in the early stages of recovery in accordance with the widely accepted view that the return of motor function is for the most part experienced within the first three months post-stroke." The patient then usually reaches a plateau at six months into therapy.
      A major role of rehabilitation is to restore the stroke patient's mobility, enabling participation in daily activities. About a third of those who survive their stroke are left with considerable disability even after intensive rehabilitation.
      Residual neurological deficits generally include hemiparesis, or weakness on one side of the body, sensory loss and reduced mobility. Muscle weakness is also a concern and many times is the limiting factor in performing physical tasks. Lower body strength in particular has been shown to be a predictor of level of disability and quality of life.
      When looking at exercise from a health standpoint, it is incredibly evident how important strength training is toward improving the quality of life. Exercise reduces your probability of suffering from heart disease and in addition helps patients with an easier and faster recovery.
      Strength training may not seem important to you now but think how much harder it would be to start a program after you have suffered from a stroke.
      With normal aging, muscles lose strength at varying rates. Those that continue to be active with both cardiovascular and strength training exercise will lose muscle but at a much slower rate. Stroke related disability only adds to the risk of deconditioning and further functional decline in association with aging.
      Additionally, stroke survivors have lower functional and endurance capacities than similarly aged healthy individuals. Stroke patients might never regain 100 percent of their capabilities but they can benefit from strength training.
      Muscle weakness is the inability of muscle to generate normal levels of tension and can be attributed to atrophy caused by disuse, trauma or neuromuscular dysfunction. In the latter, the ability to activate all motor units of a muscle to the full extent is lost. A consequence of a stroke is that voluntary activation of motor units is lost and pathways from the motor cortex are damaged.
      Following a stroke, the most important activities are those that help to improve neural adaptations to exercise. Over-training should still be avoided for these patients which could lead to deterioration in strength. Studies examining knee strength found that as little as six weeks of isokinetic exercise (two to three times a week for 20 to 60 minutes) result in marked gains in both flexor and extensor strength.
      For practical purposes the best exercise programs can be carried out in the community or at home since most people do not have regular access to isokinetic devices.
      Conventional resistance exercises using resistance tubing and small hand weights have demonstrated to be extremely effective. Repetitions should be set about eight to 10 per exercise and the patient should rest before they begin to use substitute motions (cheating) to perform the exercise.
      In addition to the physical benefits of strength training, stroke survivors' perceptions of their physical capabilities, general health, and well being also improve dramatically.
     
     Kim Springer and her husband, Mike, are certified by ACE, NASM and ACSM as personal trainers. They can be reached at 233-9442, by fax at 233-9446 or by e-mail at springtrain@netscape.net.