Stroke Connection - September/October 2008 - (Page 16)
Those with severe limitations (e.g., paralyzed on one side of the body and spending significant amounts of time in bed) may do their exercises sitting in a chair and get assistance doing range of motion exercises with their affected limbs. They may be able to do neck stretches, knee lifts, ankle rotations, and flexing and extending their elbows and wrists on the unaffected side of their body. Those with moderate limitations (e.g., significant weakness in a limb) may be able to engage in physical activity in a pool where their affected limbs are lighter or use a recumbent stationary bike with assistance from a friend or family member or even a Velcro strap to keep their affected foot on the pedal. Those who can move all four limbs despite weakness in one or two of them (mild limitations) have even more options, including swimming and walking or using a recumbent stationary bike or stair stepper. Those with no functional limitations have no excuse for not participating in some form of physical activity. The trick is finding one you like. (To read the full interview with Dr. Frates, visit www.strokeassociation.org and type “Dr. Frates interview” in the search box.) Recipe for physical activity There are three main ingredients in aerobic physical activity: intensity, duration and frequency. Whether you engaged in physical activity before your stroke or not, begin any new physical activity regimen slowly. “An exercise session that is completed at a low intensity is better than no exercise session at all,” Dr. Frates said. “Moderate intensity, when you can talk but not sing, might be possible for some survivors, depending on their level of heart health and overall fitness.” 16 S T R O K E C O N N E C T I O N September | October 2008 Many survivors come to post-stroke physical activity after a long period of convalescence during which their muscles have atrophied and they have lost aerobic capacity. “A reasonable goal for someone in that condition is accumulating 10 minutes of physical activity each day or over the course of a day,” Dr. Frates said. “That can be broken into two five-minute segments. With the guidance of their physician they might be able to add five minutes after a week or so depending on how things are going.” Frequency is also important. The exercise prescription is to be active most days of the week. Lorraine Essig goes through her 40-minute workout three days a week. As survivors increase their strength and endurance, they may be able to increase the frequency. “It is best to progress at a slow and steady pace that is comfortable,” Dr. Frates said. “The most important thing is to start,” said Dr. Rose. “Five minutes of physical activity is better than zero minutes of physical activity. Survivors should do what they can, what their physician has given them permission to do. Five minutes can turn into seven minutes can turn into 10 minutes.” Resistance training Resistance training — either with weight machines or exercise bands — is another important component of physical activity. “Often survivors have secondary weakness,” Dr. Rose said. “This results from inactivity since the stroke. A strengthening program benefits this secondary weakness. I recommend consulting a physical therapist to establish a proper resistance training program.” Lorraine Essig works out three days a week in the comfort of her home. “I can be in a bad mood, but after I’ve done my exercises, that disappears.”
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