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Signs, Symptoms, and Exercise Considerations for Stroke Victims

Although exercise has many benefits, a high amount of stress on the body can trigger negative events that one should look out for.  It is of vital importance to understand the signs and symptoms of cardiac events, such as the occurrence of a stroke.  Strokes occur when a blood vessel that is connected to the brain becomes extremely blocked from plaque build-up, causing a lack of oxygenated, nutrient-filled blood being delivered to the brain.

Stroke is the fourth leading cause of death in America today and can also cause long term changes leading to disability or lack of mobility/neuro-motor functioning.  This type of cardiac event can happen at any age but generally affects those ages 55 and older, and as we age our risk of having a stroke become greater.  Of all populations men, African Americans, and people with diabetes or heart disease are at the highest risk.

Some of the warning signs of having a stroke include sudden weakness of the face, arms or legs (especially on one side), sudden confusion or inability to speak, lack of vision, dizziness or coordination problems, and a sudden, severe headache.  If you have any of these signs, stop exercise immediately and get to the hospital or call 9-1-1.

The major goal of exercise after a stroke should be to improve the overall quality of life for the victim.  In addition to improving measures of quality of life, other measures such as functional capacity and mobility (i.e. increasing gait velocity), neurological impairment, and motor function (i.e. lowering the energy cost of a hemiparetic gait), will also benefit from regular exercise. The three major rehabilitation goals for the stroke patient are preventing complications of prolonged inactivity, decreasing recurrent stroke and cardiovascular events, and increasing aerobic fitness.

Before beginning an exercise program, the two most important things to consider are if the benefit outweighs the risk, as well as, the severity of the stroke.  A stroke victim should be evaluated by a medical professional before initiating a program—performing strength and aerobic training can lead to serious musculoskeletal injury.

To prevent muscle deterioration from prolonged inactivity, performing exercises that mimic movements of everyday life activities (i.e. standing from a seated position, squatting down, walking, reaching overhead) should performed regularly.  Moreover, moving the entire body throughout its full range of motion should also be considered.  In terms of aerobic fitness, stroke patients have been shown to achieve significantly lower maximal workloads and heart rate and blood pressure responses than control subjects during progressive exercise testing to volitional fatigue.

Setting reasonable goals to return to pre-stroke fitness levels as opposed to above baseline levels should be aimed for.  Exercising will be significantly harder post-stroke, but is of vital importance for the individual in order to improve their quality of life.

 

By Anthony Locast

 

Sources
Gordon, Neil F., et al. “Physical Activity and Exercise Recommendations for Stroke Survivors.”Circulation, American Heart Association, Inc., 27 Apr. 2004, circ.ahajournals.org/content/109/16/2031.

Strength Training with Orthopedic Limitations

 

Strength and conditioning and physical therapy go hand-in-hand in the rehabilitation process, but they are often seen as separate or opposing entities. Physical therapy helps individuals to recover from injuries, surgeries, impairments with the use of manual therapy (massage, myofascial release, joint traction etc.), electrotherapy (used for pain relief and passive muscle activation), and the implementation of an exercise program (depending on the severity of the injury/impairment). Most patients enjoy the benefits of the manual therapy and hands-on treatment from the therapist and feel better after relaxing with ice and electric stimulation. However, building the strength required to return to daily activities and beyond comes from performing resistance exercises with periodical progression.

Injuries, surgeries, and diseases leave us weakened and/or physiologically imbalanced. The initial focus following a diagnosis is to alleviate the impairment, enhance tissue repair, and improvement of range of motion. When appropriate, basic therapy exercises can be progressed by adding resistance to increase overall strength and correct imbalances. Both physical therapy for injured or orthopedically limited population and strength training for healthy individuals use the same principle of progressive overload to achieve the common goal of strength improvement.

Outside of the physical therapy office, individuals should continue to follow a resistance training program to continue the recovery process and make improvement even beyond where they were pre-injury. Although it is important to isolate a single muscle or muscle group during the recovery process, total body and bilateral exercises should be performed to prevent further imbalances and to improve overall fitness. Building strength in the muscles surrounding a joint can lead to less pain in joints during certain activities. Strengthening opposing areas of the body and learning better techniques/ movement patterns can lead to better habits that will aid in future injury prevention.

 

By David McCalla, CSCS

Strength Training for Seniors

As we age, our bodies start to change, our priorities shift, and things start to hurt that never did before. Old adults often experience difficulty walking for distances, climbing stairs, or carrying groceries. These changes are largely due to muscle loss which mainly results from inactivity.

In order to help us stay strong and vital during older adulthood, we need to participate in regular strengthening exercises, which can help prevent osteoporosis and frailty by stimulating the growth of muscle and bone. Feeling physically strong also promotes mental and emotional health. Strength training exercises are easy to learn and are safe and effective for the older population. Strength training helps you maintain bone density, improve balance and coordination, reduce risk of falling, and maintain independence.

When starting an exercise routine, always consult your doctor first. It may be beneficial to work one-on-one with an experienced fitness professional to ensure you are performing appropriate exercises or if you have any orthopedic concerns. If starting on your own, start by focusing on exercises which utilize your own body weight, and learning the proper form. By doing so, you will build a base level of strength before adding extra challenges (i.e. resistance bands or dumbbells) into the mix.

Resistance training has been proven to be beneficial for individuals with chronic conditions. In some cases, certain symptoms may be relieved with regular exercise. Here are some of the benefits of common conditions in older adults:

  • Arthritis—Reduces pain and stiffness, and increases strength and flexibility.
  • Diabetes—Improves glycemic control.
  • Osteoporosis—Builds bone density and reduces risk for falls.
  • Heart disease—Reduces cardiovascular risk by improving lipid profile and overall fitness.
  • Obesity—Increases metabolism, which helps burn more calories and helps with long-term weight control.
  • Back pain—Strengthens back and abdominal muscles to reduce stress on the spine.

As always, we recommend that you please consult with your doctor before beginning any exercise program.

 

By Louise Mills-Strasser, MS, ACSM EP-c

Creating SMART Goals for the New Year

January is the time of year when we set resolutions. The phrase “new year, new me” is a common mantra. It’s great to set new expectations for yourself; whether it is to commit to a new hobby, cooking healthier meals, spending more time with your kids, or deciding to lose weight. When it comes to making a New Year’s Resolution, broad or general statements are a good start, but most people need to do a little more to make them a reality. Sometimes when we simply make broad statements we end up off track pretty quickly. When you put pen to paper it helps you see and visualize these goals getting accomplished. Creating SMART goals is an effective method to create a plan of attack. Read on for step-by-step instructions to turn your resolutions into SMART goals!

  • Specific
  • Measurable
  • Attainable
  • Realistic
  • Time-Oriented

Specific
Specific is the What, Why, and How of the S.M.A.R.T. model. Goals should be written out clearly and simplistically to emphasize these points.

Basic Example: “I want to run”

SMART: “I want to run 1 mile. by February 15, 2017 by exercising at Peak 3 days per week for 1 hour and start with ¼ mile the first week then ½ mile the second week and so on and so forth.”

Measurable
Goals should be measurable so there is hard evidence that you have accomplished the goal. Using the SMART goal above for this example, the goal can be measured by February 15th. The essential measurement is whether or not this client was able to run a complete mile. by February 15th.

Attainable
Goals should be achievable; they should push you a bit so you feel challenged, but well-defined enough so that you can attain them.

Using the example from above, this client wants to run 1 mile. in about a 6 week time frame. After speaking with your Exercise Physiologist, you have learned that just running 1 mile without training can cause injury, so building up little by little is the best option per week. Committing to exercising and utilizing a running program are the “How” of the SMART model.

If you plan your steps wisely and establish a reasonable timeframe, you should be able to carry out those steps. On the other hand, if a goal is impossible to achieve (i.e. the client wants to lose 30 lbs. in the same time frame), you may not try to accomplish it.

Realistic
Ask yourself if the goal is realistic. In reference to the client and their fitness goals, we have discussed how the goal itself is realistic within the specified time frame.

Another consideration might be if the goal is realistic for this client. Have they spoken with their doctor? Are they committed to exercising at least 3 days per week? Do they have any injuries that might prevent this goal from happening?

Time-Oriented
When are you going to achieve this goal? What can you do in the next six weeks? What are you going to do today? Today you can commit to exercising.

Short terms goals are the building blocks of our long-term goal. If the client’s ultimate goal is to run 5 miles, the long term goal should then be set in an attainable time frame, for example, a 16 week period. Along the way, setting smaller goals will set you up for success!

Utilize our SMART Goal tools to help you be successful in the New Year! Planning before January 1 is already a step towards a successful 2018!

 

By Corynne Duprey

 

Dealing With Stress During the Holidays

The most common issue gym-goers have is that it’s hard to fit workouts in during the holidays.  On top of that, this is known to be the most stressful time of the year because of all the shopping and deciding the perfect gift for your loved ones, hosting and attending family parties, home decorating, and other events during this time of year.  Moreover, the cold weather and snow seem to add to people’s stress levels and make it even harder to make it to the gym.  Unfortunately we can not avoid the extra responsibility we must take on along with work and other life events during this time, therefore we must attack this stress head-on in order to remain calm and actually enjoy the holidays while still taking care of ourselves and our wellness.`

One of the first and most important aspects to dealing with stress is to write your tasks and goals down on a piece of paper (or in your phone) in order ease the mind knowing that your thoughts and responsibilities are organized and physically present for you to remember.  You have to head to the mall for Christmas shopping, pick up your kids at school and then have a holiday party in the evening, but you still want to fit in an exercise somewhere?  Map out your day the night before so that you can fit in enough time to exercise.

If you are like most people, the mental and physical benefits of exercise are important to you; missing your routine workouts can make you angry and feel unaccomplished.  According to a study done at the University of Liverpool, aerobic exercise training has antidepressant and anxiolytic effects which helps protect against harmful consequences of stress (Effects of Physical Activity and Exercise Training).  These findings can be credited to improved blood circulation throughout the body including the brain, lowered blood pressure, and improved production of endorphins (neurotransmitters that act as chemical messengers).  Exercise can regulate and improve the release of serotonin and dopamine, which are two hormones that play a heavy role in our mood, as well as, lower the production of adrenaline (fight or flight sympathetic response)—which at too high of levels can negatively effect our stress levels.  Therefore, skipping your workouts will only add to your stress levels, so make sure to prioritize your cardio training!

Another effective way to deal with holiday stress is to practice yoga (take a class, have your physiologist teach you, or watch an instructional video online).  In reality, yoga is mostly a combination of different stretches, postural corrections and functional movements to ease tension and relax the muscles of the body—so basically a good 10-20 minute session of stretching and deep breathing will do the trick.  The most effective way to use yoga/stretching to ease stress would be to either start your day or end your day by stretching—but stretching at any point in the day is much better than nothing.  Muscle tension, especially along the neck, can play a big role in effecting your mood and making you irritable.  If you have any specific injuries along the neck or spine you should check with your doctor to see if you’re eligible for physical therapy or need to see a specialist, but if you are just tense or tight, try some of these stretches at home in a very slow manner to see if they help. Remember to always listen to your body! Muscle tension anywhere in the body may increase your stress, so find out where your muscles are the most tight, and ask a physiologist at Peak how to stretch out those muscles!

Follow this link for some helpful stretches to help relieve neck pain!

—By Anthony Locast

 

Salmon, Peter. “Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory.” Clinical psychology review 21.1 (2001): 33-61.

“The Effects of Physical Activity and Exercise Training on Psychological Stress and Well-Being in an Adolescent Population.” Journal of Psychosomatic Research, Elsevier, 29 May 2002, www.sciencedirect.com/science/article/pii/002239999290114H.