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When people started getting new weakness many decades later, that same belief was still in tact.  As a result, many individuals resumed exercising on their own, often with a vengeance, frequently producing additional weakness.  Based on these anecdotes and the initial theory that PPS was caused by overburdened motor neurons, it is understandable that most clinicians were cautious about prescribing any form of exercise.  Now, more than a decade later, there is considerable evidence that almost everyone can benefit from some form of exercise.  For many individuals, this level of exercise may be nothing more strenuous than gentle stretching or various types of yoga.  For others, it may be considerably more vigorous and even include aerobic training.  With this range of options, it is impossible to prescribe a set of exercises suitable for everyone.  Instead, a list follows of general principles and guidelines that can be used by most people with PPS to develop a safe and effective exercise program:

Individualized and supervised program.  Exercise programs should be supervised initially by a physician or physical therapist experienced in neuromuscular diseases, if not polio. All programs should be customized to each person’s needs, residual strengths, and symptom patterns.  Given these constraints, research studies have shown that some polio survivors (but not all) can improve muscle strength (caused by new muscle hypertrophy and the growth of additional terminal axon sprouts) and enhance cardiovascular endurance with a closely monitored training program.  In fact, some studies

have reported an increase in strength in muscles both with and without new weakness.

Type of exercise.  There are numerous kinds of exercise.  Finding the one that is right for each person and each limb often takes trial and error.  Usually, it is a good idea to find two or more exercises that can be varied, exercising specific muscles every other day.  For example, walking or exercising the lower extremities one day and alternating with an exercise for upper extremities the next day.  This program provides a period of rest for each muscle group and variation that keeps the overall exercise program challenging and enjoyable.  As a general rule, muscles that have a grade of 3 or less (using the muscle examination scale: 0 = no contraction up to 5 = normal strength) should be protected and not exercised; grade 3+ muscles can be exercised moderately; and grade 5 muscles can be exercised more vigorously.

Expect improvement.  Exercise should make one feel better physically and psychologically or both.  If the activity is not strenuous enough to improve an individual’s strength, much less the cardiovascular system (e.g. stretching or yoga exercises), it still should give a psychological lift just to be doing a special activity for oneself on a regular basis.

Listen to your body.  Avoid pain, fatigue, and weakness.  These symptoms are signals that your muscles have overworked.  A brief period of fatigue and minor

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