Exercise as it relates to Disease/Resistance Training and Stroke

Resistance Training is any training that primarily stresses the musculo-skeletal system, as opposed to Aerobic or Cardio-vascular training. Resistance Training is used to improve muscle strength, bone density, motor pathways, and connective tissue strength. It can also be used to improve balance, and as a rehabilitation or amelioration activity for people with chronic diseases or severe injuries.

Stroke is a neurological impairment, caused by either a lack of blood flow to an area of the brain (ischemic), or a hemorrhage (hemorrhagic). This can result in loss of sight, speech, or movement functionality, often on only one side of the body. Impairments to motor control can severely limit capacity of patients to move, perform day to day tasks, and remain independent –either financially or socially.

This article investigates the uses of Resistance Training in the rehabilitation of Stroke patients. Stroke sufferers often lose the ability to innovate muscle groups effectively, and are subsequently severely impaired in day to day activities. They suffer from loss of coordination, strength, and mobility in the affected regions.

An MRI of an hemorrhagic stroke in the cerebellum

Stroke and Resistance Training

Resistance Training has been demonstrated to improve a variety of recovery and rehabilitation metrics in Stroke patients. Resistance Training activities can be used to facilitate improvements in strength, movement functionality, and motor function for Stroke patients. A meta-analyses by Morris et al. found that there were few reported negative effects to strength training stroke patients, while achieving large effect sizes and improvements in practical activities like walking up stairs. Ouellette et al. found that high intensity Resistance Training over 12 weeks had a variety of benefits when compared to a control group who completed only stretching. Flansbjer et al. found that strength training improved the speed and ease with which older patients could stand upright from a seated position, in addition to increases in overall strength. Meanwhile, a 4 year longitudinal study, again from Flansbjer et al. found that strength gains from Resistance Training were maintained which indicates that there are significant long term benefits to Resistance Training as a rehabilitation intervention. Weiss et al. determined that for patients >60 years old, resistance training not only improved strength and motor functionality, but also increased competency in both static and dynamic balance. These studies also found that strength was improved on both the impaired, and non-impaired side, which indicates that resistance training provides a benefit for stroke patients beyond rehabilitation of their movement and motor control.

Recommendations

Stroke patients should consult with their doctor regarding the integration of Resistance Training as a recovery intervention. It is vital that patients undergo a pre-exercise screening; Stroke victims may have additional morbidity risks which need to be taken into account when designing the resistance training program. Resistance Training for recovery and rehabilitation from stroke should be undertaken with care, using a program defined by a health professional. Weight or resistance used in the program should be moderate to low, at least initially. Neurological gains can be made through lifting with the damaged, or undamaged side. Fixed joint activities such as leg extension, leg press, ankle dorsiflexion and other similar activities are recommended as they remove the requirement for the patient to stand and balance during the activity.

The American Heart Association includes Resistance training in its recommendations for the recovery and rehabilitation of Stroke patients. It is also recommended that the prescribing professional take consideration to integrating other exercise types to enhance rehabilitation and complement the gains obtained from Resistance Training. Incorporating other types of exercise into the rehabilitation of a Stroke victim will also assist in reducing further risk factors, particularly in the case of cardio-vascular type exercise activity.

Further reading

• http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/PhysicalChallenges/Weight-Training-After-Stroke_UCM_309780_Article.jsp
• https://en.wikipedia.org/wiki/Resistance_training
• https://en.wikipedia.org/wiki/Stroke
• http://www.livescience.com/25717-stroke-recovery-contralateral-training.html
• http://www.ncpad.org/94/706/Resistance~Training~for~Persons~with~Physical~Disabilities