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Using Exercise After A Stroke To Get Your Life Back

Written by: Nick Jack
Category: 2014
on 06 September 2018
Hits: 6965

Stroke is one of the world's biggest killers and a leading cause of disability. While our modern technology has provided us with some incredible ways of improving our living, it has also come at a huge cost to our health as obesity, poor lifestyle and nutrition choices continue to ruin the way our body functions. The high incidence of stroke seems to go unnoticed within the media, yet stroke kills more women than breast cancer and more men than prostate cancer. In 2017 there were more than 56,000 new and recurrent strokes – that is one stroke every nine minutes! When you consider that more than 80% of strokes can be prevented, knowing what things you can put in place to prevent this is vital. In this article we will talk not only about how to prevent a stroke but also what you can, and NEED to do if you have already suffered one so you can get your life back.

What Happens When You Have A Stroke

A stroke is caused by an interruption of the flow of blood to the brain or by a rupture of blood vessels in the brain. The damaging effects of a stroke depend on what parts of the brain are affected, as well as the amount of damage. Common after affects contribute to resulting weakness on the side contra lateral to the brain injury.

In 2017 was more than 475,000 people living with the effects of stroke. This is predicted to increase to one million by 2050.

These people will be made aware of the need to start an exercise program and clean up their nutrition and lifestyle habits. And while this is a great start this may only take you so far if you are not more precise with your CHOICE of exercise. Many stroke survivors are lacking the support, knowledge, and tools necessary to begin an exercise program. They just guess at what to do, or even worse a health professional says just do some cardio every day and you will be right. And for some people cardio activities are very difficult for they have lost their ability to move correctly. Some cannot even walk! Learning how to get their movement back is of upmost importance.

We see this same problem with MS and spinal cord injuries. See article Why Strength Training Is Vital For MS

In the past, exercise and more specifically strength training, with stroke victims or brain injuries has been misunderstood and at times even controversial.

Most people with stroke are usually prescribed “safe” or moderate exercise programs, with more emphasis on cardio vascular exercise or using isolated exercises and stretches to treat the affected side. Typically machines are used for strengthening as they force the muscles to work in a symmetrical method that eliminates mistakes at the same time making it safer. I myself used machines when starting as a trainer as I was told that free weights are too risky and that the client would benefit from doing bilateral movement as opposed to single arm or single leg exercises. I found that this approach did not really help these clients to improve what they came to see me for in the first place which was – how to move better!

It also did not address the problem of spasticity or lack of flexibility with the affected arm or leg, which is often severely restricted in pronation and bent. Using an isolated stretch seemed to do nothing to change the actual length tension of the muscle as soon as we stopped stretching. I suspected the solution would be with the strengthening and movement approach but I needed a different model than machine training and isolated movements. What I found was that a much more integrated approach of using movement focused exercises, with more reliance on single arm and contralateral activity produced significantly better results.

Interesting Stroke Facts

According to the National Stroke Association:

  • 10% of stroke survivors recover almost completely
  • 25% recover with minor impairments
  • 40% experience moderate to severe impairments that require special care
  • 10% require care in a nursing home or other long-term facility
  • 15% die shortly after the stroke
  • Approximately 14% of stroke survivors experience a second stroke in the first year following a stroke.

Recently we have been working very closely with several clients suffering brain injuries, severe movement dysfunction, and muscle loss caused from either accidents or strokes. The effects of these conditions can often be quite devastating and some people never regain the skills they had prior to the incident. Having said that, there are some that do recover and develop significant improvement in daily living tasks. Surprisingly, it can happen quite quickly if the right stimulus is provided. This article looks at some of the research we have been able to use and implement effectively with several clients.

Here is a testimonial from one of our clients who was in our Lift For Life program for over 18 months.

“I have been getting personal training from No Regrets Personal Training for 6 months now and I have loved every minute of it! Nathan is such a patient, caring and understanding person but he still pushes you. I have definitely improved out of sight since going to training, my movement, my balance, my walking, my strength and my overall appearance have improved quite a lot and I only expect it to continue! I haven't missed a session because I love it!” - Shannyn Moon

Shannyn is only 31 years of age and has suffered from 2 severe strokes that have left her with partial paralysis on her right side. Her goal is to be able to walk down the aisle for her wedding in her words “like a normal person”.

What Exercise Is Best?

There is no one exercise that is best for everyone, just the one that is best for you. Firstly adding some light cardio is great and the easiest thing to start doing is walking 30-60 minutes everyday. If you want to add some cycling, swimming or even jogging if you are able to then that is fine. Just do not overdo it, and do not make this the cornerstone of your program. Cardio should be completed in combination with a strength training program.

Why?

For the benefits of strength training and adding muscle is the secret to looking good and maintaining health of joints and bones. It also plays a massive role in maintaining metabolic rate, controlling blood sugars, hormones and a host of other vital health functions. Once you lose muscle these factors all begin to spiral out of balance and potential for serious health problems is on the horizon. Regular, consistent exercise is one of the fastest and most powerful ways to lower your insulin and leptin resistance. 210 minutes of moderate intensity physical activity is recommended per week for health benefits (which if you do the math is only 30 minutes per day), which can be broken up into smaller time intervals (eg. 3 x 10 minutes). This can help to regulate your blood glucose levels and ultimately reduce the likelihood of developing further complications in the future.

While aerobic exercise is beneficial, studies show that resistance training is more effective due to the metabolic adaptions of skeletal muscle. As part of our Lift For Life program we advise completing strength and resistance training 2 to 3 times per week to notice the benefits of your exercise regime. Overuse of cardio exercise can even be detrimental to your health, see video about heart health below.

 

What strength exercises are best?

Learn Movement Skills First

I first came across the Complex Movement concept many years ago when working with sporting athletes looking to improve movement efficiency to ultimately develop improved strength and power. It just took me some time to think that I could use the same principles of teaching sports to people with injury or even just beginners. Originally I believed if I used the typical muscle approach to training this would automatically equal faster and more powerful. Yet I found anytime I used a complex task that was actually a lot lighter load, but required much more brain concentration and focus, and they were able to execute it as close to perfectly as possible, the strength gains and improvement across multiple skills, was much higher than when we focused on strength alone. This now makes up a big part of our sports program.

 

Over time I began applying this theory to beginners, then to injury and rehabilitation, more recently with older adults where I found this to be also true. And interestingly enough the gains were more significant with the rehab and older adults more so than the sports due to the amount of skill and strength lost.

This led me to reading hundreds of books and completing many courses in this area to develop programs and exercises with the goal of trying to improve a person’s movement efficiency. Basically we are training the neuro musculoskeletal system with our goal to get your body’s systems to work in a highly coordinated and effective fashion, so that functional tasks are completed successfully.

This aligned perfectly with our goal for rehabilitation and more specifically stroke victims because the goal of the individual who has experienced a stroke is to reach the highest possible level of independence and be as productive as possible (Just like Shannyn wanting to walk down the aisle!) The difficult and challenging part here is that the progress and recovery is so unique for each person, depending on the level of damage and paralysis. There is no one magic exercise that works every time. A method of assessing where to start and determining how each person learns best will decide how effective the program would be.

Using a reverse engineering approach with the focus being on the end result – improved human movement and function, we needed to use a way to find out what movement patterns they needed, and how good they were at completing each one. From this we could design a stepping stone approach to learning and devise plans and programs to enhance each movement pattern.

But this is where it gets very interesting and even contradictory. With the “Average Joe”, who lacks overall conditioning, we could use a more simple and isolated muscle approach to build some strength and reserve before tackling the more complex integrated movements.

For example to improve the ability to squat we could use an approach of simple exercises evolving to harder more integrated.

  1. Hip extension progressing to
  2. A swiss ball squat against the wall to a
  3. Squat with a barbell.

With the stroke or brain affected clients we had more success with starting with more complex and difficult tasks often completed in a split stance, using contralateral arm and leg movements that mimic the action used in walking. See videos below.

 

This takes advantage of how the neuromuscular system is designed to work in the first place, which is in a highly coordinated manner. The body really is a complex system made up of many chains known as slings. These slings, when they are working well, help us move efficiently, produce more force, and create more speed. However, when there is a weak link in the chain, most people don’t address the chains but rather target the muscles. Very, very rarely do muscles work in complete isolation or anywhere close to it. Some muscles contract to provide movement while some muscles contract to provide stability. This is all done at the same time. They don’t work separate to each other. In addition to this and as we have already discussed, the more coordinated and complex movements have a greater effect on the brain. And because the brain controls the muscles, it makes sense to try and change this!

There is a detailed report you can download below that explains in great detail with pictures and instructions how to develop your movement patterns. Given the heart's never-ending workload, it can easily be brought down by a poor diet, lack of exercise, smoking, and illness caused by neglect to other parts of our body. This report explains everything you need to know about improving not just your heart health but your overall health. I created this report to include ALL of the specific exercises and foods to eat for treating and preventing various heart and lung conditions. Click here to download your instant PDF copy.

What Is The Most Effective Ways To Learn These New Tasks?

I highly suggest reading the book “Motor Learning and Performance” by Richard A Schmidt and Timothy Lee as this really helped with my program effectiveness and adapting different learning styles for each client. We knew that our purpose of conditioning was to teach your body how to train smarter and move better for life. We need to improve various abilities such as strength, balance, co-ordination and agility all relative to each other. I like to use the analogy of getting an upgrade on your computer. In the gym it is the perfect place to master these skills.

Your ultimate goal should be to master every form of movement enough times that it becomes automatic! Once you learn to move properly in a gym you don’t worry about your technique when you’re playing a sport, moving something at work or even just lifting something in the garden. If you’ve done it right in the gym, and done it enough times it’s already built into the system. This is what is referred to as a Motor Engram. This is why it is so important for a new gym goer or someone recovering from injury to learn ONLY GOOD MOVEMENTS. This way it will teach the body the perfect automatic movement it needs to prevent further injury.

But What Is The Best Way To Learn?

In the beginning we would intervene and guide the clients movements so that it was as close to perfect as possible. We knew that to change a movement we needed approximately 5000 perfect reps to make it automatic. But what we found more effective, was to not intervene and only help when required, and actually allow for some mistakes to be made. This would allow the problem solving nature of the brain to develop. Providing video feedback and use of mirrors became extremely effective in the client learning how to overcome the problems faster than us trying to help all the time.

Below is videos of examples of exercises used to enhance the ability to stabilize, prevent falls and walk better.

 

And with Shannyn using external nervous system stimulus to the feet to improve walking, she made more improvement than any other exercise we had ever tried. Using a bare foot approach of walking across several different surfaces to enhance the actual foot mechanics changed her movement pattern almost instantly. Her damaged foot for the first time began to dorsi flex and find its way across the uneven terrain. We got her to walk across  

  1. Concrete
  2. Uneven grass
  3. Stones – this was the hardest but also the most effective

The different nerve sensations and the requirement of the foot to feel its way across the surface forced the nervous system to adapt and create better method of movement. Coupling that with video feedback for them to observe and try to change enabled us to alter their permanent way of walking faster than using standard stationary exercises we had used before.

Over time we added a Sensa Mat to our training program to basically bring the stones indoors! This has been a remarkable addition to our training program and the results are simply amazing for people with walking impairments.

Read our articles below to see more about how we use the Sensa Mat

Conclusion

Strength training for strokes and other accident related injuries cannot be underestimated. At times, isolated movement and muscle approach is needed and can be beneficial in adding some muscle, but a program that utilizes an integrated movement approach will produce faster and superior results. Finding creative ways to mimic and simulate daily tasks will not only significantly improve movement skills and function, but add much needed muscle improved flexibility for tight muscles that previously did not respond to stretching or releasing. Use of various learning tools such as video and external surface will also speed up the learning and enable you to complete tasks never before possible. Once you are able to move more efficiently it is much easier to complete a more rigorous exercise program that keeps your body functioning at it's optimal best and prevent disease and disability from ruining your life.

References:

  • Motor Learning & Performance by Richard A Schmidt
  • Bending The Aging Curve by Joseph Signorile
  • Anatomy Trains by Thomas Meyers
  • National Stroke Association

If you live in Melbourne and would like to know more about our Lift For Life program please click the image below to request a free health consultation.