Mar 7, 2011

Suggestions for Exercise

From Fifth International Polio & Independent Living Conference in Saint Louis
Suggestions for Exercise
Polio survivor, Nancy Caverly, Saint Louis, Missouri, introduced the topic of exercise and energy conservation by sharing her experiences.
About 15 years ago, with my youngest child securely placed in school, I decided to become a jock and take part in one of the major exercise programs in Saint Louis. The first day of the class, I was impressed by my size, which was larger than all of the thin women who had signed up to become super-jocks. Also, I was impressed by my inability to perform most of the exercises. Nevertheless, on my little pad on the floor, I pursued all of the exercises I could possibly do. I went home after an hour of a rigorous workout, took a hot bath, and went to bed for the rest of the day. I did finish the six-week course, because I had paid for it, but after the first day I did only the exercises that my body would allow me to do comfortably and without strain. I chalked the experience up as one major mistake in my personal quest for how best to maintain my body for the years to come – this was not the way.
The other exercise I tried doing, because I had done it extensively before polio at age 17, was swimming. My first morning included walking down a long flight of steps, changing clothes and getting into the pool, and swimming with businessmen who came to do 50 laps on their lunch hour. That day, I did 36 laps, or 1/2 mile, and again went to bed for the day. This time I did not wipe swimming off of my list of acceptable exercises, because I knew that swimming had many positive points for exercising. I decided to start low and build up my laps to find out the reasonable number for my body. Now, I swim two days a week, between 8 and 10 o'clock in the morning. The reasonable number for me is 20 laps in the 100% accessible 25-meter pool at a local school. I do ten laps of freestyle or crawl stroke, two laps of back stroke, two laps of elementary back stroke, two laps of breast stroke, two laps of side stroke, and a few stretching exercises. For the last two laps, I do whatever makes me feel the best, I check my pulse rate after about ten laps and it usually is about 112 to 118 a minute, the minimum necessary for cardiovascular conditioning. It takes me approximately 20 to 25 minutes to do that number of laps. The cardiovascular stimulation that I am getting from swimming is great; I am unable to exercise in any other way (walking, cycling, etc.) for that length of time.
On the Tuesdays and Thursdays after swimming, my energy level during the day is much higher. I do not go to sleep at 8 o'clock watching a movie on television. I am still moving at 10 o'clock that night, not with energy that I should not have, but with energy that is available to be used.
After swimming for five years, I was telling our local pharmacist that I was having some low-back pain from an old diving injury. He suggested I try swimming with fins. With fins, I get faster movement so that it takes me less time and fewer strokes, but I get more resistance. The low back pain decreased within a three-month period and has not recurred. As a polio survivor, I know I am going to find a year-round swimming pool where I can swim at least two times a week, wherever I live in the future. That is where my body and I are with exercise.
Non-Fatiguing General Conditioning Exercise Program
(The 20% Rule)
Stanley K. Yarnell, MD (now retired), San Francisco, California
The non-fatiguing general conditioning exercise program using the 20% rule was designed to restore stamina or endurance for those individuals who have continued to be bothered by profound fatigue following surgery, illness or trauma.
The program begins by determining the polio survivor's maximum exercise capability with the help of the clinic physical therapist. The type of exercise can be in a pool or on dry land, using an arm erqometer or an exercise bicycle, depending on the individual's abilities and preferences. If one prefers swimming, the maximum number of laps that the patient can swim is used as the maximum exercise capability. If the survivor has considerable residual weakness and is only able to swim one lap in half an hour, then the amount of time actively swimming can be used as the maximum exercise capability rather than the number of laps.
Having established the maximum exercise capability, the polio survivor is instructed to begin his aerobic swimming program at 20% of the determined maximum exercise capability. He can swim three to four times per week at that level for one month, and then he is instructed to increase by 10%. For example, if an individual is able to actively swim in a pool for half an hour, then one-half hour would be his maximum exercise capability. He would begin swimming just six minutes per session three to four times per week for a month before increasing the amount of time actively swimming to nine minutes three to four times per week for another month. Then he would increase by 10% once again so that he was actively swimming 12 minutes per session three to four times per week for another month, and so on. After three to four months, our patients have reported that they feel an increase in their general stamina or endurance.
Alternatively, if an arm ergometer or exercise bicycle is used, the same basic principle can be utilized, calculating distance pedaled or time spent actively pedaling. The individual begins his aerobic or non-fatiguing general conditioning exercise program at 20% of maximum exercise capability three to four times per week for one month before increasing the distance by 10%. He continues with that level of activity for another month before increasing by another 10%, so that he is exercising at 40% of maximum exercise capability.
For example, if an individual is able to pedal an exercise bicycle for one mile or is able to actively pedal the bicycle for up to 20 minutes, then that is his maximum exercise capability. He is instructed to begin his exercise program at one-fifth of a mile (or, if time is used, then four minutes is the beginning exercise time). This is repeated three to four times per week for a month before increasing the distance to one-third of a mile or six minutes. Our patients are encouraged to maintain that for an additional month before increasing by another 10%, and so on.
Individuals are cautioned to stop if they become fatigued during their exercise program, or if they experience pain or aches in their muscles. Most polio survivors are able to continue increasing their exercise program to nearly the maximum exercise capability, though it clearly would take a full nine months if this program were strictly followed. Conditioning or aerobic exercise at this submaximal level allows the individual to regain a healthier sense of stamina without damaging delicate old motor units.
It is imperative to incorporate the concept of pacing and spacing within the non-fatiguing general conditioning exercise program, meaning that rests are to be taken every few minutes.
The 20% rule is sometimes also applied to polio survivors when they are given instructions in a home flexibility and stretching program so they do not exercise too vigorously.
This exercise program can be modified with the supervision of a physical therapist, depending on the progress made by the polio survivor. This program may not eliminate fatigue, but we have found it effective for those who have a significant element of deconditioning contributing to their sense of fatigue.

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