Exercise in Impaired Neuromuscular Systems

Question 1

Aerobic Fitness in Stroke

Answer 1

40% worse than sedentary peers
VO2 peak averages 15-18 ml/kg/min - out of breath walking to fridge
CVD and CVA - primary mortality causes

Question 2

Stroke Considerations

Answer 2

Hemiparesis
Atrophy
Dyscoordination
Balance impairments
Visual perception/cognitive impairments
*Fall Risk

Question 3

Stroke Considerations

Answer 3

Hemodynamic abnormalities
Fatigue
Depression
Pain
Increase energy expenditure

Question 4

Aerobic Stroke Goals

Answer 4

Improve or maintain CV function and functional ability

Reduce CV risk

Question 5

Resistance Stroke Goals

Answer 5

Improve or maintain functional capacity

Reduce falls

Question 6

Flexibility Stroke Goals

Answer 6

Improve or maintain ROM/prevent contracture

Question 7

Aerobic Stroke Training

Answer 7

20-60 min
3-5x/wk
Low to moderate (40-70% peak VO2)

Question 8

Strength Stroke Training

Answer 8

2-3x/wk
Low to moderate (3 x 8-10 reps)
Emphasize functional and core strength

Question 9

Parkinson’s

Answer 9

Progressive loss of dopaminergic cells in substantial nigra
Onset @ 50-60 years
Affects 2% over 65

Question 10

Parkinson’s Characteristics

Answer 10

Rigidity
Resting tremor
Bradykinesia
Gait/postural disturbances
Cognitive/affective disturbances

Question 11

PD Considerations

Answer 11

Autonomic fluctuation
Impaired thermoregulation/sweating
Want to exercise at similar time every day
Orthostatic hypotension

Question 12

PD Aerobic Goals

Answer 12

Be able to continue walking

Improve or maintain cardiovascular function and functional ability

Question 13

PD Resistance Goals

Answer 13

Improve or maintain functional capacity

Reduce risk of falls

Question 14

PD Flexibility Goals

Answer 14

Improve or maintain ROM/prevent contracture

Question 15

PD Aerobic Training

Answer 15

Up to 60 min
At least 3x per week
Low to moderate (40-80% peak VO2 or HR)

Question 16

PD Walking Training

Answer 16

20-30 min per day
4-6x per week
Self-selected pace

Question 17

PD Resistance Training

Answer 17

At least 3x per week
Low intensity (1 x 8/12)
Exaggerate movements
Emphasis on extensor/core musculature

Question 18

PD Flexibility Training

Answer 18

Gentle, static stretching
Emphasis on chest expansion
1-3x per week

Question 19

PD Training Considerations

Answer 19

Increase slowly
RPE can be hard to interpret
Monitor medication changes, sweating and painful dystonia

Question 20

Multiple Sclerosis

Answer 20

Chronic, demyelination of CNS

Onset @ 20-40 years

Question 21

MS Considerations

Answer 21

Spasticity
Dysfunction of ANS
Cardioacceleration
Blunted BP response
Heat sensitivity

Question 22

MS Considerations

Answer 22

Agonist/antagonist imbalance
Thermoregulation
Incontinence
Exacerbation/remission

Question 23

MS Aerobic Goals

Answer 23

Improve or maintain CV function

Question 24

MS Resistance Goals

Answer 24

Improve or maintain functional capacity

Reduce risk of falls

Question 25

MS Flexibility Goals

Answer 25

Improve or maintain ROM/prevent contracture

Question 26

MS Aerobic Training

Answer 26

30 min (fatigue easy) At least 3x per week Low to moderate (50-75% VO2) - typically low side

Question 27

MS Resistance Training

Answer 27

Isotonic Isokinetic Perform aerobic and resistance on different days

Question 28

MS Flexibility Training

Answer 28

Gentle, static stretching 5-7x per week Prior to exercising

Question 29

MS Training Considerations

Answer 29

Morning is optimal but don't overdue | Hydration critical

Question 30

Motor Neuron Diseases

Answer 30

Affect upper/lower motor neurons Inherited or sporadic Progressive

Question 31

MND Considerations

Answer 31

Weakness Atrophy Respiratory Dysfunction Cognitive disturbances - inappropriate response to situation

Question 32

MND Considerations

Answer 32

Mild-moderate intensity aerobic and/or resistance training likely beneficial