An Effective Exercise Prescription for Ataxia Polly Swingle, PT The Recovery Project, LLC www.therecoveryproject.net 734-953-1745 1
Are you Functional? Sit to stand from a chair without the use of your hands 5 times? Walk across the street? Carry 10 pounds? Walk a flight of stairs? 2
Signs and Symptoms of Ataxia Gait ataxia Loss of strength: pelvic girdles followed by legs. Spasticity into extension. Upper extremity and trunk weakness as disease progresses. Sensory loss: light touch, position, vibration in extremities results in balance deficits. Poor cardiovascular endurance. Scoliosis Pes Cavus of feet (tight heel cords) 3
What does the research say? The cardiovascular system will adapt to prolong endurance training are similar in the young and old. Once thought inevitable that muscle strength will decline with age and disease, no longer is considered an inevitable consequence of aging. Balance training may be improved at any age as long as intensity, duration and frequency is sufficient to overload. Flexibility programs have been shown to have beneficial effect of individuals with chronic diseases. 4
Why Is Exercise Important? Prevent falls Maintain function Independence Maintains overall health 5
Barriers to effective exercise Lack of time (too busy- most common excuse across the board Advice Find time slot-30 minutes, 5 x day/wk Add to daily routine-during lunch hour, exercise while watching TV Take fitness break instead of coffee break. Can spend minimal time and receive big return. Exercise first thing in the morning. 6
Barriers to effective exercise don t say you don t have enough time. You have exactly the same number of hours per day that were giver to Helen Keller, Michelangelo, Mother Teresa, Leonardo da Vinci, Thomas Jefferson, and Albert Einstein. 7
Barriers to effective exercise Lack of energy, lack of motivation Advice Schedule activity when must energetic. Remember physical activity will increase you energy level. Start with 5-10 minutes, may find 20-30 minutes is not so energy sapping. Plan ahead Set a motivational goal. 8
Barrier to effective exercise Fear of injury Advice Warm up, cool down Exercise at right level Choose non-risky activities. Choose the best activity ( which a PT should certainly guide) 9
Barriers to effective exercise Lack of resources Advice Walking does not require great resources. Many community resources are inexpensive (YMCA offers scholarships programs Y-cares, $10 month for full membership. 10
Barriers to effective exercise Too old Advice No one is too old 30 min/day regardless of age Can strength train sitting in a chair Exercise prevents falls You do not stop exercising because you grow old or your disease progresses. You grow old and your disease will progress faster because you stop exercising! 11
Physical Stress Theory exercise Overload Specificity Progression Recuperation/recovery Use/disuse 12
Physical Stress Theory Was developed to address how tissues, organs, and organ systems adapt to varying levels of physical stress. Levels of stress below maintenance levelsdecreased tissue tolerance to stress (atrophy) Maintenance levels-do not change tissue (no change) Stresses that exceed maintenance levelsincreased tissue tolerance to stress (hypertrophy) 13
Exercise principles Overload/intensity Tissue must be exposed to a load to which it is not normally exposed to improve in function. Overload is applied to aerobic capacity/ endurance, balance, flexibility, and strength/ resistance training. Must be individualized. Applies to: intensity, duration, frequency and speed. 14
Exercise Principles Training will only improve those parts of the body being trained. Implies that to become better at particular exercise or skill, must perform that exercise or skill. Clinicians should prescribe optimal exercise intensities to adhere to specificity of training principles and also have patients perform functional activities for motor learning. 15
Exercise Principle Try to reach optimal level no later than by third or fourth session. As patient improves, must steadily progress intensity levels to continue to provide overload stimuli. 16
Exercise principles Body needs time to allow physiological mechanisms required for the activity to adapt. Overload training should not be done daily since muscles require time to heal. 17
Exercise principle Use it or lose it Must be periods of low intensity between periods of high intensity for recovery Consider cross training. 18
Characteristic Of An Warm up/cool down Resistive training Balance exercises Flexibility exercises 19
Warm up/cool down Warm up 5-10 minutes Passive: increase temperature by external means. General: increase temperature using non-specific body movements. Specific: increase temperature using similar biomechanics used in subsequent, more strenuous activity, which provides rehearsal of activity or event. Is like warming up your car. 20
Cool down Cool down-5-10 minutes Is a gradual tapering off of intensity Prevents blood from pooling in the lower extremities. Decreases likelihood of drop in BP, lightheadedness, fainting, or abnormal heart rhythms. Promotes removal of waste products from muscles. 21
Benefits of warm up/cool down Rehearse movement Elevate body temperature Increase muscle blood flow Increase speed of nervous impulses Increase flexibility of muscle Reduce incidence and likelihood of musculoskeletal injuries. 22
Exercise categories Aerobic capacity/endurance Balance Coordination Agility Body mechanics/ postural stabilization Flexibility Gait and locomotion Muscle performance 23
Recommended amount of exercise 150 minutes/ week. 24
Aerobic conditioning/endurance Frequency: 3-7 days per week Intensity: 220-age x (60-80%) 30-40 minutes or as tolerated Interval training/circuit training 25
Circuit training Stations Walking/running Toe raises Push-ups/planks Standing balance Sit to stand Heel raises Quad/hamstrings and calf stretches. 26
Balance Training Frequency : 1-7 days/week Intensity static and dynamic Time: 10-15 minutes. Type: foam, stability balls, tai chi, etc. 27
Body mechanics and postural Incorporated into aerobic capacity/endurance training, balance and agility training, strength training. Weighted vest Balance wear vest. Other 28
Gait and locomotion training Frequency: 5-7 days/week Intensity: must challenge limits of gait and locomotion: change speed, surface, superimposing activities on gait, decrease supportive devices. Weighted vest/balance wear 29
Muscle performance (strength Frequency: 2-3 x week per muscle group with 48 hours of rest between sets of exercise Intensity: 60-80% of 1 RM. 12-25 reps, 1 set Full ROM Slow pace With good form and technique. 20-30 minutes 30
Flexibility training Frequency: 2-7 days/week Intensity: 60 second stretch shown most effective for increasing ROM. Incorporate breathing and stretch. 31
Exercise prescription Warm up x 10 minutes (heart rate at 220-age x.6) treadmill, bike, walking, rowing, nu-step Circuit strength training x 20 minutes Squats/leg press Heel raises Toe raises Bicep curls Triceps extension rows 32
Exercise prescription Find 1 repetition max strength (1RM) Exercise at 60% of 1 RM 12-25 repetitions, 1 set Once reach 15 repetitions about 5% increase of weight. Full ROM, slow pace (1,2,3) 33
Exercise prescription Balance exercises (10 minutes) Stand feet together eyes open/closed Stand heel to toe eyes open/closed Stand on one leg eyes open/close Walk straight line Walk backwards and sideways 34
Exercise prescription Stretching x 10 minutes, hold each stretch 60 sec Hamstrings x 3 Heel cords x 3 Chest/anterior shoulders x 3 Hip flexors x 3 35
Exercise prescription Cool down x 10 Walking, bike, treadmill 36
Elliptical trainer Nu step 10 minute warm up or cool down 37
Rows 38
Squats Heel raises 12-15 repetitions 39
Toe raises Bicep curls 12-15 repetitions, 1 set 40
Triceps extension exercises 12-15 reps, 1 set 41
Anterior shoulder/pec stretch Heel cord stretch Hold 60 secs, 3 repettions 42
Hamstring stretch Hip Flexor stretch Hold 60 seconds, 3 repetitons 43
Questions 44
DISCLAIMER The information provided by speakers in any presentation made s part of the 2013 NAF Annual Membership Meeting is for informational use only. NAF encourages all attendees to consult with their primary care provider, neurologist, or other health care provider about any advice, exercise, therapies, medication, treatment, nutritional supplement, or regimen that may have been mentioned as part of any presentation. Products or services mentioned during these presentations does not imply endorsement by NAF. 45
PRESENTER DISCLOSURES Polly Swingle The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months. No relationships to disclose or list. 46