Exercise Guidelines for Polio Survivors
Originally published in 2023 by Post-Polio Health International
Article SUMMARY
“I’m sure most of you have heard that exercise can be dangerous to a polio survivor. You’ve heard things like ‘use it or lose it,’ that muscle strengthening contributes to overuse, that if you are feeling muscle pain, then you’re burning out motor neurons, or that you can’t do strenuous exercise. And some of that is true. There are reasons those things were perpetuated, but they’re not exactly true. The truth is that there are just as many or more dangers of not exercising as of exercising. Let’s explore some different types of exercise and how to determine what’s right for you.”
Dangers of Inactivity
“Let’s start with some of the dangers of not doing exercise, or inactivity. For everybody, polio survivor or not, if you are not engaging in much activity, are immobilized for some reason, or are stuck in bed for an illness or injury, deconditioning occurs. That means muscles atrophy and get weaker. It’s most pronounced in muscles that are our primary postural muscles—the spinous, paraspinals and lower limbs. Those are the muscles we normally use to work against gravity. For somebody on strict bed rest, studies have shown that muscles lose 10 to 15 percent of their original strength per week of bed rest. Over five weeks, that can add up to 50 percent. Of course, strict bed rest isn’t often used anymore.
For most medical conditions, we try to keep people as mobile as possible, so the amount of weakening that happens when you have limited activity is a lower percentage of what we see with strict bed rest. When people aren’t moving, they can also get connective tissue or soft tissue contractures where joints stop moving as well and may lose bone strength or bone density.”
Health Benefits of Exercise
“A major health benefit of exercise is, of course, improved cardiovascular health. Inactivity is a major risk factor for the development of cardiovascular disease, and it works in secondary prevention as far as reducing mortality for people with cardiac disease. If you go through cardiac rehabilitation programs, you can reduce the impact of whatever disease is present. Exercise helps to decrease blood pressure, decrease triglycerides and bad cholesterol, increase good cholesterol, and reduce the risk of blood clots, which can lead to other medical issues.”
How much exercise do you need?
“The answer to this very much depends on the individual, and, especially for someone who’s had polio, there are a lot of factors to consider. Before starting an exercise program, I recommend getting a medical evaluation. If you’re over the age of 35, the rule of thumb is that you should be exercising about 30 minutes per day. Now, this is not necessarily true for polio survivors because exercise is really just on the gradient of activity - normal daily activities versus what is done for exercise. Depending on what your day-to-day activity looks like, you may or may not need to do a lot of additional exercise. This is especially true in a polio survivor who is still ambulatory and who may have a fair amount of deficits, so that actually just walking in your day-to-day life is basically the energy equivalent of exercise for somebody who doesn’t have physical impairments. Sometimes exercise is really just increasing the activity you do in a day.
The benefits are dose-related up to a point. That means that there is a ceiling effect, and at some point, more exercise is not better. Exercise is also dependent on long-term compliance, meaning doing exercise today won’t necessarily benefit a person next year. It has to be part of a lifestyle balance and having energy for exercise or day-to-day activity versus just maintaining your life and a level of function.”
Exercise Components
There are four main components of exercise:
Aerobic Conditioning
Strengthening
Flexibility
Coordination
Symptoms of Overuse
Any fatigue that lasts more than a few hours after the activity likely signals you’re doing too much.
If you feel weaker after the activity or if you can do less later that day or the next day, that’s a bad sign.
If the muscles are painful, that’s overstressing and breaking down tissue.
If you have a sensation of muscles cramping, twitching or crawling, that’s another sign of overuse. Sometimes these overuse symptoms don’t come on the same day.”
“You understand your body better than anybody else,
so when you’re working with a therapist or a trainer or talking to your PCP,
don’t be afraid to speak up and say, ‘Hey, I just can’t do that’ or ‘That hurts to do that.’ “
Additional Advice for Polio Survivors
“You understand your body better than anybody else,
so when you’re working with a therapist or a trainer or talking to your PCP,
don’t be afraid to speak up and say, “Hey, I just can’t do that” or “That hurts to do that.”
Give feedback and don’t let anybody bully you into doing something you know you shouldn’t do.”
“Developing an exercise program will almost always require trial and error. It’s a matter of trying something, seeing how your body responds, and going from there. That’s why we talk about starting slow and progressing slowly because you don’t want to make big errors.”
Summary
“Exercise is not the enemy. It shouldn’t hurt, but on the other hand, it’s not necessarily easy, either. We want gentle exercise programs, but it is going to be a little bit of work. It has to be very individualized. One of the most unique things about polio is that there’s no standard recommendation for a polio survivor because everybody’s different.
Getting a medical assessment before starting is important, particularly to make sure your heart and lungs are fine to stress. As far as finding somebody who really knows the ins and outs of polio and what you can and can’t do, that can be difficult. It is hard to find somebody with experience, but there are some resources available through PHI (including the Post-Polio Directory which is continuously updated).
There are therapists that are always willing to talk to a therapist you’re working with or your physician.
Most importantly, you know your body and you know its signals. Pay attention to that. Exercise performed with the right prescription, instruction and technique can be beneficial and improve function and well-being.”
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Published with permission from ©2023 Post-Polio Health International (PHI). ISSN 1066-5331 Vol. 39, No. 3 Permission to reprint must be obtained from Post-Polio Health International (PHI)