Exercise Rehabilitation for Neurological and Neuromuscular Conditions

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Stroke

Responsible 2,500 deaths per year in New Zealand, stroke is our third largest killer. Twenty-four Kiwis each day will experience a stroke- 90% occurring in those over the age of 65. It is estimated that there are up to 60,000 stroke survivors in New Zealand.

 

Stroke survivors are often de-conditioned and predisposed to a sedentary lifestyle. This can adversely impact on activities of daily living, increase the risk of falls and may contribute to a heightened risk for recurrent stroke and other health conditions. Commonly, stroke survivors have 50-60% lower levels of fitness than those their age and gender who had not had a stroke. 1

Benefits of Exercise for Stroke Survivors

Fitness if often particularly low in stroke survivors. It may limit their ability to perform everyday activities and also worsen stroke-related disability. 2

 

Current evidence recommends that stroke survivors be involved in regular aerobic and strength exercise to:

  • Improve aerobic fitness 3
  • Reduce risk of recurrent stroke 2
  • Reduce risk factors for cardiovascular disease  2
  • Improve cognitive function
  • Improve quality of life
  • Improve balance and coordination 2
  • Improve muscular strength on the affected side 4

Parkinson's Disease

Parkinson's Disease affects 1% of the population aged over 65 years old. 5

The motor (gait impairments, postural instability, falls) and the non-motor (depression, apathy, fatigue, sleep disturbances, cognitive decline) features of Parkinson's can lead to worsening of symptoms, greater levels of disability and an increased mortality risk. A sedentary lifestyle compounds these problems.

Exercise programmes may be an effective strategy to delay or reverse functional decline for people with Parkinson's. There is a large body of evidence to support exercise as being beneficial with regards to activities of daily living, quality of life, strength, balance and gait speed. 6

 

Benefits of Exercise for Parkinson's Disease

  • Improved underlying impairments
  • Improved economy of walking
  • Enhanced function
  • Reduced disability in persons with early and mid-stage Parkinson's
  • Improved in gait, balance and disability
  • Improved fitness

 

"Beyond its benefits on physical health, exercise gives patients a more active role in the management of their Parkinsons. Exercise programmes among those with neurological disorders increase the patient's sense of self-efficacy, their sense of involvement in their care and overall belief in their abilities to perform certain activities. In addition, patient involvement leads to higher satisfaction with care, and greater likelihood of following provider recommendations. In essence, exercise puts patients at the centre of care, which is exactly where patients ought to be". 7

Dementia (Alzheimer's Disease)

In 2014, it was estimated that 53,000 people had dementia. This has increased from around 40,000 people in 2008. It is thought that by 2050, more than 147,000 people (2.6% of the population) will have dementia, almost triple the current number! 8

The most common form of dementia among older adults, Alzheimer's Disease, is a degenerative brain disease that results in progressive mental deterioration with disorientation, memory disturbance and confusion. Symptoms such as these can interfere with the ability to perform activities of daily living, ultimately affecting a persons quality of life.

A growing number of studies have linked Alzheimer's with physical deterioration and reduced muscle mass, resulting in higher risks of falls and fractures, decline in mobility and further loss of independence as well as reduced quality of life. 9

Benefits of Exercise for Alzheimer's Disease

  • Enhanced function when performing activities of daily living
  • Fewer neuropsychiatric disturbances such as irritability and depression
  • Improved depressive symptoms
  • Improved cardiovascular and cardiorespiratory fitness
  • Improved functional capacity components - flexibility, agility, balance, strength 9
  • Improved cognitive aspects such as sustained attention, visual memory and decision making function

 

Treadmill

Evidence

1. Stroke Foundation, 2016. http://www.stroke.org.nz/stroke-facts-and-fallacies

2. Billinger, 2014. Physical Activity and exercise recommendations for Stroke survivors: a statement for Healthcare Professionals from the American Heart Association. 

3. Globas, 2012. Chronic stroke survivors benefit from high-intensity aerobic treadmill exercise: a randomized control trial.

4. Weiss, 2000. High intensity strength training improves strength and functional performance after stroke.  

5. Lees, 2010. The bare essentials: Parkinson’s disease.

6. Goodwin, 2008. The effectiveness of exercise interventions for people with Parkinson’s disease: A systematic review and meta-analysis.

7. Rosenthal, 2013. The benefits of exercise in Parkinsons disease.

8. Alzheimers New Zealand, 2012. http://www.alzheimers.org.nz/news-info/nz-information/dementia-economic-report-2012

9. de Souto Barreto, 2015. Exercise training for managing behavioral and psychological symptoms in people with dementia: A systematic review and meta-analysis.