Exercise Physiologists (EP’s) study the body’s physiological response to exercise and have an in depth understanding of what is happening inside the body on a biological level when we exercise. They also study the pathophysiology (how the disease affects the body) of certain disease or illnesses. In understanding both of these elements, EP’s can now use exercise as medicine to treat chronic disease, illness and injury.
Let us look at a case study of a person who has suffered from a chronic illness to really understand what has changed and what an exercise program can do for that person.
A 58 year old male suffered an ischemic stroke 12 months ago resulting in right sided hemiplegia. He previously worked full time as a real estate agent and enjoyed taking his dog for daily walks. Since the stroke he has been forced to retire from his job and feels that he is unable to exercise or even take his dog for a short walk without becoming totally exhausted. He is able to walk however because of his hemiplegia it is effortful and he is not very confident.
A slippery slope of inactivity starts here, whereby this gentleman is becoming more and more inactive and starts to withdraw from social activities.
So what is an ischemic stroke and what happens as a result of it and not being physically active?
An ischemic stroke happens when there is a blockage in one of the vessels supplying blood to the brain. This lack of blood means that region of brain is not receiving its oxygen or nutrient supply which leads to eventual death of brain tissue. The brain is responsible for sending and receiving signals for movement, sensation and thought processes. Immediately after the stroke there is a host of inflammatory markers around the injury site and the body is going into recovery mode trying to repair what it can.
After 3 months of hospitalisation, this gentleman was discharged back home into the community and apart from standard rehab provided by the hospital he has not been engaging in much physical activity at all. This lack of physical activity causes changes in the body that add further to injury caused by the stroke.
When you suddenly stop your normal exercise routine the first thing to be affected is your cardiovascular fitness (measured by VO2max). Research shows a decline of VO2max by 7-10% after just 12 days of inactivity. Aerobic exercise increases the hearts ability to pump blood to the body, reduces arterial stiffness and improves vessels ability to transport blood, increases the number of capillaries to exchange oxygen in the body and increases the amount of mitochondria which creates energy for muscles to move. All this results in the body being more efficient in utilizing oxygen and requires less effort from the heart. Just from this you can see what you stand to lose when you become deconditioned after having a stroke. These benefits from aerobic exercise are essential for his quality of life, health and function because an increase of just 10% in VO2max can mean the difference between being able to do any everyday task such as going to the bathroom or getting dressed independently.
After stroke your risk of secondary disease such as heart disease, diabetes and a secondary stroke are increased dramatically. Regular aerobic exercise has been shown to reduce these risks. In addition, you may have heard of neuroplasticity. This is the brains ability to relearn and rewire itself with repetitive and intense practice and exercise. Neuroplasticity is mediated by growth factors such as BDNF, NT-3 and IGF-1, all of which have been shown to increase in body after at least 10 min of aerobic exercise.
This gentleman was prescribed a home exercise program consisting of aerobic and resistance exercise. He couldn’t achieve the gains he made through these exercises simply by starting to walk on his own. This was because he had lost his confidence and was put off by the exhaustion and aches and pains he was experienced with trying to walk further. His walking was also slower than usual and he couldn’t not reach a cardiovascular challenging threshold by walking alone.
As well as continuing with his home exercise program independently, this gentleman is now back to taking his dog on short walks daily which means he will maintain and build on this level of activity. Not to mention the impacts this has on quality of life and emotional well being.
If you suffer from a chronic condition such as stroke, contact us to see if an Exercise Physiologist can help you increase your activity and get healthier.