POST-POLIO SYNDROME AND EXERCISE FOR OLDER ADULTS
Polio. The word sent chills into every parent’s heart in the early part of the last century. This devastating disease attacked the nerve cells of its victims; for some, it was fatal while others were left with lasting effects throughout their lives. Due to widespread vaccination, polio has been eliminated from the Western Hemisphere, but continues to circulate in other parts of the world.
What is Post-Polio Syndrome? Thirty or more years past the onset of polio, many survivors of polio are experiencing an onset of progressive and persistent new muscle weakness, abnormal muscle fatigue and often generalized fatigue, as well as muscle and joint pain. In some people, symptoms attributed to post-polio syndrome include difficult breathing or swallowing. For a diagnosis of PPS, symptoms must have persisted for at least a year and other neurologic, medical and orthopedic causes of symptoms have been ruled out.
How can exercise be useful to those with Post-Polio Syndrome? While the onset of Post-Polio is thought to be due to the premature death of nerve endings affected by the polio virus, some new weakness is also caused by lack of activity or exercise. Medical professionals have misunderstood whether they should encourage or discourage exercise for those with Post-Polio Syndrome. However, exercise is safe and effective when prescribed and monitored by experienced health professional. It is most likely to benefit those muscle groups that were least affected by polio and should include cardiopulmonary endurance training and gentle exercise, rather than rigorous strengthening exercises. Heavy or intense resistive exercise and weight-lifting using polio-affected muscles could further weaken rather than strengthen these muscles.
What is the best type of exercise for polio survivors? Water exercise is generally considered to be the best form of exercise for polio survivors, and can result in improved range of motion, better balance and increased strength. An individual with Post-Polio should work with a medical professional, who will create a custom-tailored individualized exercise program. An initial assessment of the individual’s muscle strength, range of motion, flexibility, and endurance will be performed. Then, the professional will supervise the individual with Post-Polio Syndrome for two-four months, during which time they will monitor pain levels, fatigue and weakness, and make adjustments to the exercise plan. The resulting exercise routine can be either taken to an exercise professional familiar with Post-Polio Syndrome, or can be done independently.
How should water exercise be performed? Individuals with Post-Polio should exercise in warm water (90-92 degrees Fahrenheit or 30-33 degrees Celsius) and should do their routine in a depth of either waist or chest high in order to avoid the effects of over-heating. The intensity of exercise should be low to moderate and with a slow progression, particularly in muscles that have obvious chronic weakness. An appropriate routine should include a rotation of exercise types, including stretching, aerobic conditioning, gentle strengthening, endurance, and range of motion exercises. The exercise routine should be reduced or discontinued if additional weakness, excessive fatigue, or prolonged recovery time is experienced. Special attention should be paid to two muscles which may not respond to exercise: the abductor pollicis brevis (the hand muscle that moves the thumb) and the gastrocnemius (calf muscle.) These muscles often show no recovery after acute poliomyelitis. In these cases, do not exercise these particular areas, and seek orthotic management such as a brace in order to support the weakened muscle or muscles.
What are some resources and programs for Post-Polio exercise?
West Vancouver Aquatic Centre: Post-polio group exercise classes are held on Wednesdays and Fridays from 9:30-10:30 am http://westvancouver.ca
Stan Stronge Pool: For those that are eligible to attend, Post-polio classes are held on Tuesdays from 11-12, and Fridays from 1-2 pm http://vch.eduhealth.ca or call 604-310-3810
Jewish Community Centre Adapted Aquatics Centre: Both Waterworks classes and one-on-one support are available for polio survivors. https://www.jccgv.com/content/jcc-aquatics-programs–
Personal Trainers with experience in Post-Polio programming:
Post-polio Heath, volume 19, issue 2, spring2003
Post-Polio Syndrome: Identifying Best Practices in Diagnosis & Care. March of Dimes, 2001
Leonard, Robbie B. Roosevelt Warm Springs Institute for Rehabilitation Pool Exercises and Guidelines for Polio Survivors
Bruno, Richard. The Ten Commandments of PPS