A stroke is a medical emergency that affects the blood supply to part of the brain. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or ruptures. There are several medical conditions that increase the risk of a stroke, including high blood pressure, high cholesterol and type 2 diabetes. Individuals who have a history of stroke, heart attack or irregular heart rhythms like atrial fibrillation are also at increased risk of stroke.
Multiple Sclerosis (MS) is a chronic disease affecting the brain and spinal cord. In MS, the immune system attacks nerve fibers and myelin sheathing (a fatty substance which surrounds/insulates healthy nerve fibers) in the brain and spinal cord. This attack causes inflammation, which destroys nerve cell processes and myelin – altering electrical messages in the brain. MS is unpredictable and affects each patient differently – some individuals may be mildly affected, while others may lose their ability to write, speak or walk.
Parkinson’s Disease (PD), a chronic and progressive neurodegenerative disease, affects movement and typically emerges in adults over the age of 50. Symptoms include difficulty moving, tremors, rigidity, gait impairment and postural changes.
Exercise benefits:
- Exercise will not reverse Multiple Sclerosis or Parkinson’s disease. However, positive effects of exercise include slowing down the disease progression and assisting in managing symptoms, flare-ups and limitations by improving coordination, balance and increasing strength.
- Regular exercise after a stroke can improve aerobic fitness, glucose tolerance, brain blood flow, muscle function and bone health. It can also increase mobility, improve walking speed, duration and gait mechanics while enhancing balance and postural control.
Exercise guidelines:
- A well-rounded program for an individual with Parkinson’s Disease should include flexibility training, cardiorespiratory exercise, functional training, resistance training and neuromuscular coordination-skill exercises. Drills to improve gait and core strength can aid in preventing and slowing the debilitating effects of the disease and fall prevention.
- Individuals with Multiple Sclerosis are encouraged to listen to their body and work at an intensity that feels good. Fatigue is more prevalent in this population and light to moderate exercise is encouraged, as tolerated. Thermoregulation can be challenging for individuals with MS, so care should be taken in warmer exercise environments such as a pool or warm studio.
- After a stroke, an individual may experience chronic or acute gait changes and balance deficits putting them at an increased risk for falls. In addition, individuals with MS or PD can have rigidity, spasticity and tremors which can increase fall risk. Have a support system nearby such as a chair.
SilverSneakers class recommendations:
- EnerChi, SilverSneakers Yoga and SilverSneakers Stability® can provide good balance exercises for individuals with PD. Encourage participants to attend class at times when their symptoms are not as prevalent. These symptoms may fluctuate according to the time of day and from one day to the next.
- SilverSneakers Yoga, EnerChi and SilverSneakers Stability® along with Classic, as tolerated, will benefit individuals with MS. Seated options are important, as well as standing balance support.
- Classic, EnerChi and SilverSneakers Yoga provide participants who have experienced a stroke, a seated option for the entire class. Each of these classes incorporate exercises focused on improving balance and kinesthetic awareness, both of which are often impaired as a result of a stroke. The weight shifting movements incorporated within EnerChi are shown to significantly improve balance.
- Classic can help individuals who have had a stroke safely build aerobic capacity through seated and/or standing movements in class thus, improving endurance. Exercises such as walking in place, marching, etc. can improve stamina as well.
- SilverSneakers Yoga can aid in decreasing stress and managing high blood pressure when practiced regularly. High blood pressure is a risk factor for stroke as well as the reoccurrence of stroke after an initial event.
Instructor tips for participants with nervous system conditions:
- Urge participants to arrive early and retrieve equipment safely.
- Encourage “fun” in agility, balance and coordination drills to promote smooth movement.
- Advise participants to follow physician’s directives.
- Be sure participants drink water before, during and after exercise.
- Remember to cue “chest up” as individuals with PD can experience significant kyphosis.
- With each of these chronic conditions, the severity and complexity of the disease will vary greatly from one individual to another as well as from one day to the next. Therefore, encourage participants to listen to their body and work within their limits. Continuously cue for safety reminders.
- Individuals who are recovering from a stroke may have difficulty with verbal communication, memory and understanding commands and tasks. Give short, direct cues for movements utilizing both verbal and visual cues.
- Following a stroke, individuals may experience muscle spasticity, paralysis or loss of muscle movement particularly on one side of the body. Strength may be affected greatly on one side of the body compared to the non-affected side.
- Cue consistently to remind participants that the chair is available for balance support when standing.