Why is it important?

Strength training, also known as resistance training, improves muscle strength. When your muscles are stronger, it is easier to carry in your groceries, take out the garbage, and other tasks of your daily routine.

What types of exercises are considered resistance or strength?

Any exercises that involve hand-held weights, weight machines, stretch bands, or even balls are usually strength exercises. These types of exercises, like the stretching exercises, can involve any muscle of your body-- from your head to your toes.

You may choose to exercise alone or with an "exercise buddy." Often, sharing the experience with a friend can be more fun, a chance to learn from each other and stay motivated. Joining or starting a wellness program with other polio survivors may also help. Our 1996-1999 study at the University of Michigan (Tate & Leonard, 2001) of a holistic wellness program for women who had polio (www.med.umich.edu) found that the biggest change was in participants' exercise routines and resultant physical activity. Program participants changed dramatically in their reported regular participation in vigorous exercise. While prior to their participation 57% never regularly exercised vigorously and 23% did so often or routinely, after their participation, only 26% never did and 41% reported exercising regularly often or routinely. Similarly, program participants demonstrated a marked improvement in terms of the regularity with which they exercised with moderate exertion. Prior to the program's onset, 63% stated that they did so three or more times per week. Following the program's conclusion, 78% of program participants reported conducting moderate exercise with this regularity. Also, while prior to the program's onset, 42% of participants said they never engaged in stretching exercises, and 23% said that they did routinely following program participation, only 11% said that they never did stretching exercises, 35% of participants said that they did them routinely. Six months following the conclusion of the program, 61% of participants said that they had increased their level of physical activity during the last six months. We also found that exercising vigorously at least three times per week was associated with improved assessments of depression and distress.

Whether with a group or on your own, exercise programs can occur on land or in the water. It is important to do whatever works best for you. If swimming is not possible, you may want to exercise in your house, at a health club or gym, or outdoors. Pick an exercise you enjoy, whether it is walking, stretching, or any other exercise, and begin with small bouts. It is not necessary for you to perform only one activity. You can combine all your favorites. Also, you do not have to do the activity all at once. For instance, Tom enjoys biking, stretching and walking, so his exercise program includes:

Morning:

• 2 minutes stretching
• 2-5 minute break
• 2 minutes walking
• 2-5 minute break
• 2 minutes stretching
• 2-5 minute break
• 2 minutes biking

Afternoon:

• 2 minutes stretching
• 2-5 minute break
• 2 minutes walking
• 2-5 minute break
• 2 minutes stretching
• 2-5 minute break
• 2 minutes biking

This is how he began his exercise program, and slowly, over the course of months, he began to increase the bouts of exercise and decrease the length of his breaks. It is very important to rest between exercise sessions. Make sure you rest long enough to fully recover after the exercise; otherwise you may remain in a constant state of overload, which has negative effects on function. Incorporating regular rest periods into an exercise routine is called "interval training."

Exercising in a warm pool is another way to work out. According to Lauro Halstead, M.D. Water therapy was the exercise of choice for many persons during their recovery from the original polio. It is still excellent therapy. Because of the buoyancy of water, it allows people to do things they can't perform on land. For especially weak limbs, inflatable cuffs can be used to float an extremity. For other limbs, water resistance provides a workout that can be fine-tuned to each person's strength. The principal disadvantages of hydrotherapy are that the temperature may not suit one's body and it may be difficult to find pools that have lifts (if needed). Also, the surfaces around pools tend to be slippery and dangerous for anyone with a tendency to fall.

Aquatic programs for exercise have been recognized as morale boosting and physically beneficial. An early study by Hoffman and Maynard (1992) describes a swimming program for polio survivors as having a "therapeutic effect." Emphasizing the added benefit of group exercise, the authors go on to say: " it is of great importance to recognize that perhaps one of the greatest benefits of a program that brings together individuals who share a common concern is the emotional support they receive from knowing they are not alone in their efforts to confront the late effects of polio." In a more recent Swedish study by Willen and Sunnerhagen (2001), 15 persons with polio's late effects worked out in a pool for 40 minutes twice a week for 5 months. At the end of the study, participants reported an increased sense of well being, pain relief, and increased physical fitness. Additionally, at the end of the 5-month period, their heart rates during exercise were down. The study's investigators recommend this program of pool exercises in heated water.

In his 1998 book, Managing Post-Polio: A Guide to Living Well with Post-Polio Syndrome, Halstead additionally provides general guidelines for customized exercise based on his personal and clinical experience with the effects of polio:

• Individualized and supervised program. Exercise programs should be supervised initially by a physician or physical therapist experienced in neuromuscular diseases, if not polio. Each program should be customized to your personal needs and residual strengths. Given these constraints, research studies have shown that some polio survivors (but not all) can improve muscle strength (as a result of new muscle hypertrophy, or enlargement) and enhance cardiovascular endurance with a closely monitored training program. In fact, some studies have reported an increase in strength in muscles both with and without new weakness.
• Type of exercise. There are numerous kinds of exercise. Finding the one that is right for you and each of your limbs often takes trial and error. Usually, it is a good idea to find two or more exercises that can be varied, exercising different muscles on alternate days. For example, walking or exercising the lower extremities one day and then performing an upper extremity exercise the next. This kind of schedule provides a period of rest for each muscle group and variation that keeps the overall exercise program challenging and enjoyable. As a general rule, muscles that have a grade of 3 or less (using the muscle examination scale: 0 = no contraction and 5 = normal strength) should be protected and not exercised; grade 3+ muscles can be exercised with caution; grade 4 and 4+ muscles can be exercised moderately; and grade 5 muscles can be exercised vigorously.