Start Slowly; Make Adjustments; Keep Going
Halstead also lays out the following guidelines as you begin your exercise program:
- Expect improvement. Exercise should make you feel better physically, and even, mentally. If the activity is not strenuous enough to improve your strength, much less your cardiovascular system (e.g., stretching or yoga exercises). It still should give you a psychological lift just to be doing a special activity for yourself on a regular basis.
- Listen to your body. Avoid pain, fatigue, and weakness. These symptoms are signals that your muscles have overworked. A brief period of fatigue and minor muscle pain for 15 minutes to 30 minutes after exercise is usually normal. Symptoms that last longer than 30 minutes to 60 minutes reflect muscle overwork and possible injury. If this occurs, the exercise should be reduced or stopped. Any exercise that causes additional weakness should be discontinued immediately.
- Pacing. Pacing [i.e., not going too fast and methodically taking breaks] has been shown to be safe and effective in increasing strength in some individuals. The intervals of exercising can be as short as 2 minutes to 5 minutes alternating with equal intervals of rest. The evidence also shows that secondary symptoms, such as generalized fatigue, can be reduced as individuals become conditioned and are able to perform more work with less expenditure of effort.
- Use your best muscles. Polio is often a focal, asymmetric disease with variable amounts of weakness in different limbs. Exercise the limbs least affected or those completely unaffected by polio, while avoiding the more affected extremities. For instance, if only the legs were affected, then the arms can be used in a fairly strenuous program that includes swimming or using an upper extremity arm bicycle; meanwhile, the legs will usually get adequate exercise in the course of doing daily activities.
- Warm up and cool-down. As with other exercise programs, a warm up [very light movements such as walking slowly, arm circles or leg lifts that are done for about 5 minutes to get your muscles warm, and to get the blood flowing through your body] followed by gentle stretching should be done to improve flexibility and reduce the possibility of injury. After exercising, a cool-down period [very light movements like the warm ups that will slowly decrease heart rate and prevent any feeling of lightheadedness that can occur if exercise is stopped abruptly] should take place. Finally, the type of activity should be one that the participant enjoys to minimize the potential for dropping out because of lack of interest.
Having the tenacity to stick with the program and make the proper adjustments is a real challenge, but polio survivors are good at setting goals and achieving them. Across the country men and women who had polio are beginning to apply these principles of exercise and are experiencing much success. The real reason to get into motion is that exercising can make you feel better! Joan Headley (personal communication, February 26, 2002), high profile polio survivor with a mild disability attests to that in her personal account:
"In 1994, seven years after I had switched jobs from teaching school (and being on my feet most of the day) to working at the International Polio Network where I consciously stayed off of my feet, several observations caused me to rethink my approach to activity.
The pain in my 'good' leg was gone, but was replaced by a pain in the hip of my 'polio' leg. Shopping trips and other family outings were cut short because I did not have the stamina to be on my feet for more than a couple of hours. Each year it became more difficult to climb the stairs to reach my symphony seat because my legs were weak. Then one night, while walking up those stairs and "listening to my body," I also realized I was panting and "out of shape."
One day an elderly polio physician suggested that the pain in my 'polio' leg was not from muscle weakness, but from connective tissue tightness and perhaps I should 'stretch it.' It was at that point I decided to make a change. I visited Bally's with my brother and sister-in-law and we made the circuit trying each machine identifying my weakest muscles. So, I began an 'exercise' program using Dr. Stanley Yarnell's (St. Mary's Hospital, San Francisco) 20 % Rule. I did a select exercise to the greatest extent I could, and then cut it back to 20% and slowly added repetitions and distance carefully observing if there were any consequences.
Today, eight years later, I have eliminated the pain in my leg by doing 30-35 repetitions at least five times a week, as well as two exercises for my arms. I also walk one mile an average of four times a week and do about an hour of stretching exercises once a month in the pool.
For a few years, I walked in the neighborhood park and an added benefit was that I left all of my daily work problems there. I now walk at the YMCA on an official track with no worry about bumps in sidewalks or my safety when I walk in the evenings. I still leave my problems behind, however-the happily embraced extra benefit of a good exercise program.