William Lo: The rules of exercise

Tuesday, September 26 2017, 1:27PM

 

Hey guys, what’s going on, today I want to talk about exercise. I find this topic difficult to write about because it’s a bit controversial.

As stroke survivors, we’ve all been told different things about what works and what doesn’t, and this has probably left us all banging our heads at some point.


Many of us were left in the dark about how to recover, and how to maximise our gains beyond the period of spontaneous recovery in hospital – myself included.


It took me months and lots of reflection to finally bring some certainty and sense of control back into my life after my stroke.


So please read on with an open mind, as I pull back the curtains and reveal stuff I’ve been fortunate enough to learn from my experience and as an undergrad occupational therapy student.

These are the cardinal rules I’ve learnt throughout my stroke journey, the ones I currently live my life to and ones I wished I had known earlier.

 

RULE 1: MORE EFFORT DOES NOT ALWAYS EQUAL BETTER:

This is one of those rules which might’ve been ingrained in our minds when we were children, when we were told that anything we wanted to achieve could only be done through hard work.
“No pain, no gain.” – right?

The point I’m trying to get at here is that with exercise after stroke, you are going to have to adopt a different set of beliefs to those which worked for you in the past.


For a long time after my stroke, I believed that more effort was better. Every time I strained or exerted more force in my any movement, I found that I was able to produce a much stronger, quicker movement. You might’ve noticed this with your ability to grip with your affected side. Once you’ve regained ability to flex your fingers, I can almost guarantee that you were encouraged by your therapist to “build on” this movement, by pumping out zillions of reps with different hand grips or the hospital standard “thera putty.”

Unfortunately while well intentioned, putting more physical effort/exertion into your movements only teaches your brain to use “too much” effort when its relearning movements, particularly ones which would’ve required minor cognitive effort prior to your stroke.

This is why you might’ve found that once you were able to flex your fingers it was almost impossible to learn how to relax, or open your hand again. Your brain is so used to pumping cognitive effort into closing that it was never exposed to the experience of learning to “relax” or turn off the muscles which helped your hand to close.

Even though I can now extend my fingers, it took me years to break out of this learnt habit and lots and lots of personal research.

If I could go back, I would probably avoid the use of hand grips and putty to train my grip. Rather I would focus on picking up stress balls or blocks, which wouldn’t encourage as much effort on my part. This way at least I would be able to experience the “feeling” or relaxing my fingers, by seeing that I was able to drop a ball after had grasped it. Remember that our brain reorganises itself from experience, and by experiencing this it will create a “blueprint” of how much cognitive effort is required to grasp and release a ball. Similarly with stretching out your fingers, something I continue to do today. By stretching out your fingers like you would when you crawl, you will give the brain both a visual and feeling of what it felt like before to relax.  

RULE 2: TARGETED, DISTRIBUTED PRACTICE ALWAYS BEATS MASS PRACTICE.

One of the other rules which you might have heard from your therapists and health professionals is the idea of performing 8,453,231 repetitions of exercises during the early stage of stroke, to capitalise on the first two years of your recovery. This time is often seen as the “golden period” of recovery. While this is somewhat true, I’ve found that recovery after stroke doesn’t discriminate whether you are 3,4,5 years in your recovery and is largely dependent on the type of exercise you are doing.  


I think this is mainly because there is no such thing as plateau, and as long as you are doing exercises (frequently but not all the time) which do not follow pre learned habits or routines (in the case of electrical stimulation), you will always be able to make gains. Remember your brain is constantly seeking things to add to its “blueprint”, to make it learn how to perform movements better, faster and as close as possible to what it had previously done before. By making the switch to only doing novel exercises which actually continue to challenge the brain and IMMEDIATELY applying these to real life, not only does recovery become more encouraging, but also not a job of trying to “maintain” or “hold onto” gains you would’ve made.


I thought a picture would be appropriate here, to demonstrate both my skills as a talented artist and what I’ve said above.

So as you can see from the graphs above, continuing to do the same exercises day after day, year after year, plateaus quite quickly, as your brain is only “maintaining” its current ability to do a task/skill.

Mass practice mainly involves doing the same thing all the time, for example, this may involve doing exercises you were given since your discharge from hospital 6 months ago.

Targeted practice, on the other hand, continues to challenge the brain, by continuing to update its “blueprint” of how to do a task. Parts of exercises are constantly changed to match your current skill level – for example I like to update mine every 2 weeks.  Therefore the rate of recovery or return of gains will always be consistent, because the brain never gets bored or comfortable.

If I could go back in time I would’ve definitely done targeted exercise or practice 3-5 days/week, rather than continuing to do the same exercises 7days/ week, without any updates to exercises whenever I saw improvements. 

You’ll find that the more you recover, it will be almost impossible to continue to maintain doing “therapy” exercises every day, as this will almost always get in the way of other priorities.

In the early years after my stroke I remembered I carried this lingering guilt that I had to keep the foot on the pedal, by continuing to exercise so that I could get back to who I was before. Not only is this impossible, but also unfair to myself. Remember that there is NO QUICK FIX in stroke, and that recovery is more of continuing to add small incremental improvements each day, to reach our potential. This doesn’t mean that we have to prove to ourselves that we are “bulletproof”, by pushing extremes to speed up the process.


Trust me, this will only lead us to plateau very quickly and fry our brain circuits. 

Rather, recovery is more about developing a greater awareness of ourselves, and our new purpose. This will involve different changes in the way we think.

Remember exercise after stroke is a very different exercise to before – we are exercising our brain and not necessarily our body. Therefore, we have to structure exercises based on how our brain learns. This will involve doing exercises which are novel and continue be challenging in different environments. 


By doing exercises which fit this category, for  3-5 days/week if not more, you will find that the rate of recovery will almost never remain the same, as opposed to doing the same thing, 7 days/week.


Best of luck with your recovery,

 

William Lo