NOTE: This Message was originally addressed to Tom Mckeever
      from Dempt@eskimo.com and was forwarded to you by Tom Mckeever
                           --------------------
> Exercise - What is Right for You
>
> Mavis J. Matheson, MD
> written April 1995
>
>     
-----------------------------------------------------------------------
>
> Many people with a history of polio can improve muscle strength and
> cardiovascular conditioning with an exercise program.[1], [2] One of
> the problems that people with Post-polio Syndrome face is how much
> exercise they should be doing. We have all been told to conserve our
> energy. We know that too much exercise will further damage already
> weak muscles. We also know that if a muscle is not exercised it will
> lose strength. So what should we be doing?
>
> Determining how much we should do isn't easy. We must learn to
> recognize fatigue. We must learn which pains mean overworked muscle
> and which are part of normal aging. We need to pay attention to our
> bodies and use pain and fatigue as signals. We have to let go of the
> "no pain; no gain" philosophy we learned while we were recovering from
> polio. We must also learn to use how we feel today to assess
> yesterday's activity and plan for tomorrow. Dr. Agre and Dr. Rodriquez
> have shown that polio survivors can assess their own muscle
> fatigue.[3]
>
> The key to exercise for people with Post-polio syndrome is to suit the
> activity to the amount of damage to the muscle. This damage may be a
> result of the original polio and from Post-polio overuse. Different
> researchers use different methods of determining just how much a
> muscle or group of muscles is damaged and what exercises are
> appropriate.[1],[4]
>
> After consulting with our doctors to assure ourselves that we don't
> have some disease process other than PPS causing our problems, we must
> decide how much to do. What can we do when we don't have a Post- polio
> Clinic and physicians willing and able to do four limb EMGs? Without
> using EMG, we can still look at our histories and we can feel how we
> are doing now. Using this information we can try to set up or get the
> physiotherapists (many of whom have little or no knowledge of
> post-polio syndrome) to set up appropriate exercise programs for us. I
> suggest you try to figure out what each of your limbs should do based
> on your experience with that limb.
>
> For each limb, ask yourself "Which is the most severely involved
> muscle in this limb?" "Is that muscle weak?" and "Am I noticing signs
> of increasing weakness in that muscle?" Increased pain in the muscle,
> twitching, decrease in quality of movement, being able to walk shorter
> distances, having more trouble with stairs, more difficulty standing,
> muscle wasting, difficulty holding your arm up, driving, dressing and
> tiring with fewer and fewer repetitions during your regular exercise
> routine are common signs of increased weakness in a muscle or limb. Do
> you know of any reason other than PPS why that muscle may be weak? For
> example has the muscle been immobilized recently?
>
> A limb that does not have any weakness is classed as no clinical polio
> [1] and you can use it like any normal limb. These are the limbs you
> can use to get a good workout for you heart and lungs (cardiovascular
> workout). Be active 3-4 times a week for at least 20 minutes getting
> your heart rate up to 60-80% of maximum. You can exercise these limbs
> like normal limbs. It is also sensible to do gradual exercises to
> maintain strength and flexibility. If you notice any signs of
> increasing weakness, you must reevaluate you limb and your exercise
> program for that limb.
>
> If your muscle is mild to moderately weak but shows no signs of
> increasing weakness, the limb would be classed as clinically stable
> polio.[1] You can exercise these muscles with care. They should
> probably not be significantly fatigued. Try exercising 3 times per
> week for periods of 10-20 minutes with frequent rests. Progressive
> resistance exercises (also called non-fatiguing strengthening
> exercises) with gradually increasing weights may be used to maintain
> and possibly gain strength. Monitor yourself carefully while you
> exercise and if you notice any signs of increasing weakness, you must
> reevaluate you limb and your exercise program for that limb.
>
> If your muscle is severely weak, the limb is probably appropriately
> classed as severely atrophic polio.[1] Active exercise of the limb is
> likely impossible. Passive range of motion exercises may be used to
> maintain flexibility.
>
> If your muscle is weak and showing increasing weakness, ask yourself
> "Am I doing too much or too little?" Unless the limb has been
> immobilized recently (for example, in a cast or on bed rest) you are
> probably doing too much. The limb should be classed as having
> clinically unstable polio.[1] You should try decreasing the amount of
> activity that limb is doing, use energy conservation, and get your
> rests. These are the muscles that are being damaged by overuse. You
> must not fatigue them. It is probably a good idea to stretch to
> maintain flexibility and range of motion. If the limb has been getting
> too little activity, you can try a carefully graduated program of
> non-fatiguing exercises. Monitor yourself carefully while you exercise
> and if you notice any signs of increasing weakness, reevaluate your
> exercise program for that limb.
>
> Whatever your exercise program, continue to make changes to help you
> conserve energy. Pay attention to fatigue and rest when you are tired
> (before you are exhausted). If you are overweight, you need to lose
> weight. Dr. Peach and Dr. Olejnik found that patients who successfully
> control the factors responsible for neuromuscular overuse did not lose
> muscle strength.[5]
>
>     
-----------------------------------------------------------------------
>
> [1].Gawne, AC: Strategies for Exercise Prescription in Post-Polio
> Patients, In Halstead LS, Grimby G(eds.) Post-Polio Syndrome (1995)
> pp. 141-164
>
> [2].Fillyaw MS, Badger GJ, Goodwin GD, Bradley WG, Fries TJ, Shukla A:
> The Effects of Long-Term Non Fatiguing Resistance Exercise in Subjects
> With Post-Polio Syndrome, Orthopedics, (1991) vol. 14:1253-1256.
>
> [3].Agre JC, Rodriquez AA; Neuromuscular Function in Polio Survivors;
> Orthopedics, (1991) vol. 14 no. 12: 1343-1347.
>
> [4].Feldman, RM, The use of EMG in the differential Diagnosis of
> muscle weakness in post-polio syndrome, Electromyogr. clin.
> Neurophysiol., (1988),28,269-272
>
> [5].Peach PE, Olejnik S. Effect of treatment and non-compliance on
> post-polio Sequelae. Orthopedics. 1991; 14:1199-1203
>
 * WCE 2.01á4/2037 * You haven't lived 'til you've done it with a polio survi
--- WILDMAIL!/WC v4.12 
1:374/22.0)
---------------