Sports Medicine: Just the Facts

• The role of exercise in preventing and treating osteo-
  porosis can be summarized by five points in the
  American College of Sports Medicine position state-
  ment (ACSM Post Stand, 1995):
  
  
  1. Weight-bearing physical activity is essential for
     developing and maintaining a healthy skeleton.
  
  
  2. Strength exercises may also be beneficial, particu-
     larly for non-weight-bearing bones.
  
  
  3. If sedentary women increase their activity, they may
     avoid the further loss of bone that inactivity can
     cause and may even slightly increase bone mass.
  
  
  4. Exercise is not a substitute for postmenopausal
     hormone replacement therapy.
  
  
  5. An optimal exercise program for older women
     includes activities for improving strength, flexibil-
     ity, and coordination, since improvement in these
     areas lessens the likelihood of falls and fractures.
  
  
  
  

EPILEPSY

• It is estimated that less than 5% of individuals with
  epilepsy participate in a regular exercise program
  (Nakken, Lyning, and Tauboll, 1985). Parents, coaches,
  physicians, and epileptics themselves often limit participa-
  tion in exercise for fear of uncontrolled seizures, embar-
  rassment, or because of ignorance about the disease.


• Contrary to common fears, it is rare for seizures to
  occur during exercise. Multiple studies show that
  exercise decreases seizure frequency (Nakken,
  Lyning, and Tauboll, 1985; Horyd et al, 1981). The
  cause of this is under debate but is thought to be pos-
  sibly from beta-endorphin release, lowered blood pH
  after lactic acid release, increased gamma-aminobu-
  tyric acid (GABA) concentration, or possibly
  increased mental alertness and attention.


• Some studies have shown that seizure frequency can
  increase in the post exercise period (Nakken et al,
  1990; Horyd et al, 1981).
  •Exercise has been shown to improve self-esteem and
  the overall sense of well being in epileptics (Nakken,
  Lyning, and Tauboll, 1985-Nakken et al, 1990). In a
  population where isolation and depression are
  common, participation in exercise may be a way to
  improve self worth and social integration.

EXERCISE POST CEREBRAL
VASCULAR ACCIDENT

•Exercise is important in primary and secondary pre-
vention of cardiovascular and stroke risk. A study of
over 16,000 men found an inverse relationship
between cardiovascular fitness and stroke mortality
(Lee and Blair, 2002).

• Poststroke patients often suffer from weakness, paral-
  ysis, sensory loss, and decreased overall exercise
  capacity. A study by Mackay-Lyons revealed in less
  than 1 month after stroke, patients developed a signif-
  icant compromise in exercise capacity (MacKay-
  Lyons and Makrides, 2002).
  •A study by Fujitani showed that poststroke patients who
  exercised by increasing activities of daily living, showed
  a significant increase in peak oxygen intake (Fujitani et
  al, 1999 ). Additionally, poststroke patients’ training on
  treadmills showed significant improvements of VO2max,
  gait, and overall functional mobility, balance, and mus-
  cular activity (Macko et al, 2001; Laufer et al, 2001). A
  supervised exercise program for stroke survivors with
  multiple comorbidities is effective at improving fitness
  while potentially decreasing risk of further disease and
  disability (Rimmer et al, 2000).


• Strength training can safely be used in most post-
  stroke rehabilitation to improve muscle strength and
  overall balance (Rimmer et al, 2000). Caution should
  be used in patients with uncontrolled hypertension as
  well as avoidance of excessive weight and valsalva.

CEREBRAL PALSY (CP)

• In patients with cerebral palsy and other chronic neuro-
  muscular syndromes, physical therapy has become a main-
  stay in treatment. The purpose of therapy is to enhance
  motor development and minimize the development of con-
  tractures. Emphasis is generally placed on range of motion,
  both passive and active. Neuromuscular electric stimula-
  tion has been added to improve mobility, control muscular
  movements, increase strength, and to decrease spasticity.


• Strength training has been avoided in cerebral palsy
  owing to a theory that it can lead to increased spasticity
  in antagonist muscles; however, multiple studies have
  shown that in mild-moderate spastic CP strength train-
  ing can improve motor skills and strength without
  decreased range of motion or increased spasticity
  (Dodd, Taylor, and Damiano, 2002; Haney, 1998). In
  addition, strength training may lessen the amount of
  bone loss that frequently occurs in less mobile CP
  patients (Dodd, Taylor, and Damiano, 2002).


• Aerobic exercise has been studied minimally in CP
  patients. Horseback riding and swimming are often
  activities offered for patients with cerebral palsy;
  however, studies show that many patients with cere-
  bral palsy do not participate in aerobic activities
  (Darrah et al, 1999). Aerobic exercise in CP has
  been shown to increase fitness level and VO2max
  while also improving patient’s social skills, behav-
  ioral and emotional problems, and overall sense of
  well being.

98 SECTION 1 • GENERAL CONSIDERATIONS IN SPORTS MEDICINE