The right exercise program depends on what

Consequently, muscle strengthening does not increase much with this type of activity. Step aerobics works primarily the muscles in the front and back of the upper legs the quadriceps, and hamstrings and the gluteal muscles as a person steps up and down on a raised platform a step in a routine set to music at a designated pace.

As soon as these muscles start to feel sore, exercisers should stop, do something else, and return to step aerobics a couple of days later. High-intensity step aerobics can strain the joints, particularly the knees and hips. Water aerobics is an excellent choice for older people and for people with weak muscles, because it prevents falls on a hard surface and provides support for the body. It is often used for people with arthritis and sometimes for injury rehabilitation.

Water aerobics involves doing various types of muscle movements or simply walking in waist- to shoulder-deep water.

Aerobic exercises done out of the water, however, are more effective for weight loss and for helping to prevent osteoporosis. Cross-country skiing exercises the upper body and the legs. Many people enjoy using machines that simulate cross-country skiing, but others find the motions difficult to master and stressful around the hip joints and inner thighs although working with shorter leg strokes often helps.

Because using these machines requires more coordination than most types of exercise, a person should try out a machine before buying one. Cross-country skiing outdoors is more enjoyable to some people but adds the challenges of exercising in the cold while maintaining balance.

Rowing strengthens the large muscles of the legs and upper arms and back. More people use rowing machines than row on water, although rowing outdoors adds the challenge of coordinating the oars and the joys of spending time in a boat. However, if the boat does not have a sliding seat, the leg muscles will not be strengthened.

Proper form is essential to minimize injury. Strength training Strength training People should consult their doctor before beginning competitive sports or an exercise program. Doctors ask about known medical disorders in the person and family members and about symptoms the Aging, estrogen deficiency, low vitamin D or calcium intake, and These loads can be free or machine weights, cable weights, or even body weight used in exercises such as push-ups, abdominal crunches, and chin-ups.

Pilates is a series of exercises designed to increase flexibility and strengthen core abdominal and back muscles. Although Pilates is often thought of as a program for experienced athletes, Pilates programs can be designed for people of all fitness levels. Because Pilates techniques must be done correctly for people to achieve benefit, most experts suggest that people begin by taking a class or two with a Pilates instructor before trying it at home.

Tai chi is a system of gentle physical motions and stretches that are coordinated with specific breathing techniques. It is often used for stress reduction.

Some forms of tai chi are more intense and vigorous than others, but generally tai chi is considered more of a stress reduction technique rather than true exercise. Yoga usually is not exercise. Yoga stretches muscles and has benefits of mental and physical relaxation. Many people enjoy yoga. However, yoga does not benefit the heart, increase endurance, or help build muscle or improve muscle function unless doing the more demanding positions regularly.

Elliptical machines can be used for cardiovascular fitness. Benefits compared to running and bicycling, for example, are less stress on the spine and less joint strain, because there is no impact as the body glides when using an elliptical machine.

Also, higher and more continuous muscle tension can facilitate better leg muscle development and endurance and strength. Most elliptical machines have handles to coordinate arm movements with leg strokes, thereby providing a full body workout that increases cardiovascular fitness. Conditioning guidelines for example, target heart rate, and frequency and duration of exercise when using an elliptical machine are no different from those for other aerobic exercises, such as running or bicycling.

Elliptical machines must fit the user. The machines must provide a comfortable leg stroke length to avoid causing the legs to extend too far forward or back and straining the hip muscles. New forms of exercise, especially exercise classes, are always being developed. Some become widely popular and others are less popular but no less effective. Some people are more motivated to exercise when they vary their routine, and newer popular workouts can improve motivation.

However, more familiar forms of exercise and even some activities that are not traditionally described as exercise such as ballroom and other forms of dancing can be equally effective. Interactive video games that encourage physical activity sometimes called exergames may provide some benefit, but they are not a substitute for a regular exercise program. The left side of each panel shows the right hemispherectomy, which was performed to treat epilepsy 4 years before this study.

The scan was performed while the subject dorsiflexed his left or right ankle 10 times over 30 s, rested for 30 s, and repeated this block design sequence a total of four times. The arrow points to the primary sensorimotor cortical sulcus. A more-diffuse SMA activation was also seen extending into the premotor area. In general, training must aim to optimize the control of spared ascending feedback and descending neural controllers. Functional neuroimaging studies have revealed robust examples of regional cortical plasticity associated with sensorimotor gains and training protocols.

Investigational findings vary according to the location and severity of anatomical loss, the activation task used during a functional MRI study, and the intensity and duration of a specific rehabilitation intervention. Impairment in behavioral performance correlates positively with the degree of shift of activation contralesionally to homologous M1 neurons and primary sensory cortex S1. The left hemisphere controlled the ankle movements of both lower extremities Figure 1A.

The best outcomes are achieved in patients with the most sparing of the corticospinal tract. Transcranial magnetic stimulation can be employed to determine the amount of intact M1 and to test for changes in its excitability during retraining of motor skills.

In animal models of stroke, M1 and related motor cortices and the spinal cord evolve robust changes in their structure and function in response to specific types of motor training.

Strength training, by contrast, can alter the excitability of spinal motor neurons and induce synaptogenesis within the spinal cord, but does not alter the organization of the motor map. Initial strengthening might depend on improved descending control of a movement before a change in muscle mass occurs. The ability to vary discharge rate markedly influences the fluctuations in force necessary for the submaximal contractions that are required to perform everyday tasks.

The main effect of resistance training is to increase the volume of muscle fibers in response to stress-related gene expression. Fitness training might induce changes in spinal reflexes, depending on the particular behavioral demands of the task. Different types of practice and experience, therefore, differentially affect the distributed sensorimotor systems, and this experience-specific plasticity offers opportunities to enhance recovery after stroke.

Experimental studies indicate that the biological changes associated with practice-induced plasticity are molecular e. Exercise, at least in relatively inactive caged rodents, leads to changes in gene expression, including upregulation or downregulation of genes encoding molecules associated with learning and memory, and also to neurogenesis.

For example, brain-derived neurotrophic factor is upregulated by exercise. This growth factor modulates the function of intracellular signaling systems such as calcium-calmodulin kinase II and mitogen-activated protein kinase, leading to the activation of cAMP response element-binding protein, which functions in a critical pathway for learning, synaptogenesis and axonal sprouting.

Exercise and skills learning mediate multiple integrated responses in neural systems, as well as cardiovascular, endocrine, immune and other physiological systems, all of which might promote cerebral reorganization, synaptic efficacy, and recovery of function after stroke.

The biological responses to exercise in patients might be less pronounced than those in relatively experience-deprived, genetically homogeneous laboratory animals. Responses are also likely to depend on how long after stroke the exercise is initiated, the amount of exercise therapy administered, and the duration, type and context of the task that is practiced by a patient.

In terms of improving daily functioning, task-specific training seems to benefit stroke patients more than does general exercise, as it does in healthy subjects who wish to learn a new motor skill. One of the problems in demonstrating the specific effects of practice of any given task across rehabilitation trials has been the low intensity of training, which might limit the robustness of outcomes. In addition, responsiveness to training has been observed mostly in patients who have retained reasonable motor control, such as being able to at least partially extend the wrist and fingers or flex the hip and extend the knee on the hemiparetic side.

The Extremity Constraint Induced Therapy Evaluation EXCITE trial systematically tested a task-oriented neurorehabilitation therapy among patients who were able to initiate extension movements at the wrist and fingers. In addition, this intervention employed 6 h a day of highly structured, therapist-led, progressive and repetitive adaptive practice. Training involved gradual approximation of subcomponents of upper extremity task-related movements, subsequently progressing to the practice of fuller movements as these became feasible.

Practice tasks included 40 well-defined activities. In addition, the CIT group was instructed to practice specific upper extremity tasks after each daily session and to aim to solve problems that limited the use of the affected hand throughout the day at home. On completion of the intervention, the CIT group was given a home program of tasks to practice for 30 min daily using the affected hand. The intensity of training for a compliant subject could reach 60—80 h of upper extremity practice in the 2 weeks of CIT, another 6 h a day of forced use at home for 14 days, and 15 h a month of functional activities using the affected hand for 11 months, before the primary outcome measures were obtained.

Statistically significant and clinically relevant improvements in paretic arm motor ability and daily use were observed in individuals receiving CIT; lesser improvements were observed in participants receiving usual and customary care. In addition, the improvements following the 2-week CIT intervention persisted for at least 1 year and were not influenced by age, gender, or initial level of paretic arm function.

In summary, a well-constructed, intense, and task-oriented skills learning intervention that was shown in smaller studies to be associated with cortical reorganization, as measured by functional MRI and transcranial magnetic stimulation, proved to have at least moderate clinical benefits compared with almost no specified practice.

Task-oriented training for walking after stroke has included activities to improve balance and stepping. Practice in walking along courses with modest obstacles might improve balance and walking speed in outpatients who want to improve their sense of safety. Gait practice with rhythmic auditory cues, similar to marching music, can also improve walking variables. The paretic leg can be unloaded to prevent buckling. A therapist can help position the foot and assist knee control throughout the step cycle.

The subject can concentrate on repetitive practice of hip flexion for leg swing, knee flexion and extension, heel strike at the end of the swing, and other gait components see Box 1. Studies to date show modest improvements in walking speed in chronically disabled, slow walkers after six or more weeks of training on a treadmill, but the results have not been superior to those of the same intensity of over-ground practice alone in patients who were randomized on admission to inpatient rehabilitation after stroke.

Decide which impairments, disabilities and daily activities are reasonable goals for training. Slow walking that is effortful and makes it impossible to cross a street before the traffic light changes. Fatigue during walking and fear of falling, which prevent the patient from attending church or visiting friends.

Practice components of impaired movements of the affected limbs to achieve task-related actions. Try to reproduce these selective flexor and extensor movements during the stance and swing phases of walking.

Practice should be progressive in intensity and at levels of difficulty near maximal performance. Have another person provide slight resistance during the isolated lower limb flexor and extensor movements. Add partial squats while standing with the back against a wall. Exercise the lower extremity flexor and extensor muscles across each joint using the resistance of elastic bands or weights as tolerated. Increase the time walked by a feasible increment weekly until a planned community distance equal to at least several blocks has been achieved.

Walk on uneven surfaces. Electromechanical robotic devices 33 — 35 aim to provide task-specific gait training by enabling patients to emulate the kinematics used by healthy subjects, and several commercial devices are available.

Small trials conducted to date have produced promising results, but have not shown this approach to be better than more-conventional training of the same intensity. Step training combined with functional electrical stimulation of the ankle dorsiflexors to aid foot clearance and knee control also shows promise by at least modestly improving walking speed. The aim of practice is centered on the regaining of skills, but task-oriented learning should be supplemented by exercises to build muscle strength and increase endurance.

Initial resistance exercises lead to improved strength before an increase in muscle fiber diameter occurs, because the ability to efficiently perform a novel task, such as lifting hand weights, requires the acquisition of new skills, including biomechanical adjustments and timing.

The principles of strengthening approaches are similar for both able-bodied individuals and people with disabilities. Progressive resistance exercise is a method of increasing the ability of muscles to generate force.

Increases in spasticity, such as the development of increased upper extremity flexor tone, are unlikely to occur. A meta-analysis including both healthy older individuals and patients after stroke found that progressive resistance exercise generally improved the ability to generate force.

Maintenance of functional strength might, therefore, fail without an exercise regimen. It might be expected that the moderate to large effects of strengthening would carry over into an improved ability to perform daily activities and participate in usual roles, but this has not been definitively demonstrated.

These muscle groups could be the focus of strengthening exercises, along with efforts to improve the timing of their activation during reciprocal lower extremity stepping. Feedback during training about the timing of loading of the stance leg compared with hip flexion of the swing leg could improve step length and the symmetry of the amount of time spent in stance or swing for each leg. Patients often experience marked deconditioning after stroke.

The easiest way to obtain a conditioning effect is by first walking faster as gait improves, then by treadmill walking or bicycling on a recumbent stationary bicycle with the affected foot tied into a stirrup Box 1. The intervention group showed significant improvements with respect to cardiorespiratory fitness, mobility, paretic leg muscle strength, and participation in daily life compared with the control group. Walking speed over 15 m and walking distance for 6 min are commonly used measures of walking ability after stroke.

Cardiovascular fitness, balance, and paretic leg strength are independently associated with longer walking distance and walking speed during a 6-minute walk. In summary, fitness training is feasible in patients with hemiparesis who are able to ambulate without human assistance. Task-related training seems to produce immediate benefits. A number of randomized clinical trials have highlighted the value of exercise programs in individuals living in the community after stroke.

Some studies aimed to lessen specific impairments, whereas others tried a more global approach to skills practice, strengthening and fitness. One study showed that both a week supervised exercise program and a program consisting of 1 week of supervised instruction followed by 9 weeks of unsupervised exercise led to physical benefits, such as greater 6-minute walking distance. The gains persisted for at least 1 year. Another well-designed trial randomized individuals, 3 months after hemiparetic stroke mean age 70 years and independent in walking , to a structured, progressive, physiologically-based, therapist-supervised, in-home program that comprised 36 sessions of 90 min over 12 weeks, or to a program of usual care.

The exercise program targeted flexibility, strength, balance, endurance and upper-extremity function. Gains for the intervention group exceeded those in the usual care group with regard to balance, endurance, peak aerobic capacity, mobility, and participation in usual roles.

These gains were modest but clinically important. The effects had diminished 6 months after treatment ended. Another randomized trial provided a comparison between usual treatment and an intensive exercise program for balance, strength, conditioning and skills learning, starting at admission to inpatient stroke rehabilitation.

Although some functional gains were apparent at the end of inpatient care, no additional improvements following the initial gains were apparent at 3, 6 or 12 months after stroke with this very modest increase in formal training. In summary, readily applied home exercise programs can lead to improvements in variables related to physical functioning and quality of life, but the intensity of the intervention must progressively push towards these goals.

The benefits are clinically significant, if modest. Most importantly, the intervention must be continued for at least two weekly sessions of exercise or restarted every few months to maintain the accrued benefits. Following stroke, patients often report feeling sluggish, weary, sleepy, bothered by fatigue, and having a low level of energy. Fatigue can of course also reflect a mood disorder, side effects of medications, sleep that is limited by insomnia, sleep apnea or pain, or psychosocial problems.

Patients frequently have difficulty distinguishing the effect of their neurological impairment from the effects of fatigue. Sleep apnea is common after stroke, and can cause daytime drowsiness. Nightly analgesics and primary interventions for any source of pain, antidepressant medication, and occasional use of stimulants such as caffeine or methylphenidate in modest doses can lessen a daytime sense of fatigue.

Fatigue after stroke might also be considered to be a problem of fatigability that develops with even modest exertion. An exercise-induced reduction in the ability of muscles to produce force or power, regardless of whether a task can be sustained, is a common if often overlooked cause of what a patient means by fatigue.

After stroke, unusual postures of the upper extremity might place a heavy load on accessory muscles, leading to fatigue in their use. Exercise for Older Adults Also called: Seniors' fitness.

Learn More Related Issues Specifics. Research Clinical Trials Journal Articles. Resources Reference Desk Find an Expert. For You No links available. Brisk walking or jogging, dancing, swimming, and biking are examples. Strength exercises make your muscles stronger. Lifting weights or using a resistance band can build strength. Balance exercises help prevent falls Flexibility exercises stretch your muscles and can help your body stay limber If you have not been active, you can start slowly and work up to your goal.