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Chapter Objectives

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Upon completion of this chapter, the learner should be able to:

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  1. Explain basic physiological principles underlying cardiovascular and pulmonary functions related to exercise metabolism.

  2. Discuss factors contributing to and possible mechanisms involved in reduced exercise capacity in populations with neurological conditions.

  3. Discuss possible mechanisms underlying reductions in exercise capacity in people with neurological conditions.

  4. Identify potential benefits of cardiovascular fitness training in populations with neurological conditions.

  5. Design exercise programs to improve the cardiovascular health and fitness of people with neurological conditions.

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Introduction

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After a dramatic exacerbation of her multiple sclerosis 1 month ago, Mrs. Mack is just beginning to experience some motor recovery. During this time of reduced physical activity, she reports frustration that her stamina and endurance have decreased from levels before the exacerbation. The physical therapist notes that Mrs. Mack’s resting heart rate is high; in addition, she experiences shortness of breath and her heart rate increases dramatically during physical activity.

With patients such as Mrs. Mack, it is essential to provide physical rehabilitation interventions that improve their cardiovascular/pulmonary status. This also applies to individuals with neuromuscular diagnoses, who may have primary or secondary impairments of cardiovascular/pulmonary function, as discussed in this chapter.

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The importance of effective functioning of the cardiovascular and pulmonary systems to good health is irrefutable. Nevertheless, the cardiopulmonary health and fitness of individuals with neurological disabilities have long been overshadowed by a preoccupation with the neuromuscular system. Traditionally, recovery in neurological populations was attributed almost exclusively to improved functioning of the neuromuscular system; consequentially, most interventions were directed at enhancing the capacity of that system. This “single-system” approach seemed rational, given the obvious limitations imposed by neurological impairments (e.g., muscle weakness, changes in muscle tone, and sensory-perceptual disturbances). However, traditional approaches have not optimized functional independence, leading therapists to seek more effective, multisystem approaches to neurorehabilitation. With this broader perspective came a greater emphasis on the cardiovascular system and, to a lesser extent, the pulmonary system.

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It has become standard practice in some neurorehabilitation facilities to engage patients in aerobic training to enhance their daily function and quality of life. However, challenges remain in improving cardiopulmonary health and fitness in neurological populations. Fitness in these populations is affected by a host of interacting factors, such as the location and extent of the neurological lesion, presence of comorbidities (particularly cardiovascular disease and diabetes), lifestyle habits, and premorbid activity level. Some of these factors can be modified, whereas other factors, such as age and severity of the neurological condition, are nonmodifiable and therefore limit the potential for cardiopulmonary adaptations to training. Moreover, establishing baseline fitness levels and monitoring responses to training in individuals with compromised motor and postural control are not easy tasks. Thus, it is vitally important for rehabilitation professionals to understand the fundamental aspects of fitness assessment and training protocols and the principles upon which they are based.

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