SS and stroke

[Shaun Pang]

A very good friend of mine who has atrial fibrillation recently suffered an embolic stroke. It's the 4th day since the stroke - he's able to move around on his own now but have some problems with fine motor control. He's out of ICU and the doctors are working out how to go about treating the atrial fibrillation. Prior to the stroke, he was doing SS although regularity was an issue in the past few months.

He wants to go back to training soon and was wondering how he should go about getting back into it. Would you happen to have any experience working with such individuals? Thank you.

[Mark Rippetoe]

I have worked with a stroke victim. As in all such instances, the individual circumstances determine how fast he can get back under the bar. But he can get back under the bar. You'll have to help him. It will be very good practice for you.

[Tom DiStasio]

Although I am not an expert on stroke recovery, I do have some experience with this. My dad had a stroke two years ago and has since made a full recovery. He was lifting prior to the event, and then after he had the stroke he had to take some time away from the gym. After about 4 months, he was itching to get back to lifting again. After doing a little research into stroke recovery and the mechanisms of rehabilitation, I started him up on a program. As he began, we started with a high frequency training program using body weight exercises. The progression was quite slow (i.e. Bodyweight squats to a bench for 3 sets of 5 everyday for a week, then 3x6 the next week, and so on). But the key was progress. We stuck with body weight exercises for about 3 months, and during this time he was also doing a lot of cognitive rehabilitation as well. Balance is a big issue, so its important that you have supportive structures (or yourself standing there) around the trainee while he is doing his training.

I'd say a few things that I would really emphasize:
1. You need to have someone with the trainee at all times during any type of movement. They need help at first, especially with a "novel" task. What was once automatic movement for them is now foreign so they are going to need assistance in relearning what to do. In this relearning process, it is crucial that they don't fall over. Be there for them.
2. Go slow. They'll get back to the bar. But it takes time (as Rip said, some sooner than others depending on the severity of the stroke). It also takes a lot of patience.
3. Limit the number of exercises per session. Quality over quantity. Give them something that they can have success with and then move on. 2-3 exercises per session worked well in my situation.

After some time with body weight exercises, we moved onto some light weights (holding onto weight plates/dumbbells) and this went on for about 2 months before he was ready for a barbell again. He started with an empty bar and stay with this for quite some time. The problem of balancing himself with an external load on his shoulders was a very new task and challenged him quite a bit. I started cutting down on the frequency of training at this point (3 times per week). But progress ensued and once he was able to do the bar for 3 sets of 10, we added weight and went down to 5's. From here, we faced a few challenges along the way but overall it was pretty normal training. Now, at the age of 65, he has made a full recovery and is squatting 225 for 5's and benching 185 for 5's. Its something he's really proud of.

[Shaun Pang]

Thank you Rip and Tom for the detailed advice. Will do my best to get him back into training.