Weekend Archives: Strength Training of the Memory-Impaired

[Mark Rippetoe]

A Pilot Study of Strength Training in the Memory-Impaired Elderly | Inna Koppel

[JFord]

Up until recently, I've never been too optimistic about the benefits of exercise for patients with neuromuscular disease. Unless the patient is either in a remission from his or her disease (which happens with some diseases such as multiple sclerosis) or the patient's disease hasn't progressed far (e.g. Parkinson's), a training effect doesn't seem feasible.

Likewise, with patients suffering from a cognitive disorder like dementia, it is very difficult to instruct patients in proper movements and to get compliance. This is why a bad fracture can be a death sentence for those with severe Alzheimer's disease. An orthopod can pin a fracture or replace a hip but the patient doesn't have the cognitive powers to fully participate in rehab. He’s still likely to end up bed/wheel chair-bound with all the associated deleterious health consequences of serious immobility.

This might be incorrect though. I have a very interesting patient with myasthenia gravis. This is a progressive disease that medications can make better but can’t reverse. It’s an autoimmune disease which destroys the motor end-plate which is the connector between muscle fibers and the neurons they talk to. Once the disease progresses to the point where the signal is blocked from actuating the muscle to a high degree, I can’t imagine exercise working because the muscle just doesn’t do what the nerve tells it to do.

My patient (late seventies) became quite refractory to the medications but insisted on starting an exercise program. He wasn’t doing barbell work but rather performed body weight squats, modified push-ups, sit-ups, and planks. I hadn’t seen him in several months and the change was dramatic. His gait, balance, and overall functionality was markedly improved. He was anxious to show off his newfound prowess.

So, I don’t know. N=1 in my observation but it does change my thinking about all of this. I've never seen an MG patient improve like this except transiently during the honeymoon stage of starting meds. I feel that this change was pretty amazing.

By the way, he also felt compelled to let me know what a horny bastard he’d become. He’s now eyeing the ladies at his assisted living facility in a new light.