My client has cerebellar ataxia and has been advised by his physical therapist to perform exercises that would maintain/improve his overall body strength. From what I've gathered, this condition greatly affects motor skills and balance. This is an elderly individual that I will begin training once a release is obtained from his physician, but I was curious if you had anymore insight into cerebellar ataxia and how to combat it with exercise.
First, what are ataxias and cerebellar or spinocerebellar degeneration*? Ataxia often occurs when parts of the nervous system that control movement are damaged. People with ataxia experience a failure of muscle control in their arms and legs, resulting in a lack of balance and coordination or a disturbance of gait. While the term ataxia is primarily used to describe this set of symptoms, it is sometimes also used to refer to a family of disorders. It is not, however, a specific diagnosis.
Most disorders that result in ataxia cause cells in the part of the brain called the cerebellum to degenerate, or atrophy. Sometimes the spine is also affected. The phrases cerebellar degeneration and spinocerebellar degeneration are used to describe changes that have taken place in a person’s nervous system; neither term constitutes a specific diagnosis. Cerebellar and spinocerebellar degeneration have many different causes. The age of onset of the resulting ataxia varies depending on the underlying cause of the degeneration.
Many ataxias are hereditary and are classified by chromosomal location and pattern of inheritance: autosomal dominant, in which the affected person inherits a normal gene from one parent and a faulty gene from the other parent; and autosomal recessive, in which both parents pass on a copy of the faulty gene. Sporadic ataxias can also occur in families with no prior history.
Ataxia can also be acquired. Conditions that can cause acquired ataxia include stroke, multiple sclerosis, tumors, alcoholism, peripheral neuropathy, metabolic disorders and vitamin deficiencies.
There is no cure for the hereditary ataxias. If the ataxia is caused by another condition, that underlying condition is treated first. For example, ataxia caused by a metabolic disorder may be treated with medications and a controlled diet. Vitamin deficiency is treated with vitamin therapy. A variety of drugs may be used to treat gait and swallowing disorders. Physical therapy can strengthen muscles, while special devices or appliances can assist in walking and other activities of daily life. The prognosis for individuals with ataxia and cerebellar/spinocerebellar degeneration varies depending on its underlying cause.
* The above information is provided by the National Institute of Neurological Disorders and Stroke, which is part of the National Institutes of Health.
The exercise program you design for your client will be partially based on the underlying cause, if it is known. For example, if the cause is due to a stroke or peripheral neuropathy due to diabetes, then you will need to design an overall program for the client taking into account the particular precautions and recommendations for these specific conditions. If the underlying cause is not known or is hereditary and not acquired, then designing an individualized program for the older adult should include endurance, flexibility and balance in addition to strength.
On August 1, 2007 the American College of Sports Medicine (ACSM) and American Heart Association (AHA) unveiled updated physical activity recommendations for healthy adults ages 18 to 64 years and companion recommendations for those ages 65 and older. The companion recommendations extend to adults ages 50 to 64 years who have chronic health conditions or functional limitations that impact their fitness, physical activity or ability to move.
The following basic recommendations were made by the ACSM and the AHA for adults over the age of 65 (or adults ages 50 to 64 with chronic conditions such as arthritis):
- Do moderately intense aerobic exercise 30 minutes a day, five days a week.
- Do vigorously intense aerobic exercise 20 minutes a day, three days a week.
- Do eight to 10 strength training exercises, 10 to 15 repetitions of each exercise twice to three times per week.
- If you are at risk of falling, perform balance exercises.
- Have a physical activity plan.
Both aerobic and muscle strengthening activity is critical for healthy aging. Moderate intensity aerobic exercise means working hard at about a level-six intensity on a scale of 10. You should still be able to carry on a conversation during exercise.
Older adults or adults with chronic conditions should develop an activity plan with a health professional to manage risks and take therapeutic needs into account. This will maximize the benefits of physical activity and ensure your safety.
Although the guidelines for older adults and adults with chronic conditions are similar to those for younger adults, there are a few key differences and points to consider.
- The general recommendation is that older adults should meet or exceed 30 minutes of moderate physical activity on most days of the week. However, it is also recognized that goals below this threshold may be necessary for older adults who have physical impairments or functional limitations.
- Functional health is an important benefit of physical activity for older adults. Physical activity contributes to the ease of doing everyday activities such as gardening, walking or cleaning the house.
- Strength training is extremely important. Strength training is important for all adults but especially so for older adults as it prevents loss of muscle mass and bone and is beneficial for functional health.
- The minimum recommendations are just that: the minimum needed to maintain health and see fitness benefits. If a person can exceed the minimum, he or she can improve personal fitness, improve management of an existing disease or condition and reduce risk for health conditions and mortality.
- Flexibility is also important. Each day a person should perform aerobic or strength training activities, taking an extra 10 minutes to stretch the major muscle and tendon groups, with 10 to 30 seconds for each stretch. Repeat each stretch three to four times. Flexibility training will promote the ease of performing everyday activities.
- American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med. Sci. Sports Exerc 30:975–991, 1998.
- Haskell W. L., I. M. Lee, R. R. Pate K. E. Powell, S. N. Blair, B. A. Franklin, C. A.Macera, G. W. Heath, P. D. Thompson, and A. Bauman. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med. Sci. Sports Exerc. 39:1423 1434, 2007.