Elite Athlete Training Principles can Benefit Neurological Rehabilitation
Introduction
Intensive motor training is now recognised as vital in helping patients regain as much physical ability as possible following a neurological insult such as a stroke or spinal cord injury. The rehabilitation community is learning more about maximising recovery and taking advantage of neuroplasticity. It's not an easy journey, and there is still much to learn.
At Anatomical Concepts, we look to other fields for insight and inspiration that we can bring to rehabilitation. For example, elite athletes like our rehabiliation clients will set training goals, undergo rigorous physical training and adhere to strict plans to achieve peak performance. This article explores the potential benefits of applying the principles of elite athlete training to help individuals recover from neurological conditions.
Let's get physical
Athlete at the Stirling Adapted Highland Games
Who would not be impressed by athletes' achievements in the Paralympic games? Irrespective of disability, we can all strive for higher physical achievement and fitness levels.
At Anatomical Concepts, we are proud to sponsor the Adapted Highland Games as part of the annual Stirling Highland Games. It can be a little surprising to see someone tossing the caber from a wheelchair or shot-putting whilst strapped to a chair, but it is also an inspiration and a reminder that everyone can strive to improve their health and fitness no matter their starting point.
We are fans of physical training and love to explore the relevance of this domain to recovery from a disability.
Readers might not know that physical education has long been connected with physical rehabilitation. It goes back to the 19th century in Europe and, in the UK, evolved into a profession called Remedial Gymnastics.
This was originally focused on military personnel injured during the Second World War, and it eventually became a profession in its own right before being absorbed into physiotherapy in 1985. The aim was always to use exercise as a preventative and corrective treatment method to enhance physical function. The method emphasised movement to improve joint mobility, muscle strength, coordination, stamina, and overall physical health. We seem to have recognised throughout human history that exercise is medicine.
In modern rehabilitation, it is becoming clear that the journey to recovery from a neurological condition, such as spinal cord injury or stroke, can be challenging and demanding. Of course, in many cases, complete recovery will not be possible considering the present state of the art. However, many of our clients want to keep as fit as possible because they hope a cure will someday be possible. If they allow secondary conditions to shape their fitness level, they may not be fit enough to take advantage of medical developments in the future. This is a strong motivator for many of our clients who use an FES bike.
Initially, the goals may be surgical or medical during an acute treatment phase. Once medical stability is reached, patients need something more akin to physical training. What the Remedial Gymnasts did years ago is now being enhanced by technology such as robotics, virtual reality (gamification), and sensor-guided training.
So, let's step back and consider the arguments for considering rehabilitation as if we are training athletes. Notice that these overlap to some extent.
Argument 1: The Importance of Goal Setting
Both elite athletes and recovering patients need goals. They also will need a "coach" to help guide and keep training on track.
Elite athletes and their coaches set clear, measurable, and stretching but attainable goals to track progress and maintain motivation. Similarly, incorporating goal setting in the rehabilitation process is desirable but not easy. Still, when done well, it can give patients a sense of purpose and direction and a clearer path to recovery. So many individuals have told us that no one discussed what was possible regarding functional recovery. Their physicians did not want to give "false hope", which is understandable but can lead to feelings of NO hope. As humans, we all must feel that we have control over aspects of our lives, and when this is diminished, we can feel a great sense of loss.
Training and exercise need to become a habit and commitment is more likely if goals are meaningful
Collaborative goal setting between patients, therapists and even family members can help to ensure that the targets are as realistic as possible and tailored to the individual’s needs. Achieving smaller but meaningful milestones can boost motivation and promote a more positive attitude towards rehabilitation and a sense of progress. We have clients who tell us that the efforts they have made to overcome disability are the "hardest but most rewarding" of their lives. Perhaps functional goals were impossible to set at the beginning, and in that case, the goals may need to be activity-based. Difficult or not, both athletes and patients need goals.
A goal is something to strive for, and when achieved, it can bring great pride and accomplishment. Training as an athlete or in rehabilitation is demanding and sometimes needs to be sustained for long periods to get results. We quickly learn that it is not about "fads or fashion"; the first imperative is adhering to the training programme.
Regularly review and adjust goals: As patients progress through rehabilitation, their needs and abilities will change. Regularly reviewing and adjusting goals ensures that they remain relevant, challenging, and achievable. This ongoing evaluation process also provides an opportunity to celebrate successes and identify areas for improvement.
Argument 2: Training Intensity
We imagine that training intensity must be important for those undergoing rehabilitation as well as athletes. However, we must not fall into the trap of thinking that greater effort is always best.
Elite athletes occasionally push themselves to the limit in training sessions to improve their performance on the field. We should not imagine athletes pushing themselves to the limit in every session. The volume, frequency, and intensity of training will vary, considering the person's ability to recover and the training phase in relation to the current goal. It is not possible to train "flat out" all the time.
In neurological rehabilitation, high-intensity or interval training is often stated to be more effective in improving motor function than low-intensity training. This is because intense physical activity seems to promote neuroplasticity, the brain's ability to rewire after injury. Again, we should be careful how we interpret "intense" as this is always ambiguous in the research literature and inevitably very individual in practice.
Both elite athletes and patients must become conscious of their ability to recover from training and the consequences of fatigue. Whilst high intensity is often advocated, we should always remember that training intensity must consider the individual's starting ability and ability to recover from the effort.
Rehabilitation programs that do not actively involve the patient or consider their motivation levels may see higher dropout rates and less effective outcomes. Patient engagement is crucial for sustained rehabilitation efforts.
Our bodies don't function like cars that stop when they run out of fuel. Instead, fatigue is a complex emotion influenced by real-time factors such as heat, humidity, core temperature, glucose levels, and electrolyte balance, combined with predictions from past experiences. This explains why runners instinctively pace themselves slower at the start of a race on a hot day compared to a cool one. It's not that they have less energy; their brains understand that the effort will demand more. When we reach what feels like our maximum effort in endurance activities and are halted by fatigue, it's a "relative maximum"—the best we can do under specific conditions. This differs from an "absolute maximum," which is the peak under any condition. By altering their perceptions, athletes can often trick themselves into achieving better physical performances. Research has shown that athletes can partially influence how hard their training is by how hard they "expect" it to feel.
Whilst it may seem tempting to manipulate the expectations of patients so that they can train harder, this might prove to be a mistake due to the elevated fatigue exhibited by many.
Argument 3: Individualised Training Programs
Elite athletes and rehabilitation patients should follow personalised training programs to optimise their performance. These programs address specific weaknesses, strengths, and individual goals. Applying this principle to neurological rehabilitation, therapists can develop customised training programs that target each patient's unique needs, promoting better outcomes and faster progress. Individualised programs can also help identify the most effective exercises, technology and training methods for a particular patient, ensuring efficient use of time and resources.
When designing programmes, continuity is essential. No elite athlete trains intensely for a week or two and then does nothing. They have a long-term plan that updates over time.
This needs to be the way with rehabilitation, too. It has become fashionable for some therapy centres to offer intensive therapy weeks. While there is nothing intrinsically wrong with this, the trainee undergoing this rehabilitation programme needs to think about "what comes next" and whether they can continue to access the technology resources they have used as part of their training. At Anatomical Concepts, we would like to see many more adapted gyms so that those with a disability can more easily take advantage of the training resources close by, rather than having to seek out speciality treatment centres.
Argument 4: The Role of Feedback and Adaptation
Both elite athletes and individuals undergoing rehabilitation thrive on constructive feedback to improve their performance. Feedback mechanisms are essential in ensuring that adjustments can be made to training regimes, allowing for the most efficient path toward goals.
Therapists and patients should engage in regular discussions to evaluate progress and adjust rehabilitation programs accordingly. This adaptive approach is crucial since it acknowledges that recovery is not a linear process and tends to plateau occasionally. Individuals may respond differently to various therapies. By regularly reviewing progress and being flexible with training strategies, patients can benefit from a responsive rehabilitation plan that continuously evolves to meet their changing needs and capacities.
A smart watch could be an effective way of gaining feeback on training progress
Amateur and professional athletes increasingly use smart sensors and software to help plan exercise and monitor their performance and recovery. I routinely use a smartwatch that monitors my exercise effort, heart rate, heart rate variability, and blood oxygen. It can tell me when I have recovered adequately from exercise. I also have sensors that clip to exercise equipment to monitor the velocity of movement and the power generated.
While certain conditions may make some sensors inaccurate, considering which sensors might be useful in an individual case is always worth exploring. Measuring something tends to be a useful step in bringing about constructive change through feedback. Not leveraging available data and biomarkers to tailor interventions can result in a one-size-fits-all approach that does not account for individual variability in recovery.
Argument 5: Progressive Overload and Adaptation
In elite athletic training, progressive overload is essential for continuous improvement. As we noted above, by gradually increasing training intensity, duration, volume or frequency, athletes stimulate their bodies to adapt and grow stronger. If we don't vary training, the body adapts to the level of effort and becomes comfortable. Physical learning stops and needs to provoked by changing the form of exercise.
This principle can also be applied to neurological rehabilitation, where gradual progression in motor training can help patients to rebuild neural connections, improve motor function, and enhance overall physical ability. As the patient’s abilities improve, therapists can adjust the intensity and complexity of the exercises to ensure continuous progress.
Argument 6: Recovery and Rest
As we saw above, fatigue, rest and recovery are important to athletes and to rehabilitation trainees. Fatigue is almost certainly an issue for many neurological patients. For example, after a spinal cord injury we find changes in muscle fibre types and metabolism that complicate the response to training effort. Rest and recovery are integral components of elite athlete training, allowing the body to repair and adapt to the stresses imposed by exercise. Similarly, incorporating rest periods and focusing on recovery in neurological rehabilitation can prevent burnout, reduce the risk of injury, and optimise the benefits of motor training. Adequate sleep, stress management, and relaxation techniques can also contribute to better recovery and overall well-being.
How to balance training and recovery to avoid fatigue or burnout
Argument 7: Nutrition for Optimal Performance and Recovery
Elite athletes adhere to precise nutrition plans to fuel their bodies for peak performance and recovery. In neurological rehabilitation, conventional wisdom suggests that a well-balanced diet provides patients with the essential nutrients to support healing, enhance energy levels, and improve cognitive function. Patients can develop personalised nutrition plans tailored to their needs by consulting with a registered dietitian, promoting optimal recovery. The challenge with nutrition lies in the widespread lack of understanding of the topic. However, most individuals could benefit from increased protein intake and the ability to avoid fad diets (of which there are many).
Argument 8: Avoiding Reductionist Approaches:
Focusing solely on the injury site or affected body part in rehabilitation without considering the broader systemic impacts can lead to incomplete recovery. Ignoring the interconnectedness of bodily systems and the psychosocial aspects of recovery can result in suboptimal outcomes.
Similarly, athletes typically focus on peak performance in their specific event but will also consider how to train to take advantage of interconnectedness effects. For example, sprinters do not just train by running but will use other methods to develop power from the starting blocks and flexibility to avoid injury.
Final Thoughts
Viewing rehabilitation through the lens of athletic training provides a dynamic and hopeful perspective and aligns with the latest advances in therapeutic techniques.
As we continue integrating technology and personalised strategies into rehabilitation, we must maintain open communication between therapists and patients. Encouraging a partnership approach maximises the potential for recovery, empowering individuals to achieve their best possible outcomes efficiently and effectively. This urgent need to reconsider our approach can significantly enhance the quality of rehabilitation, making it an engaging and potentially transformative journey.
Postponing rehabilitation efforts can lead to irreversible complications and diminished recovery potential. Delays can exacerbate issues such as muscle atrophy and loss of function.
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