A rehabilitation program can help the patient cope with abnormal body mechanics and posture. Gait training, orthopedic devices, and a carefully supervised exercise program are recommended. Moderate exercise can improve muscle strength, cardiorespiratory fitness, ambulation, and the patient’s sense of well-being. However, activities that increase muscle or joint pain or fatigue should be prohibited. (5) Lifestyle modification which reduce demands on symptomatic muscles by alternating rest with activity, the use of bracing, avoiding strenuous demands, and weight reduction have been shown to be the most effective therapeutic approaches. (13)

The general goal of management of physical therapy is to provide the person with principles and methods for self-management of their body. The most important aspect of the program is patient and family education regarding the pathology caused by acute polio, the process of recovery, and the effects of long-term compensation. Specifically interventions should include the current use of or need for orthotic or assistive devices, the control and prevention of pain, decrease abnormally high work demands on muscles, correcting posture, and maintaining function while protecting the bodies joints and muscles. For clients with PPS exercises can be used safely with modification and careful monitoring. A beginning rule of thumb is for the therapist to estimate the intensity that the subject can tolerate and then apply one half, reduce the estimated repetitions to one half, and double the time of estimated rest periods. If fatigue does not last longer than 30 minutes or appear in the next 2 days and if pain does not increase, the program can be continued and gradually increased. Increased fatigue or pain is an indication for reevaluation of the exercise with consideration of decreasing the amount of exercise or activity. (1) Patients should be encouraged to participate in wellness programs that can provide them with information and guide them in training behavioral changes that focus on nutrition, exercise, functional activity, posture, stress reduction, and coping. (10)

In research done by Stanghelle and Festvag (14) one of the main purposes of the study was to measure the cardiorespiratory fitness 3 – 5 years later in patients previously seen and treated for PPS. The findings show that the working capacity in these patients deteriorated more than expected for healthy persons with increased age, and they had a greater increase in body weight. Thus, the lower aerobic capacity combined with higher body weight might contribute to the increasing polio-related symptoms and disability. 33% reported increased breathing problems during the follow-up. This article demonstrates the importance of and need for these patients to be active in some type of cardiorespiratory training in order to best maintain functional levels of aerobic capacity.

It is well known that decreases in muscle mass occur with increasing age, with proximal muscles of the lower extremity particularly affected. This decrease in muscle mass is due to a decrease in both fiber number and diameter. (15) Cellular changes are found in all organs with aging. As we age, strength and coordination decline and movements tend to become slower. Muscle alterations are complex and poorly understood, because the composition of muscles changes over time with the replacement of myofibrils by fat, collagen, and scar tissue. Individual muscle fibrils also change in their permeability to water, sodium, and chloride, which increases with age. By age 60, the total loss in lean muscle mass represents 10% to 20% of the maximum muscle power attained at age 30. (15) The highest strength levels for men and women are generally reached between the ages of 20 and 30 years, at the time when muscle cross-sectional area is usually the largest. Thereafter, strength in most muscle groups declines and progresses slowly at first and then more rapidly after middle age. Strength loss among elderly individuals is directly associated with their limited mobility and physical performance. (16)

With aging, the number and size of peripheral nerve fibers diminish with a concomitant decrease in conduction velocity. (15) Nerve conduction velocity declines 10 to 15% from 30 to 80 years of age, while maximum breathing capacity at age 80 is approximately 40% of a 30 year old individual. (16) The cumulative effects of aging on central nervous system function are exhibited by a 37% decline in the number of spinal cord axons and a 10% decline in nerve conduction velocity. (16) With regard to aging effects, there is no question that the physiological and exercise capacities of older people are generally below those of their younger counterparts. What is uncertain is whether these differences are caused by true biologic aging or are simply the results of a lack of use brought on by alterations in lifestyle and activity opportunities as people age. No longer can older men and women be stereotyped as sedentary with little or no initiative for active pursuits. There is currently a tremendous upswing in the participation of “senior citizens” in a broad range of physical activities and exercise programs. Research clearly demonstrates that if an active lifestyle is continued into later years, a relatively high level of function is retained, and vigorous activities can be engaged in safely and successfully. In addition, regular exercise throughout life offers significant protection against a variety of diseases and risk factors, particularly those related to the cardiovascular system. In older men and women, exercise training, particularly resistance training, facilitates protein synthesis and retention, and blunts the “normal” and somewhat inevitable loss of muscle mass and strength with aging. Among healthy elderly individuals, exercise training can enhance the heart’s systolic and diastolic properties and increase aerobic capacity to the same relative degree as in younger adults. Regular moderate to vigorous physical activity produces physiologic improvements regardless of age. (16)

When recommending a therapeutic exercise program for the postpolio patient, one needs to take into consideration the patients own particular clinical situation in order for the program to benefit the patient and not lead to overuse problems. This can be somewhat challenging for the clinician as each patient is unique. The initial poliomyelitis illness effected each patient differently. In each patient, the pattern of muscle weakness is different. Due to the pattern of muscle weakness, the joints most vulnerable to pathology are also different. The concept of overuse weakness is not new, although the mechanisms for it are presently not well understood. Several different physiologic mechanisms responsible for overuse of muscles exist, including both metabolic fatigue of the muscle as well as anatomic disruption of muscle fibers from overwork. (17)