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Spring 2011
REHABILITATION & RECOVERY

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Increase Your Endurance

Train Like a Triathlete with Discipline and Persistence

By Lori Ann Bravi

As an Ironman triathlete and occupational therapist, I often tell my clients that their rehabilitation after stroke is similar to my training for a triathlon. It takes persistence, discipline and desire to make progress as an athlete, just as it does to meet the short- and long-term goals in rehab.

There are many days when I wake up tired and do not feel like going to swim practice before work. But I go because I know the importance of steadily and slowly building strength. There are also times when I do not feel up for the 3-hour bike rides. It crosses my mind that skipping a workout will not matter in the long run. But once I get going, I always feel better and stronger. By mid-season, I find that climbing hills on my bike for long stretches is actually easier and more enjoyable because I did the prep work for my endurance in the off-season.

Endurance is a key factor in rehab after stroke. It is actually a very complex part of rehab because it must be built slowly, yet steadily, in order to positively impact the daily routine. There is a rule of thumb that states,  “for every day spent in bed or in the hospital, one week of physical activity is required to regain the strength that was lost.”  Stroke survivors must start slowly and accept that building endurance again will and  should take time if approached correctly. Keeping this in mind, a survivor should work together with a therapist to create measurable and reasonable goals with slow increases in difficulty.

Persistence is important when building endurance. We do not always see the small gains we make, often mistaking this for not making any progress at all. A survivor may feel ready to stand in the shower again rather than sit on a tub bench. But in reality the body is building the endurance needed to tolerate such a complex activity. If someone is able to handle two minutes of standing at the start, consistency in rehab will steadily increase those minutes to three, four, five and even more over time. The greatest successes happen over time, not overnight.

Discipline is also very important when building endurance. It takes the guesswork out of deciding whether or not to do the exercises or go to therapy every day. Following a basic routine in order to stay active will most likely directly increase endurance. Committing to a program is committing to oneself. Survivors owe it to themselves to do those additional repetitions of each exercise every day, or add one new exercise to the routine weekly to increase strength and endurance. Caregivers can help this process by giving the person encouragement and support during the rehab process.

Desire is one of the most important components of building endurance. I can encourage clients to perform activities or exercises during a therapy session. However, I cannot make them do the programs at home. In order to see long-term changes that will move them ahead, the survivor has to want to improve. That is how they will notice six months later that they are now able to stand in the shower again. With persistence, discipline and desire survivors can slowly, yet steadily, build endurance and positively impact their daily routines. Again, caregivers can help give motivation and feed a survivor’s desire to make progress.

Lori Ann Bravi, MS, OTR/L is a Level IV Occupational Therapist at the Rehabilitation Institute of Chicago where she specializes in Neurorehabilitation and serves as a faculty member with the RIC Academy. She was awarded the Baskin Award in Research for her publication in Topics In Stroke and is a two-time recipient of the Buchanan Fellowship for her research in stroke rehabilitation.

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