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INTRODUCTION

Even when I have an off period, I can’t go too crazy because the threat of having a seizure doesn’t go away. As long as you’re focused and dedicated—especially in a sport—there’s no reason it should dictate your life.

Dai Greene, former 400-metre hurdles world champion

Neurological disorders are now the leading cause of disability in the world.1 This chapter addresses the benefits of physical activity for some specific neurological conditions observed in regular clinical practice. The evidence base for treatments of these conditions has grown, with some research suggesting potential preventive as well as rehabilitative and management roles for physical activity in neurological conditions. Physical activity and effective functional mobility training (including sports participation) remain under-prescribed in the management of neurological conditions. The following sections provide a brief overview of cerebrovascular disease (stroke), Parkinson’s disease (PD), multiple sclerosis and epilepsy, before discussing the effects of physical activity prescription in the prevention or management of these conditions.

CEREBROVASCULAR DISEASE (STROKE)

Stroke is a disease of the vascular supply to the brain. The effects of physical activity and its protective mechanisms for vascular disease are well established Physical activity can also provide a secondary preventative effect, alongside working as a rehabilitation tool post stroke.2 A stroke is characterised by rapidly developing neurological symptoms of vascular origin resulting from brain ischaemia. This is the result of either an occlusion of the blood supply to the brain (thromboembolic) or a haemorrhage. Stroke remains the second highest cause of death in high-income countries and is top among middle-income areas, accounting for 14.6% of all deaths.3

Key concerns post stroke can be divided into three categories:

  • Physical

    • – muscle weakness or spasticity

    • – loss of sensation

    • – stiffness

    • – incontinence

  • Emotional

    • – mood disorder

    • – personality changes

  • Cognitive

    • – loss of memory

    • – poor concentration

    • – unable to problem solve or process information effectively

    • – visual neglect

    • – aphasia.

PRACTICE PEARL

Stroke-like signs such as hemiplegia and aphasia can occur during physical activity but may relate to the more common concern of transient hypoglycaemia. A finger prick test will support effective diagnosis.

Effects of physical activity on stroke mortality

Physically active men and women have a 25–30% reduced risk of stroke when compared with inactive men and women. Various physical activities, ranging from walking to occupational movement, provide benefits to men and women, uninfluenced by age or gender.

Key data comes from observational studies as well as two meta-analyses of physical activity and stroke.4, 5 The magnitude of the effect in those studies is shown in Table 14.1. The beneficial effects of higher levels of occupational physical activity are similar in extent to those seen in general physical activities, such as walking.

Table 14.1Dose–response ...

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