PPS: Stress tests, exercise - Harmful or Beneficial?
Eddie Bollenbach

From several Posts to the Post-Polio-Med Email List, With Permission

Eddie Bollenbach Bio & Picture

Date: Sun, 2 Mar 2008 19:44:20 -0500
From: "Eddie Bollenbach"
Subject: Re: [PPM] stress test and PPS

If my doctor told me to take a stress test after an EKG I would take it and not worry about PPS. I took the chemical stress test and didn't even notice any difference after they put the chemical in that was "supposed" to speed up my heart. To not do this because you are worried about neurons getting stressed is a non-sequitur to me. Believe me, there will be people taking the stress test there that have had multiple heart attacks and are in much worse shape then you are (your doctor is trying to save you from this). You might just be able to avoid being in their situation with a bit of recommended diagnostic preventative medicine. .........Eddie

Date: Tue, 4 Mar 2008 14:40:00 -0500
From: "Eddie Bollenbach"
Subject: [PPM] Cardiovascular Stress Tests and PPS

Following this post is is a bibliography which was copied from the International Polio Network publication covering our best understanding of exercise and the Post-Polio Patient.

In some of the studies patients were used to exercise them to exhaustion and then check their status afterward. If the researchers felt this drastic action would cause permanent injury to these PPSers they would not have gotten permission to do the experiment and it would not have been ethical under any guidelines that I know.

There is no evidence, first of all, to support the contention that repetitive exercise damages neurons. We don't even know the cause of PPS.

There is good consensus and evidence that overexercise results in fatigue of muscles and can damage them in healthy patients and those with PPS especially if muscles have too few fibers innervated by motor neurons, as in PPS. They will fatigue faster.

A stress test using chemicals has about zero probability of harming polio related muscles.If exercise is continued repetitively in weakened muscles there will be an effect that results in pain, extended fatigue, and other symptoms. If this is continually done muscles will get weaker even if the person has not had polio but the load continuously exceeds the capacity of the muscles to contract.

Anyone who overuses a muscle ONCE will be told by the body that this should not have been done with the intensity and duration of the activity. You don't need electronic equipment to measure this as the body has built in systems to tell you if you hurt it which have been developed throughout evolution over millions of years. This has been refined because it protects overused muscle fibers and allows the individual to be better able to reproduce rather than be disabled and unable to attract a mate because they will not survive as well as healthy individuals...

Anyone who will not take an stress test on a doctor's recommendation because they had polio and because of anonymous advise from a mailing list is making a mistake and is thinking in an incorrect way about PPS.

There is no evidence in any literature anywhere, despite millions of such tests being done in the United States every year, that a chemical stress test will result in irreversible damage to the neuromuscular system. No Evidence anywhere. If you want to just THINK that you will be hurt think of this. If the doctor saw a slight change in the electrocardiogram, say a Q wave abnormality (the electical cycle produces PQRST waves where each letter corresponds to a normal angle point in the tracing, or a single bump before or after then tracing) the individual may have had a silent heart attack and this may presage a bigger fatal one.

It may also be nothing in which case applying stress either chemically or with exercise can point to whether it is serious or not. Deviations in the other parts of the tracing like ST elevation and so on can clue the doctor in to other possible catastrophic consequences that may be possible in time or even imminent.

I have to be blunt here because fear, ignorance, and misinformation can result in terrible consequences. I am a scientist. We work with evidence and not how we "feel" about what could happen. There is evidence that stress tests can and do save thousands of lives. There is no evidence that exercising intelligently and with guidance with PPS can hurt you in any significant or permanent way and the consensus among researchers is that the right kind of exercise, without regard to a chemical stress test which is not exercise, may help you a lot.

The best determinant of this is your reaction to exercise itself. Motor unit number estimation tests (MUNE) can give you an estimate of the density of your motor units and may show a decrease in the number of them over time. There are people without the symptoms of PPS who have low MUNE numbers because of the damage from the original polio. If you want to see how many neurons are degenerating over time take a MUNE before a stress test and take a MUNE after a stress test for heart disease and I would bet dollars to donuts you will not see any difference.

MUNE first of all is an estimate and secondly they are done at a point and then later, say five years later, to see if neuron loss is occuring and how fast. If you rest all that time in bed you will lose more motor units than if you try to do what you can without pain. And some tests done with MUNE to estimate if the progression of PPS neuron loss over time have shown no difference from normal loss while other tests have shown 3 multiple times the loss of normals. The test is dependent on the method used and the lab. And it is an estimate! That's what the E stands for.

To make a long story short, and I am truly sorry if this offends anyone, if anybody on this mailing list or any other mailing list advises a person not to take a stress test for cardiovascular disease because the stress is going to do damage and worsen PPS and that this is a risk greater than not following a doctor's recommendation to take a stress test for detection of cardiovascular abnormalities is doing harm to people, period.

My best advise is to take the test. You will not have any permanent damage and probably, from the testimonials here from most people, not have any untoward significant problems. I have PPS and when I went for a stess test I didn't even consider PPS at all before, after, or during the test..

Here is some reading

Margaret (Peggy) Whitcomb's reply

Contact Professor Edward P. Bollenbach
Academic Web Pages: Home: http://www.angelfire.com/mi/nccc/
Microbiology: http://www.angelfire.com/mi/nccc/mine.html
Chemistry: http://www.angelfire.com/mi/nccc/chem.html

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