Conversation with Dr. Richard Macko

Dr. Richard Macko works as an associate researcher for the Baltimore Geriatric Research, Education and Clinical Center (GRECC) where he studies the effects of aerobic exercise on patients who have had strokes.
A neurologist by training, Macko found his way from California to the East Coast 14 years ago after residency and fellowship stints, at the University of California-Los Angeles and University of Southern California, respectively.
Once in Baltimore, Macko applied the GRECC’s focus on exercise, lifestyle and aging issues to stroke.
Exercise can improves fitness, metabolism, insulin and blood sugar levels, and even walking ability in stroke survivors, even years after the stroke occurred.
Macko’s work on the Adaptive Physical Activity program has been put into a pilot test in an Italian community. The researchers believe that chronic stroke patients who participate in the program for six months will show improved balance, walking and ADL functions compared to those participating in the usual physical activities.
Macko’s research in the clinic has demonstrated a link between improved brain plasticity in chronic stroke patients and those participating in a walking program. The brain never stops changing. This is possible because of neural pathways that can reorganize to perform new tasks, the process known as brain plasticity, or neuroplasticity. The brain can rewire itself many years after an injury, such as a stroke. The brain works as a team- a healthy section can take over for an injured section to continue to function. This is much like the way a shooting guard on a basketball team might switch positions when the point guard is injured in order to move the ball up the court. Like the basketball player, the brain can improve through practice. Performing task-repetititive activities, known as massed practice, can help improve motor learning and motor performance in those who injured their brain. For example, stroke patients who trained on the treadmill for six months in Macko’s clinical program have shown improved balance and increased mental functions.
There is evidence that a plateau of recovery in stroke patients simply does not exist as previously thought. Stroke patients can improve longer than the short window of recovery time.
The clinical program lasts 6 months and involves moderate activity training, primarily on the treadmill. The program’s lower-limb workouts include using a treadmill modified with handrails and other safety devices, as well as stair-stepping, shifting weight from foot to foot, and other exercises tailored to the patient’s abilities. The upperextremity exercises include reaching, grasping, and other repetitive movements.
In the clinic, patients have shown improvements beyond the brain. Insulin sensitivity, for example, has improved. The clinical trials found that 58 percent of the participants were able to improve their diabetes classification. If a person was diabetic, the patient’s blood sugar improved to normal levels.
In 2006 and 2007, Macko published research that shows that more than 3 out of 4 stroke survivors are either pre-diabetic or have type two diabetes. As muscles shrink in partially paralyzed parts of the body, insulin resistance can increase, which can lead to diabetes.
If a stroke survivor has type two diabetes, he has triple the chance of sustaining another stroke as well as a greater chance of suffering a heart attack.
Macko hopes the research can not only prevent diabetes but reverse metabolic conditions. His research team has applied for grant money that would move the program into the community for testing.