The “Stroke Belt” is usually defined as an 11 state region which includes; Virginia, North Carolina, South Carolina, Georgia, Alabama, Mississippi, Louisiana, Arkansas, Tennessee, Kentucky and Indiana.
Incidences of strokes in these states is 50% higher than in the West and in the Northeast of the US, and 30% higher than in Midwest of the US.
We can see that not only is the “Mystery of Southeast Stroke Belt” a reality but there also exists a “Mystery of Midwest Stroke”, because for unknown reasons, the Midwest of the country has a higher incidence of strokes than in the West and Northeast of the country.
If we compare incidence of strokes between West and the Northeast of the country with New York, we can see that the incidence of strokes is much higher in the West and Northeast than in New York and because of this fact, we can call it the “Mystery of Northeast and West Stroke”.
Actually any incident of stroke, it doesn’t mater if it is in the Southeast of the country or in the Northeast of the country or anywhere in the world, it is a mystery because till this day, no one knows why some people have strokes.
Understanding why incidence of stroke is more common in some region than another will enable us to understand real cause of stroke anywhere in the world.
By comparing incidence of strokes between different regions we can see that geographical factors play an important role in the incidence of strokes. The question is how?
To discover how geographical factors determine incidences of strokes is best to start with the region where incidences of the strokes is the most common in US and that is the Southeast region, known as the “Stroke Belt”.
If we take a look on the map of this area, we can see that a significant part of all these state territories is that they have flat surfaces of the ground.
It will be simple to make a conclusion that physical geography is responsible for the high number of stroke incidences in this area, and that people who live in hills and in the mountains are less prone to stroke. One more contributing fact to make such a conclusion is that this stroke belt has a “buckle” -- a zone-within-a-zone that has stroke death rates “substantially higher” than the stroke belt itself, and twice as high as the rest of the country.?.
Reporting in the May issue (1997) of the American Heart Association journal “Stroke”, the scientists identify the “buckle” as the coastal plain sectors of North Carolina, South Carolina and Georgia. In this 153-county area, the new study shows, stroke deaths are 2.1 times higher than the rate of the nations average among people whose ages are 35 to 54, and 1.7 times greater for people between the ages of 55 and 74.
We can see that this “simply conclusion” is actually based on hard facts. Population living in coastal plain in those three states is more prone to stroke than people who live in mountains region in same state.
It shows that people living in flat area or plain area are more prone to stroke than people who live in mountains and hilly area but question is why geographical-environmental factor is in some extent responsible for incidence of stroke?
Now it is left to explain why people who live in these plain areas are more prone to stroke than people who live in areas where there are hills and mountains.
People who live in area with hills and mountains are more frequently forced to use and challenge their own motor skill ability because in every day of there life, they are more confronted with activities like walking up the hill, walking down the hill and walking diagonally up the hill and walking diagonally down the hill. And people who live in flat areas do not have the chance to walk down the hill or up the hill, they most of their lives walk only on flat surfaces. Walking on the flat surface for most of the time has for consequence that habitually gait is used in greater extent than by people who living in hilly and mountains areas.
We can conclude that people who live in hills and mountain areas in general, are more frequently confront with activities that force mental awareness in time of doing this particular physical activity.
The physical activities that obligate us to the some extent or full mental awareness are providing mental stimulation to central nervous system. Habitual walk alone doesn’t provide enough mental stimulation to the neuromuscular control centre.
The fact that in mountain area, geographical environment more frequently force to do physical activity by increased mental effort, and that have consequences of providing mental stimulation to the central nervous system and that explain why people in mountains region are less prone to stroke than people who live in flat areas.
But in the state of Florida we have a completely different situation. If we take a look in the physical geography of Florida we can see that the whole area is flat, as same as the coastal plain sectors of Georgia, South Carolina and North Carolina and this area is known as a “Buckle” of the “Stroke Belt”- an area within the area.
The south part of Florida has one of the lower incidences of strokes in the US. The question is why?
People who live in the south part of Florida, same as the people living in the coastal plain sectors of Georgia, South Carolina and North Carolina, do not have the opportunity to walk up a hill or down a hill.
But people in the south part of Florida, have more opportunities to walk with bare feet. Because of the warm climate for most part of the year, people spend more time on the beaches or in swimming pools.
Walking with bare feet on the sandy beaches and in the water, is an effective way for maintain and improving the sense of balance and motor skill ability in general, and people living in the southern part of Florida have plenty of opportunities to do that. Walking with bare feet demand increased level of mental avernes about surface and small object that is on the ground like sharps stone etc and that is factor that demand constant mental awareness for the time of doing this activity.
Walking by wearing footwear doesn’t demand from as to take care where we are stepping and how we are stepping and because of that fact we can do locomotion by using habitually gait.
In the south part of Florida, the great majority of people live in the coastal areas near the beaches, and a reason for this is that the inland of south Florida is mainly a swamp.
In the north part of Florida, much more people live in the inland area and because of that, people in the north part of Florida have much less opportunities to walk with bare feet and less opportunity to be engaged in water sport than the people in south Florida.
They can be more physically active but this kind of activity is mostly habitual and doesn’t sufficiently contributing to maintaining and improving motor skill ability.
That explains why people in the south part of Florida are less prone to strokes than people living in the north part of Florida and people living in the rest of the US, excluding New York.
The New York metropolitan area has the lowest stroke rates in the country. The question is why?
If we take a look in the map of this area, we can see that entire New York metropolitan area is located on flat surface similar as the coastal plain sectors of Georgia, South Carolina and North Carolina where the incidence of strokes is the highest in the US.
People living in the New York metropolitan area have much less opportunities to walk with bare feet compared to people living in the coastal plain sectors in Georgia, South Carolina and North Carolina, and far less than people living in the south part of Florida.
All physical geographical factors which contribute to lower incidences of the strokes states located on the hills and mountains like the states in the West and Northeast or states in the Southeast like Florida (Southern part of Florida), in the New York metropolitan area are non existent.
This all tells as that in the New York metropolitan area, the incidences of strokes should be higher then in the coastal plain sectors of Georgia, South Carolina and North Carolina, but contrary, they are far lower then anywhere in the US.
One important factor which makes the New York metropolitan area different from any other part of the country is that people are using the public transport system like nowhere else in the US.Every weekday, four and half million people use the subway alone.How the use of the public transport system (contributing) causes lower incidences of strokes will be understood by understanding firstly, how using the public transport system effects our sense of balance, postural stability and motor skill.
One thing is that people who use private cars are most of the time walking with the usual speed (habitually walk). For example; they do not need to hurry to catch their own car, the car always waits for them (contrary to the train or public buses), it is always at home or in the parking place and they always can afford to walk with their usual speed. (Usual speed is speed of habitual walk).
People, who use public transportation many times, come in a situation to increase their speed of the walk with the intention to catch the train or bus, and sometimes they decrease their speed below the speed of usual (habitual) walk with the intention to avoid waiting long on the station for the train or bus.
Each time when we change the speed of the usual (habitual) walk to slow or to brisk walk, we are challenging our own postural stability and any challenge for postural stability is in same time challenge for motor skill ability.
Each time when we are challenging our own postural stability, we are at the same time improving our own postural stability.
Improvement in postural stability will positively affect motor skill ability and habitual gait patterns and in same time it will revitalized entire nervous system.
The next important factor which is contributing towards the improvement of the postural stability and motor skill ability is when traveling on the train is the effect of speeding and slowing of the train on the people inside the train.
For example, if we stand or walk on the platform of the train which moves at a constant speed, we need the same level of postural stability as we need when we are standing or walking on the flat ground.
But if we are standing or walking in the train at a time when the train increasing speed, and at the time when the train decreasing the speed, we need to put more effort to avoid fall on the floor of the train (loss of balance). Each time when we put more effort than usually to maintain balance it positively effect postural stability and motor skill and everything that positively effect motor skill in same time positively effects neuromuscular centre.
Another fact is that the time between speeding and slowing of the train is only a few minutes long, because in the city area, the distance between the stations is short. For example, by traveling in the intercity train, we are spending much more time traveling with a constant speed. The time between speeding and slowing in an intercity train is much longer, because of the distance between stations is much bigger.
In the case when we are traveling by subway, we are affected every few minutes to the effects of speeding and every few minutes we are affected by the effects of slowing.
Most of the time we spend inside the train sitting, but we still are spending plenty of time standing and walking inside a slowing and speeding train, for example when we are entering a train and before we have the chance to reach the available seat, the train already starts to leave the station, and in this short time we are exposed to the effects of a speeding train, and at the time when the train is slowing down before it stops at the station, many times we have to leave the seat and walk towards the exit door because the time the train spends at the station is very short, just enough for some passengers to leave and for some passenger to enter in the train.
In these situations, people are forced to put more effort than usually to maintain required level of postural stability that enable them to avoid fall.
Another situation when we are unintentionally challenging own motor skill is when we are walking in the crowded area, like; underground station or in the busy street, shopping centre etc. In this case we frequently forced to change speed and direction to make way trough crowd.
In other words anywhere were surrounding geographical or man made environment like subway or man caused environment like crowd, demand from us frequently to change speed and direction of the walk people are les prone to the stroke than people who live in geographical and man made environment that not demand frequently change of the speed and direction of the walk.(Diversity of motion stimulates brain. Diversity of motion cause that we are more frequently mentally involved in that what we are doing. Mental involvement in physical activity is the factor that providing mental stimulation to the brain. Habitually physical activity doesn’t provide mental stimulation for neuromuscular control centre.)
We can conclude that in general, people who live in the New York metropolitan area are more frequently forced to put mental effort by doing every days walk compared to people who live in the rest of the country, and that has the consequence of lower incidents of strokes in the New York metropolitan area than anywhere else in the US.
One thing that is left to explain is why in the United States, African Americans are more prone to stroke than White Americans.
One fact is that a big percentage of African Americans live in an area known as the “Stroke Belt”.
For example, African American men and women in the “Stroke Belt” area have a higher stroke death rate than their racial counterparts in other regions of the country.
This means that African Americans living outside the “Stroke Belt” area have a lower stroke death rate than African Americans living inside the “Stroke Belt” area.
In this case, we can conclude that somehow, the difference in the physical geography of these regions is responsible for the difference in the rates of stroke incidents concerning African Americans living in different parts of the country.
The next question is why African Americans have a higher rate of stroke incidence than White Americans.
The answer is that they are more prone to stroke because they in general have less opportunities to do physical activity that contributing to maintain own motor skill ability.
One reason is that African Americans in general have a lower socioeconomic status compared to White Americans and that has the consequence that proportionally, much less African Americans have houses near the beach or have swimming pools at home, and in the towns and the city all over the country in flat areas or in areas with the hills and mountains, African American mostly have houses on the flat ground. This and similar other factors are the cause for African Americans having in general less opportunity to exercises own motor skill, and that has the consequence of a higher susceptibility to strokes.
In general, they have less opportunity in every day of life, to challenge own motor skill and postural stability and because of this factor they in general less frequently providing mental stimulation to the neuromuscular control centre than White American.
We can conclude that African Americans and White Americans by doing the same level of activity that positively effect sense of balance and motor skill are equally prone or not prone to strokes. One more convincing fact is that after age of 55 the stroke mortality rate for White American increases and is equal to that of African American. Increased incidence of the stroke after age of 55 is attributed to decrease in diversity of physical activity on one side and on the other side to prolonged period of doing habitually physical activities.
An African American that more frequently come in situation to do physical activity that force to exercise own sense of balance, postural stability and motor skill ability is much less prone to strokes compared to a White American that les frequently came to situation to do physical activity that force exercise own sense of balance, postural stability and motor skill ability.
Understanding how for the humans health and wellbeing is important the sense of balance, postural stability, postural strength and motor skill, will enable us to win the battle against stroke, against obesity and many other illnesses.
Central nervous system depends on mental stimulation. By doing exercise on exercise machines or most exercise designed for “burning calories” we are not providing mental stimulation to the brain and in generally this type of exercise are producing negative consequence for health.
For example, by prolong time of physical inactivity the muscle and bones losing strength and mass. It is same by neuromuscular control centre. By prolong time of habitually doing physical activity the neuromuscular control centre is not used in required extent necessary to maintain optimal condition. For example; running and walking on the tread mill we are not propel our self whit legs and feet but in greater extent we are habitually maintain lifting motion of the legs and mindlessly (habitual locomotion) falling from one leg to other.
Habitual walk and run by prolong period of time doesn’t provide in sufficient extent mental stimulation to central nervous system.
In some case geographical and/or man made environment, where we are living obligate as to do common activity in such a way that our mind is in present. For example when we are going down hill we have to take care not to fall down. And all time by doing this activity our mind is in present. We can’t walk down the hill with habitual gait patterns. Unexpected obstacles on our way by walking or running are factor that obligate us to keep mind in present.
The sense of balance is entwisted with postural stability, postural strength and motor skill ability. Improvement in postural stability is bind with improvement of the sense of balance, postural strength and motor skill ability. We can challenge own motor skill and postural stability as far as we can maintain the sense of balance. Improvement in motor skill ability positively effect postural stability and on the other hand, improvement in postural stability positively effect motor skill ability.
Each time when we are challenging own postural stability we are providing mental stimulation for neuromuscular control centre and for entire nervous system.
Plenty evidence shows that increase in body weight increase chance of suffering from stroke. It is enough to take look at obesity map and in stroke map and we will notice that region with higher obesity rate have higher incidence of stroke compared to state with lower obesity rates. It clearly shows that rates of obesity are correlated with incidence of stroke. Natural geographical-environmental factor and man made environmental factor play important role in obesity prevalence and in incidences of stroke. It shows that not every physical activity is beneficial for physical and mental health and not every physical activity is beneficial for weight control. Same level of physical activities done on (plain area) even ground will produce different outcome for health and weight and shape of the body compared to physical activity done on (mountains and hilly area) uneven ground.
Just occasionally using consciously effort to maintain optimal body posture and balanced gait will reduce risk of stroke and it is because by using consciously effort we are putting more mental effort than usual.
Incorporating some simply, non-strenuous but mental effort demanding physical activity or designed exercise in every day life will be most effective measure to ward stroke and many common disease and health condition.
For examples, every day habitually walk doesn’t demand mental effort bat slow walking or brisk walk and change of the speed of the walk demand mental output. It need to take in consideration that slow walking or brisk walking for prolong period of time is not beneficial for mental and physical health because after some period of walking at same speed this type of walk starting to be habitual. The best way is to frequently change of the speed of the walk.
In general every physical activity, regardless of intensity level, that contributing to maintenance or improvement of existing motor skill, sense of balance and postural stability in same time contributing to effective prevention of the stroke.
Physical activities that have protective role against stroke are in same time are highly effective as means to achieve effective recovery after stroke.
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