Exercise recommendations following stroke

This review includes recommendations on exercise and physical activity for stroke patients. The authors concluded that exercise programs can greatly increase quality of life for stroke patients.

Stroke patients often experience long term disability and cannot live independently due to mental and physical disabilities. In addition, their resulting sedentary lifestyle puts them at a higher risk of future vascular events. Studies have shown that physical activity and exercise have the potential to improve both physical and mental deficits. However, there is not a comprehensive set of recommendations available for healthcare professionals on activities and exercises to encourage.

This review examined previous trials regarding exercise and stroke patients. The authors summarized the findings and developed several recommendations based on these.

Following a stroke, exercise and activity plans need to be tailored to individual patients. Patients will need a preexercise evaluation that includes a full medical history and physical examination to prevent injury and cardiac (heart) arrest. This evaluation should involve exercise tests that look at heart rate, rhythm and blood pressure.  

Immediately after stroke, the program should aim to prevent further complications of prolonged inactivity, regain movement and recover daily tasks while minimizing bed rest. This should include encouraging intervals of low-level walking and self-care activities, seated activities and motor challenges. The frequency will be altered based on patient tolerance.  

Once a patient is released from hospital, they should enter outpatient rehabilitation. There are several types of exercise recommended for stroke patients.

Aerobic exercises such as walking, cycling on a stationary bike, or functional seated activities may be included. This should ideally be performed 3-5 days per week for 20-60 minute sessions. Aerobic exercise has been shown to reduce motor impairment and improve cognition and improve vascular health. Treadmill walking in particular may be helpful.

Strength and endurance exercise involves resistance training of upper or lower limbs. This can include using free weights or elastic bands. This type of training is best performed as circuit training, where patients would alternate between exercises during a single session. Ideally, 8-10 exercises should be performed where each exercise should be repeated 10-15 times. This set can then be repeated 1-3 times, 2 or 3 times a week. Strength training improves muscle strength and ability to perform daily tasks.

Flexibility training involves stretching, where stretches are held for 10-30 seconds, 2-3 days per week. Flexibility training should be performed with aerobic or strength training. This should prevent injury.

Neuromuscular training involves balance and coordination exercises such as Tai chi or yoga, or activities using paddles or sports balls. In addition, video games can also be useful as they challenge hand-eye coordination. This can improve mobility, quality of life, and prevent falls. This type of exercise should be performed with the other exercises 2-3 days per week.

The authors concluded that based on previous trials, exercise is important at improving mobility, health and quality of life of stroke patients.

Always discuss any type of phyical activity or exercise program with your doctor before beginning. They will be able to help you decide what would be safest and most effective.