We know that exercise is important for everyone, especially as a primary prevention for heart disease and stroke. However, exercise is still critically important even after a heart attack or stroke has occurred.
Some of the goals for patients who have recently had a stroke include the following:
- Modifying heart/stroke risk factors, since ~75% of patients post-stroke have heart disease, and heart disease and stroke are the number one cause of death in patients older than 65
- Improve walking speed and coordination
- Improving overall physical activity levels, as physical fitness is an independent predictor of stroke risk.
- Improve overall quality of life
- Improve exercise capacity
- Improve bone health
- Reduce vascular risks
- Increase muscle strength
- Improve balance and mobility
- Can also improve mood, employment status, and cognition
Why is exercise key to returning to the highest level of function possible after stroke?
Neuroplasticity = the body’s ability to adapt its nervous system to re-gain lost function after neural injury has occurred; aerobic exercise causes the release of neurotropic factors that are key to facilitating neuroplasticity that is involved with motor learning and cognition
Improved Neuroplasticity = more normal walking pattern, more normal muscle activation during activities of daily living and exercise, more efficient walking, improved cognition, coordination, speed of movement, activity endurance, etc
What are the barriers to exercise in these patients?
- Lack of motivation
- Lack of encouragement by family members and lack of social support
- Lack of means and not given specific goals and information regarding how much to exercise, at what intensity, and how frequently to exercise
- Lack of confidence in pursuing exercise due to a lack of self-efficacy post-stroke (due to new physical disabilities, challenges with balance, etc)
- Post-stroke rehab is frequently missing the mark, giving patients little to do, little aerobic work, and allowing too much rest for any aerobic benefits to occur
How can we encourage high intensity exercise after stroke?
- Set specific and measureable goals that are meaningful to the patient
- Garner family support and regular encouragement to participate in exercise
- Provide social support in a group exercise setting
- Help patients feel competent in intended exercise routine prior to discharge from therapy
- Address patient barriers to exercise and build confidence
- Address excessive fatigue and physical and cognitive deficits that may limit exercise participation
- Provide patients individualized exercise routines with specific exercises, modes of exercise (i.e., running, walking, biking, elliptical), specific duration, intensity (how hard to work), and educate patients on how to progress program safely
Is high intensity interval training appropriate for patients post-stroke?
Yes, high intensity training is can be appropriate, but this type of training requires more rest to mitigate the excess fatigue many patients experience naturally with exercise post-stroke. This type of training has the benefit of being able to induce muscle strengthening without impacting aerobic intensity if the heart rate is kept low with extra rest between sets and reps if necessary.