Stroke

Overview

A stroke ocurrs when blood flow to a region of the brain is obstructed, resulting in a rapid loss of brain function lasting for 24h or more or until death. The majority of strokes (87%) are ischemic, resulting from thombosis or embolism; 10% are hemorrhagic, caused by rupture of a vessel in the brain and leaking of blood into brain tissue¹.

Effects on the exercise response

Following a stroke, submaximal oxygen uptake is decreased, VO_2peak is approximately half that of age-matched healthy counterparts¹. Only 20% to 34% of individuals are able to achieve 85% of age-predicted HR_max¹. Stroke surivors tend to breathe harder with exertion and fatigue approximately 2.5 times more rapidly than those without a stroke¹.

Effects of exercise training

Recurrent stroke and CAD are leading causes of death following stroke, however, studies have shown that exercise alone can reduce mortality by 20% or more¹. Moderately active individuals have a 17% reduction in stroke risk compared with inactive persons, whereas highly active individuals have a 25% reduction in stroke risk compared withinactive persons (Lee et al, 2003). Aerobic exercise can increase VO_2peak, and improve workload response, blood pressure and cholesterol levels¹.

Management and medication

Medical treatment for stroke survivors includes the following: long-term use of platelet-inhibiting agents such as heparin and aspirin; vasodilators and anti-hypertensive medication such as ACE inhibitors and beta-blockers. In addition, medication may be prescribed for treatment of depression, hypertonia (abnormal increase in muscle tone) or cognitive deficits¹.

References

1. American College of Sports Medicine (2009) ACSM's exercise management for persons with chronic diseases and disabilities (3^rd Ed) Champaign, IL: Human Kinetics. (Ch38, p287-297)
2. American Heart Association (2004) Physical Activity and Exercise Recommendations for Stroke Survivors: An American Heart Association Scientific Statement From the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council.Circulation, 109: 2031 - 2041. [full text]

Further Reading: Textbooks

Carr, J. and Shepherd, R. (2003) Stroke Rehabilitation. London: Elsevier Ltd. [google books]

Mead, G. and van Wijk, F. (eds) (2013) Exercise and Fitness After Stroke: A handbook for evidence-based practice. Edinburgh: Elsevier [amazon]

Scott, A., & Gidlow, C. (2016). Clinical exercise science. Routledge.

Further Reading: Journal Articles

Ada, L., Dorsch, S. and Canning, C.G. (2006) Strengthening interventions increase strength and improve activity after stroke: a systematic review. Australian Journal of Physiotherapy 52: 241–248 [full text]

Billinger, S. A., Arena, R., Bernhardt, J., Eng, J. J., Franklin, B. A., Johnson, C. M., ... & Shaughnessy, M. (2014). Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(8), 2532-2553. https://doi.org/10.1161/STR.0000000000000022

Gallanagh, S., Quinn, T. J., Alexander, J., & Walters, M. R. (2011). Physical activity in the prevention and treatment of stroke. ISRN Neurology. https://dx.doi.org/10.5402%2F2011%2F953818

Lee, C.D., Folsom, A.R. and Blair, S.N. (2003) Physical Activity and Stroke Risk: A meta-analysis. Stroke 34: 2475-2481 [full text]

Ouellette, M., LeBrasseur, N., Bean, J., Phillips, E., Stein, J., Frontera, W. and Fielding, R. (2004) High-intensity resistance training improves muscle strength, self-reported function, and disability in long-term stroke survivors. Stroke 35;1404-1409 [full text]

Suggested Web Sites

NICE Guidelines. http://guidance.nice.org.uk/CG68

The Stroke Association. http://www.stroke.org.uk/