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, VO2peak is approximately half that of age-matched healthy counterparts1. Only 20% to 34% of individuals are able to achieve 85% of age-predicted HRmax1. 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 VO2peak, 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.
- American College of Sports Medicine (2009) ACSM's exercise management for persons with chronic diseases and disabilities (3rd Ed) Champaign, IL: Human Kinetics. (Ch38, p287-297)
- 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/