Returning to Exercise After a Stroke

A cerebrovascular accident, more commonly known as a stroke, occurs when a blood vessel that carries oxygen and other nutrients to the brain is stopped by either a blockage (ischaemic stroke) or rupture (haemorrhagic stroke). Both types will restrict oxygen from reaching certain areas of the brain, causing brain cells to die, leaving behind permanent damage.

It is likely that you know someone who has experienced a stroke, as they account for approximately 10,600 deaths each year and there are more than 445,000 Australian stroke survivors alive today. For most, a stroke is a life-threatening event that can cause serious long-term physical and psychological effects. As the leading cause of disability (1) in Australia, its impact can be felt for a lifetime.

Most who survive a stroke will recover to some degree, if they have timely and good quality health care. Stroke survivors can experience very different effects as a result of their stroke, with their experience dependent on where in the brain it occurs and how large of an area it affects.

Stroke survivors will often experience a reduction in movement and neuromuscular control, typically on one side of the body. Other common neurological complications include:

·      Difficulties with verbal communication or swallowing

·      Changes to body awareness and perception

·      Changes to cognition, mood or behaviour

·      Difficulties with balance

·      Feeling nauseated or fatigued

·      Muscle wastage and loss of strength

Following a stroke, recovery starts to take place as the nerves and cells of the brain start to change to facilitate the role of the lost or damaged cells. This is a process called neuroplasticity, and this can occur for months, even years after a stroke. This is the main driver and focus for physical rehabilitation, it allows the brain to connect back to the muscles as you start to regain movement through coordinated strength, endurance, and stability.

Physical rehabilitation following a stroke is recommended as first line treatment (2,3,4) and is aimed at facilitating the return of movement, sensation, and independence to complete activities of daily living. It should involve a team of health professionals, which should include an exercise physiologist.

During the acute and sub-acute phase (up to 6 months) following a stroke, a Physiotherapist will likely form a part of the rehabilitation team. A Physiotherapist may help facilitate the return of limb movement and sensation, teach the skills needed for mobility aids, and manage tight muscles or contractures to assist in regaining independence and the ability to complete activities of daily living.

Once movement starts to return to the limbs, an Exercise Physiologist specialises in the return of functional strength, mobility, endurance, balance and stability. Exercise Physiologists are the experts in movement and exercise prescription for the management of chronic conditions like a stroke. Common areas an Exercise Physiologist may help with include:

·      Strengthening exercise for the effected limbs

·      Stabilisation of the hips and trunk

·      Gait training

·      Falls prevention

·      Muscular control and coordination

·      Manoeuvring obstacles

·      Practicing moving objects to assist with activities of daily living by lifting, pulling, pushing and rotating

Exercise also plays an important role in decreasing the risk of having a stroke, as well as reducing the risk of having a secondary stroke (5). This is achieved by improving metabolic markers such as blood pressure and cholesterol, which has been shown to reduce the risk of thrombosis causing conditions such as heart attacks, strokes and pulmonary embolism.

I’ve had the privilege of working with some of the most incredible and driven people I know. As an Exercise Physiologist and as a part of their healthcare team, I have assisted them in their journey of learning to walk again, improve their independence through strength and function, and achieve their individualised movement goals.

If you have experienced a stroke, or know of someone who has, reach out to a local Exercise Physiologist with relevant experience. They are essential to help facilitate the return of functional movement that is required for independence.

Although some things may not be avoidable, it is important to remember that prevention is key – a regular exercise routine is very important to reduce the risk of having a stroke in the future, and necessary to reduce the risk of having a secondary stroke.

Reach out and contact us at Emerge Movement and Rehabilitation if you have any questions about how an Exercise Physiologist can benefit someone who has experienced a stroke, or would like us to help you or someone you know on their journey to movement.

References

1.    Australian Institute of Health and Welfare. 2022. Australia's health 2018, Overview - Australian Institute of Health and Welfare. [online] Available at: <https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/table-of-contents> [Accessed 3 August 2022].

2.    Billinger, S., Arena, R., Bernhardt, J., Eng, J., Franklin, B., Johnson, C., MacKay-Lyons, M., Macko, R., Mead, G., Roth, E., Shaughnessy, M. and Tang, A., 2014. Physical Activity and Exercise Recommendations for Stroke Survivors. Stroke, 45(8), pp.2532-2553.

3.    Winstein, C., Stein, J., Arena, R., Bates, B., Cherney, L., Cramer, S., Deruyter, F., Eng, J., Fisher, B., Harvey, R., Lang, C., MacKay-Lyons, M., Ottenbacher, K., Pugh, S., Reeves, M., Richards, L., Stiers, W. and Zorowitz, R., 2016. Guidelines for Adult Stroke Rehabilitation and Recovery. Stroke, 47(6).

4.    Saunders, D., Greig, C., Young, A. and Mead, G., 2001. Physical fitness training for stroke patients. Cochrane Database of Systematic Reviews,.

5.    Law, M., 2003. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ, 326(7404), pp.1423-0.