After a stroke, the main goal is to get back home and be as independent as possible. To achieve that goal, most stroke rehabilitation centers focus on helping people to regain lost function, such as the inability to use a hand, to speak, to swallow, or to walk. A great deal of effort is put into functional recovery so that the patient can go home safely and adequately perform activities of daily living (ADLs). There is little effort put into aerobic exercise and conditioning in most stroke rehabilitation programs.
A recent systematic review and meta-analysis published in the Journal of the American Heart Association (JAHA) found that stroke survivors benefit from aerobic programs similar to those found in cardiac rehabilitation programs. These findings may prompt a closer look at how stroke rehab programs are designed.
Aerobic exercise can help achieve goals of stroke rehabilitation
Exercise has many known benefits for the body and mind. These include lowering blood pressure and resting heart rate; raising HDL (good) cholesterol levels; lowering triglycerides; increasing the body’s ability to break down clots; improving insulin sensitivity, which helps with diabetes prevention and control; increasing muscle mass; increasing metabolism; improving mood; and lowering anxiety. Many of these benefits can also help prevent another stroke.
Another priority for most stroke survivors is the ability to walk or move around. However, research demonstrates that stroke survivors spend almost 80% of their days sitting or lying down. In doing so, they accumulate less than 50% of steps compared to what their healthy counterparts accumulate.
Sedentary behavior leads to deconditioning, reduced aerobic capacity, and lower energy levels. It also contributes to higher triglyceride levels, a risk factor for stroke. Empowering stroke survivors to be upright and mobile during the day could help prevent another stroke.
Stroke rehab programs can take a cue from cardiac rehab
Stroke survivors are usually discharged from a hospital or rehab facility with an exercise program to continue at home. The program typically focuses on functional exercises that help them perform their ADLs independently. Sometimes home physical therapy and occupational therapy are provided for a few weeks, but there is little focus, if any, on increasing aerobic capacity with a walking program.
Patients who have suffered a heart attack are often enrolled in an outpatient cardiac rehab program, which focuses on increasing aerobic capacity. There is no equivalent, aerobic activity-based outpatient program for stroke survivors. The JAHA systematic review and meta-analysis suggests that perhaps there should be.
Researchers examined 19 studies that looked at the use of aerobic training programs for stroke survivors. The aerobic training programs were mostly walking (47%), some stationary cycling (21%), some mixed modality (21%), and a few recumbent stepping (11%). The amount of exercise was comparable to the amount and intensity of that offered in most cardiac rehab centers for survivors of heart attacks. The researchers found that programs providing two to three exercise sessions a week, for 30 to 90 minutes per session for eight to 18 weeks, resulted in significant improvements in aerobic capacity and the distance the stroke survivor could walk in six minutes (the six-minute walk test).
More research is needed, but in the near future it may be that stroke survivors join heart attack survivors at cardiac rehabilitation facilities.
Incorporate more aerobic activity into stroke recovery, with or without a formal program
Until aerobic training becomes part of routine discharge planning for stroke survivors, they can speak to their physicians about starting a walking program. The goal would be to work your way up to two to three sessions a week for 30 minutes or longer per session.
Local YMCA programs may have treadmills available, as well as personal trainers, if needed, for supervision. If a stroke survivor is discharged with home physical therapy, they can discuss a walking program with their therapist. Having an exercise buddy — a family member, a friend, or a fellow stroke survivor — helps with motivation and consistency. For stroke survivors who are not walking independently, swimming or pool exercises may be beneficial.