Mega Doctor News
By American Heart Association
Having a stroke can feel overwhelming. It can paralyze limbs, interfere with speech and vision, make it harder to think or remember things. So, the thought of becoming physically active soon after having one may seem like a pretty steep hill to climb.
But experts say that’s exactly what people should do to avoid having another stroke and boost their chances for a better quality of life.
“It’s important to start moving during the recovery phase,” said Dr. Robynne Braun, an associate professor in the department of neurology at the University of Maryland School of Medicine in Baltimore. Braun also is a member of the American Heart Association’s Stroke Rehabilitation and Recovery Committee and its Stroke Council. “The goal should be to start getting people back to the highest level of activity and independence possible.”
Strokes happen when a blood vessel connected to the brain gets blocked by a clot or bursts, robbing the brain of oxygen and critical nutrients. While strokes can kill, they are also a leading cause of disability in the U.S.
And according to the American Stroke Association, nearly 1 in 4 stroke survivors will have another stroke. Physical activity is one of the key lifestyle factors that help lower the risk of another stroke, along with following a healthier diet, maintaining a healthy weight, taking medication as prescribed, and controlling other risk factors such as high blood pressure.
Physical activity should begin as soon as possible following a stroke, experts say. Research shows stroke survivors who participate in physical rehabilitation programs can rapidly improve motor strength and limb mobility within the first month, and some may reach full recovery within about four months.
But how much activity survivors should engage in – and what type – should be assessed on an individual basis, in consultation with their health care team, said Dr. Jose Rafael Romero, an associate professor of neurology at Boston University and a member of the American Heart Association’s Stroke Council.
“In general, it’s really important to be physically active and do some type of exercise after a stroke,” he said. “But not all strokes are the same. People may experience different deficits after a stroke, and we have to keep safety in mind to prevent falls or injuries.”
Why become active right away
Guidance from the American Stroke Association encourages stroke survivors to engage in regular physical activity and limit sedentary time as much as possible, even if they need assistance to do so. In addition to helping prevent another stroke, staying physically active improves mobility, walking, balance and mental health. It can reduce the risk of falls and also help prevent heart-related conditions such as high blood pressure and obesity.
The American Stroke Association and American Heart Association recommend all stroke survivors have their communication skills, functional mobility and ability to perform daily living tasks assessed before leaving the hospital and again throughout the course of recovery, as their capabilities and needs will change over time.
Patients may be referred to physical or occupational therapists to help them regain function and mobility at an appropriate pace, Romero said.
“Physical therapists and occupational therapists are trained to help patients understand what they can do safely,” he said. With their help, stroke survivors should begin moving “as soon as it’s safe and possible.”
‘No one-size-fits-all’
What kind of – and how much – movement will vary from person to person.
American Stroke Association guidance for stroke survivors includes five types of physical activity (PDF)(link opens in new window):
- Gait training exercises are typically offered by physical therapists to help people regain pre-stroke mobility.
- Stretching and range of motion exercises improve flexibility and may include yoga, Pilates, dance, calisthenics or tai chi.
- Aerobic exercises are used during recovery and range from moderate-intensity activities, such as brisk walking or water aerobics, to vigorous activities such as running, hiking and cycling.
- Balance exercises involve core muscles and can help reduce the risk of falls.
- Strength training exercises include weights and resistance bands and should only be done with a doctor’s approval.
Setting physical activity goals is important, Braun said. Those goals will vary depending on the person’s capabilities, the type of lifestyle they want to lead, and the type of lifestyle they led prior to having a stroke.
“There is no one-size-fits-all,” Braun said. “Activity is a broad term. Exercise is one form of activity. For some people, this may have been minimal prior to having a stroke, which may have contributed to their having a stroke in the first place.”
Delay can bring risks
While it may seem daunting to get moving right away, there are risks to delaying a post-stroke physical activity program, Romero said.
“When you wait too long, it may become more difficult to engage in physical activity because of complications,” Romero said. “Joints can become stiff, and it can be more difficult to stretch them out. Physical activity improves range of motion. Stretching exercises are good for that. If people cannot move their limbs, this helps reduce stiffness in the muscles.”
Even patients who cannot walk or get out of bed yet can usually benefit from some type of movement, he said. For example, they can do stretching exercises to improve mobility and dexterity.
If people cannot move on their own, Braun said a therapist can stretch a person’s arms and legs to prevent joints and tissue from becoming contracted and re-establish connections between sensory signals going from the body to the brain and movement signals from the brain to the body.
Others will be able to do much more.
“Walking is one of the best forms of physical activity there is,” Romero said. “If they can ambulate safely, they can do regular walking. Once they can move at a faster speed, light jogging can be really good. But it should always be tailored to what a patient can do without being at risk of falling.”
How much activity and how intense?
As a general rule, stroke survivors should initially try to engage in some type of movement at least a few times a week, Braun said. “A pretty safe place for people to start is 10 minutes, four times a week.”
They can build on that over time, she said, moving from light to moderate to vigorous activity as they are able.
What defines light, moderate or vigorous activity will vary from person to person and can be determined by monitoring how much a person’s heart rate increases, Braun said. For a person who is very fit, physical activity may not raise their heart rate very much, but the same activity could cause a larger jump in heart rate for a person who is largely sedentary.
One way to determine if an activity is “moderate” is by whether it makes a person feel winded, Braun said. “An activity is considered moderate if you can carry on a conversation or sing a song while doing it,” she said. Gardening, housekeeping or taking a brisk walk might be considered moderate activities.
When performing vigorous physical activity, a person typically should not be able to carry on a conversation or utter more than a few words at a time, Braun said.
Romero said it’s important for stroke survivors to monitor how they feel during physical activity to make sure they’re not doing too much.
“If a person who had a stroke experiences symptoms while doing some physical activity, such as chest pain, they should stop and be evaluated,” he said. “They need to do it safely and stay hydrated. Then perhaps they can move on to aerobic exercise. Doing this daily is best, but at least a few times a week.”
Benefits beyond the physical
The benefits of physical activity aren’t just physical, Romero said.
“There are also cognitive benefits,” he said. “People who exercise after a stroke tend to do better in terms of cognition. It can also help mood and reduce depression.”
When setting activity goals, an important question to ask, Braun said, is “What are the activities that give this person’s life meaning? Find activities that are meaningful to that person and connect them to the exercises.”
Staying active between therapy sessions – and long after health insurance stops covering them – is also important, Romero said.
“Even between sessions, keep practicing what you learn,” he said. “Sustained effort and activity are helpful over the long term. If you just do it in those sessions and stop, you may go back to where you were. You don’t want to lose what you’ve gained.”
Stroke recovery is within reach. Whether it’s in person, online or on the phone, the American Stroke Association is here to support your journey to recovery. Learn more about stroke support services.
Information Source: American Heart Association
