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AHA: Stroke recovery should include exercise

Exercise could significantly reduce disability, risk of another stroke

Friday May 23, 2014
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Exercise is a valuable, yet underused, component for post-stroke care, according to an American Heart Association/American Stroke Association scientific statement. The statement, published May 20 in the AHA’s journal Stroke, suggests stroke survivors should be prescribed exercise because they experience physical deconditioning and lead inactive lifestyles after stroke. That decreases their ability to perform daily living activities and increases their risk of having another stroke.

“There is strong evidence that physical activity and exercise after stroke can improve cardiovascular fitness, walking ability and upper arm strength,” statement lead author Sandra A. Billinger, PT, PhD, FAHA, a physical therapist at the University of Kansas Medical Center in Kansas City, said in a news release. “In addition, emerging research suggests exercise may improve depressive symptoms, cognitive function, memory and quality of life after stroke.”

However, not enough healthcare professionals prescribe exercise as a type of post-stroke therapy, she said.

“There is a big gap in America between [when] stroke patients are discharged from rehabilitation and the transition to community exercise programs when they go home,” Billinger said in the release. “Many are left on their own. We don’t have a system in place to help stroke patients feel comfortable with exercise.”

Stroke is the fourth leading cause of death in the U.S., and a leading cause of long-term disability, according to the CDC. By 2030, as many as 11 million people could be living with stroke as more people live longer.

Survivors must overcome several barriers to exercise, including the severity of their stroke, fatigue, depression, lack of social support, affordability and motivation.
“These patients may not know how or cannot afford to take advantage of exercise programs in their communities, or they can’t drive to an exercise facility, or they might not feel comfortable going to a gym,” Billinger said in the release.

Healthcare providers might need to help stroke patients build up skills and confidence needed to begin and maintain a program that includes aerobic exercise and strength training for their stroke care, she said.

Some of the statement recommendations for post-stroke care include:

• Tailoring exercise prescriptions to the tolerance of the patient and the stage of recovery, environment, available social support, activity limitations and physical activity preferences.

• Minimizing bed rest in the immediate days after stroke and having survivors sit or stand intermittently.

• Initiating an exercise training program when patients are medically stable to regain or exceed levels of activity before their stroke.

• Using rehabilitation programs that incorporate aerobic exercise, strength training, flexibility and balance.

The general recommendation is that survivors exercise at least three days a week for 20-60 minutes, but it depends on their individual functional capacity. For many stroke survivors, multiple 10- to 15-minute bouts of moderate-intensity exercise might be better tolerated.

Simple activities that slowly build endurance and strength, such as walking around the neighborhood or engaging in household chores, add up and make a difference, according to Billinger.

“Anything is better than just sitting on the couch,” she said in the release.

Statement: http://bit.ly/1hcrI30


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