PT Classroom - Stroke Survivor Exercise Recommendations for the Prevention of Recurrent Stroke and Enhancing Quality of Life and Function: An Evidence Based Approach ׀ by  Bill Lyon, PT, DPT, CSCS & Rachel K. Backhaut, PT, DPT

Stroke is the leading cause of long term disability in the United States with only 14% of stroke survivors achieving full physical recovery (Gordon, 2004). Survivors of stroke commonly have cardiovascular deficits predisposing them to sedentary lifestyles and an increased risk for additional secondary complications.

Literature Summary: Ambulatory stroke survivors may perform at 50% of peak VO2 consumption compared to age matched healthy individuals (Gordon, 2004). This makes performance of everyday tasks energetically expensive; limiting the patient’s activity and participation within the community. Current evidence suggests exercise trainability in stroke survivors is comparable to age matched healthy counter parts (Gordon, 2004). Graded treadmill training at a moderate intensity for 6 months has been shown to yield significant reductions in submaximal energy expenditure in patients with chronic stroke (Macko, 2005). Improvements in peak O2 consumption and blood pressure response have been observed in as little as 10 weeks of vigorous aerobic training (3x/wk) (Jorgensen, 2010). These findings suggest that a moderate to vigorous aerobic training program may allow daily activities to be performed with less energetic cost. The intensity of the training should be specific to the individual’s needs and skill level. Progressive resistance training 2x/wk for 4 weeks has also been shown to be effective in improving walking velocity, balance, and ADL performance in this population (Cramp, 2010). Various exercise modes including aquatic, bike, and upper extremity ergometery had similar training effects, demonstrating the possible variability within a program to fit patient physical ability and preference.(Jorgensen, 2010). Several authors suggest treadmill training may provide carry over for improving ambulation ability while enhancing cardiovascular fitness (Jorgensen, 2010;Gordon, 2004). Eight weeks of yoga training has demonstrated improvements in scores of the stroke impact scale (evaluation of cognitive, social, emotional and physical aspects of recovery), Berg Balance Scale, and Timed Movement Battery indicating improvements in both physical and emotional well being Bastille, 2004). A combination of resistance, aerobic, flexibility, and relaxation training, such as yoga, will provide the patient with the best variety for improvements in strength, endurance, balance, and quality of life.

Clinical Application: Training for stroke survivors should be similar to that of age matched healthy individuals emphasizing adequate intensity and progression to safely challenge the cardiovascular system. A variety of modes, dictated by the patient’s limitations and preferences, can be used to effectively improve cardiovascular fitness which is linked to an increased ability for ambulation, ADL execution, and a decreased risk for cardiovascular diseases and recurrent stroke. A well-balanced training program for the stroke survivor should include strength, aerobic, relaxation (such as yoga), and flexibility training to best improve all aspects of physical and mental wellness.