Exercise




Exercise is brain healthy

 

Exercise after a stroke.

Once someone has had a stroke, whether it is a minor stroke or a major debilitating stroke, exercise and lifestyle change must become a major component of their recovery. The exercise program will generally take a two-pronged approach: post-stroke recovery and health promotion.

The goal of post-stroke recovery is to engage in a rehabilitation program designed to recover as much physical ability as possible. This type of exercise program usually entails working with a physical therapist or other health professional trained in stroke recovery. The goal of the rehabilitation program is to return the patient to the highest functioning state as possible so that activities of daily living may still be performed. The idea is to promote independence and mental well-being while also improving physical function. The therapist can also help the patient improve range of motion and prevent contractures, painful shortening of the muscles that decreases flexibility. 

To accomplish the goals of this preliminary stroke rehabilitation program the patient will undergo supervised exercise sessions. However, eventually it will become necessary for the patient to take charge of their exercise program and move to the next track of the program: health promotion. Health promotion has many different facets, but in this case, the goal is to prevent future strokes or other cardiovascular events and increase fitness and wellness.

Everyone should follow standard recommended guidelines when it comes to exercising. Stroke patients are no different. However, there may need to be some modifications made to the types of exercises performed, the exercise intensity, or the exercise duration.  Remember to always start slow and gradually increase the amount of exercise performed.

American Heart Association exercise recommendations for stroke patients:

          Consult your doctor before beginning your exercise program. This will generally entail a complete medical history and physical examination. The American Heart Association also recommends that stroke patients undergo a 12-lead ECG exercise test, when feasible, prior to beginning a new exercise program. This test helps determine the appropriate level of exercise that you are capable of starting with. This information also provides a baseline to help gauge your improvement as you progress.

 

          Aerobic exercise: Aerobic exercise is rhythmic, continuous types of movement meant to increase cardiovascular functioning. Use large muscle activities such as walking, treadmill walking, stationary biking, arm ergometer (upright arm crank), or a combination of these exercises. Treadmill exercise is beneficial if your body weight needs to be partially supported by holding onto the handrails. The exercises may be started in small increments, such as ten-minute sessions, until longer exercise bouts can be tolerated. The eventual goal should be to perform 20-60 minutes of exercise 3-7 days a week. The intensity of the exercise should start low and be gradually increased as fitness improves. A good gauge of intensity is the talk test. If it is hard to carry on a conversation, the intensity of the exercise is most likely too high. Another good measure is using a 0-10 scale. A moderate intensity is about a 3-5 out of 10. If you think you are working too hard, you probably are. The goal of aerobic exercise is too improve your ability to carry out daily functions, improve walking speed and efficiency, improve cardiovascular fitness, and prevent another cardiovascular event.

          Strength training: Most adults benefit from strength training and stroke patients are no different. Recommendations for strength training are to exercise most major muscle groups 2-3 times a week. Each muscle group should have at least 24-48 hours of recovery time between exercise sessions. This means that if one muscle group, such as the legs, is exercised on a Monday, the next time they should be exercised would be Wednesday.  The strength training program should start with larger muscles that use multiple joints and progress to smaller muscles that cross only one joint. This guideline simply means that exercise such as a chest press or seated row should be performed before a bicep curl. Each exercise should contain 1-3 sets with 10-15 repetitions for a total of 8-10 exercises. It is also best to try for 30 minutes of exercise and build up to 45-60 minute sessions as fitness improves. There are many different types of strength training exercises and equipment; including machines, circuit training, free weights, and body weight training that help improve strength. The goal of strength training is to improve activities of daily living and improve functioning.

           Flexibility: Flexibility is increased by performing various stretching exercises that move a joint through its complete range of motion. Stretching exercises should be performed at least 2-3 times a week. However, it is also acceptable to perform stretching exercises after daily exercises. Stretching is most beneficial when performed after exercise as the muscles and tendons are warmed and will accept and hold the stretch easier. To stretch a muscle and joint, slowly move into a stretch until mild discomfort is felt. Hold each stretch for at least 10-30 seconds. Perform each stretch 2-3 times. Stretch all of the major muscle groups, with particular focus on the lower back, hamstrings (back of legs), and calves.  The goal of the stretching program is to increase range of motion in all of the joints and prevent or decrease painful contractures.
 

Coordination and balance: Coordination and balance exercises are meant to improve neuromuscular functioning. The point of these types of exercises is to reverse any impairment in neuromuscular functioning to the greatest degree possible. These exercises may be performed 2-3 times a week. Ideally, coordination and balance exercises should be incorporated into the regular strength training program. The goal of balance training is to improve the level of safety when going through normal activities of daily living.

Good ideas for beginning and exercise program:

Beginning a new exercise program, particularly after a major event such as a stroke, can be a daunting task.  It is always a good idea to continue with all available physical therapy sessions that are covered by insurance is funding it. Once insurance coverage ends, it is helpful to consult a Certified Personal Trainer to help design your exercise program and to ensure that you are performing all exercises correctly. Although most personal training sessions are usually not covered by insurance, they are a good way to make sure you are doing your exercises properly and safely. When looking for a trainer, it is important to find a qualified professional. The Institute for Credentialing Excellence (ICE) formed the National Commission for Certifying Agencies (NCCA) in 1987 to ensure that various organizations meet strict guidelines in their certification programs. Therefore, when looking for a personal trainer, a good idea is to find one that has an NCCA-approved certification. The following link can be used to find which organizations are NCCA approved (Institute for Credentialing Excellence, 2014). In addition to finding an NCCA approved trainer, many personal trainers undergo additional education and training in working with special-needs clients such as stroke patients. This experience will be valuable to helping you design and learn an appropriate post-stroke exercise program.

According to the American Heart Association, the risks of beginning an exercise program following a stroke are small. The greatest risk to the patient is another stroke or cardiovascular event. One of the main goals of your exercise is to help prevent a recurring episode. However, all exercise programs entail some risk. That is why it is very important to consult your physician for the recommended health screening. Start slowly and gradually progress as your fitness level and exercise tolerance improves.

Lastly, there is a difference between physical activity and exercise. Physical activity is any type of movement while exercise is structured and has a purpose. However, physical activity does count towards your daily goal of 20-60 minutes of aerobic exercise. So even a walk after dinner or a short stroll during lunch helps improve cardiovascular health. Several short episodes of physical activity spread throughout the day can quickly add up to meet your daily goal. Remember, the best exercise is the one that you will do, so find activities that you enjoy and help increase your chances for success.

References:

Institute for Credentialing Excellence. (2014). NCCA accreditation. Retrieved from http://www.credentialingexcellence.org/ncca.

Gordon, N. F., Gulanick, M., Costa, F., Fletcher, G., Franklin, B. A., Roth, E. J., Shephard, T.  (2004). Physical activity and exercise recommendations for stroke survivors: An American Heart Association scientific statement from the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council. Stroke, 35, 1229-1239. http://dx.doi.org/10.1161/01.STR.0000127303.19261.19.