Exercise as it relates to Disease/Physical activity guidelines, after a Stroke

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Physical Activity Guidelines, After a Stroke[edit]

Background[edit]

Stroke is defined by The World Health Organization as a dysfunction caused by disturbances of the brain lasting over 24 hours [1] and mainly affecting older people. [2] Occurrence of stroke is due to blockage or bleeding of arteries supplying the brain with blood.[2] Therefore, stroke can be categorized into ischemic or hemorrhagic stroke, respectively.[1] Ischemic stroke is due to atherosclerotic plaque buildup in the arteries leading to blockage. [3] Blood flow entering the outer space of the cranial cavity is known as a hemorrhagic stroke which in turn can cause damage to the brain.[1] Neuronal death in the brain caused by stroke often leaves stroke survivors with brain damage.[3] As the control centre of the nervous system, the normal functioning of the brain is crucial as it affects all cognitive activities including movement.[1] As a result, voluntary muscle movement is impaired.[3] This in turn causes immobility after stroke leading to low endurance for exercise including a reduction in cardiorespiratory health. [4] Due to immobility, most stroke survivors lead a sedentary lifestyle.[1] Exercise training interventions, such as aerobic and resistance training, have proven successful in improving cardiorespiratory fitness and muscle function as well as muscle strength [5] , thus promoting improvement of symptoms and the prevention of a recurrent stroke.[1]

Physical Activity Guidelines for Stroke Survivors[edit]

A baseline assessment should be undertaken by a healthcare provider prior to beginning physical activity. [6]

Exercise prescription considerations[edit]

  • Safety factors: [6]
Patient clinical status, risk stratification category, exercise capacity, cognitive/psychological impairment that may result in non-adherence, and ischemic threshold.
  • Associated factors: [6]
Patient musculoskeletal limitations, and personal fitness goals and motivation.

Precautions[edit]

Exercise discontinuation is dependent on diastolic blood pressure > 110 mm Hg, decreased systolic blood pressure with a reading of > 10 mm Hg during exercise, dyspnea, and ECG changes suggestive of ischemia.[6]

Aerobic Exercise[edit]

Aerobic training aims to increase VO2 max due to decline after stroke. [1] [4] Sessions should include large muscle-group activities: [5] [6]

Recommendations[edit]
  • Warm up and cool down activities should be undertaken [6] including stretching exercises to improve control of muscles and range of motion.[1] [5]
  • Encouragement of gradual return to general activities of daily living (as evaluated and modified by healthcare professional). [6]
  • Pedometer wear (can enhance adherence; minimum of 10,000 steps). [6]

Resistance Training[edit]

Types of equipments include:

  • Elastic bands [6] [9]
  • Wall pulleys [6]
  • Light (0.45-2.27kg) cuff and hand weights [6]
  • Light free weights (0.45-2.27kg).[1] [6] [9]
  • Weight machines [5] [9]

Exercises should involve the major muscle groups. [5] [6] Refer to Further Reading for examples using the following major muscle groups:

  • Arms
  • Shoulders
  • Chest
  • Abdomen
  • Back
  • Hips
  • Legs
Recommendations[edit]
  • Frequency: 2-3 days/week with separation of training the same muscle groups. [6]
  • Intensity: comfortable lifting of a load allowing 12-15 repetitions. [6]
  • Progression: increase gradually as adaptation to program occurs. [6]

Further Reading[edit]

Hope: A Stroke Recovery Guide [10]

ACSM's Guidelines for Exercise Testing and Prescription, 8th [6]

References[edit]

  1. a b c d e f g h i j k l Lu, S.Y., Lin, K.F., and Cheng, C.M. (2005). Physical Activity and Stroke, Exercise Science and Fitness, 3, 55-60. Retrieved from http://www.scsepf.org/academic_current_2_no6.htm
  2. a b Senes, S. (2006). How we manage stroke in Australia (AIHW cardiovascular health publication). Retrieved from the Australian Institute of Health and Welfare website: http://www.aihw.gov.au/publication-detail/?id=6442467815
  3. a b c Ehrman, J.K., Gordon, P.M., Visich, P.S. And Keteyian, S.J., (Eds.) (2009). Clinical Exercise Physiology, 2nd Ed., Human Kinetics.
  4. a b c Stroller, O., de Bruin, E.D., Knols, R.H., and Hunt, K.J. (2012). Effects of cardiovascular exercise early after stroke: systemic review and meta-analysis. BMC Neurology. doi:10.1186/1471-2377-12-45
  5. a b c d e f g 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. Journal of the American Heart Association, 109, 2031-2041. doi:10.1161/01.CIR.0000126280.65777.A4
  6. a b c d e f g h i j k l m n o p q r s t u v w Thompson, W.R., Gordon, N.F., & Pescatello, L.S., editors (2010). ACSM’s Guidelines for Exercise Testing and Prescription, 8th Ed., Lippincott Williams & Wilkins.
  7. a b c d e f Durstine, J.L., & Moore, G.E., (Eds.) (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities, 3rd Ed., Human Kinetics.
  8. Macko, R.F., Smith, G.V., Dobrovolny, C.L., Sorkin, J.D., Goldberg, A.P., & Silver, K.H. (2001). Treadmill training improved fitness reserve in chronic stroke patients. Archives of Physical Medicine and Rehabilitation, 82, 879-884. doi:10.1053/apmr.2001.23853
  9. a b c d Saunders DH, Greig CA, Mead GE, Young A. Physical fitness training for stroke patients. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD003316. DOI: 10.1002/14651858.CD003316.pub3.
  10. National Stroke Association. (2010). Hope: A stroke recovery guide. Retrieved from the National Stroke Association website: http://www.stroke.org/site/DocServer/hope4.pdf?docID=524