Exercise as it relates to Disease/Physical activity guidelines, after a Stroke
Physical Activity Guidelines, After a Stroke
Stroke is defined by The World Health Organization as a dysfunction caused by disturbances of the brain lasting over 24 hours  and mainly affecting older people. Occurrence of stroke is due to blockage or bleeding of arteries supplying the brain with blood. Therefore, stroke can be categorized into ischemic or hemorrhagic stroke, respectively. Ischemic stroke is due to atherosclerotic plaque buildup in the arteries leading to blockage. 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. Neuronal death in the brain caused by stroke often leaves stroke survivors with brain damage. As the control centre of the nervous system, the normal functioning of the brain is crucial as it affects all cognitive activities including movement. As a result, voluntary muscle movement is impaired. This in turn causes immobility after stroke leading to low endurance for exercise including a reduction in cardiorespiratory health. Due to immobility, most stroke survivors lead a sedentary lifestyle. Exercise training interventions, such as aerobic and resistance training, have proven successful in improving cardiorespiratory fitness and muscle function as well as muscle strength  , thus promoting improvement of symptoms and the prevention of a recurrent stroke.
Physical Activity Guidelines for Stroke Survivors
A baseline assessment should be undertaken by a healthcare provider prior to beginning physical activity.
Exercise prescription considerations
- Safety factors:
- Patient clinical status, risk stratification category, exercise capacity, cognitive/psychological impairment that may result in non-adherence, and ischemic threshold.
- Associated factors:
- Patient musculoskeletal limitations, and personal fitness goals and motivation.
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.
- Warm up and cool down activities should be undertaken  including stretching exercises to improve control of muscles and range of motion.
- Encouragement of gradual return to general activities of daily living (as evaluated and modified by healthcare professional).
- Pedometer wear (can enhance adherence; minimum of 10,000 steps).
Types of equipments include:
- Frequency: 2–3 days/week with separation of training the same muscle groups.
- Intensity: comfortable lifting of a load allowing 12-15 repetitions.
- Progression: increase gradually as adaptation to program occurs.
ACSM's Guidelines for Exercise Testing and Prescription, 8th 
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