Stroke: The Role of Physical Activity

This is for

To know the Efficacy of physical activity as a therapeutic strategy to maximise functional recovery in the rehabilitation of stroke survivors

Title

Efficacy of Physical activity in prevention and Treatment of 

Keywords

Primary Prevention, Effect of Gender, Functional Outcome.

Introduction

Stroke is a leading cause of mortality and morbidity worldwide. In the UK stroke is the third most common cause of death and the main cause of acquired disability. Approximately 130,000 individuals experience a first ever stroke per annum  . In addition to widely applicable pharmacological treatment for acute stroke, effective prevention and rehabilitation strategies are crucial. The development of such strategies is a major challenge for the 21st century medicine.

Exercise and physical activity have an increasing evidence base in the primary and secondary prevention of stroke and in stroke rehabilitation. The interface between physical activity and cerebrovascular disease is complex and of broad interest to clinicians, therapists, and epidemiologists. The importance of the relationship is becoming clearer: physical inactivity has been implicated by the INTERSTROKE study as one of the 5 key risk factors which account for more than 80% of the global burden of stroke [2]. Physical fitness training is increasingly being recommended as a component of stroke rehabilitation programmes due to the emerging body of evidence surrounding the benefits in improving the function after stroke [3]. The role of long-term physical activity in patients who have had a stroke in the prevention of further stroke is less clear. This paper provides a narrative review of the literature which addresses the interface between physical activity and cerebrovascular disease with specific reference to prevention of stroke and poststroke rehabilitation.

Background or context

Specific post-stroke exercise goals outlined by the committee are shown below:

Immediately after an acute stroke

Low-level walking, self-care activities, intermittent sitting or standing, seated activities, range of motion activities, motor challenges. At intensities that are ~ 10-20 beats/min increases in resting heart rate; rating of perceived exertion ≤11 (6-20 scale); frequency and duration as tolerated, using an interval or work: rest approach. Such activities are aimed at preventing deconditioning, hypostatic pneumonia, orthostatic intolerance, depression, and stimulating balance and coordination.
In- and Outpatient Exercise Therapy OR “Rehabilitation”

Aerobic exercises that include large-muscle activities (e.g., walking, graded walking, stationary cycle ergometry, arm ergometry, arm-leg ergometry, functional activities seated exercises) if appropriate. At intensities that are ~40-70% oxygen uptake reserve or heart rate reserve; 55-80% heart rate max; rating of perceived exertion 11-14 (6-20 scale), for 3-5 days/week, 20-60 min/session (or multiple 10-min sessions), that includes a 5-10 min of warm-up and cool-down activities. Such activities are aimed at increasing walking speed and efficiency, improving exercise tolerance (functional capacity), increasing independence in activities of daily living, reducing motor impairment and improving cognition, and improving vascular health and inducing other cardio-protective benefits.
Muscular Strength/Endurance activities include resistance training of upper and lower extremities, trunk using free weights, weight-bearing or partial weight-bearing activities, elastic bands, spring coils, pulleys, circuit training, and functional mobility. At intensities that correspond to 1 to 3 sets of 10-15 repetitions of 8-10 exercises involving the major muscle groups at 50-80% of 1 repetition max, for 2-3 days/week, with gradually increasing resistance over time as tolerance permits. Such activities are aimed at increasing muscle strength and endurance, increasing ability to perform leisure-time and occupational activities and activities of daily living, and reducing cardiac demands during lifting or carrying objects by increasing muscular strength.
Flexibility should also be a focus that involves static stretching of the trunk and upper- and lower extremities. Holding each stretch for 10-30 seconds, with the stretches performed 2-3 days/week (before or after aerobic or strength training). These activities increase range of motion of involved segments, help to prevent contractures, decrease risk of injury, and increase activities of daily living.
Neuromuscular activities such as balance and coordination activities, Tai Chi, Yoga, recreational activities (paddles/sport balls to challenge hand-eye coordination), and active-play video gaming and interactive computer games. Employ 2-3 days/week as a complement to aerobic, muscular strength/endurance training, and stretching activities. These activities improve balance, skill reacquisition, quality of life, and mobility; decrease fear of falling; and improve level of safety during activities of daily living.

Discussion

It is estimated that 610 000 first strokes occur in the United States each year. Worldwide, it is estimated that there were 11.6 million incident ischemic strokes and 5.3 million incident hemorrhagic strokes in 2010. Although transient ischemic attacks can precede stroke, most strokes occur without warning. Stroke is a preventable disease, and control of modifiable risk factors plays the major role in prevention strategies. There is substantial, consistent evidence from numerous, high quality studies that higher PA levels are associated with significantly lower risk of stroke, and this evidence suggests that PA has a protective benefit in stroke prevention beyond the traditional stroke risk factors. With the high prevalence of physical inactivity in the general population, increasing PA levels could have a significant effect on reducing stroke incidence.

Given the numerous health benefits of PA, there are many public health guidelines on the recommended volume and intensity of PA for optimal health. Although separate guidelines for stroke prevention do not exist, the recommendations for primary stroke prevention are consistent with the current US guidelines: at least 40 minutes/d of moderate to vigorous intensity aerobic PA 3 to 4 days/wk. These recommendations should be stressed as part of an overall stroke prevention strategy, but even more so in persons with other risk factors. The literature suggests that men achieve a greater reduction in stroke risk when they engage in PA at a moderate to vigorous intensity, whereas women benefit from greater amounts of low intensity PA, such as walking. Further research is needed to clarify the type and intensity of PA, potential differences by race/ethnic groups, and use of more objective measurement of PA to clarify the dose–response relationship in men and women. The recommended PA level for stroke prevention is associated with a low risk within the general population, with an acceptable risk:benefit ratio. So to use the common motivational phraseology, just do it. And do it every day!

Summary

summary or article. Points for further discussion including how to continue the discussion, ie online. Points for further research.

Funding and Declarations

funding for the systematic review and any potential conflicts of interest

Author Biography

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References

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1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263535/

2. https://professional.heart.org/professional/ScienceNews/UCM_463546_Recovering-from-a-Stroke-The-Role-of-Exercise.jsp

3. http://stroke.ahajournals.org/content/46/6/1735