Exercise in Stroke

Physical inactivity after stroke is very common, and reversing it brings wide benefits: better cardiorespiratory fitness and walking ability, greater independence in daily activities, improved mood and cognition, and support for secondary prevention through better control of blood pressure, glucose and cholesterol alongside medication. An effective programme includes several elements. Aerobic training using large muscle groups, such as walking, cycling on a static bike, arm or leg ergometry, or exercising in water, builds endurance and walking efficiency. Strengthening of the arms, legs and trunk addresses the muscle weakness that limits function. Balance and coordination work, including approaches such as Tai Chi, reduces the fear of falling and improves safety. Running through all of this is task-specific practice: repetitive, goal-directed practice of the specific functional task being trained, such as sit-to-stands or reaching, is used to improve that task.

Aerobic exercise is usually prescribed at a low to moderate intensity, around 40 to 70 percent of heart rate reserve or a rating of perceived exertion (RPE) of about 11 to 14, for roughly 20 to 60 minutes on three to five days a week, and this can be accumulated in shorter bouts with a warm-up and cool-down. Cardiorespiratory and resistance training are best assessed and initiated by a physiotherapist with relevant stroke skills once the person is medically stable, before they continue more independently. Because weakness, spasticity, altered sensation and balance problems are common, adaptation is the rule rather than the exception: seated and supported exercises, recumbent steppers, arm and leg ergometers and water-based activity allow people with significant hemiparesis to train safely. Intensity can be guided by heart rate, perceived exertion and symptoms together, individualised to the person and progressed gradually, and group classes can add valuable social contact and support adherence.

Exercise after stroke is safe when it is appropriately prescribed, but a few points deserve attention. In the first 24 hours, high-intensity mobilisation should not be offered to people who need help to sit, stand or walk; after that, mobilisation is individualised by the stroke team, and gentle early activity once the person is medically stable helps reduce deconditioning and complications such as chest infection. Post-stroke fatigue is extremely common; it is assessed for treatable contributors such as sleep disorder, depression, pain, medication effects and infection, and then managed by pacing and building up gradually rather than by avoiding activity, which would worsen deconditioning. Balance impairment and the risk of falls call for supervised or supported activity and attention to the environment. Blood pressure should be reasonably controlled, and because heart disease frequently coexists, new cardiac symptoms need assessment. People being discharged home should have access to appropriate exercise-after-stroke services and clear advice to increase their activity. The message is positive and consistent with the rest of exercise medicine: activity aids recovery, reduces the risk of another stroke, and should be adapted, supported and built up rather than avoided.

• •After stroke, combine aerobic exercise, strengthening, balance work and task-specific practice, adapted to the person.
• •Cardiorespiratory fitness falls markedly after stroke, so building endurance improves everyday function and cardiovascular health.
• •Prescribe aerobic exercise at about 40 to 70 percent of heart rate reserve, or a rating of perceived exertion of 11 to 14, on three to five days a week.
• •Adapt for hemiparesis with seated, supported, ergometer or water-based options, initiated by a physiotherapist with stroke skills, guiding intensity by heart rate, perceived exertion and symptoms.
• •Assess post-stroke fatigue for treatable causes, then manage by pacing and gradual progression, not by avoiding activity.
• •Do not offer high-intensity mobilisation in the first 24 hours to those needing help to move; mobilise thereafter as the stroke team advises, and address falls risk and cardiac comorbidity.