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AHA Scientific Statement: Physical Activity and Exercise Recommendations for Stroke Survivors1 - page 2

A second rehabilitation goal for the stroke survivor is to prevent recurrent stroke and Cardiovascular events that occur with greater frequency in patients who have had a stroke. A reduction of risk factors can decrease the incidence of recurrent strokes and coronary events. Specifically, aerobic conditioning programs can enhance glucose (blood sugar) regulation and promote decreases in body weight and fat stores, blood pressure (particularly in hypertensive patients), C-reactive protein (a sign of blood vessel inflammation ), and levels of total blood cholesterol , triglycerides, and low-density lipoprotein (LDL) cholesterol . Exercise also increases high-density lipoprotein (HDL) cholesterol and improves blood flow, blood clotting factors, and coronary artery function. These findings are consistent with a growing body of evidence that physical activity and formal exercise intervention have important implications for the medical management of patients after a stroke or other vascular event.

Scientific evidence is accumulating that stroke risk can be reduced with regular leisure-time physical activity in multiethnic individuals of all ages and both sexes. Recently, the association between baseline cardiorespiratory fitness and stroke mortality was investigated in 16,878 apparently healthy men, aged 40 to 87 years. During an average of 10 years of follow-up, men in the moderate- and high-fitness groups had a 63% and 68% lower risk of stroke death, respectively, than men who were in the lowest-fitness group at baseline. Moreover, the opposite association between aerobic fitness and stroke mortality remained even after statistical adjustments for cigarette smoking, alcohol consumption, body mass index (a measure of obesity), hypertension, diabetes , and a family history of coronary heart disease. Such studies appear to imply that it is prudent to include improved cardiorespiratory fitness as a major rehabilitation goal.

Effects of Exercise Training and Rehabilitation Programs in Stroke Survivors

The link between exercise training and improved cardiovascular fitness and health has been well established in the general population. Whether the training-induced health and fitness benefits can be applied to persons who are disabled by stroke remained unclear until recently. Evidence now suggests that the exercise trainability of stroke survivors may be comparable, in many ways, to that of their age-matched, healthy counterparts.

The Pre-exercise Evaluation

Exercise is a normal human function that can be undertaken with a high level of safety by most people, including stroke survivors. However, exercise is not without risks, and the recommendation that stroke survivors participate in an exercise program is based on the premise that the benefits outweigh these risks. Therefore, the foremost priority in formulating the exercise prescription is to minimize the potential adverse effects of exercise via appropriate screening, program design, monitoring, and patient education.