Module 7: Physical activities and exercise in stroke recovery

At the end of this module, you will be able to;

5.1. Describe the importance of initiating physical activity and exercise in stroke recovery

5.2. Principles of post-stroke exercises

5.3. Type of exercises we should promote and its frequency

5.4. Motivators and barriers to continue exercises

5.1. The importance of initiating physical activities and exercise as early as possible

In Module 4, we saw the brain’s recovery attempts after a stroke. We can help the brain in its rewiring process by initiating physical activities as early as possible. Physical activities bring a multitude of benefits not only moving arms and legs. The main advantages of early physical activities can be appreciated by reading this post: Detrimental effects of prolonged bed rest.

The main disadvantages of prolonged bed rest are as follows (source: The statement from the American Heart Association and the American Stroke Association).

  • Losing muscle strength quickly
  • Increased sodium and potassium loss through increased amounts of urine
  • Decreasing immunity
  • Losing heart muscle strength
  • Increased risk of difficulty in moving limbs
  • The difficulty of sitting and standing

Moreover, we cannot ignore that the physical activity also boosts self-confidence and psycho-social wellbeing.

The difference between the physical activities and exercise

We need to acknowledge the difference between physical activity and exercise at the very beginning. The term, physical activity, refers to any movement of the body and limbs that result in energy expenditure. The word, exercise, refers to a subset of physical activities that are planned, structured, and repetitive and are done with the aim of improving physical fitness (The American Heart and Stroke Association).

5.2. Principles of post-stroke physical activities and exercise

Research shows that we need to adhere the following principles for the maximum results.

  • Early mobility
  • Consistency of physical activities and exercise should be consistent and repetitive
  • Repetitiveness
Early mobility: How early?

The American Heart Association and the American Stroke Association says the affected individual if they do not have medical or physical contraindications as certified by the physician, needs to sit on the bed within 24 hours after a stroke. This is because early mobility improves brain changes. You can read more about this topic here: “Early mobility improves recovery after stroke”.

Consistency and repetitiveness
  • According to the American Heart Association and the American Stroke Association, physical activities is only effective if it is done consistently. This has been recognized as a formidable challenge for stroke survivors and stroke carers.
  • Repetitive practice is the key: The US post-stroke rehab fact sheet equates this to a type of practice when one should do when playing the piano or pitching a baseball.
  • The intensity of the exercises;

Exercise after stroke: http://hwcdn.libsyn.com/p/b/a/3/ba31d6360e144222/Zzz2.pdf?c_id=72611270&cs_id=72611270&expiration=1600313974&hwt=7ddf8d0963b4ee002d822d6d207dbf2f

exercises recommendations rational; https://www.ahajournals.org/doi/pdf/10.1161/STR.0000000000000022

5.3. Types of physical activities and exercise we should promote

Pre-requisites

Before embarking on an exercise program, a qualified health professional should screen and prescribe a suitable exercising program. This would be a challenge.

The Heart and Stroke Foundation outlines four types of exercises for stroke recovery. Those are as follows;

  • Endurance (aerobic)
  • Strength
  • Balance
  • Stretching
Exercises after stroke: An excellent but simple resource guide from the Stroke Foundation, New Zealand

It is rare to find online materials without copyright. However, I found an excellent open-access resource published by Margot Andrew, Margaret Hoessly, and Kate Hedges. It is under the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

Physical activities and exercise, and wellness videos for people with mobility challenges

A team of physiotherapists and occupational therapists from the University Health Network have published a list of exercises and wellness videos for people with mobility challenges. It includes an excellent collection of YouTube video clips. Here are some relevant ones. One should keep in mind that these resources do not replace the exercise regimen prescribed by your healthcare professional.

Three-part series of the “it’s Your Choice” project:
Video exercises for those living with weaker one side

How frequently one should do the rehab exercises?

How frequently one should engage in rehab exercises to gain a desirable effect? Janice Eng, a UBC physiotherapist has responded to this question. More specifically, the question was this:

How many upper limb reps per day can positively change the brain after stroke?

Quoting findings from other researchers (Nudo et al. 1996; Murata et al. 2007), she said it would be between 600- 1000 successful reach and grasp repetitions per day. The successful means if there are droppings it would not count. These findings were based on the research work of monkey brains after a stroke lesion to the motor cortex. The research has shown the hand representation in the undamaged primary motor cortex has regained. That is pretty impressive. The improvements have even progressed to precision finger grips.

To useful regain lost hand function, one should do at least more than 500 repetitive tasks a day.

Does this happen even in the best rehab centers? you can guess. It is not. Not even close to it. Catherine Lang and her team found it was about 32 per session (day). Later research that analyzed metadata showed the more the better.

5.4.Motivators and barriers to physical activities and exercise

Once started, the biggest barrier to better results is to maintain consistency. The barriers can be grouped into patient-related and environmental barriers, and lack of resources. The American Heart and Stroke associations detail out these barriers.

Barriers
Person-relatedContext-related
Depression Lack of family and other social support
FatigueLack of access to fitness equipment
Lack of motivation Lack of trained personnel
Fear of falling and other adverse effectsCost
Lack of knowledge about the usefulness Lack of transport facilities
Lack of perceived self-efficacy
Motivators
  • Providing psychological and social support
  • Accessibility to trained personnel
  • Establishing group classes
  • Desire to achieve life goals
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Author: Prasantha De Silva

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