How early someone who experienced a stroke event needs to sit on the bed if the individual has no either medical reasons not do so or severe disability?
It needs to be done as early as possible, even within 24 hours after a stroke for better recovery, according to the American Heart Association and the American Stroke Association.
However, sitting on the bed has to be followed up with intermittent standing and later with well-coordinated therapeutic exercise sessions.
This recommendation appears in their detailed statement published in the Stroke journal in 2014. It is because research shows early mobility improves chances of earlier walking ability and functional recovery.
The above findings came from a powerful randomized controlled study.
About the study
A research team compared assigned 71 stroke patients to two groups. Their mean age was 74.7. Their blood pressure, heart rate, oxygen saturation, and temperature were monitored. Among those who were safer to sit, one group received the usual standard care. and, the other group were mobilised early with a follow-up of intensive moblisation at regular inervals. Then their performance was compared on one primary outcome: the number of days required to walk 50 meters unassisted. They found that the intervention group returned to unassisted walking significantly faster than the standard intervention group (p=0.032; 3.5 median days versus 7 median days). Moreover, the other functional outcomes as measured by the Barthel index was better at 3 months in the intervention group.
The above study appeared in the Stroke journal in 2010.
However, there is a catch here. Starting physical activities early alone is not enough; it needs to be done consistently according to the above statement. This is the most difficult part.
Exercise and physical activities become effective if those are done consistently.Stroke Journal, 2014
Challenges in implementing these findings
Research reveals that although many who experience a stroke event can do exercises, they choose not to do. As a result, with time, not only their ability to walk but the ability to carry out daily activities also declines. This is because, with time, their heart-lung fitness too deteriorates.
Many factors contribute to this unfortunate situation; lack of knowledge, system inefficiency, and inadequate emphasis by healthcare professionals are the main reasons.
How to improve early mobility after a stroke
The experts recommend starting a planned exercise program as soon as the person is medically stable. The following are the specific recommendations from the American Health and Stroke associations;
The goal here is to regain or exceed pre-stroke level activity level as soon as and as much as possible. This should be started at the hospital and continued at home once discharged. The continuity is the key here for the success.
The critical principles here are;
- Maintaining the progressive task difficulty
- Functional practice
- Inclusion of aerobic (heart-lung) and strengthening exercises
The modes of adhering to above principles are;
- Treadmill exercises: Research has shown that aerobic treadmill exercise as early as within 6 days up to 6 months after stroke improves heart-lung fitness and walking distance.
- Cycling ergo-meter
- Recumbent stepper
- Chest-deep water
- Functional exercises
It is critical for the patient to develop the skills and confidence for eventual self-management of physical activity and an exercise training program.
It is critical for the patient to develop the skills and confidence for self-management of physical activity and an exercise training program.Stroke Journal, 2014: The statement from the American Heart and Stroke Associations
Experts recommend everyone to undergo graded exercise testing with ECG monitoring prior to the start of a graded exercise program. However, if the physician decides that screening for fitness is not possible due to lack of facilities, they further suggest not delaying the exercising but to tailor a program in order to suit the patient’s capability.
Due to lack of accessibility to graded exercise testing with ECG monitoring facility, experts recommend use of near-best simple test – “six minutes walk test”.
It is so critical to start a movement as early as possible; that is the key message here. For those who cannot do the exercise ECG testing, that should not be an excuse for exercise program; the recommendation is to initiate a lower-intensity one.
Whenever the prescribed exercise ECG testing is not done, a lower-intensity exercise program should be started.Stroke journal, 2014; the statement from the American Heart and Stroke Associations
- Ontario Stroke Network: Post-stroke community-based exercise guidelines
- Fitness and mobility exercise (FAME) program for stroke:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266302/
- FAME program for chronic stroke:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226792/
- Manual for basic exercises for stroke: https://www.oatext.com/manual-of-basic-physiotherapeutic-exercises-for-family-and-caregivers-of-stroke-patients.php#gsc.tab=0
- Physical activity and exercises recommendations for stroke:https://www.ahajournals.org/doi/pdf/10.1161/STR.0000000000000022
- At-home exercises for stroke survivors:https://strokeconnection.strokeassociation.org/Spring-2019/At-home-Exercises-for-Stroke-Survivors/
Canadian best practices guidelines
- Management of upper extremity following stroke: https://www.strokebestpractices.ca/recommendations/stroke-rehabilitation/management-of-the-upper-extremity-following-stroke
- Range of motion exercises for shoulder, arm, and hand: https://www.strokebestpractices.ca/recommendations/stroke-rehabilitation/range-of-motion-and-spasticity-in-the-shoulder-arm-and-hand
If you have more guidelines, manuals, and other resources related to exercises for stroke, please send us.
- Clinical consequences of stroke: http://www.ebrsr.com/sites/default/files/Chapter%201_Clinical%20Consequences_0.pdf
- Recovery and organized care: http://www.ebrsr.com/sites/default/files/EBRSR%20Handbook%20Chapter%202_Brain%20Reorganization%2C%20Recovery%20and%20Organized%20Care_2020.pdf
- Mobility rehabilitation: http://www.ebrsr.com/sites/default/files/Chapter%203_Lower%20Extremity_2020_ML.pdf
- upper extremity rehabilitation: http://www.ebrsr.com/sites/default/files/EBRSR%20Handbook%20Chapter%204_Upper%20Extremity%20Post%20Stroke_ML.pdf
- Cognitive rehabilitation: http://www.ebrsr.com/sites/default/files/EBRSR%20Handbook%20Chapter%205_Rehab%20of%20Cognitive%20Impairment.pdf
- Medical complications post-stroke: http://www.ebrsr.com/sites/default/files/EBRSR%20Handbook%20Chapter%206_Medical%20Complications.pdf
- Depression and community re-integration: http://www.ebrsr.com/sites/default/files/EBRSR%20Handbook%20Chapter%207_Depression%20and%20Community%20Reintegration_2020_ML.pdf
- Important clinical studies in stroke rehabilitation: http://www.ebrsr.com/sites/default/files/2013-working-copy-of-the-most-influential-studies_jan14-2014.pdf
- Post-stroke rehab fact sheet: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Post-Stroke-Rehabilitation-Fact-Sheet
- For physiotherapists:http://courses.strokengine.ca/