What is a Stroke?
There are two types of strokes that someone can suffer from. One is known as an ischaemic stroke which is caused by a clot or blockage in an artery supplying blood to the brain. Alternatively, a haemorrhagic stroke is when one of these arteries supplying the brain is weak and ruptures, causing blood to pool on the brain tissue. Both types impede oxygen supply to the brain which can cause a number of symptoms such as partial or one-sided paralysis or weakness, speech difficulty and cognitive deficits (AIHW, 2020). A transient ischaemic attack (TIA) is known as a ‘mini stroke’ and is when blood supply to the brain is temporarily affected and can present with similar symptoms to a stroke, although there is no permanent or long-lasting effects.
In 2020, it was estimated that 27,428 Australians suffered a stroke for the first time with
more than 445,000 survivors of stroke living with varying degrees of physical, cognitive and emotional effects consequential to the stroke (Stroke Foundation, 2020). Thus, most people will know someone who has been affected by a stroke in some capacity. Common physical side effects for people living with stroke are reduced cardiovascular capacity, muscular weakness, paralysis and altered sensation which can cause difficulties with ambulation, mobility and ability to complete activities of daily living. As a result, stroke is one of the leading causes of disability in the world. Due to the cross-over of blood supply in the brain these symptoms generally affect one side of the body and the region most affected is dependent on the region of the brain that was deprived of oxygen.
How Can Exercise Help?
A combination of aerobic and resistance training has been shown to improve cognitive
function as well as reduce the incidence of mild cognitive impairment classification in
individuals suffering stroke. The combination of training types has been shown to elicit
greater improvements to cognition in comparison to a single modality (Marzolini, McIlroy & Brooks, 2013). These forms of targeted exercise have also been shown to improve balance and gait patterns, strength in both affected and unaffected limbs and one’s ability to complete activities of daily living. Improvements to these factors promotes greater independence and self-efficacy among stroke survivors.
Aerobic training is believed to elicit both cognitive and physical benefits in stroke survivors through increasing cerebral blood flow, walking capacity and cardiorespiratory fitness. This also assists in reducing risk for further cardiovascular disease (Han et al, 2017; Tiozzi et al, 2015).
Some examples of aerobic exercise are:
See 2 examples below:
Furthermore, benefits offered by resistance training to stroke survivors include greater
muscular strength in both affected and non-affected limbs which can lead to greater
functional capacity and ability to complete activities of daily living (Han et al, 2017; Tiozzi et al, 2015). Unilateral strength training offers appropriate strength adaptations to both the affected and unaffected limb/s (if applicable).
Some examples of resistance training are:
Single leg press
Asymmetric sit to stand
Single arm row
Single arm press
See two examples below:
Incorporating both cognitive and motor tasks into exercise therapy following stroke has also been demonstrated to increase functional outcomes in survivors. Complex exercises such as those below (step up + knee drive and tandem balance + UL task coupled with decision making) target the re-development and enhancement of motor patterns and control which are key in promoting dynamic balance and stability. The decision making component in conjunction with balance and movement is complex yet has real-life translation as these multi-dimensional tasks are most challenging for survivors both physically and cognitively.
How Can an Exercise Physiologist Help?
As can be seen from above, rehabilitation following a stroke is multi-factorial and requires careful consideration. An exercise physiologist utilises best evidence-based practice to ensure an individualised program is created whilst following core principles supported by research. Having a high understanding of stroke pathology allows exercise physiologists to prescribe exercise that is both safe and effective. There is an exercise for everyone, and an exercise physiologist has the tools and training to find the right exercises for you!
Modifiable Risk Factors:
As stroke is classified as a cardiovascular disease, there are a number of modifiable risk
factors that can reduce your risk of stroke as dictated below. Exercise and regular physical activity plays a significant role in many of these risk factors.
Hypertension (high blood pressure)
Type 2 Diabetes
High alcohol consumption
High waist-to-hip ratio
AIHW, 2020, How Common is Stroke, Stroke, https://www.aihw.gov.au/reports/australias-health/stroke
Han, P., Zhang, W., Kang, L., Ma, Y., Fu, L., Jia, L., … Guo, Q. (2017). Clinical Evidence of Exercise Benefits for Stroke. Exercise for Cardiovascular Disease Prevention and Treatment, 131–151.https://doi.org/10.1007/978-981-10-4304-8_9
Marzolini, S., Oh, P., McIlroy, W., & Brooks, D. (2013). The Effects of an Aerobic and Resistance Exercise Training Program on Cognition Following Stroke. Neurorehabilitation and Neural Repair, 27(5), 392–402. https://doi.org/10.1177/1545968312465192
Stroke Foundation, 2020., Top 10 Facts About Stroke, Stroke.,https://strokefoundation.org.au/About-Stroke/Learn/facts-and-figures
Tiozzo, E., Youbi, M., Dave, K., Perez-Pinzon, M., Rundek, T., Sacco, R. L., … Wright, C. B. (2015). Aerobic, Resistance, and Cognitive Exercise Training Poststroke. Stroke (1970), 46(7), 2012–2016. https://doi.org/10.1161/STROKEAHA.114.006649