Should Exercise be Used as Medicine in Stroke Rehabilitation?

Background: Recent evidence identifies that there are more people surviving a stroke than ever before, however almost 67% leave hospital with a disability (Stroke Association, 2017). Therefore, there is a large population currently living with the effects of a stroke such as a reduction in activities of daily living, loss of independence and fatigue. Physical activity helps to reduce the impact of these effects. There is now overwhelming evidence of the benefits exercise provides towards modifiable risk factors for stroke, such as inactivity, high blood pressure, obesity (O’Donnell et al., 2016).

Aims: To provide a once a week group exercise session for stroke survivors in a local community setting using a multi-modal format (circuit training, corrective strength and balance exercise). To investigate the chronic benefits of exercise has for individuals in stroke rehabilitation in terms of functional capacity and risk management.

Recruitment: Individuals referred by stroke rehabilitation services, their GP or through local stroke support groups.

Assessments: Health (resting heart rate (RHR), systolic (SBP) and diastolic (DBP) blood pressure (BP), height, weight, BMI, waist circumference) and functional assessments (six-minute walk distance (6MWD), timed up and go (TUG) and bilateral grip strength (GS)) were completed before attendance & repeated after 12 exercise sessions. Additional follow-ups completed at 6 monthly intervals.

Results: A weekly exercise session for stroke survivors significantly improved both health and functional outcomes. BP significantly decreased [particularly SBP (p =.001) and DBP by trend (p=.061)] from hypertensive to a normotensive range. Participants also performed significantly better in 6MWD, TUG and Left-GS (p<.001, p=.025 and p=.033, respectively), right-GS increased by trend (p=.061). None of the measured outcomes showed any performance deterioration and there were no deleterious effects of the exercise reported.

Conclusion: Attendance at a weekly community stroke rehabilitation exercise session promotes continued recovery of function and improved exercise capacity (as measured by the 6MWD and effective risk factor management.