Exercise as Medicine Post – Stroke (Part 1)

The catalyst for my interest in exercise as medicine began a few years ago as I watched my grandfather battle with the impact to his life post-stroke. I saw how this changed his life; causing a steady decline in his independence and quality of life to a point where he now requires assistance to complete activities of daily living (ADL’s) that many of us take for granted. It was difficult to watch him become frustrated at small events due to his struggle to communicate effectively. After my grandfather’s speech was permanently affected, he would become distressed with the challenge of talking to and responding to the people around him. This was a major challenge for him; one that created a lot of frustration and social isolation. As well as this, having to rely on others to assist him with his ADL’s was frustrating for him and had a negative impact on his self-esteem. At the time, I didn’t realise that early treatment with a holistic view to rehabilitation could improve recovery and even enable people to regain most of their function post-stroke. Recently, I have completed an exercise physiology practicum placement with clients in various stages of recovery post-stroke. During this placement, I was lucky enough to see first-hand how the lives of these individuals can be benefitted with something as simple as exercise.  Witnessing their small accomplishments and knowing what a big difference it makes to their lives was incredibly rewarding and it was a fantastic experience to have been a small part of it.

Stroke is defined by the World Health Organisation (WHO) as a cerebrovascular accident where an interruption to the blood supply to the brain cuts off oxygen and nutrients, causing damage and/or death to brain tissue, with symptoms lasting more than 24 hours or leading to death. In 2017, according to the National Stroke Foundation, there were approximately 56,000 cases of new and recurrent strokes within Australia. Of this number, 65% of people who have suffered a stroke are left with chronic neurological deficits that impede their ability to complete activities of daily living unassisted. The ACSM also reports that 75% of stroke survivors have very high rates of developing secondary cardiovascular conditions, with coronary artery disease in about half. Long-term effects of stroke vary between individuals depending on the part of the brain affected and the severity of the stroke, long-term conditions can range from sleep disturbances to changes in mood, increased anxiety, or depression. Functional changes post-stroke may involve aphasia, neuropathic pain, incontinence, vision impairment, increased falls, spasticity, contracture, difficulty with walking, weakness or paralysis of limbs on one side of the body and/or hemi-neglect where the person is not able to recognise one side of their body. As you can see, the after-effects of stroke can be broad and complicated, with each condition posing different challenges to the individual. It’s understandable that a stroke survivor may not wish to engage in exercise if they are experiencing the above secondary conditions or feeling stiffness or pain in their muscles. Traditionally, patients were commonly advised to avoid strenuous physical activity or exercise based on the theory that this will help to preserve energy, avoid fatigue and eliminate the risk of exacerbating secondary conditions. However, modern research shows that exercising those unused or poorly used muscles can help to alleviate pain and stiffness over time and minimise or eliminate the effect of secondary conditions.

Nowadays, clinicians take a more holistic approach to rehabilitation. Exercise intervention has become a key component in the long-term rehabilitation plan to overcome any debilities and minimise their effects. One of the primary aims of rehabilitation is to increase the individual’s levels of activity and participation in exercise to increase independence. ACSM and the National Stroke Foundation advocates for exercise programmes that are task-specific and designed to suit the individual’s needs as the most effective method of improving their quality of life. In addition to this, it’s important for primary carers and clinicians to be educated in what to expect after someone has suffered a stroke. They also need to understand the importance of managing depression and motivation by encouraging and assisting the individual with ADL’s and frequent bouts of manageable exercise. Home-based exercises are particularly important as a supplement to community-based programmes that support both the stroke survivor and their primary carer. It’s important for the carer to encourage independence at home as much as possible and practicable even though the task may take some time to accomplish. Stroke survivors often struggle with tasks they once completed effectively and with ease, therefore, their carers and primary clinicians need patience and understanding to be able to assist them to achieve their long-term health outcomes.

So how exactly can exercise help? Part 2 of our blog on stroke will further discuss the psychosocial, neurological and physiological mechanisms for how specific exercise interventions can maintain and improve the daily life of stroke survivors. Stay tuned!

 

Nicole Barber (B.Sc. – Exercise & Sport Science)
Accredited Exercise Scientist (AES) (ESSAM)

P 9244 5580 – M 0422 486 943 – F 92445582

 

References:

 

Mead, G., van Wijck, F., Smith, M., Dennis, J., Dinan-Young, S., Fraser, H., Donaghy, M. and Best, C. (2010). Draft Best Practice Guidance for Developing Exercise and Fitness after Stroke (EAS) Services in Community Settings.

 

Moore, G., Durstine, J. and Painter, P. (2016). ACSM’s exercise management for persons with chronic diseases and disabilities. Champaign, ILL: Human Kinetics, pp.235 – 247.

 

Strokefoundation.org.au. (2018). Mobility and exercise after stroke fact sheet — Stroke Foundation – Australia. [online] Available at: https://strokefoundation.org.au/About-Stroke/Help-after-stroke/Stroke-resources-and-fact-sheets/Mobility-and-exercise-after-stroke-fact-sheet [Accessed 8 Jun. 2018].

 

Strokefoundation.org.au. (2018). Stroke rehabilitation — Stroke Foundation – Australia. [online] Available at: https://strokefoundation.org.au/About-Stroke/Treatment-for-stroke/Stroke-rehabilitation [Accessed 8 Jun. 2018].

 

Veerbeek, J., van Wegen, E., van Peppen, R., van der Wees, P., Hendriks, E., Rietberg, M. and Kwakkel, G. (2014). What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis. PLoS ONE, 9(2), p.e87987.

 

Who.int. (2018). WHO | Stroke, Cerebrovascular accident. [online] Available at: http://www.who.int/topics/cerebrovascular_accident/en/ [Accessed 8 Jun. 2018].