Physical exercises for stroke survivors (Part 3)

Precautions prior to having physical exercises

Stroke survivors need to observe some precautions prior to engaging in physical exercises. The reason is that s/he cannot immediately afford to start having a full-blown physical activity because now s/he has some physical limitations. Firstly, the muscles of his/her extremities—be it lower or upper—are now weak! Secondly, his/her blood pressure needs to be maintained at normal level while doing his/her physical exercises. Thus, high intensity—and highly strenuous—physical exercises are not allowed in the first few weeks of the program; and the allowable physical exercises will be introduced in gradual and incremental manner.

While it is true that some precautions limit the implementation of the physical exercise program for a stroke survivor, s/he cannot also afford not to have any physical activity at all for a long time; otherwise, his/her physical deterioration will be accelerated.

It has to be emphasized, too, that before any stroke survivor patient will start having physical exercises, that a medical doctor with specialty in rehabilitation medicine, or a physical therapist, be consulted beforehand because the physical exercise program needs to be customized, and tailored fit, to the medical condition of the patient. The severity of stroke is not the same in all patients; it varies from one patient to another.

In this article, some recommended physical exercises will be mentioned; it is meant to inform stroke survivors and their relatives that after acquiring the illness and the disability, that a lot of things can still be done to improve their medical condition. It is meant to erase the misconception that once afflicted with stroke, that you can no longer join any physical exercise program.

Recommended physical exercises

The American Heart Association (AHA) has recommended the following as the physical activities and exercises for stroke survivors:

While in the hospital:

  • Exposure to orthostatic or gravitational stress

While still in the hospital, the patient will be encouraged to have intermittent sitting or standing. In these exercises, the patient is exposed to stresses as a result of having an erect posture (orthostatic) or generated by the pull of gravity (gravitational). The patient is not given any extra physical load, but by the weight of his own body. After hospital discharge, the physical exercise therapy will be continued, focusing on improving the strength of the muscles paralyzed by the stroke.

After discharge from the hospital:

  • Aerobics

The AHA recommends that aerobic exercise training—combined cardiovascular, strength, and flexibility—be done three times a week for around 12 weeks. In most gym centers, every aerobic exercise session lasts for an hour. Thus, three hours of aerobic exercises per week needs to be done. Aerobic exercises are meant to stimulate and strengthen the heart and the lungs. Hence, the following can be done in a well calibrated mannerin a gym or an outdoor sports center: dancing, walking, jogging, or stationary rowing in a gym. If the person can afford to do it, based on the assessment of a medical doctor or physical therapist,  swimming or cycling can also be engaged in.

  • Treadmill exercise with or without body weight support

Treadmill exercise is also recommended; being a form of aerobic exercise, it can be done three times a week (three hours per week) for 6 months. The advantage of a treadmill exercise is that its intensity can be regulated and made progressive. In addition, if the patient cannot fully stand using his own strength, a body weight support can be put in place.

  • Strength training

A progressive resistance-training program, which was done within a 12-week period and twice per week, turned out to improve muscle strength, gait and balance of stroke survivors. The strength of lower limb was increased by 68% on the affected side. The motor performance and the ability to maintain balance when at rest and when moving also showed improvements. Thus, based on this study, it is recommended that stroke survivors be enrolled in progressive strength training for a 12-week period, done at twice per week.

Reference:

Gordon, Neil F., M. Gulanick, F. Costa, G. Fletcher, B. A. Franklin, E. J. Roth, and T. Shephard. “Physical Activity and Exercise Recommendations for Stroke Survivors”. Circulation 109 (2004): 2031-2041.

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