This article is based on American heart Association's scientific statement on post stroke exercise to enhance stroke survives Activities of Daily Living(ADLs) and general Fitness.I hope this article will really give essential understanding on this topic to all Exercise Specialists dealing with stroke survivors.This will also help to promote evidence based practice of exercise science.
The link between exercise training and improved cardiovascular fitness and health has been well established in the general population. Whether the training-induced health and fitness benefits can be extrapolated to persons who are disabled by stroke remained unclear until recently. Evidence now suggests that the exercise trainability of stroke survivors may be comparable, in many ways, to that of their age-matched, healthy counterparts.
In a RCT that involved 42 hemiparetic stroke survivors, vigorous aerobic exercise training 3 times per week for 10 weeks evoked significant improvements in peak oxygen consumption and workload, submaximal exercise blood pressure response, exercise time, and sensorimotor function; moreover, the latter was significantly related to improvement in aerobic capacity.The findings demonstrated that stroke patients can increase their cardiovascular fitness by a magnitude that is similar to that of healthy older adults who engage in endurance training programs.
The effect of 6 months of treadmill aerobic exercise training on the energy expenditure and cardiovascular demands of moderate aerobic exercise with a graded treadmill for ambulation was studied in stroke patients with chronic hemiparetic gait. The program elicited significant reductions in submaximal energy expenditure; these reductions were progressive with continued exercise training. An important implication of this study was that it extended the observation of a potential benefit from task-oriented aerobic exercise training to the clinically relevant task of hemiparetic ambulation. The data suggest that aerobic exercise training and improved cardiovascular fitness might enable activities of daily living to be performed at a lower percentage of the aerobic capacity.Recently, the effects of a 1-hour-per-day, 3-day-per-week, 12-week exercise program of combined cardiovascular, strength, and flexibility training was studied in 35 stroke patients with multiple comorbidities.Compared with controls, the exercise group demonstrated significant gains in peak oxygen uptake and strength and improvements in body composition.
The effect of a 6-month home exercise training program was investigated in a prospective, randomized, controlled clinical trial that involved 88 men with CAD and disability, two thirds of whom were stroke survivors.The subjects demonstrated significant increases in peak left ventricular ejection fraction and high-density lipoprotein cholesterol and decreases in resting heart rate and total serum cholesterol with exercise training.
In a 12-week cycle-ergometer training study, exercise capacity and self-concept improved in 7 hemiparetic stroke patients. However, there were no direct measurements of cardiorespiratory fitness, and motor function improvements were characterized by subjective descriptions rather than standardized functional evaluations.
Collectively, these findings support the use of regular aerobic exercise to improve cardiovascular health and fitness after stroke, which is consistent with recent consensus statements on exercise for able-bodied individuals. Strength training also has been found to have beneficial effects in patients with stroke. Several studies have shown strong associations between paretic knee-extension torque and locomotion ability and between both hip flexor and ankle plantar flexor strength of the paretic limb and walking speed after stroke.
A recent investigation evaluated the effects of a 12-week, twice-per-week, progressive resistance-training program on muscle strength, gait, and balance in stroke subjects.Lower-limb strength increased 68% on the affected side and less so on the intact side. Transfer time, motor performance, and static and dynamic balance also showed improvements. These results confirmed those of a previous study that showed benefits of strength training of the hemiparetic knee.
Traditional stroke rehabilitation programs emphasize functional training as a means to help the individual gain and maintain as much independence as possible. Training in the performance of mobility and personal care tasks, together with attempts to improve muscle strength and coordination, continue to form the central areas of focus of most rehabilitation programs. Whether these exercise-training programs enhance aerobic fitness is not clear. The heightened degree of physical skill required to perform these tasks and the physiological stress placed on the deconditioned individual’s cardiovascular system while performing activities of daily living suggest that a physiological training effect is likely to occur when these movements are performed in a sustained and systematic manner. Because increased levels of physical activity are associated with a reduced risk for stroke and cardiovascular disease and enhanced physical and psychosocial performance, such interventions performed in a stroke rehabilitation program may have a favorable effect on the prevention of recurrent stroke and cardiovascular events.
A recent study evaluated the relative cardiovascular stress of physical therapy and occupational therapy sessions in 20 patients undergoing a stroke rehabilitation program.The time per session in which the achieved heart rate was within the prescribed target heart rate zone was found to be extremely low, which suggests that these sessions elicited inadequate cardiovascular stress to induce a training effect.
Both of these last 2 studies found that activities that evoked the greatest heart rate increases were performed in the upright position and involved transitional movements. Approximately one third to one half of the treatment time was apportioned to standing activities.
Some researchers have raised concerns that occupational therapy sessions for poststroke patients may involve periods of intense isometric work that induce excessive cardiovascular demands. In contrast, others have suggested that workloads for stroke patients who participated in physical therapy were appropriate, evoking relatively low levels of cardiovascular stress. Moreover, it has been theorized that the predominantly static nature of most stroke rehabilitation programs might contribute to the low physical endurance of poststroke patients.
Extrapolation of what is known about the training effect of regular exercise by able-bodied individuals suggests that certain levels of exercise that are achieved during many stroke rehabilitation programs may improve aerobic fitness and thereby help reduce the risk for recurrent stroke and cardiovascular events. Accordingly, professionals who design and conduct stroke rehabilitation programs should consider allocating more time to aerobic exercise training to optimize patient outcomes.
References
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