From the recent Stroke Connection Mag / Spring 2020 / Get Moving
The benefits of physical activity after stroke
As a stroke survivor, you have about a one in four chance of having another stroke. Exercise may help you beat those odds. But if the word “exercise” makes you break out in a cold sweat without moving a muscle, just think of it as “moving more.”
More and more studies and experts concur: Moving is imperative for stroke survivors to feel better on many levels — physical, emotional, social, mental, cognitive.
“Exercise is a very powerful medicine in the case of patients who have already had one stroke and who are at risk of having another,” said Ross Arena, department head of physical therapy and a professor at the University of Illinois Chicago.
Simply put, because inactivity is often a risk factor for stroke, it stands to reason that activity could reduce that risk.
“I’m a very big proponent that heart health is brain health,” said Sandy Billinger, associate professor in the department of physical therapy and rehabilitation science at the University of Kansas. “The heart is my favorite organ. If the heart is not working efficiently or has blockages, that will affect every organ, the brain included.”
And when stroke has affected part of the brain, total brain health takes center stage.
“The brain really relies on glucose and oxygen to survive,” Billinger said. “If it’s not getting that because the heart isn’t doing its job, that will affect the brain in the long term. Then you’re at risk for vascular dementia, cognitive impairment and a second stroke.”
But right after a stroke, the focus in rehab is on regaining abilities and as much independence as possible. Exercise other than that may take a back seat.
Yet even after rehab ends, “There’s not as much structured focus on lifestyle, on being physically active, on diet,” Arena said. For people who have never exercised, such movement is “an extremely tough sell,” he said, “especially in secondary prevention.”
Billinger, who is also neurovascular division director of the KU Alzheimer’s Disease Center, also cited the hesitation factor. “I can talk all day about the benefits of exercise, but if somebody has never exercised and is not interested, it’s a difficult conversation to have,” she said.
Even if you were physically active before your stroke, physical and cognitive changes may pose new challenges. That can be intimidating for some survivors. Keep in mind that almost everyone can find a way to move more. You don’t have to be able to run or walk without assistance, use fancy equipment or even leave the house to get started.
Whether you’re at the starting line or a few steps (or leaps) out, try these tricks to incorporate movement into your everyday life. Ten sounds like a good, digestible number, so here we go:
Do so as much, as often and as intensely as you’re able. If that means marching in place in your wheelchair or emulating boxing movements — with or without weights — go for it.
“This might mean getting up from the chair, taking a few laps around the room if you’re going to the kitchen, or walking outside with a family member,” Billinger said.
There are many ways to move. If you’re mobile, one of the best is walking.
Simply sit less.
Maybe stand during commercials if you’re watching TV. Or if you’re reading or knitting, set the timer to go off every half-hour to remind yourself to stand up.
Know the guidelines, but don’t let them overwhelm you.
If you’re a stroke survivor — and you can engage in physical activity — aim for three to four 40-minute sessions of moderate- to vigorous-intensity aerobic exercise per week, according to the American Heart Association. Moderate exercise such as walking briskly or riding an exercise bike should make you break a sweat or noticeably increase your heart rate. For a vigorous activity, try jogging. If these are too difficult …
Talk to your health care professional about your concerns.
Keep a few things in mind: No question is dumb. You’re in charge of you. And, added Dr. Billinger, “This is a whole lifestyle shift. It’s challenging because there’s a lot you’re going through.” So be upfront. Tell your provider, “I’m interested in physical activity, but I don’t know where to start,” Billinger said.
If you’re concerned about balance, your doctor or physical therapist might recommend a recumbent stepper or recumbent bike, she added.
The key is having what Arena called “a bidirectional conversation,” meaning that you are an integral part of a team of providers.
“It’s about educating people on the benefits of moving more; reframing conversations so they’re not ‘150 more minutes per week,’ but ‘any movement is better than none,’ or even just sitting less during the day.
“It’s more about that amount of sitting they do, the steps they take and their structured exercise. Get them to do all of those? Awesome. Get them to do any one of those three things? Awesome still.”
Remember, everything adds up.
“Three to five 10-minute bouts of movement count as an activity versus just sitting,” Ballinger said, “
Listen to your body.
“I’ve had to educate people about exercise: ‘You will breathe faster. Your heart will beat faster,’” Billinger said. “Some people who don’t exercise don’t know that; they hear that shortness of breath is bad. We have to be careful that we’re educating our patients not to overdo, and that soreness is OK, but pain is not.”
Think outside the exercise box.
David Sunshine, owner and director of the Dallas Yoga Center, said yoga can be instrumental in helping stroke patients deal with gait, mobility, flexibility and overall energy.
“Yoga creates new neural pathways that will encourage the right and left hemispheres of the brain to communicate and work together,” he said. “This in turn creates greater mind/body awareness, freedom of movement, and can help someone feel more fully alive.”
The key is making sure the movements are simple, slow, cross-lateral and are done mindfully in conjunction with the breath, he said. “Do them from a full sense of awareness, and not just a mechanical repetitive motion.”
Keep in mind that movement begets movement.
You can be your own snowball, your own tumbleweed. A walk around the living room can progress to one around the block and then throughout the neighborhood. In the process of strengthening your legs, Billinger said, you’ll find that getting up from the couch or on and off the toilet is easier.
Move more, Arena said, and “you’ll have less shortness of breath going up the stairs.”
Look for activities the family can do together like walking or chair exercises, Billinger said. “That way, you’ll all engage, and everybody is healthier. Whatever you can do as a family will be the best thing.”
Or check out community centers or the YMCA. Many offer beginner classes, which give you not only companionship but also accountability. “Water programs are excellent,” Arena said.
If you’re not up to leaving home yet, you can still enlist the family in such activities as these American Stroke Association exercise videos.
Be patient with yourself.
Your body has gone through a lot, and it may take time to feel comfortable and safe again.
Video: Supported reaching and grasp, just one of many post-stroke exercise videos in our YouTube library