When it comes to patients poststroke, physical activity and exercise is simply good medicine that needs to be prescribed for all survivors, according to a scientific statement recently released by the American Heart Association (AHA) and the American Stroke Association (ASA). The statement asserts that exercise and activity programs not only reduce risk of subsequent stroke, but also strengthen independent living abilities, maintain or improve cognition, and reduce depression.
The statement (.pdf), which appears in Stroke, says that stroke survivors often develop a "chronic sedentary lifestyle" after a stroke, which leads to further decline and a greater incidence of other cardiovascular events. "What is particularly disconcerting is that many of these stroke survivors have the ability to undertake higher levels of physical activity but choose not to do so," authors state.
The research team was led by Sandra A. Billinger, PT, PhD, FAHA, and co-chaired by Ross Arena, PT, PhD, FAHA.
The report describes the "vicious circle of decreased activity" in patients who experience stroke, many of whom have moderate to severe disability and/or dementia before suffering the stroke. Typically these patients are already inactive and intolerant of exercise, which contributes to the risk of initial stroke. After the stroke, they face an even more daunting challenge to engage in appropriate exercise and activity.
The statement emphasizes the importance of "multidimensional" exercise prescriptions that are customized to the circumstances of individual patients and are based on medical history, physical examination, and a thorough understanding of the patient's home environment and support systems. Authors recommend exercise as soon as possible after the stroke event, and mobilization within 24 hours. The statement also encourages the use of strength training and aerobic exercise in addition to work with balance and flexibility, in a program that aims to return the patient to activity levels that are equal to or exceed prestroke levels.
Authors also write that for an exercise prescription to be truly effective, health care providers need to understand the patient motivators and barriers to continuing an exercise program in ways that alter lifestyle. The statement suggests that involvement in group exercises and a desire to carry out daily tasks were particularly strong motivators, but says that this may not be the case for all patients.
Overall, the statement urges providers to find an appropriate, patient-centered path to achieving the crucial goal of adequate exercise and activity. "Clearly, there is an urgent need to bridge these treatment gaps by developing and implementing approaches that provide all stroke survivors with access to effective, comprehensive stroke risk-reduction interventions, including exercise," authors state.
APTA offers resources to physical therapists (PTs), including a podcast, around care of patients with limitations in functioning after a stroke, and has created a PT's "guide to stroke" at Move Forward.com as well as a pocket guide to physical fitness for survivors of stroke for PTs. APTA also cites the role of physical activity in stroke reduction in resources aimed at patients, physical therapists, and policymakers. Members can provide their patients with a handout on stroke prevention (.pdf, listed under "Neurology"), and can share information on this topic with others by downloading resources at APTA's Issue Briefs webpage.
Research-related stories featured in News Now are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.
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