Getting Stroke Survivors Moving

by Women's Brain Health Initiative:

Worldwide, one out of every six people will have a stroke in their lifetime. Thankfully, a large number of those individuals will survive the stroke, but many of those survivors will experience long-term disability. In Canada alone, it was estimated that at least 405,000 people were living with long-term stroke disability in 2013, and that number is projected to grow dramatically over the next 20 years to 726,000.

Stroke survivors experience a wide range of complex post-stroke consequences, including impairments in movement, balance, speech, vision, memory, and cognition. Each person is affected differently depending on what part of the brain is affected, how extensive that area is, and how long the brain tissue is deprived of oxygen.

Physical inactivity increases the risk of stroke. Individuals who have had a stroke often become even less physically active, as exercising is more challenging post-stroke for a variety of reasons, including fatigue.

When stroke survivors are sedentary, they become more and more physically “deconditioned,” which negatively impacts their ability to perform daily living activities, and correspondingly increases their risk of falls and recurrent stroke, as well as other health conditions like diabetes.

Engaging in exercise post-stroke can help reverse that negative cycle, providing numerous physical and psychosocial benefits. It also provides cognitive benefits that are especially important given that up to two-thirds of people who experience a stroke suffer from cognitive impairments as a result.

Post-stroke exercise boosts brain function

A recent meta-analysis conducted by Dr. Lauren Oberlin and colleagues – published in 2017 in Stroke, a journal of the American Heart Association – examined the findings from 14 studies published between 2001 and 2016 on the effects of physical activity on post-stroke cognitive function. After combining and analyzing the collective results, the researchers found a positive overall effect of physical activity training on cognitive performance. The cognitive benefits were achieved in as little as 12 weeks, with programs that combined both aerobic and strength training providing the largest cognitive gains (compared with either aerobic or weight training alone).

This research also revealed a very important, new finding: it is never too late to reap the cognitive benefits of exercise after a stroke. “Doctors used to believe that most cognitive improvements post-stroke would be experienced in the acute and subacute phase, within three months after the stroke,” said Dr. Oberlin, a postdoctoral fellow at Weill Cornell Medicine. “However, our research shows that exercising has a positive impact on cognition well beyond that. We found that participants who started exercising on average 2.6 years after a stroke still experienced cognitive gains.”

Brain scans show the impact of post-stroke exercise

Researchers from the Florey Institute of Neuroscience and Mental Health conducted a study using magnetic resonance imaging (MRI) scans and memory tests to track how exercise affects neuron regeneration after a stroke. The 35 participants were divided into groups that performed aerobic, strength, and resistance exercises. Preliminary findings showed that exercise led to new neuron growth on the side of brain with the stroke-associated lesions and slowed or stopped atrophy on the opposite side of the brain. The researchers noted that these findings – shared in July 2019 in Alzheimer’s & Dementia – were early and encouraging, but emphasized that more testing in larger studies is needed.

How to get stroke survivors moving

It is clear that exercise has the potential to help stroke survivors in numerous ways, yet many are not getting the physical activity that they need. Most stroke survivors do not have access to quality exercise programs customized for their unique needs. To address this situation, Dr. Ian Graham is co-leading a project, funded by Brain Canada and the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, to scale-up the implementation of sustainable, evidence-based community exercise programs for stroke survivors.

There is strong evidence that exercise improves motor recovery, quality of life, and cognitive function for stroke survivors, yet there are many barriers to exercise for this population, said Dr. Graham, Senior Scientist at Ottawa Hospital Research Institute and a Professor at the University of Ottawa. “So, our project team is working to develop and field test a guidebook that will help community groups plan and deliver top-quality exercise programs to these individuals."

The guide does not provide recommendations about specific exercise regimens; rather, it outlines core program elements and safety guidelines, and presents three examples of existing Canadian programs that are operating with success. “The planning approach we outline in the guide is designed to be generic, so that the guidance can be applied to any exercise program a given community might choose,” explained Dr. Graham, a Brain Canada-funded researcher. “Each community is different, so our guide focuses on high-level guidance to help with considering and pulling together all of the factors essential to a program’s success.”

A draft version of the guide has been prepared by the project team and is currently being tested in communities of various sizes across the country. The researchers will be tracking whether the pilot programs are successful at finding participants, if those participants experience improvements and are satisfied with the program, and obtaining feedback from the communities to further refine the contents of the guide. The final guide, which is slated to be ready in September 2021, will be open-access – i.e. available for any interested community to use to help get (and keep) stroke survivors moving.

Stroke survivors need exercise programs specifically designed for their unique needs.

Stroke survivors may find it difficult, impossible, or unsafe to participate in exercise programs offered to the general public for a variety of reasons, including the degree of their disability, lack of prior experience with exercise, fear of injury, lack of transportation, and program cost. Some prefer to participate in exercise classes with others who have also experienced one or more strokes, as they are not comfortable being included in generic classes with individuals who do not have disabilities or limitations.

Source: MIND OVER MATTER V10