WEDNESDAY, January 27, 2021 (HealthDay News) – Exercise programs that are standard for heart attack survivors may also benefit people who have suffered a stroke, suggests a new pilot study.
The researchers found that a three-month cardiac rehabilitation program improved fitness and muscle strength levels in 24 stroke survivors.
Although the study is small, the researchers say it offers evidence of what is intuitive: people who recover from a stroke benefit from regular, structured exercise.
Cardiac rehabilitation programs have long been offered to people with heart disease. However, insurance does not cover therapy for stroke patients.
This is partly because, after a stroke, the emphasis is usually on rehabilitating any disability a patient may have, said Elizabeth Regan, assistant clinical professor of physical therapy at the University of South Carolina, Columbia.
“We don’t think enough about the importance of cardiovascular resistance for stroke patients,” she said.
After a stroke, people are often in a state of deconditioning, so working out in good shape and muscle strength is vital. In addition, Regan said, exercise can help decrease the risk of having another stroke.
Unfortunately, research shows that most stroke survivors do not exercise regularly.
Regan said cardiac rehabilitation, which includes supervised exercise, can help people gain the self-confidence they need to exercise on their own.
To study the issue, she and her colleagues recruited two dozen stroke survivors. They were between 33 and 81 years old and had suffered a stroke between 3 months and 10 years earlier.
All participated in a supervised program of 30 to 50 minutes of aerobic exercise, three times a week. This usually meant walking and using recumbent bikes and step machines.
After three months, the study found, exercise practitioners were in better shape than when they started. They could walk further on a 6-minute treadmill test, which is a measure of cardiovascular endurance. They also showed gains in lower body strength.
The report was published online on January 27 at American Heart Association Journal.
Dr. Lee Schwamm, a volunteer specialist at the American Heart Association, said the study highlights a major problem in treating stroke.
“There is a myopia in the way we allocate resources,” said Schwamm, who is also an executive vice president of neurology at Massachusetts General Hospital in Boston.
It is true, he said, that many stroke patients need rehabilitation for short-term disabilities, but others do not. And in any case, Schwamm said, exercise therapy – and a broader focus on cardiovascular health – could do very well for patients with long-term stroke.
He stressed that many stroke patients end up dying not from repeated stroke, but from heart disease. Regular exercise may have an even greater impact on cardiac risks than on the risk of recurrent stroke, Schwamm suggested.
He and Regan noted that this study was small and a starting point. It involved people who were “motivated” for an exercise program, Regan said, and more research is needed to see how well cardiac rehabilitation works for less enthusiastic people.
The study revealed more differentiated benefits of cardiac rehabilitation, in addition to measures of physical conditioning and strength. Some patients said they had more energy in their daily lives, while others felt that the program had encouraged them to think more about their health and ways to “live the best life”.
At the moment, Regan said, the problem is that even motivated stroke patients do not have immediate access to cardiac rehabilitation.
“It is available,” said Schwamm, “but it is not covered. So it would be very expensive.”
In the meantime, he suggested that stroke survivors look at community exercise programs, such as those administered by the cardiac association or the local Y.
Of course, in the midst of the pandemic, there are limits to face-to-face group exercises. But a regular, brisk walk is also a good bet, said Regan, adding that you should talk to your doctor if you have questions about the activities you can do.
Schwamm acknowledged that for people who do not exercise, “it may not be pleasant at first”.
“I would try to reformulate it,” he said. “Change from ‘This is something I have to do’ to ‘I have the power to do something. I was 50 years old and was sedentary, and now I am an exercise practitioner’.”
More information
The American Heart Association / American Stroke Association has more information on stroke recovery.
SOURCES: Elizabeth Regan, PhD, DPT, assistant clinical professor, physiotherapy, University of South Carolina, Columbia, SC; Lee Schwamm, MD, vascular neurologist, executive vice president of the department of neurology, Massachusetts General Hospital, and professor of neurology, Harvard Medical School, Boston; American Heart Association Journal, January 27, 2021, online