Saturday, 24 May 2014

Groups call for more exercise after stroke

(Reuters Health) - People who have had a stroke can often benefit from moderate exercise, doctors and physical therapists report.

In a scientific statement from the American Heart Association and the American Stroke Association, they write that both aerobic exercise and strength training may help stroke survivors keep up their daily activities and improve their quality of life.

Becoming more active may also lower their risk of having a heart attack or a second stroke, but that remains to be shown definitively.

“Physical activity really has to be at the base of any sort of recommendation post-stroke,” said James Rimmer, from the University of Alabama at Birmingham and the Lakeshore Foundation.

Rimmer was not involved in writing the scientific statement, but has studied the effects of exercise after stroke.

About 795,000 people in the U.S. have a stroke every year, the authors of the report note. Most of them survive, but with some stroke-related impairment. Many people who have had a stroke also have other co-occurring health problems.

For those reasons and others - including a lack of support - stroke survivors typically don’t get much exercise, according to the statement. But being sedentary can only compound some of their symptoms, like fatigue and declining fitness.

The statement is an update to a 2004 document that also recommended people be more active after a stroke. Now, the authors are even more confident in that prescription, said Sandra A. Billinger, of the University of Kansas Medical Center in Kansas City.

She and her colleagues outline the importance of physical activity soon after a stroke and as part of a permanent lifestyle change.

Within the first 24 hours after a stroke, patients should try getting out of bed and moving around, they write. As the recovery process goes on, adding more movement will help them get back to performing daily activities. Ultimately, people who have had a stroke and are capable of exercise should aim for at least three days a week of aerobic activity, such as on a treadmill or stationary bike, and two to three days a week of resistance training.

One of the key times for patients to stay active is when their stroke rehabilitation program is wrapping up, Billinger said. It can be intimidating, she said, to go from working one-on-one with a physical therapist to exercising in a gym, for instance.

“There’s a gap after rehabilitation in the U.S. specifically,” she told Reuters Health. “We haven’t quite bridged that as well as some of the other countries.”

The authors note that evidence is lacking on how to encourage activity among people who can’t walk after a stroke or who have trouble communicating.

Any guidance should be tailored to the needs of a particular patient, they add.

Rimmer agreed. “Exercise really needs to be as individualized as medication,” he said.

He told Reuters Health that recumbent steppers can be an option for people with more limited mobility, because they are easy to get on and off and are very safe.

More research is needed to help find the optimal dose of exercise to lower the risk of falls or second strokes, for instance, Rimmer said.

Billinger said patients should talk with their doctor before starting any intensive exercise. She emphasized that for people who are limited in their exercise capabilities, even walking back and forth to the mailbox a few times a day is a good start.

“Anything to get them moving is better than nothing,” she said.

SOURCE: Stroke, online May 20, 2014.

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