Best Physical Exercise for Stroke Patients

 

By Oluwasola Samuel, Freelance Writer. With editorial support and medical review by the DLHA Team.

Elderly black man attempting to walk with aid post stroke

Elderly black man attempting to walk with aid post stroke. Image by rawpixel.com on Freepik

 

Introduction

 

Exercise for post-stroke recovery falls into different categories like physical and cardiorespiratory, mental, language, etc. 

 

Physical exercise (often simply referred to as exercise for short) plays a crucial role in the process of stroke recovery. At different stages following a stroke, many patients experience motor and other brain and nerve-related disabilities. 

 

For example, a stroke patient may have muscle weakness and less control of their arm and/or leg, etc. This can make it difficult to perform everyday tasks like eating, dressing, and bathing. 

 

As a result, such patients are recommended to undergo physiotherapy, a program that involves the treatment of disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise rather than by drugs or surgery. 

 

Physical therapy or physiotherapy helps stroke patients regain the use of their affected body parts and also learn how to live with the loss of certain body movements. This helps patients fit back into society and enables them to continue their lives without hindrance.  

 

According to the clinical guidelines, stroke patients should undergo at least 45 minutes of rehabilitation therapy for a minimum of 5 days per week, provided the patient can tolerate the intensity of the exercise.1

 

This blog post discusses exercise, the benefits of the different types of physical exercise in support of stroke recovery, and other important information, so you can make informed choices for yourself, a friend, or a family member during stroke recovery.

 

What is Exercise? 

 

Exercise is a great way to keep your body and mind in good shape. Exercise is like feeding your body and mind with refreshing nutrients. It's the food your body and mind need to stay physically fit and mentally stable.

 

When you exercise, you move your body in different directions, following a structured rhythm. As you do this, your muscles work out, which helps your body stay strong and flexible. 

 

Exercise improves your overall health and especially the health of your lungs, heart, muscle, and mental status.

 

One beautiful thing about exercise is that it can be done either in the gym or at home, depending on your schedule. 

 

 

What common exercise types are there? 

 

There are different types of exercise you can indulge in, and they are classified into different categories, namely:
 

  • Strength training exercises

 

These involve using resistance to build muscle strength and endurance. It helps to increase muscle mass, improve your posture, reduce your risk of injury, etc. 

 

Examples of strength-training exercises include: 

  • Using resistance band
  • Weightlifting
  • Push-ups
  • Squats
  • Lunges, etc. 

 

  • Aerobics exercise

 

This type of exercise is also known as cardio. It gets your heart racing and your breathing faster. Aerobic exercise is one type of exercise that helps you maintain a healthy weight. It improves your heart health, increases your energy level, and reduces your risk of heart disease or even stroke. 

 

Examples of aerobic exercises include: 

  • Biking
  • Dancing
  • Jumping
  • Rope jumping/Skipping
  • Playing sports
  • Running
  • Jogging, etc. 

 

  • Flexibility exercise

 

This type of exercise helps to stretch your muscles and improve joint movement. It is important to engage in flexibility training because it will not only improve your joint movement but also reduce soreness and stiffness in your joints, improve your posture and circulation, and reduce your risk of injury. 

 

Examples of flexibility exercises include: 

  • Pilates
  • Stretching
  • Yoga
  • Taichi

 

  • Balance exercise 

 

This type of exercise works and challenges your body's balance and coordination. It improves and enhances mobility, posture, and stability; reduces your risk of falling, and improves your balance and combination.2 

 

Examples of balance exercises include: 

  • Standing or walking heel-to-toe
  • Standing on one leg
  • Yoga
  • Use of a balance ball
  • Tai Chi

 

Be mindful that not all of the listed exercises are suitable for someone recovering from a stroke. 

 

 

Why may stroke patients need exercise? 

 

Stroke patients often exhibit different symptoms, which reduce their quality of life. Exercise is an important activity stroke patients can engage in to improve their health. 

 

Engaging in regular exercise reduces your risk of stroke and other diseases like high blood pressure, diabetes, etc, in the first place. It also improves your physical and mental health by boosting your mood and easing your anxiety and depression symptoms

 

Stroke patients should keep in mind that engaging in exercise can improve their physical disabilities and help them recover the function of their bodies and quality of life. It's common for stroke patients to feel fatigue, pain, and brain damage. Engaging in exercise can help you regain your strength and improve joint mobility, balance, and coordination. 

 

 

Which physical exercises are best for stroke recovery? 

 

Different exercises aid stroke recovery and these exercises are effective because they target the affected body part. These exercises are classified into three parts namely:
 

  • Shoulder, wrist, and hand exercise
  • Leg, ankle, and foot exercise
  • Balance exercise

 

Please consult your healthcare provider before starting any exercise. This would give you  information to make the best choices of exercise for you.

 

1. Shoulder, wrist, and hand exercise

 

Stroke patients often experience post-stroke symptoms like weakness of the muscles and limited movements in the upper and lower body. This is caused by the damage caused by a stroke to the part of the brain that controls the muscles around the shoulder, wrist, and hand. Hence, physiotherapy is advised to help restore the muscle's strength, balance, coordination, and functional independence. 

 

Some of the exercises advised include:

 

  • Crumpling and uncrumpling of paper

 

This exercise is good for working on the muscles of your shoulder and all the fine movement skills of your hand. To perform this exercise, you will need a piece of paper, a flat surface like a table, and a chair to sit upright. 

 

As you begin the exercise, ensure you are sitting upright with both arms placed on a table. Take a piece of paper and crumple it with both arms. At this point, make sure your shoulders aren't raised but are in a relaxed position. 

 

After crumpling the paper, uncrumple the paper with both hands. You can repeat this process as many times as you want. If this process seems easy, you can increase the amount of paper used. Aim to do this at least three times a week, or as instructed by your physical therapist. 
 

  • Shoulder horizontal range motion

 

This exercise is great for maintaining the range of the shoulder and facilitating rolling on the bed with ease. To execute this exercise, you will have to lie on your back on a flat and firm surface. The flat and firm surface will provide you with a stable base for your body. 

 

In this position, you have to interlock both the affected and unaffected fingers with both palms facing your chest. Then use your unaffected arm to pull your affected arm across your body, towards the side of the unaffected arm. Ensure to hold this position for 10 to 15 seconds. 

 

Doing this will help stretch and strengthen the muscles in the affected shoulder. You can repeat this exercise at least three times daily or as advised by your physical therapist. 
 

  •  Supported reaching and Grasping

 

This exercise is great for the muscles in and around the shoulder and the wrist. To perform this exercise, you will need a chair and a flat surface, preferably a table. 

 

You have to sit upright with your affected arm placed on the table and the unaffected arm placed on your thigh. From this position, you will have to push forward the affected arm placed on the table like you are trying to reach out to grab an imaginary object, and then you have to bring the affected arm back to its initial position. 

 

Repeat this process till you feel the muscles in your arm become fatigued. While doing this, ensure to keep your affected arm in place, straighten your elbow, and extend your fingers at the end of the exercise. As you bring your arm back to its initial position, ensure to bend your elbow and make a fist.

 

2. Leg, ankle, and foot exercise

 

A stroke can leave awful side effects in its wake. It could affect the way you sit, move, stand, balance, and walk. Engaging in specialized exercises that target the affected areas of your body is key to helping you recover your balance and mobility. 

 

Some of the exercises advised include: 
 

  • Calf Stretch Exercise

 

The calf stretch exercise is good for maintaining ankle mobility and walking. To execute this exercise, you will need a platform, either a table or a chair. Let's assume you are using a table. You will have to place both hands on the edge of the table, holding it firm. You will then need to stretch out the affected leg backward, but ensure your knee is straight. 

 

You can hold this position for a few minutes and repeat the same process for the unaffected leg. While doing this, ensure that your leg is outstretched towards the back, then make your heel touch the floor. By doing this, you will notice the muscles at the back of your outstretched leg being stretched. 
 

  • Supported mini squat

 

This exercise strengthens the muscles in your leg, which helps you walk and rise from a fitted position. To execute this exercise, you will need a chair. You will have to stand behind the chair and ensure your knees and feet are in line. 

 

Ensure your body weight is evenly distributed on both legs. Afterward, go down a bit like you are trying to squat, but this time in a mini-squat position, then return to your original position. As you do this, you will begin to feel fatigue in your leg muscles. Ensure to perform this exercise 15–20 times per exercise routine. 
 

  • Small Step-up with support

 

This exercise strengthens your thigh, hip, and leg. To execute this exercise, you will need a staircase or a raised platform that has some form of support on both sides that you can hold on to during the exercise. Let's assume you are using a staircase for this exercise. 

 

Before you begin the exercise, ensure to place your hands on the handrail for support and place your affected leg on the first step, like you are about to go up the stairs. Maintain a straight knee position while in this position. You can repeat this exercise up to 10–15 times on both legs until the muscles in your leg feel fatigued. 

 

3. Balance Exercise

 

After suffering from a stroke, you tend to lose control of some body parts like your mouth, arm, or leg. When your leg is affected, it makes you lose control of your ability to balance your body as you used to. Engaging in certain exercises that focus on helping you improve your balance is important to get your life back on track. 

 

Some of the exercises include: 
 

  • Dynamic weight shifts

 

This exercise is great for working on weight shifting in your body, balance, and core control.4 To execute this exercise, you will need a chair or a gym ball that's less stable. Let's assume you are using a chair. To perform this exercise, you will have to sit on the chair, sitting upright, and then shift your weight to one side at a time. Repeat this exercise for about 20 – 30 times per exercise session.
 

  • Single–Leg Stance

 

This is a difficult balance exercise that's good for retaining your balance and preventing you from falling. Ensure that you perform this exercise in a controlled, safe environment with support around you. To perform this exercise, you have to stand straight and raise one leg while standing on the other.

 

While doing this exercise, be sure to maintain a straight posture. If this feels too easy, close your eyes while performing this exercise, and it becomes a bit difficult. Do this exercise on both legs. When you feel fatigued on one leg, you can repeat the same exercise on the other leg. 
 

  • Staggered

 

This exercise is good for improving your balance, and it helps prevent you from falling. To perform this exercise, ensure you are standing upright with your feet close to each other. You can move your affected leg right in front of the unaffected leg. 

 

Ensure to maintain this position for 30 to 60 seconds. You can repeat the same exercise for the other leg too. If the exercise feels too easy, close your eyes, and it will become a bit difficult, which helps to improve your balance. Doing this for a longer period will not only improve your balance but also your core.

 

 

Which exercise types are not suitable for stroke patients?

 

While you need to engage in a specialized exercise to help you recover the function of your body, it's advisable to avoid any exercise that requires sudden movements, quick turns, or exercises that deplete your energy quickly. 

 

You should avoid exercises like weight training, jumping rope, and running because they pose a high risk of injury to you. If you are unsure which exercise to do, it's advisable to consult your physical therapist to help you create a personalized exercise program that's safe and effective to help improve your health. 

 

What are the other therapies available to improve stroke recovery? 

 

Apart from physical therapy, there are a few other rehabilitation treatments available to you if you are looking to recover from a stroke. The kind of stroke symptoms that you have will determine the therapy you will get. 

 

The goal of rehabilitation is to help you regain the use and function of your body to improve your quality of life. These therapies include: 
 

  • Speech therapy
  • Cognitive therapy
  • Medication

 

 

Who participates in a stroke rehabilitation team? 

 

Your journey to recovery from a stroke will be supported by a team of passionate healthcare professionals who are dedicated to helping you regain your strength, independence, and quality of life. These experts empathize with the challenges you have and are committed to guiding you on your path to recovery. 

 

These healthcare providers include: 
 

  • Physicians

 

These are the neurologists and psychiatrists who will be your primary caregivers. They oversee your care plan and provide medications to you. They work closely with other specialists to ensure your treatment is going well according to plan.
 

  • Physical Therapists

 

The physical therapist will work with you to assist in improving your mobility, strength, and coordination using a specialised and well-structured exercise plan tailored to your specific needs. 
 

  • Occupational Therapist

 

The occupational therapist works with you, assisting you to learn and perform daily tasks like dressing, cooking, eating, and bathing.
 

  • Speech and Language Pathologist

 

This specialist will help you regain and improve your communication and swallowing difficulties that might arise due to your stroke. They ensure they help you regain speech clarity and improve comprehension and swallowing function. 
 

  • Nurse

 

The nurse will provide you with support, comfort, and safety while also ensuring your medication is administered. They also educate you on the importance of self-care and lifestyle changes. 
 

  • Psychologist

 

The psychologist provides support to help you cope with the emotional stress, trauma, and psychological challenges that come with having a stroke. They work with you to manage your stress, anxiety, and depression to improve your recovery process.
 

  • Dietitian

 

The dietitian provides you with professional nutritional advice, counseling, and support, ensuring you eat a balanced meal to help improve your recovery. 

 

 

FAQ:

 

  • How long does it take to recover from a stroke? 

 

One thing you should know is that recovery from a stroke depends on the severity of your stroke, how fast you were able to get treated, and how quickly you can recover the use of your affected body parts. This is why rehabilitation is necessary and important for stroke recovery. 

 

Also, according to expert research, to recover from a stroke, patients should ensure they engage in physical activity to help reduce post-stroke fatigue and a sedentary lifestyle.7

 

There is little evidence to back up the relationship between exercise and post-stroke fatigue, but exercise likely has a direct and positive impact on fatigue. However, more research needs to be carried out to prove this.

 

  • Can I prevent another stroke after the first one? 

 

The truth is that once you have a stroke, you are at risk of having another stroke in the future. To prevent another stroke, you have to limit the risk factors by doing the following: 

  • Take your medications
  • Eat a healthy diet
  • Stop smoking
  • Get support
  • Get enough rest
  • Stay hydrated
  • Reduce stress
  • Treat other stroke risk factors

 

 

Conclusion

 

Exercise plays an important role in the stroke recovery process. Some exercises specifically target the affected body part to help recover its functionality. Before stroke patients engage in any exercise, they must get clearance from their physical therapist to know when and the type of exercise to engage in. 

 

Physical therapists should incorporate or advise stroke survivors to engage in regular physical activity, including low-to-moderate intensity aerobics, muscle-strengthening exercises, and reducing sedentary periods. This can help prevent future strokes and improve the overall health and well-being of stroke survivors. 

 

 

References:
 

1. National Clinical Guideline Centre (UK). NICE Clinical Guidelines No. 162. Stroke Rehabilitation: Long Term Rehabilitation After Stroke [Internet]. Royal College of Physicians (UK); 2013 May 23. [cited 2023 Nov 28]. 

2. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson L, et al. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews [Internet]. 2012 [cited 2023 Dec 2];(9).

3. Centers for Disease Control and Prevention.(CDC). Prevent stroke: What you can do [Internet. Last review April 12. 2022 [cited 2023 Nov 28]. .

4. Mayo Clinic. Why your core muscles matter [Internet, 2022 Sept. 22].  [Cited 2023 Nov 28]. 

5. Stroke Association. Occupational therapy [Internet. n.d.]. [Cited 2023 Nov 28]. 

 

 

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Published: December 5, 2023

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