Stroke Exercise Testing

Understanding stroke exercise testing.

The field of stroke exercise testing is a varied one, complicated by the different effects of a stroke on patients.  While some stroke survivors have no physical disability as a result of the stroke, for others, the stroke has affected their ability to move.

Suffered no physical disabiltiy.

If a patient has suffered no physical disability as a result of the stroke, they will be able to begin exercising again as soon as their doctor clears them, and a trainer will be able to choose from the full range of activities and exercise options when designing a fitness program, limited only by the patient’s baseline fitness.  In this case, no specialized stroke exercise testing is necessary.

Movement restrictions.

If, however, a patient’s ability to move has been compromised by their stroke, it will be necessary for them to go through rehabilitation first before embarking on a traditional exercise plan. Physical and occupational therapists will design a program of rehabilitation that aims to improve their physical functioning as much as possible.

However, despite rehabilitation, many patients do not make a full physical recovery, with strokes remaining one of the leading causes of long-term disability in the UK.  As a result, stroke survivors are often deconditioned, and thus become predisposed to a sedentary lifestyle.

This becomes part of a vicious cycle that limits their ability to comfortably perform a wide range of activities of daily living, with a concomitant reduction in overall activity levels.  This in turn increases their risk of falls, while also contributing to an increased risk of recurrent stroke or cardiovascular disease.

Be careful with timings.

Unfortunately, for most stroke survivors, physical rehabilitation ends within a few months of the stroke.  This is based on the long held assumption that most – if not all – recovery of motor function occurs within a few months of the stroke.  However, recent evidence suggests that aggressive rehabilitation beyond this time period, including treadmill exercise with or without body weight support, increases aerobic capacity and sensorimotor

Thus it is important to design longer term rehabilitation programs for stroke survivors that can help to optimize functional motor performance in stroke survivors – this can include aerobic exercise training, with and without partial body weight–supported walking.  This will improve strength, timing of muscle activations, and cardio fitness.

This type of training is complemented by specialized training to improve daily living skills – these can include skill and efficiency in self-care, occupational skills, and also leisure-time activities. Testing will need to focus on areas such as quality of life, functional capacity and mobility (eg, increasing gait velocity), neurological impairment, and motor function (eg, lowering the energy cost of a hemiparetic gait).

In summary.

When this type of rehabilitation is combined with cardio fitness programs, it can meet the major rehabilitation goals for stroke patients:

• Preventing complications of prolonged inactivity
• Decreasing recurrent stroke and cardiovascular events
• Increasing aerobic fitness
• Improving daily living skills and thus quality of life