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Stroke Survivors Urged to Exercise

Regular aerobic movement can prevent recurrence

MONDAY, April 26, 2004 (HealthDayNews) -- Exercise not only can prevent a first stroke, it can also prevent second or third occurrences.

New guidelines from the American Heart Association say that 20 minutes or more of aerobic exercise three to seven times a week can help reduce the risk of recurrent strokes. The guidelines, apparently the first of their kind, appear in the April 27 issue of Circulation: Journal of the American Heart Association.

"No matter how severe the stroke, individuals can do some kind of exercise," said Dr. Gerald Fletcher, a cardiologist with the Mayo Clinic in Jacksonville, Fla., and a spokesman for the American Heart Association. "In the past, it was felt that exercise might not be safe but it really is safe. It just has to be adapted to their disability. It's certainly not dangerous."

"Everybody knows that exercise is good for you, and it has been shown that regular exercise is a way of controlling blood pressure, cholesterol, heart, lungs, all those sorts of things. And, of course, these are all things that prevent you from having a stroke," said Dr. Steven Flanagan, vice chairman of rehabilitation medicine at Mount Sinai Medical Center in New York City. "We know that, [but] I'm not aware of any studies examining whether that type of exercise prevents stroke in people who have already had one."

Every year about 700,000 people in the United States have a stroke, about a third of which are recurrent strokes. Today, there are an estimated 4.7 million stroke survivors in the United States. While 14 percent of people who have a stroke experience full recovery of physical function, 25 percent to 50 percent need some help with the activities of daily living (dressing, bathing, walking, etc.), and about 50 percent suffer severe long-term effects such as paralysis.

According to the study authors, stroke care has typically emphasized the first few months after the stroke, with less attention to what came after, the belief being that most or all recovery of motor function happened in this earlier time period.

"The focus early on after a stroke is to re-teach an arm to work, but we also have to keep in mind that we should be encouraging just good overall cardiovascular fitness," Flanagan said. "That's the value of this study. It makes us think about it. Now that we've gotten as far as we think we can go with rehab to function, let's get you doing something to keep you in shape."

Of course, one size does not fit all when it comes to an exercise routine after a stroke. "Depending on what the limitations are, you have to be able to tailor your program accordingly," Flanagan pointed out. "Not everyone is going to be able to run on a treadmill, but they might be able to get on a bicycle, particularly a reclining one."

With this caveat in mind, the new guidelines recommend that stroke survivors do 20 to 60 minutes of aerobic exercise (such as walking, treadmill, bicycle) three to seven days per week. The sessions don't have to be done all at once.

For strength training, the guidelines suggest at least one set of 10 to 15 repetitions using weights or resistances. Eight to 10 different exercises should be included in each session, and the sessions should be repeated two to three days a week.

Finally, the guidelines also recommend stretching and flexibility training before the aerobic or strength-training sessions two to three days a week. Balance and coordination exercises should also be done two to three days a week.

Although there are different degrees of stroke severity and different degrees of how well a person will recover, "the diagnosis of a stroke isn't a sentence to remain wheelchair-bound or bed-bound the rest of your life. Most people recover to some degree," Flanagan said. "This study reinforces something that I've always known -- that exercise is good."

"Stroke patients want to be accepted into society," emphasized Fletcher. "They can do exercise in their own way. They need to go to health clubs. They can go on a stationary bike and use one arm, and I have seen that done."

More information

For more on stroke and exercise, visit the British Stroke Association or the American Heart Association.

SOURCES: Steven Flanagan, M.D., assistant professor of rehabilitation medicine, Mount Sinai School of Medicine, and vice chairman of rehabilitation medicine, Mount Sinai Medical Center, New York City; Gerald Fletcher, M.D., cardiologist, Mayo Clinic, Jacksonville, Fla.; April 27, 2004, Circulation: Journal of the American Heart Association
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