PHYSCIAL ACTIVITY AND AEROBIC CAPACITY IN STROKE
1 INTRODUCTIE
Currently, stroke is a leading cause of long-term disability worldwide. More than 20% of stroke survivors do not reach
independent walking.
Stroke patients often show motor and functional limitations, which have a major impact on daily functioning and
quality of life. Due to these limitations, patients are often forced into inactivity in daily life, resulting in an increase of
social isolation, fatigue, depression, reduced aerobic capacity and an increase in risk of cardiovascular complications.
Physiotherapist should pay attention in improving physical activity and cardiorespiratory fitness after stroke. The
evidence why it is necessary to integrate this into neurological rehabilitation is presented in two presentations and in
this course.
2 PHYSICAL ACTIVITY, RISK FACTOR IN STROKE
Definition physical activity= any bodily movement produced by skeletal muscles that results in energy expenditure.
For example muscle work needed for:
Walking -> moderate intensity ( 3 – 6 METS) Doing the dishes -> light intensity
Body posture Performing daily life activities
Leisure and sports activities
An inactive life appears to increase the risk of stroke and thus is described as a risk factor.
Risicofactoren
Non modifiable: Leeftijd, Gender (men higher risk), Hereditary, Previous stroke
Modifiable: High BP, Smoking, Overweight, High chosterol values, Sedentary behavior (physical activity +
cardiorespiratory fitness), Diabetes, Arteriosclerosis, Cardiac problems, Alcohol abuse, stress
Stroke patients are often unaware of these risk factors. It is considered one of the tasks of a physiotherapist to clarify
this to patients, family and/or caregivers. -> de combinatie van risicofactoren zorgt voor cummulatief effect dus
gevaarlijker
3 WHAT DETERMINES HOW PHYSICAL ACTIVE A STROKE PATIENT LIVES
The following factors have an influence on how physically active a stroke patient lives.
Age Gender
Character Motivation
Education level Social background
Environmental factors Financial possibilities
Injury-related !
Hemiparesis
Spasticity
Vision
Memory/ concentration
Epilepsy
Fatique
Swallowing, eating, speaking Physical activity
Language / reading
Behavior
Dizziness, balance
Incontinence
Headache
Depression
, Gap in rehabilitation
Health (smoking) and life-style related:
Pre-stroke Physical activity = often low Vascular problem
Post-stroke No to little change in lifestyle Vascular problem
Time use
In previous years researchers stated that therapy is offered during a limited period during the
hospitalized phase. Therapy often includes many individual treatments, whereby a stroke patient is
often assigned to the treating physiotherapist to perform the therapy.
This is confirmed in a great European study, which concluded that:
Hospitalized patients in rehabilitation center are often on their rooms, inactive and without
interaction,
70%-80% off the time they are performing non-therapeutic activities,
The amount of therapy time is determined by the management and not by the staff of the
rehabilitation center,
Functional recovery becomes more when therapy time increases.
In recent literature, these findings are reconfirmed. So, 86.6% of the time awake was spent on sedentary
activities. Literature shows that patients during the post-hospitalization phase are not living physically active
enough during the therapy sessions.
Offering more activities in every phase of rehabilitation might increase functional recovery.Take caution of
early mobilization in the acute phase!
4 PHYSICAL ACTIVITY IN DIFFERENT PHASES OF RECOVERY
The terms “acute”, “sub-acute” and “chronic” are often used in recovery research without adequate definitions. Figure
1 summarizes the timing (hours, days, months) of several important biological processes in ischemic and hemorrhagic
stroke, as well as the temporal terms (hyper-acute, acute, early and late sub-acute, chronic) over the first six months
post-stroke and further.
The current understanding of brain repair processes present that the majority of behavioral recovery and the rapid
changes occur in the first week-to-months post-stroke. Relatively, few research have initiated intervention studies
within the first week until the first month post-stroke.This time period is a critical period for neural plasticity and
should be a target period for intervention studies, with some uncertainty about how intense and how early to start
the training. Outside the period of 3 months rather modest effects are expected.Plasticity enhanced interventions
should be use in the first months of recovery.
1 INTRODUCTIE
Currently, stroke is a leading cause of long-term disability worldwide. More than 20% of stroke survivors do not reach
independent walking.
Stroke patients often show motor and functional limitations, which have a major impact on daily functioning and
quality of life. Due to these limitations, patients are often forced into inactivity in daily life, resulting in an increase of
social isolation, fatigue, depression, reduced aerobic capacity and an increase in risk of cardiovascular complications.
Physiotherapist should pay attention in improving physical activity and cardiorespiratory fitness after stroke. The
evidence why it is necessary to integrate this into neurological rehabilitation is presented in two presentations and in
this course.
2 PHYSICAL ACTIVITY, RISK FACTOR IN STROKE
Definition physical activity= any bodily movement produced by skeletal muscles that results in energy expenditure.
For example muscle work needed for:
Walking -> moderate intensity ( 3 – 6 METS) Doing the dishes -> light intensity
Body posture Performing daily life activities
Leisure and sports activities
An inactive life appears to increase the risk of stroke and thus is described as a risk factor.
Risicofactoren
Non modifiable: Leeftijd, Gender (men higher risk), Hereditary, Previous stroke
Modifiable: High BP, Smoking, Overweight, High chosterol values, Sedentary behavior (physical activity +
cardiorespiratory fitness), Diabetes, Arteriosclerosis, Cardiac problems, Alcohol abuse, stress
Stroke patients are often unaware of these risk factors. It is considered one of the tasks of a physiotherapist to clarify
this to patients, family and/or caregivers. -> de combinatie van risicofactoren zorgt voor cummulatief effect dus
gevaarlijker
3 WHAT DETERMINES HOW PHYSICAL ACTIVE A STROKE PATIENT LIVES
The following factors have an influence on how physically active a stroke patient lives.
Age Gender
Character Motivation
Education level Social background
Environmental factors Financial possibilities
Injury-related !
Hemiparesis
Spasticity
Vision
Memory/ concentration
Epilepsy
Fatique
Swallowing, eating, speaking Physical activity
Language / reading
Behavior
Dizziness, balance
Incontinence
Headache
Depression
, Gap in rehabilitation
Health (smoking) and life-style related:
Pre-stroke Physical activity = often low Vascular problem
Post-stroke No to little change in lifestyle Vascular problem
Time use
In previous years researchers stated that therapy is offered during a limited period during the
hospitalized phase. Therapy often includes many individual treatments, whereby a stroke patient is
often assigned to the treating physiotherapist to perform the therapy.
This is confirmed in a great European study, which concluded that:
Hospitalized patients in rehabilitation center are often on their rooms, inactive and without
interaction,
70%-80% off the time they are performing non-therapeutic activities,
The amount of therapy time is determined by the management and not by the staff of the
rehabilitation center,
Functional recovery becomes more when therapy time increases.
In recent literature, these findings are reconfirmed. So, 86.6% of the time awake was spent on sedentary
activities. Literature shows that patients during the post-hospitalization phase are not living physically active
enough during the therapy sessions.
Offering more activities in every phase of rehabilitation might increase functional recovery.Take caution of
early mobilization in the acute phase!
4 PHYSICAL ACTIVITY IN DIFFERENT PHASES OF RECOVERY
The terms “acute”, “sub-acute” and “chronic” are often used in recovery research without adequate definitions. Figure
1 summarizes the timing (hours, days, months) of several important biological processes in ischemic and hemorrhagic
stroke, as well as the temporal terms (hyper-acute, acute, early and late sub-acute, chronic) over the first six months
post-stroke and further.
The current understanding of brain repair processes present that the majority of behavioral recovery and the rapid
changes occur in the first week-to-months post-stroke. Relatively, few research have initiated intervention studies
within the first week until the first month post-stroke.This time period is a critical period for neural plasticity and
should be a target period for intervention studies, with some uncertainty about how intense and how early to start
the training. Outside the period of 3 months rather modest effects are expected.Plasticity enhanced interventions
should be use in the first months of recovery.
