New AHA/ASA Statement on Physical Activity After Stroke

Megan Brooks

May 27, 2014

Physical activity and exercise advice should be incorporated into the management of stroke survivors, an updated scientific statement from the American Heart Association (AHA) and the American Stroke Association (ASA) concludes.

The new scientific statement supports and extends the 2004 AHA/ASA scientific statement on the value of physical activity for stroke survivors.

Today there is "even stronger evidence since we included randomized controlled trials for aerobic exercise and strengthening," writing group chair Sandra A. Billinger, PT, PhD, from the University of Kansas Medical Center in Kansas City, told Medscape Medical News.

"We also are excited to include information regarding early activity in the acute stage of stroke. There is research to suggest that moving people (at 24 hours poststroke) is beneficial," Dr. Billinger said. "We also added a section on barriers to exercise after stroke to inform healthcare providers that this is an issue that should be addressed."

The scientific statement, published online May 20 in Stroke, is endorsed by American Academy of Neurology.

Neglected Component of Poststroke Care

Each year in the United States, about 795,000 people sustain a stroke, or about 1 person every 40 seconds, and most of them survive. Evidence suggests that stroke survivors experience physical deconditioning and lead sedentary lifestyles, the writing group notes.

"The assessed body of evidence clearly supports the use of exercise training (both aerobic and strength training) for stroke survivors," they report. Exercise training improves functional capacity, the ability to perform daily activities, and quality of life, as well as reducing the risk for future cardiovascular events, they say.

"The promotion of physical activity in stroke survivors should emphasize low- to moderate-intensity aerobic activity, muscle-strengthening, reduction of sedentary behavior, and risk management for secondary prevention of stroke," the statement says.

It emphasizes the importance of personalized exercise prescription. "After a stroke, the physical activity goals and exercise prescription for the patient need to be customized to the tolerance of the patient, stage of recovery, environment, available social support, physical activity preferences, and their specific impairments, activity limitations, and participation restrictions," the statement adds.

Immediately after a stroke, the first goals during poststroke physical activity aim to prevent complications of prolonged inactivity, regaining voluntary movement, and recovering basic activities of daily living, the statement notes.

The harmful effects of bed rest include diuresis with significant losses of sodium and potassium, reduced blood plasma volume and cardiac output, depressed immune function, increased resting heart rate, loss of muscle strength, reduced exercise capacity and orthostatic tolerance, and increased risk for joint contracture and deep venous thromboembolism.

Early mobilization (within 24 hours after stroke, and at regular intervals afterward) results in earlier walking and improved functional recovery, the statement notes.

Once the patient is medically stable, the next goal is to initiate an exercise training regimen designed to regain or exceed prestroke levels of activity.

The ultimate goal is at least 3 days a week of aerobic activity lasting at least 20 minutes per session, although for many stroke survivors multiple short bouts of moderate-intensity physical exercise, such as three 10- to 15-minute bouts, will be better tolerated, the statement says. Resistance training for clinically stable stroke survivors performed 2 to 3 days a week is also advised.

Exercise is a "very valuable yet underused" component of poststroke care, the statement notes. "The evidence strongly supports the benefits of physical activity exercise for stroke survivors. With education in and encouragement for the benefits and safety of exercise after stroke, and with development of appropriate programs in hospitals and in communities, the ability to recruit patients to these programs should increase."

The authors have disclosed no relevant financial relationships.

Stroke. Published online May 20, 2014. Abstract

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