PA in Neuro Populations

30 mins of moderate intensity PA for 5 days a week, or 150 mins accumulated, or 75 mins of vigorous intensity PA

Aerobic PA for 20-60 mins, 3-5 days a week; Strength, neuromuscular, and flexibility exercises for 2-3 days a week

63%

Environmental enrichment, groups, independent practice programs

It is safe to start cardiorespiratory training early after a stroke.

Environment, supports, patients' functional and cognitive ability, and patient goals should be considered when tailoring exercise for stroke patients.

Some strategies for motivating stroke patients to engage in exercise include identifying motivators, addressing barriers and fears, educating about sitting less and moving more, and discussing previous physical activity and attitudes towards exercise.

Cardiorespiratory fitness is the ability to transport and use oxygen for prolonged endurance exercise. It is usually expressed as max O2 uptake (VO2 max), peak power output, or anaerobic threshold.

The goals in the acute stage of stroke recovery are to prevent complications of prolonged inactivity and to regain voluntary movement and basic activities of daily living.

In the sub-acute stage of stroke recovery, the exercise recommendations include initiating an exercise program aiming to reach pre-stroke levels of activity, focusing on gait, upper extremity function, balance, muscle strength, motor skills, and functional activities. Cardiovascular and strengthening exercise are also recommended for motor recovery.

Stroke survivors need to achieve a level of moderate to vigorous physical activity (MVPA) to improve cardiovascular outcomes. Bouts of more than 10 minutes of MVPA are important for post-stroke exercise programs. Interventions should be more than 3 months long and maintain the intensity. High-intensity interval training (HIIT) is emerging as a feasible intervention in chronic stroke.

3-5 days per week, 20-60 min/session, 5-10 min warm-up and cool-down, resistance training of UL and trunk using free weights, elastic bands, pulleys, 1-3 sets of 10-15 reps of 8-10 exercises involving major muscle groups, 50-80% 1RM, 2-3 days/week, resistance gradually increased over time as tolerance permits

Exercise is a driver of neuroplasticity post-stroke. Brain-derived neurotrophic factor (BDNF) is upregulated after exercise, leading to increased plasticity. In rats, higher intensity forced exercise led to an increase in BDNF, while more frequent short bouts of voluntary exercise sustained the upregulation of BDNF over time. It is uncertain whether this translates to humans post-stroke.

Contraindications: Uncontrolled angina, cardiomyopathy, recent MI, moderate stenotic valvular heart disease, resting systolic blood pressure >180mmHg or resting diastolic BP >100mmHg, complex ventricular ectopy, significant drop in BP during exercise, left main coronary artery stenosis, uncontrolled resting tachycardia >100 bpm, electrolyte imbalance, unstable or acute heart failure, tachyarrhythmias or bradyarrhythmias, new or uncontrolled arrhythmia, high degree atrio-ventricular block, severe stenotic or regurgitant valvular heart disease, mental or physical impairment leading to inability to exercise adequately, hypertrophic obstructive cardiomyopathy, third degree heart block, acute aortic dissection, acute myocarditis or pericarditis, unstable diabetes, uncontrolled visual/vestibular disturbances, recent injuries without medical assessment, proven inability to comply with recommended adaptations to the exercise program and inability to maintain upright posture in sitting, febrile illness, extreme obesity (usually >150kg), acute pulmonary embolus or pulmonary infarction, deep venous thrombosis. Precautions: Resting tachycardia >100 bpm, uncontrolled diabetes, uncontrolled hypertension, severe orthopedic problems, severe spasticity, severe fatigue, severe cognitive impairment, severe dyspnea at rest, severe peripheral neuropathy, musculoskeletal problems, cognitive impairment, recent surgery

Heart rate (simple, inexpensive, takes pulse, can use HR monitors, apps, SpO2 monitor can be used), BORG scale, observation (color, sweating, breathing, effort), questioning, HRR (takes resting HR into account)