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Aerobic Exercise Is Key to Rehab After Stroke

Research shows stronger recovery if you get your heart pumping

spinner image An occupational therapist helping a female patient use a static bicycle during physical therapy
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What if rehab for stroke survivors included the kind of heart-pounding aerobic activity commonly prescribed for people who’ve experienced a heart attack?

True, many people who leave the hospital after a stroke have some limitations in their movements. So rehab for stroke survivors usually focuses more on physical and occupational therapy aimed at “improving specific impairments in walking, strength, balance and coordination,” says Elizabeth Regan, clinical assistant professor and physical therapist at the University of South Carolina. “Limited time is spent working to achieve improvements in aerobic fitness.”

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The benefits of exercise after a stroke

But there’s a place for aerobic exercise for the more than 795,000 U.S. adults who have a stroke each year, recent research suggests. After looking at 19 studies, Regan and colleagues concluded that survivors could indeed benefit from aerobic exercise in the same way cardiac patients do. And that’s regardless of the specific type of activity they choose, how mobile they are or how much time has passed since they had the stroke, the team reported in 2019 in the Journal of the American Heart Association.

To measure that improvement, the researchers looked at the results of what’s known as the six-minute walk test, a standard way of measuring fitness by comparing the distance subjects can walk in a given amount of time. For stroke survivors who could walk less than 315 yards in six minutes (going roughly the length of three football fields), completing an aerobic exercise program helped 58 percent of them tack on an additional 58 yards. Not surprisingly, those with mild movement impairments saw the most benefit.

Types of physical activity for stroke recovery

It’s important to start at the right level and build up gradually:

  • Gait training exercises
  • Stretching and range-of-motion exercises
  • Aerobic exercise
  • Balancing exercises
  • Strength-training exercises

Source: American Stroke Association

“Aerobic exercise specifically impacts endurance,” Regan says. “Doing at least 30 minutes of aerobic conditioning, two to three times a week, for eight to 18 weeks can make a difference in walking and general endurance. And it can translate to the ability to move more, which can impact how much a stroke survivor can do in the community.”

Subsequent research confirms these findings. In a study published in 2021 in Cerebrovascular Diseases, researchers compared more than 2,900 stroke survivors who did cardiac rehab, defined in this instance as a mix of aerobic activity and resistance training, with survivors who did not. The exercisers had significantly better health outcomes two years after their stroke than the non-exercisers. They were 53 percent less likely to die of any cause, 12 percent less likely to have another stroke and 36 percent less likely to need a return visit to the hospital. Another report from 2023 in JAMA Network Open found that stroke severity did not stop people from getting benefits of being more physically active, even at low levels.

Guidelines for exercising safely post-stroke

“Performing aerobic exercise is good for mobility, overall health and risk for future cardiovascular events,” Regan says. She recommends a cardiac rehab program or community exercise program designed specifically for stroke survivors. For people with good mobility, Regan suggests SilverSneakers or Walk With Ease, two programs that “are great ways to achieve these benefits.”

And if logging 60 to 90 minutes of aerobic activity a week — whether you do it on your own or as part of a structured program — sounds daunting, don't worry. No one’s expecting you to be able to follow this regimen overnight. But know that “every little bit counts,” Regan says. “Stroke survivors should start where they are and build up gradually. Shorter bouts of more frequent activity can be a great way to get started and be successful.”

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If walking is too painful, or not yet possible, patients should talk to a physical therapist about other types of aerobic activity to try. Options may include recumbent biking (a low bike with a supportive back) or an arm bike, which uses a pedaling motion of the arms to boost heart rate. For those with serious weakness on one side of the body, an arm bike or a seated step machine such as a NuStep, which enables single arm and leg motion, can be used to get one side of the body actively moving.

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