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Clinical Evidence of Exercise Benefits for Stroke

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Exercise for Cardiovascular Disease Prevention and Treatment

Abstract

Even though stroke is the third, not the first, most common cause of disability-adjusted life years in developed countries, it is one of the most expensive to treat. Part of the expense is due to secondary problems in the post-stroke period including: cognition, memory, attention span, pain, sensation loss, psychological issues, and problems with mobility and balance. Research has identified that exercise has both positive physical and psychosocial effects for post-stroke patients. Therefore, this scientific statement provides an overview on exercise rehabilitation for post-stroke patients.

We will use systematic literature reviews, clinical and epidemiology reports, published morbidity and mortality studies, clinical and public health guidelines, patient files, and authoritative statements to support this overview.

Evidence clearly supports the use of various kinds of exercise training (e.g., aerobic, strength, flexibility, neuromuscular, and traditional Chinese exercise) for stroke survivors. Aerobic exercise, the main form of cardiac rehabilitation, may play an important role in improving aerobic fitness, cardiovascular fitness, cognitive abilities, walking speed and endurance, balance, quality of life, mobility, and other health outcomes among stroke patients. Strength exercise, included in national stroke guidelines and recommended for general health promotion for stroke survivors, can lead to improvements in functionality, psychosocial aspects, and quality of life for post-stroke patients. Flexibility exercises can relieve muscle spasticity problems, improve motor function, range of motion, and prevent contractures. Stretching exercises can also prevent joint contractures, muscle shortening, decrease spasticity, reduce joint stiffness and improve a post-stroke patient’s overall function. Neuromuscular exercises can improve activities of daily living (ADL) through coordination and balance activities. Traditional Chinese exercises are used to improve walking and balance ability as well as increase muscle strength, which is important for post-stroke patients.

The present evidence strongly supports the power of exercise for post-stroke patients, which in this study combined aerobic exercises, strength training, flexibility exercises, neuromuscular exercises, and traditional Chinese exercises. This research can encourage post-stroke survivors to consider the importance of exercise in the rehabilitation process.

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References

  1. Pollock A, St George B, Fenton M et al (2014) Top 10 research priorities relating to life after stroke--consensus from stroke survivors, caregivers, and health professionals. Int J Stroke 9(3):313–320

    Article  PubMed  Google Scholar 

  2. Winstein CJ, Stein J, Arena R et al (2016) Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke 47(6):e98–e169

    Article  PubMed  Google Scholar 

  3. Pang MY, Charlesworth SA, Lau RW et al (2013) Using aerobic exercise to improve health outcomes and quality of life in stroke: evidence-based exercise prescription recommendations. Cerebrovasc Dis 35(1):7–22

    Article  PubMed  Google Scholar 

  4. Hasan SM, Rancourt SN, Austin MW et al (2016) Defining optimal aerobic exercise parameters to affect complex motor and cognitive outcomes after stroke: a systematic review and synthesis. Neural Plast 2016(6):2961573

    PubMed  PubMed Central  Google Scholar 

  5. Constans A, Pin-Barre C, Temprado JJ et al (2016) Influence of aerobic training and combinations of interventions on cognition and neuroplasticity after stroke. Front Aging Neurosci. doi:10.3389/fnagi.2016.00164

  6. Globas C, Becker C, Cerny J et al (2012) Chronic stroke survivors benefit from high-intensity aerobic treadmill exercise: a randomized control trial. Neurorehabil Neural Repair 26(1):85–95

    Article  PubMed  Google Scholar 

  7. Lennon O, Carey A, Gaffney N et al (2008) A pilot randomized controlled trial to evaluate the benefit of the cardiac rehabilitation paradigm for the non-acute ischaemic stroke population. Clin Rehabil 22(2):125–133

    Article  PubMed  Google Scholar 

  8. Jacquin A, Binquet C, Rouaud O et al (2014) Post-stroke cognitive impairment: high prevalence and determining factors in a cohort of mild stroke. J Alzheimers Dis 40(4):1029–1038

    PubMed  Google Scholar 

  9. Smith PJ, Blumenthal JA, Hoffman BM et al (2010) Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosom Med 72(3):239–252

    Article  PubMed  PubMed Central  Google Scholar 

  10. Batcho CS, Stoquart G, Thonnard JL (2013) Brisk walking can promote functional recovery in chronic stroke patients. J Rehabil Med 45(9):854–859

    Article  PubMed  Google Scholar 

  11. Cumming TB, Tyedin K, Churilov L et al (2012) The effect of physical activity on cognitive function after stroke: a systematic review. Int Psychogeriatr 24(4):557–567

    Article  PubMed  Google Scholar 

  12. Cumming TB, Marshall RS, Lazar RM (2013) Stroke, cognitive deficits, and rehabilitation: still an incomplete picture. Int J Stroke 8(1):38–45

    Article  PubMed  Google Scholar 

  13. El-Tamawy MSDM, Abd-Allah F et al (2012) Aerobic exercises improve blood flow and cognitive functions in anterior circulation ischemic strokes. Egypt J Neurol Psychiatry Neurosurg 49(1–2):305–308

    Google Scholar 

  14. Kluding PM, Tseng BY, Billinger SA (2011) Exercise and executive function in individuals with chronic stroke: a pilot study. J Neurol Phys Ther 35(1):11–17

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rand D, Eng JJ, Liu-Ambrose T et al (2010) Feasibility of a 6-month exercise and recreation program to improve executive functioning and memory in individuals with chronic stroke. Neurorehabil Neural Repair 24(8):722–729

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hsu AL, Tang PF, Jan MH (2003) Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil 84(8):1185–1193

    Article  PubMed  Google Scholar 

  17. Gama GL, de Lucena Trigueiro LC, Simao CR et al (2015) Effects of treadmill inclination on hemiparetic gait: controlled and randomized clinical trial. Am J Phys Med Rehabil 94(9):718–727

    Article  PubMed  Google Scholar 

  18. Quaney BM, Boyd LA, McDowd JM et al (2009) Aerobic exercise improves cognition and motor function poststroke. Neurorehabil Neural Repair 23(9):879–885

    Article  PubMed  PubMed Central  Google Scholar 

  19. Billinger SA, Mattlage AE, Ashenden AL et al (2012) Aerobic exercise in subacute stroke improves cardiovascular health and physical performance. J Neurol Phys Ther 36(4):159–165

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bang DH, Son YL (2016) Effect of intensive aerobic exercise on respiratory capacity and walking ability with chronic stroke patients: a randomized controlled pilot trial. J Phys Ther Sci 28(8):2381–2384

    Article  PubMed  PubMed Central  Google Scholar 

  21. Toledano-Zarhi A, Tanne D, Carmeli E et al (2011) Feasibility, safety and efficacy of an early aerobic rehabilitation program for patients after minor ischemic stroke: A pilot randomized controlled trial. NeuroRehabilitation 28(2):85–90

    PubMed  Google Scholar 

  22. Park BS, Kim MY, Lee LK et al (2015) The effects of a progressive resistance training program on walking ability in patients after stroke: a pilot study. J Phys Ther Sci 27(9):2837–2840

    Article  PubMed  PubMed Central  Google Scholar 

  23. Son SM, Park MK, Lee NK (2014) Influence of resistance exercise training to strengthen muscles across multiple joints of the lower limbs on dynamic balance functions of stroke patients. J Phys Ther Sci 26(8):1267

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lee SB, Kang KY (2013) The effects of isokinetic eccentric resistance exercise for the hip joint on functional gait of stroke patients. J Phys Ther Sci 25(9):1177–1179

    Article  PubMed  PubMed Central  Google Scholar 

  25. Michelle M, Ouellette MNKL, Jonathan FB et al (2006) High-intensity resistance training improves muscle strength, self-reported function, and disability in long-term stroke survivors. Stroke 35(6):1404–1409

    Google Scholar 

  26. Ivey FM, Prior SJ, Hafer-Macko CE et al (2016) Strength training for skeletal muscle endurance after stroke. J Stroke Cerebrovasc Dis. doi:10.1016/j.jstrokecerebrovasdis.2016.10.018

  27. Kim CMEJ, MacInthr DL, Dswson AS (2001) Effects of Isokinetic strength training on walking persons with stroke: a double-blind controlled pilot study. J Stroke Cerebrovase Dis 10(6):265–273

    Article  CAS  Google Scholar 

  28. Flansber UBDD, Lexell J (2006) Knee muscle strength, gait performance, and perceived participation after stroke. Arch Phys Med Rehabil 87(7):974–980

    Article  Google Scholar 

  29. Bohannon RW (2007) Muscle strength and muscle training after stroke. J Rehabil Med 39(1):14–20

    Article  PubMed  Google Scholar 

  30. Mehta PS, Viana R, Mays R et al (2012) Resistance training for gait speed and total distance walked during the chronic stage of stroke: a meta-analysis. Top Stroke Rehabil 19(6):471–478

    Article  PubMed  Google Scholar 

  31. Pak PC (2008) Strengthening to promote functional recovery poststroke: an evidence-based review. Top Stroke Rehabil 15(3):177–199

    Article  PubMed  Google Scholar 

  32. Bale SL (2008) Does functional strength training of the leg in subacute stroke improve physical performance? A pilot randomized controlled trial. Clin Rehabil 22(10–11):911–921

    Article  PubMed  Google Scholar 

  33. Dourbonnais DBS, Lepage Y, Beaudoin N et al (2002) Effect of force-feedback treatments in patients with chronic motor deficits after a stroke. Am J Phys Med Rehabil 81(12):890–897

    Article  Google Scholar 

  34. Duncan SS, Richards L, Gollub S et al (2003) Randomized clinical trail of therapeutic exercise in subacute stroke. Stroke 34(1):2173–2180

    Article  PubMed  Google Scholar 

  35. Pang MYEJ, Dawson AS, McKay HA et al (2005) A community-based fitness and mobility exercise program for older adults with chronic stroke: a rndomized, controlled trail. J Am Geriatr Soc 53(10):1667–1674

    Article  PubMed  PubMed Central  Google Scholar 

  36. Flansber UB, Lexell J (2008) Progressive resistance training after stroke: effects on muscle strength, muscle tone, gait perforamnce and perceived participation. J Rhabil Med 40(1):42–48

    Article  Google Scholar 

  37. Clark DJ, Patten C (2013) Eccentric versus concentric resistance training to enhance neuromuscular activation and walking speed following stroke. Neurorehabil Neural Repair 27(4):335–344

    Article  PubMed  Google Scholar 

  38. Jennifer L, Hunnicutt SEA, Embry AE et al (2016) The effects of power training in young and older adults after stroke. Stroke Res Treat 2016(4):1–5

    Google Scholar 

  39. Rodrigo Fernandez-Gonzalo SF-G, Marc T, Cristina P et al (2016) Muscle, functional and cognitive adaptations after flywheel resistance training in stroke patients: a pilot randomized controlled trial. J Neuroeng Rehabil 13(1):37

    Article  PubMed  PubMed Central  Google Scholar 

  40. Ada L, Dorsch S, Canning CG (2006) Strengthening interventions increase strength and improve activity after stroke: a systematic review. Aust J Physiother 52(4):241–248

    Article  PubMed  Google Scholar 

  41. Ouellette MM, LeBrasseur NK, Bean JF et al (2004) High-intensity resistance training improves muscle strength, self-reported function, and disability in long-term stroke survivors. Stroke 35(6):1404–1409

    Article  PubMed  Google Scholar 

  42. Studenski S, Duncan PW, Perera S et al (2005) Daily functioning and quality of life in a randomized controlled trial of therapeutic exercise for subacute stroke survivors. Stroke 36(8):1764–1770

    Article  PubMed  Google Scholar 

  43. Song GB, Park EC (2015) Effects of chest resistance exercise and chest expansion exercise on stroke patients’ respiratory function and trunk control ability. J Phys Ther Sci 27(6):1655–1658

    Article  PubMed  PubMed Central  Google Scholar 

  44. Marzolini S, Oh P, McIlroy W et al (2013) The effects of an aerobic and resistance exercise training program on cognition following stroke. Neurorehabil Neural Repair 27(5):392–402

    Article  PubMed  Google Scholar 

  45. Aidar FJ, de Oliveira RJ, Silva AJ et al (2012) The influence of resistance exercise training on the levels of anxiety in ischemic stroke. Stroke Res Treat 2012(7):298375

    PubMed  PubMed Central  Google Scholar 

  46. Selles RW, Li X, Lin F et al (2005) Feedback-controlled and programmed stretching of the ankle plantarflexors and dorsiflexors in stroke: effects of a 4-week intervention program. Arch Phys Med Rehabil 86(12):2330–2336

    Article  PubMed  Google Scholar 

  47. Wu CL, Huang MH, Lee CL et al (2006) Effect on spasticity after performance of dynamic-repeated-passive ankle joint motion exercise in chronic stroke patients. Kaohsiung J Med Sci 22(12):610–617

    Article  PubMed  Google Scholar 

  48. Ada L, Goddard E, McCully J et al (2005) Thirty minutes of positioning reduces the development of shoulder external rotation contracture after stroke: a randomized controlled trial. Arch Phys Med Rehabil 86(2):230–234

    Article  PubMed  Google Scholar 

  49. Nuyens GE, De Weerdt WJ, Spaepen AJ et al (2002) Reduction of spastic hypertonia during repeated passive knee movements in stroke patients. Arch Phys Med Rehabil 83(7):930–935

    Article  PubMed  Google Scholar 

  50. Bressel E, McNair PJ (2002) The effect of prolonged static and cyclic stretching on ankle joint stiffness, torque relaxation, and gait in people with stroke. Phys Ther 82(9):880–887

    PubMed  Google Scholar 

  51. Weijer VC, Gorniak GC, Shamus E (2003) The effect of static stretch and warm-up exercise on hamstring length over the course of 24 hours. J Orthop Sports Phys Ther 33(12):727–733

    Article  PubMed  Google Scholar 

  52. Decoster LC, Cleland J, Altieri C et al (2005) The effects of hamstring stretching on range of motion: a systematic literature review. J Orthop Sports Phys Ther 35(6):377–387

    Article  PubMed  Google Scholar 

  53. Guissard N, Duchateau J (2006) Neural aspects of muscle stretching. Exerc Sport Sci Rev 34(4):154–158

    Article  PubMed  Google Scholar 

  54. Kokkonen J, Nelson AG, Eldredge C et al (2007) Chronic static stretching improves exercise performance. Med Sci Sports Exerc 39(10):1825–1831

    Article  PubMed  Google Scholar 

  55. Radford JA, Burns J, Buchbinder R et al (2006) Does stretching increase ankle dorsiflexion range of motion? A systematic review. Br J Sports Med 40(10):870–875

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Reid DA, McNair PJ (2004) Passive force, angle, and stiffness changes after stretching of hamstring muscles. Med Sci Sports Exerc 36(11):1944–1948

    Article  PubMed  Google Scholar 

  57. Guissard N, Duchateau J (2004) Effect of static stretch training on neural and mechanical properties of the human plantar-flexor muscles. Muscle Nerve 29(2):248–255

    Article  PubMed  Google Scholar 

  58. Jeon HJ, An S, Yoo J et al (2016) The effect of monkey chair and band exercise system on shoulder range of motion and pain in post-stroke patients with hemiplegia. J Phys Ther Sci 28(8):2232–2237

    Article  PubMed  PubMed Central  Google Scholar 

  59. Marzolini S, Tang A, McIlroy W et al (2014) Outcomes in people after stroke attending an adapted cardiac rehabilitation exercise program: does time from stroke make a difference? J Stroke Cerebrovasc Dis 23(6):1648–1656

    Article  PubMed  Google Scholar 

  60. Dias CP, Freire B, Goulart NB et al (2016) Muscle architecture and torque production in stroke survivors: an observational study. Top Stroke Rehabil 24(3):206–213

    Article  PubMed  Google Scholar 

  61. Allison R, Shenton L, Bamforth K et al (2016) Incidence, time course and predictors of impairments relating to caring for the profoundly affected arm after stroke: a systematic review. Physiother Res Int 21(4):210–227

    Article  PubMed  Google Scholar 

  62. Gao F, Ren Y, Roth EJ et al (2011) Effects of repeated ankle stretching on calf muscle-tendon and ankle biomechanical properties in stroke survivors. Clin Biomech (Bristol, Avon) 26(5):516–522

    Article  Google Scholar 

  63. Jang WH, Kwon HC, Yoo KJ et al (2016) The effect of a wrist-hand stretching device for spasticity in chronic hemiparetic stroke patients. Eur J Phys Rehabil Med 52(1):65–71

    PubMed  Google Scholar 

  64. Jo HM, Song JC, Jang SH (2013) Improvements in spasticity and motor function using a static stretching device for people with chronic hemiparesis following stroke. NeuroRehabilitation 32(2):369–375

    PubMed  Google Scholar 

  65. Lincoln NB, Parry RH, Vass CD (1999) Randomized, controlled trial to evaluate increased intensity of physiotherapy treatment of arm function after stroke. Stroke 30(3):573–579

    Article  CAS  PubMed  Google Scholar 

  66. Anderson C, Rubenach S, Mhurchu CN et al (2000) Home or hospital for stroke rehabilitation? Results of a randomized controlled trial: I: health outcomes at 6 months. Stroke 31(5):1024–1031

    Article  CAS  PubMed  Google Scholar 

  67. Koc A (2015) Exercise in patients with subacute stroke: a randomized, controlled pilot study of home-based exercise in subacute stroke. Work 52(3):541–547

    Article  PubMed  Google Scholar 

  68. Roerdink M, Lamoth CJ, Kwakkel G et al (2007) Gait coordination after stroke: benefits of acoustically paced treadmill walking. Phys Ther 87(8):1009–1022

    Article  PubMed  Google Scholar 

  69. Glaister BC, Bernatz GC, Klute GK et al (2007) Video task analysis of turning during activities of daily living. Gait Posture 25(2):289–294

    Article  PubMed  Google Scholar 

  70. Hyndman D, Ashburn A, Stack E (2002) Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers. Arch Phys Med Rehabil 83(2):165–170

    Article  PubMed  Google Scholar 

  71. Mansfield A, Aqui A, Centen A et al (2015) Perturbation training to promote safe independent mobility post-stroke: study protocol for a randomized controlled trial. BMC Neurol 15:87

    Article  PubMed  PubMed Central  Google Scholar 

  72. Jung K, Kim Y, Chung Y et al (2014) Weight-shift training improves trunk control, proprioception, and balance in patients with chronic hemiparetic stroke. Tohoku J Exp Med 232(3):195–199

    Article  PubMed  Google Scholar 

  73. Cho KH, Lee KJ, Song CH (2012) Virtual-reality balance training with a video-game system improves dynamic balance in chronic stroke patients. Tohoku J Exp Med 228(1):69–74

    Article  PubMed  Google Scholar 

  74. Morone G, Tramontano M, Iosa M et al (2014) The efficacy of balance training with video game-based therapy in subacute stroke patients: a randomized controlled trial. Biomed Res Int 2014(10):580861

    PubMed  PubMed Central  Google Scholar 

  75. Hall AM, Maher CG, Lam P et al (2011) Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial. Arthritis Care Res 63(11):1576–1583

    Article  Google Scholar 

  76. Li F (2014) Transforming traditional Tai Ji Quan techniques into integrative movement therapy-Tai Ji Quan: moving for better balance. J Sport Health Sci 3(1):9–15

    Article  PubMed  PubMed Central  Google Scholar 

  77. Zheng G, Li S, Huang M et al (2015) The effect of Tai Chi training on cardiorespiratory fitness in healthy adults: a systematic review and meta-analysis. PLoS One 10(2):e0117360

    Article  PubMed  PubMed Central  Google Scholar 

  78. Li F, Harmer P, Fitzgerald K et al (2012) Tai chi and postural stability in patients with Parkinson's disease. N Engl J Med 366(6):511–519

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Wang C, Schmid CH, Rones R et al (2010) A randomized trial of tai chi for fibromyalgia. N Engl J Med 363(8):743–754

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Verhagen AP, Immink M, Meulen A et al (2004) The efficacy of Tai Chi Chuan in older adults: a systematic review. Fam Pract 21(1):107–113

    Article  PubMed  Google Scholar 

  81. Kim H, Kim YL, Lee SM (2015) Effects of therapeutic Tai Chi on balance, gait, and quality of life in chronic stroke patients. Int J Rehabil Res 38(2):156–161

    Article  PubMed  Google Scholar 

  82. Xu XD, Zhang H, Bai J et al (2014) Analysis of curative effect for Tai chi on the balance function of patients with hemiplegia after stroke. Hebei Cangzhou Integ Med Hosp 36(8):1149–1150

    Google Scholar 

  83. Taylor-Piliae RE, Hoke TM, Hepworth JT et al (2014) Effect of Tai Chi on physical function, fall rates and quality of life among older stroke survivors. Arch Phys Med Rehabil 95(5):816–824

    Article  PubMed  Google Scholar 

  84. Hart J, Kanner H, Gilboa-Mayo R et al (2004) Tai Chi Chuan practice in community-dwelling persons after stroke. Int J Rehabil Res 27(4):303–304

    Article  PubMed  Google Scholar 

  85. Li Yl HXJ, Cui LN (2012) Clinical observation on sitting Tai Chi exercise used for 30 cases of patients with depression after stroke. Chin Nurs Res 26(8):2254–2256

    Google Scholar 

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Han, P. et al. (2017). Clinical Evidence of Exercise Benefits for Stroke. In: Xiao, J. (eds) Exercise for Cardiovascular Disease Prevention and Treatment. Advances in Experimental Medicine and Biology, vol 1000. Springer, Singapore. https://doi.org/10.1007/978-981-10-4304-8_9

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