Exercise

1
Exercise
2
Risks of not exercising after stroke

• Reduced muscle strength and power
• VO2 max about 50 of age-matched controls
• Difficulty with activities of daily living, e.g.
  hoovering, shopping
• Unable to cross the road fast enough
• ? risk of further vascular events
• ? risks of falls
• ? community integration
• ? Risk of hospitalisation
• ? Risk of long term complications.

3
Risks associated with exercise after stroke

• The same risks which are associated with other
  co-morbidities e.g. Cardiac and OA
• The risks associated with stroke impairment e.g.
  weakness, fatigue, comprehension
• The risks associated with activities and stroke
  e.g. falls, pain

4
Benefits of exercise after stroke

• Improves physical fitness
• Improves walking performance (as long as walking
  is included)
• Benefits are exercise-specific
• Subjective evidence of mood / socialisation
  improvements

5
Current service models

• There are 3 different stroke-specific service
  models for Exercise after Stroke in Scotland
• Rehabilitation extensions (NHS run)
• Leisure services (e.g. Glasgow Vitality
  service)
• NGOs e.g. Different strokes, CHSS groups

6
Pathways into Exercise after Stroke
Discharge from hospital rehabilitation
Community stroke survivors
Screening for absolute contraindications Functiona
l Assessment Referral to EAS service Complete a
referral form
Health care professional
Feedback
Pre-exercise assessment
Exercise professional
Exercise after stroke sessions in leisure centre
Continue exercise after stroke sessions
Mainstream exercise services
7
COMMUNITY PHYSICAL ACTIVITY PATHWAY
Patient identified who would benefit from
increasing physical activity levels
Yes
No
Is patient ready to increase physical activity
levels?
Does patient have any absolute contraindications?
e.g. BP 180/100mmHg, unstable angina, acute or
chronic heart failure, uncontrolled tachycardia
or arrhythmia, uncontrolled diabetes etc.
May not be ready now. Offer information on
Physical Activity and leave open-door for
discussion in the future.
Not for community physical activity programme
until stable /reviewed by GP or cardiologist as
appropriate. Consider Cardiac/Pulmonary rehab
Services.
No
Yes
Would patient benefit from/wishes behavioural
change support?
No
Yes
Does patient have a history of heart disease or
stroke?
Offer Live Active Referral Scheme 12 months 11
behavioural change support via face to face
telephone consultations tailored activity
goals. Use referral form or contact 0141 287 9873
Yes - Re-emphasis role of Live Active Programme
No
Is patient interested in a structured group
activity?
Offer Vitality Programme Suitable for individuals
with long-term conditions low aerobic
fitness/functional ability. Offer help to
complete PAR-Q form if required. Individuals with
established heart disease or stroke can only
access this programme via the Live Active
referral scheme. Please Note Vitality classes
are group based only.
No
Yes
Signpost to Local Leisure Providers for info on
activities e.g. gym, health walks, swimming.
Reinforce active options, e.g. walking, using
the stairs etc
8
Instructor training

• Recommended by Skills Active
• Currently only 1 course endorsed Later Life
  Training 6 day course with qualification (
  therefore insurance!)
• Available to AHPs Exercise Instructors.
• Includes some workforce planning
• Ensures basic competencies

9
Resources

• Live Active Administrator
• 0141 287 9873
• Vitality Programme Co-ordinator
• 0141 287 9882
• Walk Glasgow Co-ordinator
• 0141 287 0963
• Culture and Sport Glasgow
• 0141 287 4350