Getting back to fitness after stroke

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Getting back to fitness after stroke

• Mark Smith
• Consultant Physiotherapist
• Stroke Rehabilitation
• NHS Lothian

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Key terms

• Physical Activity any bodily movement produced
  by skeletal muscles that results in energy
  expenditure
• Exercise a type of physical activity that is
  planned and structured done to improve or to
  maintain physical fitness
• Physical Fitness a set of attributes that
  includes cardio-respiratory endurance,
  flexibility, body composition, balance, agility,
  power, strength, reaction time, speed and
  co-ordination

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Types of Exercise

• Aerobic consists of rhythmic, repeated and
  continuous movements of the same large muscle
  groups for at least 10 min at a time. Eg.
  Walking, cycling, jogging, continuous swimming,
  classes
• Resistance exercise (strength training)
  activities that use muscular strength to move a
  weight or work against a resistive load. Eg.
  Weight lifting and exercises using weight
  machines in gyms
• Flexibility training mainly stretching aimed at
  increasing or maintaining range of motion at
  joints

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Barriers to exercise

• Time limitations
• Financial limitations
• Limited access to facilities
• Disability
• Lack of appreciation of the benefits
• Concerns about risks of exercise
• Habit - lifestyle
• The weather!
• Only fit people do it!

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Benefits of Aerobic training

• Cardiovascular disease decreased mortality and
  better mobility
• Blood pressure reduces high BP
• Diabetes improves cardiovascular fitness,
  glycaemic control and insulin sensitivity, and
  reduced mortality
• Arthritis walking reduces knee pain in
  osteoarthritis
• Bone health increased bone mineral density

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Benefits of Resistance training

• Increases muscle strength and size, walking speed
  and stair climbing even in older people
• Arthritis reduced knee pain and disability
• Bone health increased bone density
• Weight maintenance can oppose loss of muscle
  mass

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Benefits of Resistance training

• Balance combination of resistance training and
  flexibility training can reduce the risk of falls
  in older people
• Depression strength training may be as
  effective as some medications at reducing the
  symptoms of depression in older adults

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Risks of exercise

• Biggest risk is not starting!
• Injuries
• Falls
• Acutely increased BP
• Adverse cardiac events
• Hypoglycaemia

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Who can exercise?

• Almost anyone!
• Medical screening in cases of prior illness
• Benefits of exercise, particularly in association
  with a balanced diet and lifestyle management,
  are freely available
• Edinburgh Leisure Ageing Well Project

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Exercise after stroke

• Exercise?
• or
• Fitness training?

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Physical fitness training after Stroke

• Cochrane Systematic Review (Saunders et al 2004)
  12 high quality research studies (randomised
  trials) with 289 patients in combination with
  more recent studies suggest that there may be
  benefits for
• Strength
• Disability
• Mobility walking speed, endurance
• Balance

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Training the trainers Exercise for Stroke Course

• Planning Exercise after Stroke Course for Fitness
  Trainers based on STARTER began in 2007
• Queen Margaret University and University of
  Edinburgh
• CHSS, Edinburgh Leisure, NHS Greater Glasgow,
  Scottish Government
• 200 hours lectures, tutorials, SD learning
• NVQ Level 4
• 18 participants
• July 2008

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Exercising after stroke

• Tone spasticity
• Compensations (overuse)
• Weakness
• Numbness
• Swelling
• Functioning dressing, going to the toilet
• Balance
• Communicating
• Venue - access

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Exercising after stroke

• Modifications
• Minimise compensations/increased tone
• Symmetry
• Upper limb - shoulder
• Lower limb foot/ankle
• Closed chain vs Open chain
• Classes vs 11
• Building a pattern into lifestyle
• Using best environment

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Access to exercise and physical fitness training
after stroke

• Physical Activity and Health Alliance
• Ageing Well Get Up and Go Project
• Collaboration between the Lothian Stroke MCN
  (Community Service Development Subgroup) and
  Edinburgh Leisure
• To develop appropriate service interventions and
  physical fitness pathways for stroke in Lothian
• Using local leisure facilities

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Access to exercise and physical fitness training
after stroke

• Programme design evidence-based
• Simple
• Functional
• Do-able exercises graded
• Do-able regime
• Enjoyable and varied
• Appropriate location
• Challenging
• Evaluation prospective, observational, cohort
  study
• Referral

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Exercise pathways after stroke

• In Edinburgh
• North
• WGH RVH CRS Ainslie Park
• South
• RIE Liberton ECSS Gracemount

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Acknowledgements

• Dr Gillian Mead, Lecturer, University of
  Edinburgh
• Dave Saunders, Lecturer, University of Edinburgh
• Susie Dinan, Senior Research Fellow, Royal Free
  and University College Medical School, London
• John Dennis, Clinical Specialist Physiotherapist,
  Greater Glasgow
• Dr Frederike van Wijck, Lecturer, Queen Margaret
  University, Edinburgh
• Prof Marie Donaghy, Queen Margaret University
• Helen MacFarlane, Edinburgh Leisure

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