Stroke survivors should be prescribed exercise to help counteract physical deconditioning and inactive lifestyles, according to an American Heart Association/American Stroke Association scientific statement.

Lack of activity after stroke decreases survivors’ ability to perform daily living activities and increases their risk of having another stroke.

“There is strong evidence that physical activity and exercise after stroke can improve cardiovascular fitness, walking ability and upper arm strength,” said Sandra A. Billinger, P.T., Ph.D., statement lead author and a physical therapist at the University of Kansas Medical Center in Kansas City, Kan. “In addition, emerging research suggests exercise may improve depressive symptoms, cognitive function, memory and quality of life after stroke.

“Yet, too few healthcare professionals prescribe exercise as a form of therapy for stroke. There is a big gap in America between once stroke patients are discharged from rehabilitation and the transition to community exercise programs when they go home. Many are left on their own. We don’t have a system in place to help stroke patients feel comfortable with exercise.”

Stroke survivors must overcome several barriers to exercise — including the severity of their stroke, fatigue, depression, lack of social support, affordability and motivation.

“These patients may not know how or cannot afford to take advantage of exercise programs in their communities, or they can’t drive to an exercise facility, or they might not feel comfortable going to a gym,” Billinger said. “We as healthcare providers need to help stroke patients develop the skills and confidence they need to begin and maintain an exercise program that includes aerobic exercise and strength training as part of their stroke care.

“The key to exercise is that it only works if done consistently.”

Specific recommendations for post-stroke care include:

  • Adapting exercise plans to a patient’s tolerance and stage of recovery, environment, available social support, activity limitations and preferences.
  • Minimizing bed rest and having survivors sit or stand within days after a stroke.
  • Starting the exercise program when patients are able to regain or exceed their pre-stroke activity levels.
  • Incorporating aerobic exercise, strength training, flexibility and balance into rehabilitation programs.

The statement recommends that stroke survivors exercise at least three days a week for 20 to 60 minutes, although some survivors may benefit by breaking activity into 10- to 15- minute sessions of moderate activity.

Simple activities that slowly build endurance and strength, such as walking around the neighborhood or engaging in household chores, add up and make a difference, Billinger said.

“Anything is better than just sitting on the couch,” she said.

Stroke is the fourth-leading cause of death in the United States, and a leading cause of long-term disability. By 2030, as many as 11 million people could be living with stroke as more people live longer.

The statement was published in the American Heart Association journal Stroke.