A guide to exercise after a stroke

Free movement is something we all take for granted until we’re immobilized by a health event. For stroke patients, limited mobility is usually more than a temporary problem. Like many health issues, stroke recovery requires exercise. The earlier it begins, the more strength patients have to recover an independent lifestyle.

“For so many reasons, we want to get them moving either actively or passively as soon as possible while they recover from the acute stage of a stroke,” says James D. Fleck, MD, a neurologist at Indiana University Health Physicians. Stroke patients usually make their greatest motor improvements within several weeks of a stroke, with the fullest recovery occurring at about the six-month mark. 

Beyond their mobility issues, stroke patients may have arthritis and other health conditions found in the general population. In that respect, Fleck says they are no different than other patients who benefit from exercise. Their exercise strategies, however, must be adapted for each patient’s unique challenges. “I can’t emphasize enough the expertise of rehabilitation, physical and occupational therapists for stroke patients,” he says.

Depending on the severity of the stroke, walking safely and using the arms can be difficult. As a result, stroke patients are predisposed to falls, and therefore, broken bones. Almost 40 percent will have a fall in the first year after their stroke, according to the National Stroke Association. Fleck says physical therapists help reduce the risk for falls by working on gait, balance and strength. 

Stroke patients often have muscle contractures and joint-related weaknesses that affect their orthopedic health. When the nervous system is affected and muscles are not being told what to do, they naturally lose strength. In physical therapy, Fleck says there may be some passive movement to keep muscles and joints as mobile as possible.

For patients with only moderate use of their arms, the shoulder joint is one of the most common orthopedic problems. A deficit of muscle tone can cause the shoulder joint to become lax and separate, resulting in pain and further loss of function. “This is one of the more frequent reasons I’ll send a stroke patient to see an orthopedic specialist,” Fleck says. Treatment often requires a sling or some manipulation to keep the joint healthy.

In Fleck’s opinion, physical and occupational therapists are the game changers for most disabilities associated with a stroke. “They can often do more for patients than I can because they address anything that gets in the way of functioning,” he says. “If an arm is weak or you can’t pick up your feet well, they’re the ones who can help you figure out ways to work around that.”

For more information about physical therapy and rehabilitation at Indiana University Health, visit our site

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