BENEFITS OF AEROBIC EXERCISE AFTER STROKE

The debilitating loss of function after a stroke has both primary and secondary effects on sensorimotor function. Primary effects include pa resis, paralysis, spasticity, and sensory-perceptual dysfunction due t o upper motor neuron damage. Secondary effects, contractures and disus e muscle atrophy, are also debilitating. This paper presents theoretic al and empirical benefits of aerobic exercise after stroke, issues rel evant to measuring peak capacity, exercise training protocols, and the clinical use of aerobic exercise in this patient population. A stroke , and resulting hemiparesis, produces physiological changes in muscle fibres and muscle metabolism during exercise. These changes, along wit h comorbid cardiovascular disease, must be considered when exercising stroke patients. While few studies have measured peak exercise capacit y in hemiparetic populations, it has been consistently observed in the se studies that stroke patients have a lower functional capacity than healthy populations. Hemiparetic patients have low peak exercise respo nses probably due to a reduced number of motor units available for rec ruitment during dynamic exercise, the reduced oxidative capacity of pa retic muscle, and decreased overall endurance. Consequently, tradition al methods to predict aerobic capacity are not appropriate for use wit h stroke patients. Endurance exercise training is increasingly recogni sed as an important component in rehabilitation. An average improvemen t in maximal oxygen consumption (V over dot O-2max of 13.3% in stroke patients who participated in a 10-week aerobic exercise training progr amme has been reported compared with controls. This study underscored the potential benefits of aerobic exercise training in stroke patients . In this paper, advantages and disadvantages of exercise modalities a re discussed in relation to stroke patients. Recommendations are prese nted to maximise physical performance and minimise potential cardiac r isks during exercise.