How to Improve Your Fitness After a Stroke

You or a loved one experienced a stroke. It was very concerning, you’re now on the other side of it. On the one hand, you’re glad to be alive. On the other hand, you’ve noticed reductions in your strength and endurance. And along with those reductions come a lot of severe consequences, like:

• Not being able to be as active.
• Because of the inactivity, there’s the risk of developing diabetes, high blood pressure, or a bad cholesterol profile.
• There’s the risk of another stroke or a heart attack.

And that’s really going to put a damper on your quality of life.

• Can you continue to travel? What kinds of vacations can you take?
• Can you continue to play with your grandkids?
• What about going out with your friends and family?
• Will you need help with basic activities, like getting out of bed, showering, etc.? Who will be helping you?

Lots of our clients come to us after experiencing a stroke, because they don’t want to go down without a fight.

Original source: here.

In this article, you’ll learn:

• What happens to your strength, endurance and balance after a stroke.
• How to improve your fitness after a stroke.

If you want a program that is more personalized to you than this article can provide, we have a special program called “Life After Stroke.” If you want to see whether or not this program is for you, just fill out the application form on our home page. That’ll set up a no-pressure, 10-15 minute zoom call (it’s free).

What Happens to Your Fitness After a Stroke?

Frequently strokes happens in people with low fitness levels to begin with, but it can also happen in some fit individuals as well.

Here is how a stroke affects different fitness qualities:

Cardiovascular Endurance

The primary measurement of cardiovascular endurance is called “maximal oxygen consumption” (or VO_2max). One study found that in both men and women, the VO_2max after a stroke drops to between 10-17 ml/kg/min. How does that compare to people who haven’t had a stroke? In sedentary men over 60, the VO_2max is 30-35 ml/kg/min. In endurance-trained men over 60, the VO_2max is 40-45 ml/kg/min. In sedentary women over 60, the VO_2max is about 22-25 ml/kg/min. In endurance-trained women over 60 the VO_2max is 35-40 ml/kg/min.

To translate this “geek-speak” to real-world terms, the bare minimum VO_2max needed to live independently is about 17.5 ml/kg/min.

Light activities, like dressing yourself, showering, going to the washroom, etc. require a VO_2max of about 20 ml/kg/min.

Things like light housework (dusting, vacuuming, etc.) or yard work (raking leaves, etc.) require a VO_2max of about 22 ml/kg/min.

Those are the bare minimum. In other words, if your VO_2max is 22 ml/kg/min, and you’re raking leaves, although in general it’s considered light yard work, it’s not light for you. Because you’re using 100% of your capacity. But if your VO_2max is 30 ml/kg/min, then raking leaves is only 73% of your capacity.

Unfortunately there are some irreversible changes that happen after a stroke that prevent the endurance from returning to pre-stroke levels, even with training, but there can be substantial improvements. In one study, people who’ve had a stroke and engaged in endurance training (cardio) improved their VO_2max by 34%. In other words, if, as a result of the stroke, their VO_2max dropped to 15 ml/kg/min, with endurance training, it can rise to about 20 ml/kg/min. Above the threshold needed to maintain independence.

But that’s a general rule. The variation in improvements can vary substantially, based on:

 

• The severity level of the stroke.
• In which part of the brain the stroke occurred. Some parts of the brain have more severe consequences than others.
• How soon you begin rehab.
• How diligent you are with the rehab.

 

Lots of people can get to within 20% of their pre-stroke levels, and a few people may even be able to exceed their pre-stroke endurance (if they weren’t exercising before the stroke).

Muscle Strength

To talk about muscle strength, we have to distinguish between the side of the body that had the stroke and the side of the body that didn’t. Both sides will experience drops in strength, but the drop on the stroke side will be much more pronounced. There are also some very specific muscle-by-muscle changes that happen after a stroke. According to one study:

• Muscles closer to the centre of the body (like shoulders, chest, upper back) have larger drops in strength compared to muscles farther from the body (like the forearms and calves).
• Muscles responsible for flexion (like biceps, the front of the shoulder, abdominals, etc.) have larger drops in strength compared to those responsible for extension (like triceps, back of the shoulder, para-spinal muscles, etc.)

By how much does strength drop after a stroke? According to one study, the side of the body that didn’t have a stroke loses about 34% of its strength. On the side that did have the stroke, the calves were 52% weaker and the quads (front of the thighs) were 36% weaker than the side that didn’t have the stroke.

Interestingly enough, this is where we need to distinguish between muscle strength and muscle mass. Because, although muscle strength drops substantially, muscle mass is unchanged after a stroke, according to this study.

Now yes, some people do experience losses in muscle mass after a stroke, but it’s not because of the stroke directly. It might be collateral damage, due to things like:

• Changes in appetite.
• General immobility – you move less, and lift less things, you’ll lose muscle mass as well.

Balance

Of course, with drops in strength, balance decreases as well, so the risk of falling is higher.

The brain has a “map” of where the body is in space, and how the different parts of the body relate to each other. If the brain is damaged during and after a stroke, you can imagine that the “map” gets disrupted as well, so there’s a worse perception of where the body is in space.

 

How to Improve Fitness After a Stroke

While it does seem that unfortunately most of the time, fitness doesn’t recover to pre-stroke levels, exercise does substantially improve fitness even in those who’ve had a stroke. It makes the difference between living independently and being dependent on either loved ones or professionals to get around.

How do you improve your fitness after a stroke? For both cardio and balance training, it’s virtually identical to how you improve your fitness even if you didn’t have a stroke.

Here are the guidelines for cardio if doing moderate intensity:

• Duration: 150 minutes per week (you can divide it however you want – 3 times per week for 50 minutes, 5 times per week for 30 minutes, etc.)
• Type: everything is about the same. Walking, elliptical, rowing, swimming, cycling, etc.
• Moderate intensity is 65-85% of your maximal heart rate (your maximal heart rate is 220 minus your age).

If you’re thinking “150 minutes per week is a lot”, I would agree with you. It really depends on how far post-stroke you are, and whether you’re currently exercising. If the stroke just happened a few weeks ago, definitely don’t start at 150 minutes per week. Start at maybe 40-60 minutes per week, and progress from there.

Here are the guidelines for cardio if doing high intensity:

• Duration: 75 minutes per week (you can divide it however you want – 3 times per week for 25 minutes, 2 times per week for 36 minutes, etc.)
• Type: everything is about the same. Walking, elliptical, rowing, swimming, cycling, etc.
• High intensity is anything over 85% of your maximal heart rate (your maximal heart rate is 220 minus your age).

If you’re currently sedentary, don’t jump into high intensity training right away. Start with about 4-8 weeks of progressive moderate intensity training, before trying high intensity training.

To improve your balance after a stroke, just follow the exercises that I describe in this video.

To improve your strength after a stroke, it’s almost identical to improving your strength when you haven’t had a stroke, with one key difference: lower duration of exercise sessions, but higher frequency.

You get tired easier, so you can’t access as much of your capacity. But because you’re doing very little work during your exercise sessions, you also recover faster. Hence the ability (and maybe necessity) of higher frequency strength training. Whereas someone who hasn’t had a stroke should be strength training 2-4 times per week, you can likely do it 3-6 times per week.

Perhaps instead of doing 3-4 sets of an exercise, you would instead do 2 sets, but again, at a higher frequency.

As for the other details, those stay the same (number of repetitions, the actual exercises, etc.). I elaborate on how to improve your strength in much greater detail in this video.

Results

What can you expect as a result of following the advice in this article?

• The ability to improve your fitness after a stroke.
• Continue to do the activities that you enjoy, whether that’s travel, playing with your grandkids, golfing, volunteering, socializing with your friends, etc.
• Avoid having to be dependent on either loved ones or healthcare professionals for basic activities like showering, putting on your clothes, or even walking around.
• Avoid developing other conditions as a result of your immobility, like diabetes, osteoporosis, etc.

 

If you want a program that is more personalized to you than this article can provide, we have a special program called “Life After Stroke.” If you want to see whether or not this program is for you, just fill out the application form on our home page. That’ll set up a no-pressure, 10-15 minute zoom call (it’s free).