What is the aim for rehab in Stroke patients?
Reduce rate or reverse deconditoning
What are 3 main reasons for low fitness levels in stroke patients?
- Body composition changes
- Advancing age
- Physical inactivity
Why does body composition change in stroke patients?
- Reduced central neural drive - main cause of de-conditioning
- Muscle atrophy
- Muscle fibre-‐type changes
- Activated inflammatory pathway
- Hemi-paretic side osteoporosis
- Impaired peripheral blood flow
Describe the relationship between thigh muscle mass and fitness in stroke patients
Size of thigh muscles correlates with Vo2peak.
- The paretic thigh mass is usually about 20% lower than the normal thigh.
- The inter-muscular area in the paretic thigh is usually 20% higher than the normal thigh
(Elevated intramuscular fat is linked to insulin
resistance.)
What happens to muscle fibre types in stroke patients?
The convert Type 1 fibres to Type 2.
Therefore less Type 1 fibres which are resistant to fatigue and insulin sensitive
This normally occurs due to inactivity but can also occur due to neural activities
How does an activated inflammatory pathway affect a stroke patient?
It causes an increase of cytokines in the body therefore excessive cyotkines contributes to muscle dystrophy and insulin resistance
Describe some consequences of hemi-paretic osteoporosis in stroke patients
Less physical activity Muscle atrophy Poor cardiorespiratory fitness Higher risk of fracture 14% decline in bone density in the first year
The skeletal muscle, bone, and vasomotor
regulatory abnormalities on the paretic side
may contribute to worsening cardiovascular
risk how?
By propagating physical inactivity, insulin resistance and the metabolic syndrome
Benefits of exercise in stroke patients:
Aerobic Training:
Increases capacity by 8 - 23%
Improves sensorimotor function
Resistance Training:
Strengthening of lower limb helps with balance
Increases walking speeds
Balance Training
Varied responses depending on spared brainstem
What improvements could be made in the experimental designs in which Stroke patients take part in?
- Pre-evaluation of medical history, physical examination, ECG and graded exercise test
- Exercise tests should be adapted to the patient based on their capabilities.
What are the leading causes of mortality in stroke patients?
- Recurrent Strokes and cardiovascular disease
What are some benefits of aerobic exercise in stroke patients?
- Can improve CVD risk factors, therefore making management of stroke easier
- Evidence that leisure time physical activity reduces the risk of stroke
- Stroke patients are able to train as much as healthy people in their age range
