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Am Fam Physician. 2004;70(2):400

Recommendations for Exercise After Stroke

The American Heart Association; Council on Cardiovascular Nursing; Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council have released a scientific statement on exercise for stroke survivors. “Physical Activity and Exercise Recommendations for Stroke Survivors” appears in the April 27, 2004 issue of Circulation and is available online at

The statement is the first attempt to provide exercise guidance to stroke survivors. Stroke care has traditionally focused on acute stroke treatment or rehabilitation during the first few months following stroke. According to the statement, at least 20 minutes of aerobic exercise, three to seven times a week, can help reduce the risk of recurrent stroke.

An estimated 700,000 people in the United States experience a stroke annually, and about one third of those are recurrent strokes. Strokes can reduce the ability to exercise, and depression (that often accompanies stroke) can suppress the motivation to exercise. These problems can create a “vicious circle” of further decreased activity and greater exercise intolerance, leading to secondary complications such as reduced cardiorespiratory fitness, muscle atrophy, osteoporosis, and impaired circulation to the lower extremities in stroke survivors.

Physical activity is a cornerstone of risk-reducing interventions for preventing and treating stroke and myocardial infarction. Moreover, exercise can improve the quality of life among stroke survivors by strengthening muscles and improving mobility—all with the goal of restoring function.

Stroke survivors should undergo a complete medical history and physical examination before beginning an exercise program. Special adjustments may be needed, such as adding handrails or harnesses to exercise equipment.

The guidelines recommend that stroke survivors engage in 20 to 60 minutes of aerobic exercise such as walking three to seven days per week. The exercise can be done in 10-minute intervals with the goal being at least 20 minutes per day.

Stroke survivors often have muscle weakness, so the statement recommends strength training with light weights or resistances that allow at least one set of 10 to 15 repetitions to be performed. Strength training should be done at least two to three days per week and should include eight to 10 different exercises involving the major muscle groups.

The body is often less flexible after a stroke, which can make raising arms, moving legs, and performing various activities of daily living more difficult. Stroke survivors should do stretching and flexibility training before or after aerobic or strength training sessions on two to three days a week. Because stroke survivors often have balance problems, which put them at risk for falls, the statement suggests two to three sessions each week of balance or coordination exercises.

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