Exercise After Stroke

Benefits of Exercise after stroke

There is an increasing body of literature showing that exercise is of benefit to people after stroke [1-4]. Exercise improves physical fitness and physical function (particularly walking ability) and so reduces disability. Exercise, may, in theory have a number of other benefits e.g. improving mood, and reducing the risk of recurrent stroke and other vascular events. Anecdotally, people after stroke who have participated in exercise programmes have told us that exercise reduces fatigue, increases confidence and improves quality of life.

Exercise after stroke is recommended in the recent Royal College of Physicians guidelines for stroke [5] and the new Scottish Intercollegiate Guideline Network (SIGN) guideline for stroke [6]. SIGN also recommends, as a best practice point, that exercise should be delivered by exercise instructors with knowledge and training in exercise and stroke (p 49).

Exercise after stroke instructor course

We have developed, with Skills Active, UK standards for the delivery of exercise for people after stroke. We then set up the first Specialist Instructor Training course for exercise instructors to design and deliver exercise programmes for people after stroke. This initiative was funded by the Scottish Government, Chest Heart & Stroke Scotland, Edinburgh Leisure and Glasgow Health Board, and validated and delivered through Queen Margaret University, Edinburgh. The course is aligned with the other two Skills Active and Register for Exercise Professionals Level 4 Specialist Instructor Training Courses and Qualifications (Cardiac Rehabilitation and Exercise for the Prevention of Falls).

Exercise services for people after stroke

We are aware of considerable variation in the provision of exercise services across Scotland. Given that exercise is of benefit after stroke, it is crucial that there is equity of access to exercise and standardisation of referral pathways and service delivery, based on current scientific evidence and best practice guidelines.

The potential to improve stroke care

The overarching aim of this project is to facilitate the development of high quality exercise services across Scotland that are safe, effective, person-centred and evidence-based. This has significant potential to improve the care, health and well-being of people after stroke.

Specific aims of the proposed project

There are three aims of this project.

  1. Firstly, we will scope current provision of exercise services. This will involve surveying stroke Managed Clinical Networks, Leisure Centres, Charities (CHSS, Stroke Association and Different Strokes) and private gyms to identify whether they run exercise services for people after stroke, what the services comprise in terms of content, organisation and funding, what referral routes they use, and how they manage people who self-refer for exercise after stroke.
  2. Secondly, we will develop best practice guidelines for i) the provision of exercise after stroke services, based on current best evidence, ii) referral routes and responsibilities and iii) how to evaluate services
  3. Thirdly, this website will provide a bank of evidence, evaluation tools, guidance and lists of contacts for health professionals, exercise instructors and service uses, based on sections (a) and (b).

Key References

  1. Saunders D, Greig C, Young A, Mead GE Physical fitness training for stroke patients (Cochrane review) In: The Cochrane Library, Issue 1, 2004. Chichester UK
  2. Studenski S, Duncan PW, Perera S, Reker D, Lai SM, Richards L Daily functioning and Quality of Life in a randomised controlled trial of Therapeutic Exercise for Subacute Stroke Survivors Stroke 2005; 36:1764-1770
  3. Pang WYC, Eng JJ, Dawson AS, McKay HA, Harris JE. A community-based fitness and mobility exercise programme for older adults with chronic stroke: A Randomised Controlled Trial J Am Geriatrics Soc 2005;53:1667-1674
  4. Mead G, Greig CA, Cunningham I, Lewis SJ, Dinan S, Fitzsimons C, Young A. STroke: A Randomised Trial of Exercise or Relaxation (STARTER) J Am Geriatrics Soc 2007; 55:892-9
  5. Intercollegiate Stroke Working Party. National clinical guideline for stroke. 3rd edition London: Royal College of Physicians, 2008. View... (accessed 17 June 2009).
  6. Scottish Intercollegiate Guidelines Network (SIGN), Management of patients with stroke or TIA: assessment, investigation, immediate management and secondary prevention: a national clinical guideline. Edinburgh: SIGN, 2008. View... (accessed 17 June 2009).