Having looked at the benefits of repetitive task training after a stroke in previous blog post, I thought it could be helpful to look at another component of rehab and physiotherapy after a stroke: physical fitness and strength training. To do this we shall have a look at what some of the research suggests about this.

Many patients who have had a stroke will have had a long period of hospital admission (possibly including a period in intensive care) with relatively little mobilising and a long period of relative immobility following their discharge from hospital. Combined with the neurological effects of the stroke itself (commonly weakness on one side and reduced mobility) this tends to leave them very deconditioned and unable to tolerate a great deal of activity. Therefore, commonly a large part of rehabilitation, especially once out of the acute phase, will centre around exercises that are aimed at generally strengthening the patient and improving their fitness. This isn’t to say that these can replace specific activities such as repetitive task training but instead these exercises form a useful extra layer of physical therapy aimed at improving overall physical strength.

Now, I can hear some people saying that this seems like common sense! Anyone who has been immobile and in hospital for a long period of time will clearly be unfit and will need physical fitness and strength training regardless of anything else. However as evidence based practitioners it is important that we have evidence that supports the things that we do and are able to combine this with our clinical experience to provide the best therapy for patients. Certainly my own clinical experience as a physiotherapist is that all of the above is true and that patients regardless of their underlying neurological difficulties from their stroke tend to be very deconditioned and do benefit from general exercises and fitness training on a regular basis.

So, what does the research evidence say? Well, fortunately it is mostly supportive! A systematic review in 2016 looked at 58 trials of endurance training, strength training and a combination of the two. They concluded that endurance training and especially walking after a stroke can improve fitness and mobility. A combination of resistance and endurance training improved walking and balance but there wasn’t sufficiently clear evidence to suggest that resistance (strength) training on its own was effective. They also looked at mood and quality of life but unfortunately again couldn’t make any conclusions. The full review is available here: https://www.cochrane.org/CD003316/STROKE_physical-fitness-training-stroke-survivors

This is pretty good news from a physiotherapist’s point of view. It shows that giving patients a mixture of endurance and strength training improves mobility and balance (these are two extremely important factors for most patients). The evidence isn’t clear when it comes to effect on mood and quality of life but to be honest my own experience of seeing how much better patients seem and tell me they feel when they are exercising is almost evidence enough.

Okay, I hope that you have found this article helpful. If you or anyone you know has had a stroke then please feel free to get in touch. We are a home visit physiotherapy service serving Lichfield, Sutton Coldfield, Tamworth, Cannock, Rugeley and Walsall.