Front Panel Painting “LIFE” By William T Chua MD

For women, the Nurses’ Health Study and the Copenhagen City Heart Study showed
an inverse association between level of physical activity and stroke incidence.
12
Physical activity (in sports, leisure time or at work) also reduced risk of ischemic
strokes, in particular.
7
The protective effect of physical activity may be partly mediated by BP reduction,
improvement of lipid profiles (reduction in triglyceride, increase in HDL, and
decrease in LDL:HDL ratios), improvement of glucose homeostasis and insulin
sensitivity, and improvement in body composition and weight.
3,4
Other benefits of
physical activity include reduction in blood coagulability,
13
improvement of
coronary blood flow,
14
augmentation of cardiac function,
15
enhancement of
endothelial function,
16
improvement of autonomic tone,
17
and reduction of
systemic inflammation.
18
B.2. Secondary Stroke Prevention
Among stroke survivors, approximately 14% achieve full recovery in physical
function, between 25-50% require at least some assistance with activities of daily
living, and half experience severe long-term effects such as partial paralysis. Activity
intolerance is hence, common among stroke survivors, especially in the elderly.
19,20
Stroke survivors are also often deconditioned and thus are further predisposed to a
sedentary lifestyle that limits performance of activities of daily living, increases the
risk for falls, and may contribute to a heightened risk for recurrent stroke and
cardiovascular disease.
Cardiorespiratory Response to Acute Exercise in Stroke Survivors:
Many physiologic changes occur among stroke survivors, especially among those
with moderate to severe deficits. The cardiac response to acute exercise among
stroke survivors has been documented in some studies. Stroke patients achieve
significantly lower maximal workloads, heart rate and BP responses than control
subjects during progressive exercise testing. 21 In general, oxygen uptake at a given
submaximal workload in stroke patients is greater than in healthy subjects, possibly
because of reduced mechanical efficiency, the effects of spasticity, or both. Another
physiologic change that occurs among stroke patients is reduction in peak oxygen
uptake. Ambulatory stroke survivors may be able to perform at reduced peak oxygen
consumption and reduced peak power output that can be achieved by age- and
gender-matched individuals without a history of stroke. 19,20
Traditionally, the physical rehabilitation of stroke survivors typically ends within
several months after stroke because it was believed that most, if not all recovery of
motor function, occurred during this interval. Recent research studies have shown
that aggressive rehabilitation beyond this time period, including treadmill and aerobic
exercise, is beneficial especially in increasing strength, timing of muscle activations
and cardiorespiratory fitness or aerobic capacity 22 among stroke survivors.
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Primary & Secondary
Prevention