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Stroke – Improved fitness

Evidence Summary
Following stroke, studies which have used elements of cardiorespiratory training or a mixture of different forms of training such as circuit training type activities have demonstrated improvements in physical fitness in the form of VO2Max. This is important as low VO2 max may be associated, particularly in older adults, with limitation in function. Physical activity programmes involving resistance type activities have been shown to result in improvements in upper and lower body strength in people following stroke.

Quality of Evidence
Grade A-This recommendation comes from a synthesis of studies in the form of a Cochrane review and thus can be considered of high quality.

Strength of Recommendation
Grade 1- This recommendation comes from a synthesis of studies in the form of a Cochrane review and thus can be considered strong

Conclusion
Physical activity after stroke can result in improvements in physical fitness and in strength. Low physical fitness can be an important barrier to physical function and independence and so improvements in physical fitness could be important in empowering people after stroke.

References
• Saunders DH, Sanderson M, Hayes S, Johnson L, Kramer S, Carter DD, Jarvis H, Brazzelli M, Mead GE. Physical fitness training for stroke patients Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD003316. DOI: 10.1002/14651858.CD003316.pub7.
• Bateman A, Culpan FJ, Pickering AD, Powell JH, Scott OM, Greenwood RJ. The effect of aerobic training on rehabilitation outcomes after recent severe brain injury: a randomized controlled evaluation. Archives of Physical Medicine and Rehabilitation 2001;82(2):174-82.
• Globas C, Becker C, Cerny J, Lam JM, Lindemann U, Forrester LW, et al. Chronic stroke survivors benefit from high intensity aerobic treadmill exercise: a randomized control trial. Neurorehabilitation and Neural Repair 2012;26(1):85-95.
• Ivey FM, Ryan AS, Hafer-Macko CE, Macko RF. Improved cerebral vasomotor reactivity after exercise training in hemiparetic stroke survivors. Stroke 2011;42(7):1994-2000.
• Jin H, Jiang Y, Wei Q, Chen L, Ma G. Effects of aerobic cycling training on cardiovascular fitness and heart rate recovery in patients with chronic stroke. Neuro Rehabilitation 2013;32(2):327-35.
• Katz-Leurer M, Carmeli E, Shochina M. The effect of early aerobic training on independence six months post stroke. Clinical Rehabilitation 2003;17(7):735.
• Lennon O, Carey A, Gaffney N, Stephenson J, Blake C. A pilot randomized controlled trial to evaluate the benefit of the cardiac rehabilitation paradigm for the non-acute ischaemic stroke population. Clinical Rehabilitation 2008;22(2):125-33
• Mead GE, Greig CA, Cunningham I, Lewis SJ, Dinan S, Saunders DH, et al. Stroke: a randomised trial of exercise or relaxation. Journal of the American Geriatrics Society 2007; 55(6):892–9
• Moore JL, Roth EJ, Killian C, Hornby TG. Locomotor training improves daily stepping activity and gait efficiency in individuals poststroke who have reached a “plateau” in recovery. Stroke 2010;41(1):129-35.
• Potempa K, Lopez M, Braun LT, Szidon JP, Fogg L, Tincknell T. Physiological outcomes of aerobic exercise training in hemiparetic stroke patients. Stroke 1995;26(1):101-5.

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