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| |  Stroke Patients Benefit From Delayed Aerobic Exercise BALTIMORE, MD -- April 24, 1998 -- Contrary to conventional rehabilitation wisdom, aerobic exercise is a safe and effective way to improve the strength and cardiovascular fitness of stroke patients, even if they begin exercising six months or more after their stroke. University of Maryland School of Medicine assistant professor of neurology and gerontology, Richard Macko, MD, presented findings at the American Society of Neurorehabilitation meeting in Minneapolis today that contradict a widely-held belief that most improvement in walking and other functional abilities occurs during the initial three to six months immediately following stroke. Conventional rehabilitation is concentrated in the first months after a stroke, a period when health care reimbursement is more likely to cover it, he said.. Patients with mild to moderate walking impairment exercised on a treadmill, starting with 15 minute sessions and increasing to 40 minutes. The treadmill training improved strength and increased peak fitness. It also improved floor-walking performance significantly, Macko said. Aerobic exercise reduced the cardiovascular demands that walking makes on stroke patients. That is significant because the stroke patients tested had cardiovascular fitness levels about 40 percent lower than people of the same age who had not had a stroke, he explained. "Stroke patients are aerobically disabled by poor fitness and the high-energy demands of walking," Macko explained. "Task-oriented aerobic exercise improves fitness and enhances functional mobility in patients with mild to moderate chronic hemiparesis [partial paralysis on one side.]" Stroke is the leading cause of disability in older Americans. Recent studies indicate that there are 731,000 strokes annually in the U.S., a number that is expected to nearly double over the next 50 years, as the baby boomers age. Approximately half of all stroke patients have neurologic deficits that affect their ability to walk normally, Macko says, and three out of four have cardiovascular problems as well. Because there is a high rate of cardiovascular disease in stroke patients, Macko recommends cardiac stress testing before starting aerobic training. Supervised low-intensity aerobic treadmill training lowers the oxygen demands made on the heart while walking, evidence that this form of exercise would be beneficial in stroke patients with coronary artery disease, he added. Future research should include randomised clinical trials to study the long-term effects of regular aerobic exercise and strength training as rehabilitation tools for stroke patients, the neurologist said. "Rehabilitation research needs to be integrated with cardiovascular and quality-of-life studies, health-care outcomes research and cost/benefit analysis," Macko said. "I believe that would demonstrate the public health value of regular exercise as a way to restore mobility and reduce cardiovascular risk after stroke."
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