http://stroke.ahajournals.org/content/early/2014/05/20/STR.0000000000000022.full.pdf+html
Annually, 795,000 people in the United States experience a stroke; or ≈
1 person every 40 seconds, and nearly one quarter of these strokes are recurrent.
1
An estimated 7 million American adults are living with a stroke,
1
and it is projected that an additional 4 million will have a stroke by 2030, which
is almost a 25% increase in prevalence from 2010.
2
Data from the Framingham Study revealed a lifetime stroke risk of 1 in 5 for women and 1 in 6 for men among those 55 to 75 years of age.
3
Moreover, the incidence of stroke is likely to continue to escalate because of an expanding population of
elderly Americans
4
and the apparent epidemic in the general population regarding modifiable cardiovascular risk factors,
including diabetes mellitus, obesity, and physical inactivity. American adults with disability are more likely to be obese, to smoke, and to be physically inactive,
5
which leads to an increased cardiovascular risk in an already functionally compromised population. When considered independently from other cardiovascular diseases (CVDs), stroke continues to be the fourth-leading cause of death in the United States.
1
Unfortunately, stroke remains a leading cause of long-term disability in the United States.
1
Consequently, stroke survivors are often deconditioned and predisposed to a sedentary lifestyle that adversely impacts performance of activities of daily living, increases the risk for falls, and may contribute to a heightened risk for recurrent stroke and other CVDs. The majority of studies have investigated ischemic stroke, although stroke is often considered a broader term for a transient ischemic attack (TIA), ischemic stroke, or intracerebral hemorrhage. All 3 of these categories pose an increased risk for a future vascular event
6,7
; however, this risk is further elevated in patients with cerebrovascular disease and comorbid CVD.
6,7
Although stroke survivors vary in their level of participation in
physical activity, hospital- and community-based studies have
consistently found low levels of activity.
8,9
On a population basis, the physical activity of community-living stroke survivors is lower than that of older adults with other chronic health conditions of the musculoskeletal or cardiovascular system.
10
Physical activity and exercise have the potential to positively influence multiple physical and psychosocial domains
after stroke. We define physical activity as “any bodily movement produced by skeletal muscles that results in energy
expenditure,” whereas exercise is “a subset of physical activity that is planned, structured, and repetitive and has as a final or an intermediate objective the improvement or maintenance of physical fitness.”
11
There is strong evidence that exercise after stroke can improve cardiovascular fitness,
12
walking ability,
13
and upper-extremity muscle strength.
14
There are less consistent reports of lower-extremity muscle strength gains.
15
Although exercise has been shown to reduce falls in older adults,
16
this finding has not been confirmed in stroke,
17
likely a consequence of too few studies with relatively small sample sizes. Although exercise has primarily been used to improve physical function after stroke, emerging research suggests that exercise may improve depressive symptoms,
18
some aspects of executive functioning and memory,
19–21
and health-related quality of life
22
after stroke and poststroke fatigue.
23
Therefore, stroke survivors can benefit from counseling on increasing participation in physical activity,
24
as well as the appropriate prescription for exercise training. However, most healthcare professionals have limited experience and guidance in exercise programming for this diverse and escalating patient population. The present scientific statement is intended to help bridge the current knowledge gap in physical activity
and exercise recommendations in the stroke population.
No comments:
Post a Comment