After a stroke: Does fitness training improve health and mobility?

Photo of an older couple doing Nordic walking (PantherMedia / Christoph Hähnel)

Fitness training as part of rehabilitation after a stroke can increase physical fitness and improve mobility.

Strokes damage the brain because they disrupt the blood supply. Most people survive a stroke. But they may be left with paralysis in certain parts of their body, or have problems with various abilities, like speech. Psychological problems such as depression are also possible.

People often find it particularly important to regain mobility and speech after a stroke, as well as become as independent as possible again. Regaining emotional stability is also key.

At first glance, remaining physically fit may seem less important. But people who aren't that fit also have more difficulty doing exercises that promote recovery and maintain independence. A vicious circle can then begin: If you’re less fit, you’re less active, and you become even more unfit.

Physical fitness also plays a role in improving the health of your heart, lowering high blood pressure (hypertension), and preventing another stroke.

Research on fitness training after a stroke

Researchers from the Cochrane Collaboration – an international network of researchers – looked for good-quality studies which evaluated the benefits of fitness training after a stroke. They found 58 randomized controlled trials with a total of almost 2,800 men and women who had had a stroke. The average age of the participants was about 62.

The following three types of training were analyzed in the studies:

  • Cardiovascular programs for healthy heart and lungs (28 studies)
  • Strength training (13 studies)
  • Programs which combined cardiovascular and strength training (17 studies)

The most common form of cardiovascular training was Nordic walking, which had the goal of being able to walk faster and further. There were also programs which intended to improve independent walking (without the use of walking aids or other support). For example, one fitness program consisted of 20 minutes of walking training three times a week. A number of programs also used treadmills or exercise bikes. Some programs started during rehabilitation, within a few weeks after the stroke, while others only started after rehabilitation had finished.

Acceptance of these fitness programs was high. The participants in the studies attended an average of 65 to 100% of the training sessions. The cardiovascular exercises had a number of benefits. There were signs that the participants’ heart and lung fitness improved. Their mobility also improved, and they were able to walk faster and further. That reduced the physical restrictions resulting from the stroke. Programs that combined cardiovascular and strength training also improved mobility. Strength training alone had no influence on mobility. There hasn’t been enough research to be able to say whether strength training alone has any other effects.

Fitness training may also have adverse effects – for example muscle injuries, falls or heart problems. But in the studies, no falls, broken bones or injuries were observed during the fitness training programs, and there was no increase in the number of heart attacks.

Regaining strength and fitness after a stroke can require a lot of effort and motivation. But even minor improvements can lead to real progress.