"One of the challenges with stroke and exercise is that some people
think they can't because they have limited mobility," said Ada Tang
of McMaster University in Hamilton, Ontario in Canada.
"But studies are showing it's possible, safe and beneficial, even if
you can't exercise as vigorously as before," Tang, who wasn't
involved with the new study, told Reuters Health by phone.
"It was interesting to see that blood pressure reductions mirrored
blood pressure drops you'd expect if someone started taking
medication," senior study author Dr. Ali Ali of the University of
Sheffield in the UK said in a phone interview.
Ali's team pooled data from 20 earlier studies that evaluated
exercise programs after a stroke or mini-stroke (technically known
as a transient ischemic attack, or TIA). Altogether, the studies
involved 1,031 patients from 10 countries.
Some studies focused on aerobic exercise such as walking, running,
cycling and circuits; others evaluated resistance exercises aimed at
improving muscle strength or endurance.
The researchers found that stroke patients who participated in
exercise programs - particularly aerobic programs - reduced both
their top and bottom blood pressure numbers several points compared
with those who didn't exercise.
Exercise also improved cholesterol levels, but it had no effect on
blood glucose levels after overnight fasting or on body mass index.
Blood pressure reductions were most significant for those who
started exercising within six months of their stroke. The drop was
also more significant for those who also received lessons on diet
and health.
"If you start doing exercise early after a stroke, the effect may be
much more pronounced," Ali said.
Ali's team is now conducting research to learn what kinds of
exercise programs might be most appealing to stroke patients, and
what barriers might keep them from exercising, such as lack of
transportation and poor social support.
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"We need patients, families and doctors to think about exercise as a
treatment as important as medication," he said. "Doctors wouldn't
forget to prescribe blood pressure tablets, but we often forget to
talk about exercise after a stroke."
While the new analysis found that stroke survivors who exercise have
healthier blood pressures, it wasn't designed to prove that exercise
actually resulted in few repeat strokes for this group of patients.
One study that tracked people for three years did find that exercise
participants were approximately 80 percent less likely to be
hospitalized or die from stroke or cardiovascular disease during
that period.
Another limitation of the review is that 10 of the studies were at
moderate or high risk of bias. Future studies should take bias risk
into account, as well different risk factors for stroke, said Tang,
who has studied exercise-related changes in cardiovascular function
after stroke.
"Even a little bit of physical activity is important and
beneficial," Tang said. "The risk of having another stroke
continues, even years after a stroke, and exercise is rehabilitation
that can mitigate that."
Stroke, the second leading cause of death and adult disability
worldwide, affects about 15 million people a year, according to the
World Health Organization. About one in four are repeat strokes.
SOURCE: http://bit.ly/2kfRDRn British Journal of Sports Medicine,
online May 9, 2018.
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