Stroke Patients Benefit From Delayed Aerobic Exercise

University of Maryland School of Medicine neurologist Richard F. Macko, MD, will present findings to an 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, according to Macko.

An assistant professor of neurology and gerontology, Macko headed a six-month non-controlled study in Baltimore of 21 patients who had strokes that partially paralyzed one side of their bodies. Their average age was 67. All had their strokes at least six months before starting exercise training.

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 reports. Aerobic exercise reduced the cardiovascular demands that walking makes on stroke patients. That is significant, he says, 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.

"Stroke patients are aerobically disabled by poor fitness and the high-energy demands of walking," Macko explains. "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 adds.

Future research should include randomized clinical trials to study the longterm effects of regular aerobic exercise and strength training as rehabilitation tools for stroke patients, the neurologist says. He adds: "Rehabilitation research needs to be integrated with cardiovascular and quality-of-life studies, health-care outcomes research, and cost/benefit analysis. I believe that would demonstrate the public health value of regular exercise as a way to restore mobility and reduce cardiovascular risk after stroke." Macko’s stroke research was conducted at the Baltimore VA Medical Center, a University of Maryland teaching hospital. It was supported in part by the National Institute on Aging of the National Institutes of Health; the Geriatrics Research, Education and Clinical Center of the Baltimore VA; and a VA career development award.

The University of Maryland educates the majority of the state's doctors, lawyers, pharmacists and social workers and the majority of its dentists. In addition, nearly 90 percent of the graduates of the School of Nursing work in Maryland.