Exercise as it relates to Disease/Effective exercise rehabilitation for stroke patients; aerobic vs resistance training

Prevalence
Stroke is the fifth most common cause of death worldwide. An estimated 350 000 Australians are currently recovering from stroke, with approximately 150 000 living with a stroke-related disability.

What is a Stroke?
A stroke occurs when there is a sustaining disruption of blood flow within the brain. Depending on where the disruption occurs, the death of specialized cells will cause severe disabilities in mental cognition, motor control, or speech
 * Ischemic Stroke - A blood clot from a distant blood vessel breaks off, travels to the brain and blocks a small blood vessel (embolic). Alternatively, the blood vessel becomes so narrow that blood cannot pass through it (caused by atherosclerosis)(thrombotic)
 * Haemorrhagic Stroke – A blood vessel in the brain bursts (caused by thinning of vessel lining) (Intracerebral). Otherwise, bleeding occurs in the area surrounding the brain (not in the brain tissue)(subarachnoid)

Causes of Stroke
These comorbidities significantly increase the chances of a stroke, and stem from risk factors such as,:
 * Abnormal blood cholesterol and lipoprotein levels
 * Hypertension and atherosclerotic lesions within blood vessels
 * Diabetes, high inflammatory responses, carotid artery disease and other chronic cardiovascular diseases

Effects of Stroke

 * Paralysis of a limb or entire side of the body
 * Dysphagia, (difficulty swallowing)
 * Ataxia (Damage to the cerebellum, affecting coordination and gait)
 * Aphasia (Expressive and receptive - difficulty communicating and understanding words)
 * Chronic pain and sensory dysfunction
 * Loss of cognitive function (memory, learning, higher order thinking)

Current Rehabilitation Methods

 * Modification of lifestyle (e.g. quit smoking, regular exercise, balanced diet)
 * Appropriate pharmacological therapy to manage comorbidities and pain
 * Exercise regimes to improve strength and physical endurance

Recommendations for Effective Exercise Rehabilitation
Before undertaking exercise, the patient must be prescreened. Current medication, range of mobility, strength and associated comorbidities must be considered in devising a supervised exercise program.

Improving Compliance

 * Involvement and support from the patients family and social interaction
 * Psychological state (a positive outlook) and an interest in prescribed exercises will lead to increased motivation
 * Altering activities to reduce exercise-related pain caused from comorbidities
 * Catering to patient’s daily schedule (associated time restraints)