PT Weekly: Stroke Prevention and how to lower your risk of having a stroke through exercise

A stroke is caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue.

The most common symptom of a stroke is sudden weakness or numbness of the face, arm or leg, most often on one side of the body. Other symptoms include confusion, difficulty speaking or understanding speech; difficulty seeing with one or both eyes; difficulty walking, dizziness, loss of balance or coordination; a severe headache with no known cause; fainting or unconsciousness. The effects of a stroke depend on which part of the brain is injured and how severely it is affected. A very severe stroke can cause sudden death. Stroke was traditionally, “a disease of the old people”, but recent research and clinical experience have shown that stroke also affects younger people.

Stroke is a leading cause of morbidity and mortality worldwide, and it is likely to worsen in developing countries over the next two decades based on the projections by the World Health Organization (WHO). With the current scourge of HIV/AIDS and the battle against other communicable diseases like multi‐drug resistant malaria and tuberculosis; Nigeria, the most populous black nation in the world, stands to risk the further straining of its resources as a result of the increasing prevalence of stroke and other cardiovascular diseases due to epidemiological transition. The current prevalence of stroke in Nigeria is 1·14 per 1000 while the 30‐day case fatality rate is as high as 40%. Management of the disease is largely conservative while there is little or no funding for high‐quality research. Primary prevention is the key to reducing the burden of the disease in a country with such poor resources.

You can’t control some stroke risk factors, like heredity, age, gender, and ethnicity. Some medical conditions—including high blood pressure, high cholesterol, heart disease, diabetes, overweight or obesity, and previous stroke or transient ischemic attack (TIA)—can also raise your stroke risk. Avoiding smoking and drinking too much alcohol, eating a balanced diet, and getting exercise are all choices you can make to reduce your risk.

Why Exercise?
Exercise can reduce your risk of having a stroke or transient ischaemic attack (TIA). Just 30 minutes of moderate activity five days a week can reduce your risk of stroke by over 25%. It also has benefits for your physical and mental health including: lowering your blood pressure • lowering your cholesterol levels • reducing your risk of health problems like heart disease and type 2 diabetes • helping you to lose weight if you need to, and maintain a healthy weight • increasing muscle strength and flexibility • helping to reduce levels of anxiety and depression • increasing your energy levels • improving self esteem • helping you to sleep better.

Choice of Exercises
Your choice of exercise will depend on your interests, your physical abilities and what is available in your local area. You may prefer to exercise outdoors or indoors, to exercise on your own or with others. If you want to be more active, you can try to move around more throughout the day, by doing things like walking the dog, gardening, or taking the stairs instead of a lift. Before becoming more active or starting to exercise you should speak to your physical therapist, particularly if you have not done any exercise for some time. The side effects of some kinds of medication may also affect your exercise choices. Some types of exercise to choose from include walking, jogging, swimming and cycling. Some people enjoy going to the gym, playing a team sport or dancing. You can also try some types of exercise that improve flexibility, such as yoga and pilates.

How much exercise should I do?

Aerobic Exercises
All adults, including those over 65, should try to be active daily. Aim for at least 150 minutes of moderate aerobic activity a week in total, or 75 minutes of vigorous aerobic activity. • Moderate aerobic activity will raise your heart rate and make you feel warmer, but not too out of breath to speak. This can include cycling, walking, tennis and water aerobics. To achieve 150 minutes per week, you should do 30 minutes of physical activity five or more times a week. • Vigorous aerobic activity makes you breathe hard and you won’t be able to talk much while exercising. It can include things like football, singles tennis, running, aerobics and fast swimming. In general, 75 minutes of vigorous activity can give similar health benefits to 150 minutes of moderate activity per week.

Strength building
As well as aerobic exercise, all adults need to do strength exercises on two or more days a week, aiming to work all the major muscles. You can do strength exercises at home, such lifting small weights with your arms, or using a chair to support you doing leg exercises. You can also try using machines in the gym, with support from a trainer/physical therapist. To gain strength, you would need to repeat the exercises for a set number of times two or three times a week. Some vigorous exercises count as both aerobic and muscle-strengthening, such as circuit training, running, football and aerobics.

Improving fitness
To help improve your fitness, you can gradually build up the amount of exercise you do. Remember to have rest days, and if you have fatigue, try to be aware of what can trigger your fatigue. Always stop an exercise if you experience pain. Even if you take plenty of exercise, moving around during the day, and avoiding sitting for long periods if you can, is also important for reducing your risk of diabetes and heart disease.

When should I exercise?

Some people prefer exercising in the morning, some later in the day. Judging by how your body feels you will be able to decide what time suits you. If you plan your exercise so that it fits into your daily routine, you might be more likely to keep going with it.

Avoiding injury
Before you exercise, you can avoid injury to your muscles by: 1. warming up before starting, for example walking slowly for 10 minutes before brisk walking 2. cooling down afterward by lowering the intensity of the exercise and letting your heart rate decrease 3. stretching out your muscles at the end.

Enjoying exercise
To help you stay motivated, it is important you enjoy your exercise activities. You may wish to do the following: • try something new – perhaps you’ve always wanted to have a go at dancing, now’s your chance! • get an exercise partner – see if a friend or family member can join you and you can encourage each other • exercise to music – play some music you enjoy and the time will soon pass • set yourself some goals and celebrate when you reach them. Your goal could be anything from walking further than last time, to keeping to your exercise plan for a week •Keep going, it might be hard at first but it does get easier • join a group – many people find being in a class or group makes an activity more enjoyable and social.

 

B.I.A Akinola, PT, MSc
(Neurophysiotherapist)