# Exercise as it relates to Disease/Exercise for reducing the risk of stroke
## Background - What is a stroke?

A stroke is a brain attack which blocks blood flow to the brain, and deprives the brain tissue of vital oxygen and nutrients. When brain tissue is starved of this blood supply, brain cells begin to die at a rapid rate of two million brain cells a minute. Every moment that a patient is left untreated during a stroke increases the risk and severity of permanent brain damage, disability and death.

#### What are the different types of stroke?

* Ischemic stroke – This is the most common type of stroke accounting for 87% of strokes suffered. An Ischemic stroke occurs when a blood clot or fatty deposit (i.e. plaque, atheroma) block the arteries.
* Hemorrhagic stroke – This is only responsible for 13% of all strokes, however, is more fatal accounting for 30% of all stroke deaths. A Hemorrhagic stroke occurs when a blood vessel in the brain bursts and leaks blood into the brain. This is typically as result of high blood pressure and/or diseases involving the blood vessels in your brain.
* Transient ischemic attacks [TIA] – these are also known as ‘mini strokes’. These are a major precursor for strokes as 40% who suffer a TIA will go on to have a stroke. As you age, risk of suffering a TIA increases.

#### What are some risk factors for stroke?

| Medical risk factors | Lifestyle risk factors |
| Suffered a stroke before | Smoking |
| Suffered a TIA before | Being overweight |
| High cholesterol | Excess alcohol consumption |
| High blood pressure | High sodium diet |
| Heart disease | |
| Arterial fibrillation | |
| Carotid artery disease | |
Strokes are not biased to age, sex, or race, and so everyone has a stroke risk. Some factors do increase an individual’s risk. Those over 55 years of age have an increased risk. Men when they are younger have a greater risk than women, but as women age they are more at risk, especially to fatality as result of stroke. African Americans have an increased stroke risk as do diabetics and those with a family history of stroke. But no matter the number of risk factors someone has, everyone should do what they can to minimise their risk.

## What benefits will I see from exercise?

Up to 80% of all strokes are avoidable. This is because most strokes occur as result of unhealthy lifestyle choices.
| Exercise will increase your | Exercise will decrease your |
| Chance of recovery | Blood sugar levels |
| General health | Blood cholesterol levels |
| Aerobic capacity | Blood pressure |
| Quality of life | Body weight (when accompanied by healthy eating) |
| Coronary artery endothelial function | Risk of Heart disease |

## Recommendations for Exercise

Simply by meeting the daily recommended physical activity guidelines, stroke risk can be dramatically decreased. More specific exercise programs can be prescribed to cater for individual medications, disabilities, requirements and so forth.
| Exercise Type | Benefits | How much |
| Vigorous aerobic exercise | Improve peak oxygen uptake Improve workload lower blood pressure, and blood sugar improve sensorimotor function improve aerobic capacity | 3 times per week |
| Treadmill aerobic exercise | reduces submaximal energy expenditure improved cardiovascular fitness daily living tasks done at lower percentage of aerobic capacity lower blood pressure, and blood sugar lower cholesterol | An a hour a day |
| Combined cardiovascular, strength, and flexibility training | gains in peak oxygen uptake gains in strength improvements in body composition lower blood pressure, and blood sugar lower cholesterol | An hour a day 3 times per week |
| High intensity interval training [HIIT] and Vigorous exercise | reduces stroke risk for men and helps them recover faster | 3 times per week |
Exercise not only lowers the risk factors of having a stroke, it also minimises the disability of someone who has had a stroke and improves their quality of life. Exercise in a stroke survivor prevents complications of prolonged inactivity, decreases risk of recurrent stroke and cardiovascular events, increases aerobic fitness and enhances psychological functioning including concentration, memory and so on.

#### Guidelines you should know before getting started

If you are on and medications to lower blood pressure, cholesterol or any other health risks it is crucial that you see your doctor before participating in any exercise. Any healthcare professional leading you through an exercise program should also complete an Adult Pre-exercise Screening System [APSS]to ensure you are cleared to participate safely.

## Further information/ suggested reading / support groups

* Physical activity and exercise recommendations for stroke survivors. Exercise recommendations for stroke survivors
* Support groups Stroke support groups- Australia
* Treadmill aerobic exercise for stroke survivors. AHA guidelines
* Lifestyle risk factors for stroke. Effect on stroke risk
* Reduce your stroke risk:Health tip

## References

* 1 2 3 4 5 6 7 8 9 10 National STROKE Association. (2013). <http://www.stroke.org/site/DocServer/STROKE_101_Fact_Sheet.pdf?docID=4541> [Accessed: 29/09/14].
* ↑ Mayo Clinic Staff. Mayo Clinic. (2014). <http://www.mayoclinic.org/diseases-conditions/stroke/basics/definition/con-20042884> [Accessed: 29/09/14].
* 1 2 3 4 5 6 7 Heart Foundation. (2014). <http://www.heartfoundation.org.au> [Accessed: 29/09/14].
* ↑ Shinton, R. Lifelong exposures and the potential for stroke prevention: the contribution of cigarette smoking, exercise, and body fat. Epidemiology and community health. 1997; 51:138-143.
* 1 2 3 4 5 6 7 8 Gordan, N.F., Gulanick, M., et al. Physical activity and Exercise Recommendations for Stroke Survivors. American Heart Association. 2004; 35:1232-1234
* 1 2 3 Dr. Mercola. Peak Fitness. (2013). < http://fitness.mercola.com/sites/fitness/archive/2013/10/04/stroke-prevention-vigorous-exercise.aspx> [Accessed: 29/09/14].
* ↑ Australian Government Department of Health. (2014). <http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines> [Accessed: 29/09/14].
* ↑ Macko, R.F., Desouza, C.A., et al. Treadmill Aerobic Exercise Training Reduces the Energy Expenditure and Cardiovascular Demands of Hemiparetic Gait in Chronic Stroke Patients. American Heart Association. 1997. 28: 326-330
* ↑ ESSA. (2014). <https://www.essa.org.au/for-gps/adult-pre-exercise-screening-system/> [Accessed: 29/09/14].