# Exercise as it relates to Disease/Benefits of aerobic exercise on quality of life after a stroke
## Background
#### What is a Stroke?

A stroke will occur when there is a disruption of blood flow to the brain. The lack of blood causes a lack of oxygen which is what damages the brain. Depending on what section of the brain is starved of oxygen varies the disabilities that will result. These dead cells can cause disabilities in how you move your body, your sensory systems function, language, how you think, and your memory.

##### Types of strokes

* Ischaemic: This occurs when there is a blockage of the artery which stops the blood flow to the brain.
* Haemorrhagic: This occurs when there is a break in the artery wall causing the blood to be released on the brain stopping oxygen and nutrients to the brain.

#### What is Hemiparesis?

Hemiparesis is the loss of strength on one side of the body. Hemiparesis is prevalent in 80 percent of all stroke victims. The legs, arms and face can all be effected by this loss of muscle strength, making it difficult to do daily activities such as eating, dressing and grabbing objects.

## Quality of Life

Quality of Life (QOL) is defined by the World Health Organisation as an "individuals perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.". Depending on how damaging the stroke is and how affected the patient is by the severity of their hemiparesis, effects their chance to function normally in society post stroke. The ability to achieve goals and to make expectations on normal daily life is drastically reduced due to their inability to function independently.

## Benefits of Aerobic Exercise on QOL

The main benifit from aerobic exercise is the adaptation that allows the patient to perform day to day tasks with greater ease. In addition, it reduces the tiredness and fatigue of the patient so the body can increase its efficiency in daily life. There are so many different physcial and mental barriers that are associated with having chronic dissabilities that make it difficult for health promoting exercise to occur. These barriers if not overcome with simple and beneficial exercises, are what lead to the decline in QOL due to the sedentary behaviour of the patient. Studies have shown the positive effects of aerobic exercise on perceived exertion. One study showed in the pre test that the maximal perceived exertion of a participant was the equivalent of vacuuming for 5 minutes with rest intervals. Post 8 weeks their new perceived maximal exertion was equivalent to walking 2 miles non-stop.
| Benefits of Aerobic Exercise | Benefits on QOL. |
| *Increases Cardiac Output *Increase Oxygen Uptake *Increase Tidal Volume *Increase Blood circulation. | *Ability to do daily tasks unassisted. *Able to do more with each day * Increase functionality in muscle movement. |

## What else can be done?
#### Aerobic and Strength Training

Evidence has shown that aerobic training combined with strenth training leads to large gains in overall QOL. With the added muscular strengthening program the patients are able to gain more movement in their muscle effected by the hemiparesis. Gaining grip strength and the increase in range of movement can lead to independence which will then lead to a better quality of life.

#### Limitations

Limitations in the research involved with this field are the number of willing volunteers to participate. The sample size of all the research done are below 20 participants, with the age differences varying from 50 to 85. This means that the benefits aren't spread evenly between all participants due to the ability to adapt to exercise. Obviously in some cases exercise isn't possible due to age and the severity of the stroke, this can make for false positive tests during the research. If the participants are all volunteering it means they are driving for success, meaning they are more motivated which will usually see greater results and more adaptations to training.

#### More Research Needed

The research is very limited in the field of aerobic exercise improving quality of life alone. There hasn't been enough research into the long term benefits of the exercise programs. This is due to the expenses and voluntary nature of these kinds of studies.

## Future Reading

* Australian Stroke Foundation
* Regaining your Independence

## References

* ↑ Stroke Foundation. (2013). What is a Stroke. Available: http://strokefoundation.com.au/what-is-a-stroke/. Last accessed 4th Oct 2013.
* ↑ Stroke Foundation. (2013). Effects of Stroke. Available: http://strokefoundation.com.au/what-is-a-stroke/effects-of-stroke/. Last accessed 4th Oct 2013.
* 1 2 Stroke Foundation. (2013). Types of Stroke. Available: http://strokefoundation.com.au/what-is-a-stroke/types-of-stroke/. Last accessed 4th Oct 2013.
* ↑ National Stroke Association. (2012). Paralysis. Available: http://www.stroke.org/site/PageServer?pagename=hemiparesis. Last accessed 4th Oct 2013.
* ↑ World Health Organisation. (1997). Measuring Quality of Life. Programme on Mental Health. - (1), 1
* 1 2 3 4 5 Swank, A. (2008). Adaptations to Aerobic Endurance Training. In: Beachle, T. and Earle, R Essentials of Strength Training and Conditioning. USA: National Strength and Conditioning Association. 122-129
* ↑ Macko,R. Benvenuti,F. Stanhope,S. Macellari,V. Taviani,A. Nesi,B. Weinrich,M. Stuart,M. (2008). Adaptive physical activity improves mobility function and quality of life in chronic hemiparesis.. Journal of Rehabilitation Research & Development. 45 (2), pg1-4
* ↑ Dean,C. Richards,C. Malouin,F.. (2000). Task-Related Circuit Training Improves Performance of Locomotor Tasks in Chronic Stroke:. Arch Phys Med Rehabil. 81 (-), 409-417.
* 1 2 Fuscaldi, L. Olney,S. Nadeau, S. Brouwer, B.. (1999). Muscle Strengthening and Physcial Conditiong to Reduce Impairment and Disability in Chronic Strok Survivors. Arch Phys Med Rehabil. 80 (-), 1215
* 1 2 Chen, D. Rimmer, J. (2011). Effects of Exercise on Quality of Life on Stroke Survivors. Journal of the American Heart Association. 42 (-), 835.