Stroke is one of the world’s biggest killers and a leading cause of disability. While our modern technology has provided us with some incredible ways of improving our living, it has also come at a huge cost to our health as obesity, poor lifestyle and nutrition choices continue to ruin the way our body functions. The high incidence of stroke seems to go unnoticed within the media, yet stroke kills more women than breast cancer and more men than prostate cancer. In 2023, there were an estimated 45,785 stroke events in Australia including 34,793 first-ever strokes, which equates to one stroke every 11 minutes. When you consider that more than 80% of strokes can be prevented, knowing what things you can put in place to prevent this is vital. In this article, we will talk not only about the lifestyle changes you need to make to prevent a stroke but also what you can do if you have already suffered one so you can get your life back.
What Causes A Stroke?
A stroke is caused by an interruption of the flow of blood to the brain or by a rupture of blood vessels in the brain. The damaging effects of a stroke depend on what parts of the brain are affected, as well as the amount of damage. Common after affects contribute to resulting weakness on the side contra lateral to the brain injury.
Interesting Stroke Facts
Here are some frightening statistics from the National Stroke Foundation:
•In 2023, there were an estimated 45,785 stroke events in Australia including 34,793 first-ever strokes, which equates to one stroke every 11 minutes.
•Stroke can happen at any age, and one in four people globally will have a stroke in their lifetime.
•It is estimated that 440,481 people with a history of stroke were living in Australia in 2023 (244,756 males and 195,725 females).
•Stroke is one of Australia’s biggest killers. It kills more women than breast cancer and more men than prostate cancer.
•In 2023, it was estimated the cost of stroke in Australia was $9 billion. The lifetime costs associated with strokes that occurred in 2023 exceed $15 billion, including $5.5 billion in healthcare costs, $6.3 billion in lost productivity costs and $3.3 billion in costs related to unpaid care.
•More than 80 percent of strokes can be prevented.
•In 2023, 1 in 4 strokes occurred in people under the age of 65 years.
•Regional Australians are 17 percent more likely to suffer a stroke than those in metropolitan areas.
•When a stroke strikes, it attacks up to 1.9 million brain cells per minute.
•Without action by 2050, it is predicted the number strokes experienced by Australians annually will increase to 72,000.
People who have suffered a stroke will be made aware of the need to start an exercise program and clean up their nutrition and lifestyle habits. While this is a great start it may only take you so far if you are not more precise with your CHOICE of exercise.
Many stroke survivors are lacking the support, knowledge, and tools necessary to begin an exercise program. They just guess at what to do, or even worse a health professional says just do some cardio every day and you will be right.
For some people cardio activities are very difficult to do, if not impossible for they have lost significant strength and the ability to move correctly. Some cannot even walk! Learning how to improve their functional capacity and strength is of upmost importance.
We see this same problem with MS and spinal cord injuries. See the article – Why Strength Training Is Vital For MS
Over the last 15 years I have been working very closely with several clients suffering severe walking impairments from brain injuries, spinal cord injury, and muscle loss caused from either accidents or diseases like a MS. The effects of these conditions can often be quite devastating and some people never regain the skills they had prior to the incident. Finding a way to help improve their ability to walk was the most critical thing for them to get their daily life back to normal.
While it can be very slow and frustrating there are some people that do recover well and develop significant improvement in daily living tasks. Surprisingly, it can happen quite quickly if the right stimulus is provided. It all depends on the person and the severity of the problem.
Why Isolated Muscle Exercises Fail
After a stroke many people will lose a lot of muscle and this can have a devastating effect on how they move. In the past, exercise and more specifically strength training, with stroke victims or brain injuries has been misunderstood and at times even controversial.
Most people with stroke are usually prescribed “safe” or moderate exercise programs, with more emphasis on cardio vascular exercise or using isolated exercises and stretches to treat the affected side. Typically machines are used for strengthening as they force the muscles to work in a symmetrical method that eliminates mistakes at the same time making it safer.
I myself used machines when starting as a trainer as it made a lot of sense to keep the person safely positioned and not make the strength training exercises too hard for it will be bad for them. What I found was that this approach did not really help these clients to improve what they came to see me for in the first place which was – to help them move better!
I had some people be able to push significant weight on a leg press but barely be able to walk and need the assistance of crutches to do so. I saw the same with thing with the upper body where they could move significant weight or load if positioned on a machine but not be able to do a push-up or a movement in a standing position. They were treated as though they would be permanently disabled.
This also showed me that it was not the muscles that was the problem it was the damaged neuromuscular system that was. The only way to improve this was to find a safe way to work within that system.
In the video below I show several examples of this.
The isolated approach did not address the problem of spasticity or lack of flexibility with the affected arm or leg, which is often severely restricted in pronation and bent. Using an isolated stretch seemed to do nothing to change the actual length tension of the muscle as soon as we stopped stretching.
I suspected the solution would be with the strengthening and movement approach but I needed a different model than machine training and isolated movements. What I found was that a much more integrated approach of using movement focused exercises, with more reliance on single arm and contralateral activity produced significantly better results.
You can see more about this in the article – The critical movement you must master if you want to walk better
Do You Want Proof This Works?
Here is a testimonial from one of our clients who was trained with us for over 18 months.
“I have been getting personal training from No Regrets Personal Training for 6 months now and I have loved every minute of it! Nathan is such a patient, caring and understanding person but he still pushes you. I have definitely improved out of sight since going to training, my movement, my balance, my walking, my strength and my overall appearance have improved quite a lot and I only expect it to continue! I haven’t missed a session because I love it!” – Shannyn Moon
Shannyn was only 31 years of age at the time and had suffered from 2 severe strokes that have left her with partial paralysis on her right side. Her goal was to be able to walk down the aisle for her wedding in her words “like a normal person”.
Focus On Integrated Movement
I first came across the complex movement concept many years ago when working with sporting athletes looking to improve movement efficiency to ultimately develop improved strength and power. It just took me some time to think that I could use the same principles of teaching sports to people with injury or even just beginners.
Originally I believed if I used the typical muscle approach to training this would automatically equal faster and more powerful. Yet I found anytime I used a complex task with a lighter load, it required much more brain concentration and focus. If they were able to execute it as close to perfectly as possible, the strength gains and improvement across multiple skills, was much higher than when we focused on strength alone.
Over time I began applying this theory to beginners, then to injury and rehabilitation, more recently with older adults where I found this to be also true. And interestingly enough the gains were more significant with the rehab and older adults more so than the sports due to the amount of skill and strength lost.
This led me to reading hundreds of books and completing many courses in this area to develop programs and exercises with the goal of trying to improve a person’s movement efficiency. I found out this was not a new concept and was something discovered way back in the 1960’s by scientific researchers who discovered PNF methods when rehabilitating Polio patients. Unfortunately, this is something that not commonly known and this information has not been passed down or taught well at all.
You can read more about this in the article – Train movement not muscle
Basically we are training the neuro musculoskeletal system with our goal to get your body’s systems to work in a highly coordinated and effective fashion, so that functional tasks are completed successfully.
This aligned perfectly with our goal for rehabilitation and more specifically stroke victims because the goal of the individual who has experienced a stroke is to reach the highest possible level of independence and be as productive as possible.
The difficult and challenging part here is that the exercise selection and program methods are so unique to each person, depending on the level of damage and paralysis. There was no template or specific exercise that works every time. A method of assessing where to start and determining how each person learns best will decide how effective the program would be.
Using a reverse engineering approach with the focus being on the end result – improved human movement and function, we needed to use a way to find out what movement patterns they needed, and how good they were at completing each one. From this we could design a stepping stone approach to learning and devise plans and programs to enhance each movement pattern.
But this is where it gets very interesting and even contradictory.
With the typical person who lacks overall conditioning, we could use a simple and isolated muscle approach to build some strength and reserve before tackling the more complex integrated movements.
For example, to improve the ability to squat we could use an approach of simple exercises evolving to harder more integrated.
1.Hip extension progressing to
2.A Swiss ball squat against the wall to a
3.Squat with a barbell.
With the stroke or brain affected clients we had more success with starting with more complex and difficult tasks first which seems crazy! Obviously we have to keep the exercise safe and allow for them to make mistakes without fear of falling or injuring themselves but this is where the best results would be found.
Nearly all of the exercises would be completed in a split stance, using contralateral arm and leg movements that mimic the action used in walking.
What Is The Most Effective Way To Learn New Tasks
It all begins with the brain!
Always remember that the brain controls the muscles, so it makes sense to try and change this!
I highly suggest reading the book “Motor Learning and Performance” by Richard A Schmidt and Timothy Lee as this really helped with my program effectiveness and adapting different learning styles for each client.
My main focus is with developing stability and strength with the single leg stance and the split stance for these are both attributed to walking. Adding in upper body movements in the opposing side of the body allows for the body to use the myofascial slings and also work both sides of the brain simultaneously.
These are not exercises you would normally start with but for these cases they are essential. Unfortunately, many people are extremely unstable, and even scared in these positions so you have to find a way to make it safe and simple for them to do it.
Learning how to develop stability and strength with what we refer to as the weight shift is the key. This is where you transfer your body-weight from left to right or right to left when you walk. People with walking impairments do not do this very well at all so you have to find ways to teach this to them if you want to make any lasting changes to their gait cycle.
See video below.
This takes advantage of how the neuromuscular system is designed to work in the first place, which is in a highly coordinated manner. Once you have this in place you can start to create exercises that use the slings and create motion.
Strengthening the body via the slings is a real game-changer. These slings, when they are working well, help us move efficiently, produce more force, and create more speed. However, when there is a weak link in the chain, most people don’t address the chains but rather target the muscles.
Very, very rarely do muscles work in complete isolation or anywhere close to it. Some muscles contract to provide movement while some muscles contract to provide stability. This is all done at the same time. They don’t work separate to each other. In addition to this and as we have already discussed, the more coordinated and complex movements have a greater effect on the brain.
Use Gradual Progressions
There is no doubting that this is very difficult, extremely frustrating and very time consuming to do if you want to make any significant change.
In the beginning I often cheat on movements and guide the clients movements so that they can feel what they need to do. Once they get the idea of what to do I let them struggle with the challenge even if they are endlessly making mistakes.
For example, I like to use sticks to learn a lunge as seen below with a guy who trains with us who has a spinal cord injury.
Once I let them struggle for a while to find the strength I will always finish with good form by coming back to help them again. This is so that the last time the brain sees this movement it was the efficient version and not the compensatory version.
This process would allow the problem solving nature of the brain to develop by seeing what they need to do and also experiencing the challenge and trying to piece the two parts together. Providing video feedback and use of mirrors became extremely effective in the client learning how to overcome the problems faster than us trying to help all the time.
An example of some exercises I might use are.
1.Lunge holding a stick
2.Single cable pull with lunge
3.Single cable pull with a step back
4.Walking deadlift
5.Walking unassisted
This gives you a good idea of how to start with the stance you want to work on and build some confidence and stability before progressing to the more dynamic movements. Obviously there are many other exercises I would need to use first and I might need to make some modifications depending on the person but this is how I try to reverse engineer the exercises.
Below is videos of examples of the single cable pull exercise starting with a simple version and progressing to the more difficult version.
The Huge Effect Of Foot Stability Exercises
People with walking impairments often have very weak feet due to their lack of walking and the feet themselves become very weak. Using external nervous system stimulus to activate the muscles of the feet can have a profound effect on how they move. I have seen this first hand several times and Shannon made more improvement than any other exercise we had ever tried when we applied this method.
Using a bare foot approach of walking across several different surfaces to enhance the actual foot mechanics changed her movement pattern almost instantly.
Her damaged foot for the first time began to dorsi flex and find its way across the uneven terrain.
We got her to walk across.
•Concrete
•Uneven grass
•Stones – this was the hardest but also the most effective
The different nerve sensations and the requirement of the foot to feel its way across the surface forced the nervous system to adapt and create better method of movement. Coupling that with video feedback for them to observe and try to change enabled us to alter their permanent way of walking faster than using standard stationary exercises we had used before.
Over time we added a Sensa Mat to our training program to basically bring the stones indoors! This has been a remarkable addition to our training program and the results are simply amazing for people with walking impairments.
Read the article – How to improve walking with the Sensa Mat
What About Cardio Exercise?
There is no doubt that cardio exercise is great for preventing a stroke and also getting your life back afterwards too, but you have to find the right choice of exercise that suits your body’s needs and abilities.
The problem with this is if a person has already suffered a stroke is that they are not able to move well enough to do cardio exercise. Walking is often difficult so it is not always a viable option at first.
Firstly adding some light cardio is great and the easiest thing to start doing is walking 30-60 minutes every day. Some people will be better walking 3 short walks of 10-15 minutes instead of one long walk of 45-60 mins. If you are able to and want to add some cycling, swimming or even jogging then that is fine. Just do not overdo it, and do not make this the cornerstone of your program.
Cardio should be completed in combination with a strength training program, not replace it.
Regular, consistent exercise is one of the fastest and most powerful ways to lower your insulin and leptin resistance. 210 minutes of moderate intensity physical activity is recommended per week for health benefits (which if you do the math is only 30 minutes per day), which can be broken up into smaller time intervals (eg. 3 x 10 minutes). This can help to regulate your blood glucose levels and ultimately reduce the likelihood of developing further complications in the future.
While aerobic exercise is beneficial, studies show that resistance training is more effective due to the metabolic adaptions of skeletal muscle.
Overuse of cardio exercise can even be detrimental to your health, see video about heart health below.
You Must Eat Quality Nutrition & Get Enough Sleep
Exercise is great but if you are not eating well or have poor sleep you will not make any big changes. I think most people would be aware that they need to clean up their diet if they have had a stroke or any serious health problem.
Avoiding processed foods and eating a good variety of proteins, vegetables and good fats will go a long way to providing the body with the vitamins and nutrients it needs. The Mediterranean diet is one that many people follow but there are several others that are very similar that are just as good.
Eating a good variety of proteins especially fish and vegetables is a great start.
Also quality sleep cannot be ignored and in many cases this may be a big factor in having a stroke in the first place.
Sleep-related disorders, such as sleep apnea can that leads to reduced oxygen and blood flow to the brain which can reduce or make changes over time to the brain. If this remains chronic it can lead to increased risk of stroke or cognitive impairment from vascular disorders to the brain.
Exercise and diet play a big part in getting quality sleep but the biggest problem is often stress. We cannot avoid stress but we can build habits in place that helps us to deal with problems when they arise. The sooner you work on this and never compromise your sleep quality the easier it is to avoid it becoming a problem.
Do You Need More Help?
There is a detailed report you can download below that explains in great detail with pictures and instructions how to develop your movement patterns. Given the heart’s never-ending workload, it can easily be brought down by a poor diet, lack of exercise, smoking, and illness caused by neglect to other parts of our body.
This report explains everything you need to know about improving not just your heart health but your overall health. I created this report to include ALL of the specific exercises and foods to eat for treating and preventing various heart and lung conditions.
Click here to download your instant PDF copy.
Summary
Strength training for strokes and other accident related injuries cannot be underestimated. At times, isolated movement and muscle approach is needed and can be beneficial in adding some muscle, but a program that utilizes an integrated movement approach will produce faster and superior results.
Finding creative ways to mimic and simulate daily tasks will not only significantly improve movement skills and function, but add much needed muscle improved flexibility for tight muscles that previously did not respond to stretching or releasing. Use of various learning tools such as video and external surface will also speed up the learning and enable you to complete tasks never before possible.
Once you are able to move more efficiently it is much easier to complete a more rigorous exercise program that keeps your body functioning at it’s optimal best and prevent disease and disability from ruining your life.
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 20 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References
•Motor Learning & Performance – by Richard A Schmidt
•Bending The Aging Curve – by Joseph Signorile
•Anatomy Trains – by Thomas Meyers
•National Stroke Association
•How to eat, move and be healthy – by Paul Chek
•Movement – by Gray Cook