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Last updated: February 2024

Over 800,000 Canadians are living with stroke. People who have experienced stroke are at significantly higher risk of having another stroke or a cardiac event. Many people are less active and more sedentary following a stroke. Physical activity is an important part of a lifestyle modification program to reduce these risks.

Randomized controlled trials and systematic reviews consistently show that regular physical activity and more structured exercise are safe and can have numerous benefits including:

Improved cardiovascular fitness and muscle strength
Improved functional independence
Improved balance and walking
Improved cognition and mood
Improved health-related quality of life

Physical Activity and Stroke

Clinical guidelines recommend that people who have experienced stroke should engage in moderate-intensity physical activity (e.g., brisk walking, cycling and household chores) 4 to 7 days per week, in sessions of 20 to 60 minutes, to accumulate 150 minutes of physical activity per week. Some people may need to start with shorter sessions (10 minutes) and then gradually lengthen their physical activity sessions as tolerated.

Additionally, clinical guidelines recommend including 2 to 3 sessions each week of muscle strengthening activities to strengthen major muscle groups of the arms, legs and trunk, and moderate-intensity activities that safely challenge balance.

Specific Considerations

Up to 75% of people living with stroke also have cardiovascular disease. Refer to this section for health care professionals for physical activity-specific information and resources on cardiovascular conditions.
It is recommended that people with stroke who have known symptomatic cardiovascular disease have a graded exercise test with ECG monitoring as part of a medical evaluation before beginning an exercise program.
If the exercise intensity planned is light (<45% of predicted heart rate reserve) and there are no symptoms or history of cardiovascular disease, a clinically based submaximal test may be an option prior to recommending physical activity/exercise. The AEROBICS Guidelines (below) provide more information.
Individuals should be counselled to monitor their blood pressure if this is a concern. Physical activity/exercise should be stopped when systolic or diastolic pressures reach 200 or 115 mm/Hg, respectively.
In addition to cardiovascular disease, people can face significant and unique barriers to physical activity because of their stroke. These can include muscle weakness, spasticity, and cognition, balance and mobility impairments that can increase fatigue and risk of falling. To start exercise safely, people at higher risk of falling or with medical conditions (e.g., cardiovascular disease) should be supervised by a health care professional.

Useful Resources

Aerobics Exercise Recommendations to Optimize Best practice In Care after Stroke: AEROBICS 2019 Update (Canada)
This article provides clinical guidelines and resources to guide health care professionals in screening for and prescription of aerobic exercise following stroke.

e-AEROBICS (Dalhousie University & Heart & Stroke Foundation Canadian Partnership for Stroke Recovery and, Canada)
This e-learning course based on the aforementioned AEROBICS 2019 Update provides education to health care professionals on aerobic exercise for individuals following stroke, including screening, prescription, self-management, and behaviour change.

Physical Activity Counselling Toolkit (University of Alberta, Canada)
This Toolkit consists of handouts on physical activity and general health and various chronic conditions, including stroke and high blood pressure. The handouts are intended to be used by health care providers and/or qualified exercise professionals to support patients/clients to become more physically active.

Stroke (Moving Medicine, UK)
This website provides a step-by-step guide for discussing physical activity with your patient based on the time available (1 minute, 5 minutes, or longer) with associated patient information.

Click here for resources designed for clients.