New Research Report on Medscape

[RoyMacDonald]

It's here and is about exercise for stroke survivors.

medscape.com/viewarticle/ne...

[Jajarunner]

I read that, brilliant. The sooner it trickles down to stroke rehab the better, in the Exercise on Medical Referral worn were are always so conservative.

[Porageface]

I did not find any reference to atrial fibrillation. The potential lack of safety of HIIT in AF, paroxysmal or persistent argues against its use based solely on this paper.

[RoyMacDonald in reply to Porageface]

Doesn't the fact of having a stroke suggest the survivors had AF? Or is it possible to have a stroke without AF? The report was by "MD, medical director of the Stroke Recovery Program and Aftercare Program at JFK Johnson Rehabilitation Institute in Edison, New Jersey." So must know about AF and how strokes happen. ""We don't want people sitting on a couch 6 months after a stroke, covered in Bubble Wrap," Fleming said. "We want them actively participating in exercise." "While many were living with comorbidities (including high blood pressure or cholesterol, diabetes, and other cardiovascular conditions), all were capable of walking on their own and none were institutionalized." From the Stroke Association "Physical inactivity after stroke is highly prevalent. The assessed body of evidence clearly supports the use of exercise training (both aerobic and strength training) for stroke survivors. Exercise training improves functional capacity, the ability to perform activities of daily living, and quality of life, and it reduces the risk for subsequent cardiovascular events. Physical activity goals and exercise prescription for stroke survivors need to be customized for the individual to maximize long-term adherence." "If someone's taking medication to prevent ongoing heart disease or recurrent stroke, combining that with physical activity and diet modifications can lead to a huge reduction in future events," Medscape concludes with "(The 2014 paper says the risk for stroke recurrence can drop by as much as 80%.) Fleming said that prescribing exercise a person appreciates is also a good way to get them working out at higher intensities.

"In our facility, we have some people boxing," Fleming said. (There is no full-contact sparring.) Boxing drills can be a kind of HIIT, and they work hand-eye coordination and muscle strength, in addition to making the participants feel empowered.

They are not talking about silent strokes in the article. That is something completely different.

Seems clear to me.

All the best.

Roy

[CDreamer in reply to Porageface]

Why is there a lack of safety of HIIT with AF? No one has ever suggested that to me, in fact it was recommended to me as I cannot exercise for long because of muscle weakness so high intensity for 2 mins, 2 mins rest, interchanging from cycling legs to cycling arms.

[RoyMacDonald in reply to CDreamer]

I don't believe there isCDreamer. I've been practising it virtually since I had my stroke. I put my early release from hospital down to it.

All the best.

Roy

[Porageface in reply to CDreamer]

It’s purely intuitive that undetected ischaemic heart disease will potentially be risky behaviour with HIT.

And with respect, anecdotes, however many, can not be given the same authority as peer reviewed evidence based guidance,

[CDreamer in reply to Porageface]

Can you please provide a link to a peer evidenced review showing this as this obviously hasn’t got through to the cardiac rehab and stroke rehab training physiotherapists - who taught me. I can find any number of studies showing benefits but not one against. ?

Sometimes life is about balancing small risk against improving functionality otherwise life is just not worth living anyways.

[Porageface in reply to CDreamer]

journals.sagepub.com/doi/fu...

Found this within first minute. It seems to support my point eloquently.

Your go?

[RoyMacDonald in reply to Porageface]

How you read that in one minute I don't know. I'm not a slow reader but it took me 10. It also says "HIIT Is Associated With Mobility and Gait Improvements" It did not have any negatives that I could see about HIIT training. Seemed to think it was a good thing giving great improvements to your VO2 max. Which is what I found from my Garmin Power Pedals. The stroke unit I was on in hospital had a very sophisticated trainer that measured each leg and I could see exactly how the stroke had affected my right leg. It lost about 60% of its power measured after about 6 days post stroke. It was starting from complete immobility though as I was completely paralyzed on my right side after the stroke for 3 days.

Learning to write and draw again was the thing I found most difficult because of my right hand shaking. That's a lot better, and I can play computer games OK using my right hand now and my excuse to my Wife is that it's good for my coordination.

All the best.

Roy

[CDreamer in reply to Porageface]

Read it - my take away is this study was a call for further research as to benefits for stroke survivors with low functionality and for long term follow up.

Results. Preliminary evidence from 10 studies report HIIT-associated improvements in functional, cardiovascular, and neuroplastic outcomes poststroke; however, optimal HIIT parameters remain unknown. Conclusion. Larger randomized controlled trials are necessary to establish (a) effectiveness, safety, and optimal training parameters within more heterogeneous poststroke populations; (b) potential mechanisms of HIIT-associated improvements; and (c) adherence and psychosocial outcomes.

It is not intuitive to me that a sensible HIIT routine prescribed by a specialist neuro physiotherapist - who I see every month - would be risky. I agree that extreme exercise when you are exercising at maximum cardiac output for any length of time - such as sprint racing to the finish when running a marathon or ‘pushing through the pain’ when in AF is reckless but that is not HIIT.

In fact the opening statement says:-

Individuals poststroke possess less than half of the cardiorespiratory fitness (CRF) as their nonstroke counterparts, leading to inactivity, deconditioning, and an increased risk of cardiovascular events. Preserving cardiovascular health is critical to lower stroke risk; however, stroke rehabilitation typically provides limited opportunity for cardiovascular exercise.

[Porageface in reply to CDreamer]

An outstanding appraisal CDreamer, thank you. My main concern was that elderly patients whose coronary artery status was unknown should not be exposed to unvalidated interventions

[RoyMacDonald in reply to CDreamer]

Yes agreed CDreamer, and my stroke support dietician recommended I put on weight, but because of my body type she said the only way for me was exercise to increase muscles, as my body just won't lay down fat however much I eat. It is working since I started the HIIT regime. Slow progress though.

All the best.

Roy

[Porageface]

85% of Stroke is embolic from the left atrium. The remainder are haemorrhagic or embolic from plaque in the internal carotid arteries

[RoyMacDonald]

It's rare for anyone to be able to exercise after a hemorrhagic stroke. Not sure it ever happens. Certainly not wise to try in my opinion. My Father never was able to get up again until he died three months later.

All the people tested for both groups (control and HIIT) were all were capable of walking on their own and none were institutionalized. I don't believe that would be the case if any were hemorrhagic stroke victims.

All the best.

Roy

[Porageface in reply to RoyMacDonald]

Do you have evidence to support your opening claim?

[RoyMacDonald in reply to Porageface]

Not sure what you are referring to as my opening claim. It's a Medscape article. You either take notice of their research or not it's your choice.

The HIIT regime works for me that's all I can say.

All the best.

Roy

[RoyMacDonald in reply to Porageface]

Do you mind me asking how much exercise you do and what method you use?

All the best.

Roy

[Porageface in reply to RoyMacDonald]

Nothing more than a couple of miles of gentle paced walking on the flat. I know of no evidence around the physical benefit of anything more than this. I don’t think the monogram you posted told me anything useful beyond HIIT seems to be safe in the referenced small numbers of under 80s whose AF history is not described.

I suspect it would be filed in the round green bin in Scunthorpe.

[RoyMacDonald]

Not sure what you mean me by posting a monogram? Is that a typo?

I was told I would be in a wheelchair within 5 years when the consultant diagnosed my ankylosing spondylitis but I took to doing exercise as a way of staying mobile and it has worked for me for the last 50 years and I'm still mobile despite the major stroke, so I'm naturally very pro exercise and look for encouragement to work harder at it which I felt that article did. That was the reason I posted the link as I thought that people would be encouraged to exercise harder. Since I started a more aggressive HIIT regime I've gained an extra 1.2 kg of muscle, but I accept that it is not to everyone's taste to do that amount of exercise. I'm very impressed by your reading speed though, if not your walking speed. It may be because I'm never without pain unless I'm sitting down that I want to get it over with so go as fast as I can and am happy that it looks like I'm OK to do that without being at risk of killing myself😉. I a 30 minute walk with 2kg weights on each leg doing (slow) sprints every so often. I tried the wrist weights but they aggravated my back pain so when I get home I do half an hour of weight lifting which has less impact on my back.

All the best.

Roy

[Porageface]

Good man, I admire your tenacity, your regime obviously works very well for you

[RoyMacDonald in reply to Porageface]

Thanks. I had my first warning of the consequences of not taking my prescribed Apixaban while racing at a cycle track near Scunthorpe when I went completely blind for about 15 seconds on a bend and hit the fence. It was raining very heavily as well. That really scared me as I don't mind dying but the thought of being blind does. I skipped the next days racing and I was going to go to the Drs and ask for it to be prescribed at our pharmacy (it's in the Drs) when I had my major stroke before I could do it. Fortunately the stroke never affected my eyesight.

Strokes are a very random so you never know what part of your brain you are going to lose so I count myself lucky. I was scared of having a bleed more than a stroke, but having had a stroke I'm more scared of that now.

All the best.

Roy