Cardiovascular Disease, Stroke, and Exercise

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Cardiovascular Disease, Stroke, and Exercise

The leading cause of death in adults
Cardiovascular disease is the leading cause of death in adults and has a significant impact on the overall health status of people living in the United States. Cardiovascular disease is a class of diseases that involve the heart or blood vessels and includes stroke, heart failure, hypertensive heart disease, peripheral artery disease—in addition to other disease processes.  There is a clear need for preventative care to avoid cardiovascular disease and increasing the amount of physical activity and exercise performed has been shown to decrease all-cause mortality rates and coronary artery disease.  



What can help reduce the risk of cardiovascular disease?
Cardiovascular disease risk can decrease significantly with regular physical activity.  Regular physical activity should include activities that use large muscle groups including walking, strength training, cardio workouts, running, or swimming.  These types of activities increase exercise capacity, endurance, and skeletal muscle strength, which can aid in preventing cardiovascular disease and related disease processes, including helping to lower high blood pressure in hypertensive patients.  

Exercise can also reduce the risk of other chronic conditions, including type-2 diabetes, osteoporosis, obesity, and depression.  The American College of Sports Medicine recommends that individuals should engage in 30 minutes or more of moderate-intensity physical activity on most days, but preferably all days of the week.  

How can exercise help those who already have had a stroke?
Stroke is one of the leading causes of death in the United States and lifestyle plays a significant role in the origin of stroke and cardiovascular disease. Many of the risk factors in acquiring cardiovascular disease are modifiable.  Research has shown that comprehensive exercise-based cardiac rehabilitation reduces the rate of mortality in patients following a myocardial infarction or heart attack.  Exercise benefits cardiovascular function in several ways, including an increase in exercise or aerobic capacity.  

In the United States, stroke occurs in 1 person every 45 seconds and over half the men and women who suffer a stroke die within 8 years of the stroke.  This number is expected to rise as the population of elderly persons increases.  Overall stroke rates may also increase due to the increasing number of those diagnosed with diabetes, obesity, and the lack of physical activity among the general population. 

Comprehensive changes in lifestyle including changes in diet and exercise habits, in addition to appropriately prescribed medication where necessary, are now recognized as important initiatives aimed at preventing recurrence of stroke and acute cardiac events in stroke survivors.  Research has found that the "exercise trainability" of stroke survivors may be comparable to those in their age bracket, which means that stroke survivors can increase their cardiovascular fitness by a magnitude that is similar to healthy individuals who participate in aerobic activity.  

More: Dealing with Setbacks — How to Stay Fit While Injured or Sick

What kind and how much exercise is recommended?
One study gave specific exercise reccommendations for the post-stroke population, which included aerobic exercise, strength training, stretching, and neuromuscular (balance) activities. 

Aerobic exercises that were recommended included large-muscle group activities.   One study recommended that aerobic training be performed at 40-70% of peak oxygen uptake and heart rate reserve and at 50-80% maximal heart rate 3-7 days per week at a duration of 20-60 minutes each session or breaking up the activity into multiple 10 minute bouts of aerobic exercise.  

Strength training can include circuit training, weight machines, free weights, and isometric exercises.  Strength training should be performed 2-3 days per week with 1-3 sets of 8-15 repetitions of 8-10 exercises that involve major muscle groups. 
 
Flexibility, including stretching for major muscle groups is important, as is neuromuscular training, which includes activities that focus on coordination and balance. Flexibility activities should include stretching before or after aerobic strength training for 2-3 days per week, and neuromuscular re-education should also be performed 2-3 days per week.

Overall, exercise and diet can play a major role in the outcomes of cardiovascular disease. This article focused on exercise recommendations, but diet is also an important factor in lifestyle interventions. If you feel you are at risk for cardiovascular disease or you already have been diagnosed with cardiovascular disease, it is important to follow up with your physician and begin the discussion of lifestyle changes, including changes in diet and exercise, to get yourself on the right path to reducing your risk or reducing the effects of existing cardiovascular disease. 

To be safe, always make sure to talk to your doctor about any lifestyle changes you intend to make, to make sure that they are safe for you and your personal healthcare scenario.

Written by L Augustyn, Physical Therapist

References  
American College of Sports Medicine’s Guidelines for Exercise Testing and Prescription. 6th Ed. Baltimore MD: Lippinocott Williams and Wilkins 2000. 
Gordon et al. Physical activity and exercise recommendations for stroke survivors.  Circulation. 2004; 109:2031-2041. 
Martel GF, et al. Strength training normalized resting blood pressure in 65- to 73-year old men and women with high normal blood pressure. J Am Geriatr Soc. 1999; 47 (10)1215-1221. 
Pate R, et al. Physical activity and public health. JAMA. 1995; 273(5):402-407.