Exercise After Stroke

25 Aug

What to Expect and How Exercise Physiology Can Help

Stroke is one of the leading causes of long-term disability worldwide, often affecting a person's movement, balance, strength, coordination and confidence. While the immediate focus following a stroke is understandably on emergency medical treatment and early rehabilitation, recovery doesn't stop when someone leaves hospital. For many people, meaningful improvements continue months and even years later through ongoing rehabilitation, regular physical activity and individually prescribed exercise (Winstein et al., 2016; Church et al., 2022).

One of the most common misconceptions I hear is, "I've recovered as much as I can." While neurological recovery following a stroke varies from person to person, evidence consistently shows that targeted exercise can continue to improve physical function, cardiovascular fitness, mobility and participation in everyday activities well beyond the initial rehabilitation period (Saunders et al., 2020; Pogrebnoy & Dennett, 2020).

As an Accredited Exercise Physiologist, one of the most rewarding parts of my role is seeing people achieve goals they once thought were no longer possible. These milestones are rarely about lifting heavier weights or achieving perfect exercise technique—they're about regaining independence. Whether that's walking safely around the local shops, returning to gardening, standing confidently while cooking dinner, or simply having the endurance to spend quality time with family, these are the achievements that genuinely improve quality of life.

Understanding Stroke Recovery

A stroke occurs when blood flow to part of the brain is interrupted, causing damage to brain tissue. Depending on the location and severity of the stroke, people may experience difficulties with:

Walking and mobility
Muscle weakness
Balance and coordination
Arm and hand function
Fatigue
Cardiovascular fitness
Everyday activities

Recovery looks different for everyone, and there is no universal timeline. Some people regain function quickly, while others continue making gradual improvements over many years. Rather than viewing rehabilitation as something that finishes after discharge from hospital, it is more helpful to think of recovery as an ongoing process that can continue throughout life.

One reason this is possible is the brain's remarkable ability to adapt. This process, known as neuroplasticity, refers to the brain's capacity to reorganise and strengthen neural pathways in response to practice and repetition. Research has shown that task-specific, repetitive practice can promote neuroplastic changes that support improvements in movement and function following stroke (Kleim & Jones, 2008; Cramer et al., 2011). While neuroplasticity is greatest in the early stages after stroke, it remains possible throughout life, reinforcing the importance of continuing meaningful exercise.

How Exercise Physiology Supports Recovery

Exercise Physiology is the prescription of evidence-based exercise to improve health, function and quality of life. Following a stroke, an Accredited Exercise Physiologist develops an individualised program based on your medical history, current abilities, rehabilitation goals and any other health conditions or comorbidities.

Rather than providing generic exercises, the focus is on helping you achieve the activities that matter most in your daily life.

This may include improving your ability to:

Walk safely within your community.
Build strength for transfers or stairs.
Improve balance and reduce falls risk.
Increase endurance for shopping or social outings.
Return to recreational activities.
Improve confidence in everyday movement.

Current clinical practice guidelines consistently recommend exercise as an essential component of stroke rehabilitation and emphasise that programs should be tailored to the individual's goals, impairments and stage of recovery (Winstein et al., 2016; Church et al., 2022).

Recovery Is About More Than Walking

Walking is often one of the first goals people identify after a stroke, and understandably so. However, successful rehabilitation is about far more than simply walking further.

Many of the goals people work towards are deeply personal. For some, success may mean standing independently to prepare a meal, for another, it may be safely carrying groceries from the car, playing with grandchildren or returning to a favourite hobby.

Exercise becomes most meaningful when it directly supports these goals.

One of the advantages of working with people in their own environment is the ability to work on movements exactly where they occur. Rather than repeatedly walking along a clinic corridor, we can work on confidently navigating the front pathway, stepping safely over the threshold into the home or building endurance to walk around the local park. These functional tasks often translate more directly into improved independence because they reflect the challenges people face every day.

Building Strength, Balance and Confidence

Following a stroke, reduced muscle strength and impaired balance can make everyday activities significantly more demanding. Even simple tasks such as standing from a chair, climbing stairs or walking on uneven ground may require considerably more effort than before.

Research consistently demonstrates that appropriately prescribed exercise improves strength, mobility and functional performance following stroke (Pogrebnoy & Dennett, 2020; Saunders et al., 2020). Progressive resistance training, balance exercises and task-specific practice all have important roles within rehabilitation when prescribed according to the individual's abilities.

Equally important is the confidence that often develops alongside physical improvements. Many people reduce their activity because they fear falling or losing their balance. Over time, this reduction in activity can contribute to further deconditioning and reduced independence. By gradually rebuilding strength, improving balance and practising meaningful functional tasks, many people regain not only physical capacity but also the confidence to participate more fully in everyday life.

Improving Cardiovascular Fitness

When people think about stroke rehabilitation, they often picture exercises focused on walking or regaining strength. However, cardiovascular fitness is another essential component of recovery that can be overlooked.

Following a stroke, many people become significantly less active than they were previously. Reduced physical activity can lead to decreased cardiovascular fitness, increased fatigue, and reduced endurance, making everyday activities feel more physically demanding. Over time, this can contribute to a cycle where lower fitness limits activity, which in turn further reduces fitness.

Research consistently demonstrates that appropriately prescribed aerobic exercise can improve cardiorespiratory fitness, walking endurance and overall physical function following stroke (Billinger et al., 2014; Saunders et al., 2020). Exercise is also an important component of reducing modifiable cardiovascular risk factors, alongside appropriate medical management and lifestyle interventions, thereby reducing the risk of recurrent stroke (Winstein et al., 2016).

Aerobic exercise does not necessarily mean you’ll be running or smashing out high-intensity workouts. Depending on the individual, it may involve walking, stationary cycling, seated exercise, circuit-based functional training, or other activities that safely elevate heart rate while remaining appropriate for the person's abilities and goals.

Fatigue After Stroke

Fatigue is one of the most common and frustrating long-term effects of stroke. Many people describe feeling exhausted after completing tasks that previously required little effort.

Although it may seem counterintuitive, appropriately prescribed exercise is increasingly recognised as an important strategy for managing fatigue. Improving cardiovascular fitness and muscular endurance often reduces the effort required to perform everyday activities, allowing people to conserve energy throughout the day (Saunders et al., 2020).

Programs should always be individualised, balancing exercise with adequate recovery and considering factors such as medication, sleep, pain and other health conditions.

Why Home-Based Exercise Physiology Can Be So Effective

One of the greatest advantages of mobile Exercise Physiology is that rehabilitation occurs in the environment where it matters most, your own home and community.

Having worked in both clinic-based and mobile settings, I've seen how valuable this can be for people recovering from stroke.

Home visits also remove one of the biggest barriers to ongoing rehabilitation: travelling to appointments. For some people, organising transport, managing mobility aids or simply finding the energy to attend a clinic can be difficult. Receiving Exercise Physiology services at home allows that energy to be directed towards rehabilitation instead.

It also provides an opportunity to identify environmental factors that may influence safety or independence, allowing exercise programs to be tailored to the person's everyday surroundings.

What Happens During Your First Appointment?

Every person experiences stroke differently, which is why every Exercise Physiology assessment should be individualised.

Your first appointment focuses on understanding not only your medical history, but also the goals that are most important to you.

This includes discussing:

Your stroke history and current health
Previous rehabilitation
Current mobility and physical activity
Daily challenges
Hobbies and interests
Personal goals

An assessment may include measures of strength, balance, mobility, endurance and functional capacity, depending on your circumstances.

From there, an evidence-based exercise program is developed to suit your abilities and progressed over time as your confidence and capacity improve.

Is Exercise Physiology Covered by the NDIS?

For many people living with the long-term effects of stroke, Exercise Physiology may be funded through the National Disability Insurance Scheme (NDIS) when it is considered reasonable and necessary to support the participant's goals.

Exercise Physiology commonly aims to improve:

Functional mobility
Balance
Strength
Physical capacity
Independence with everyday activities
Participation within the community

Programs are designed around each person's individual goals, with a strong focus on building long-term capacity rather than providing short-term solutions.

If you are unsure whether Exercise Physiology is appropriate for your circumstances, discussing your goals with your support coordinator or an Accredited Exercise Physiologist is an excellent place to start.

Final Thoughts

Recovering from a stroke is rarely a straight line. Progress often occurs gradually, and every person's journey is unique. While the early stages of rehabilitation are important, they are not the end of the recovery process.

Research consistently shows that ongoing exercise can improve mobility, strength, balance, cardiovascular fitness, and participation in everyday life, even months or years after a stroke (Church et al., 2022; Pogrebnoy & Dennett, 2020). More importantly, the right exercise program can help people regain confidence in the activities that matter most to them.

At Take Back Movement, my goal is not simply to prescribe exercises. It is to help people continue progressing towards greater independence through personalised, evidence-based Exercise Physiology delivered in the environments where they live, move and participate every day across Brisbane and the northern Gold Coast.

Frequently Asked Questions

Is it ever too late to start exercising after a stroke?

No. Research shows that improvements in mobility, strength and cardiovascular fitness are possible even in the chronic stages after stroke when exercise is appropriately prescribed (Saunders et al., 2020; Pogrebnoy & Dennett, 2020).

Is exercise safe after a stroke?

For most people, yes. However, exercise should always be tailored to your medical history, current abilities and individual goals. An Accredited Exercise Physiologist can prescribe a program that is both safe and effective.

Can Exercise Physiology help reduce my risk of another stroke?

Exercise is an important component of secondary stroke prevention and can improve cardiovascular fitness, blood pressure, physical activity levels and overall health when combined with appropriate medical management and healthy lifestyle choices (Billinger et al., 2014; Winstein et al., 2016).

Do I need to attend a clinic?

Not necessarily. Many people benefit from mobile Exercise Physiology, where exercises are completed in the home and community settings where they are most relevant to everyday life.

References

Billinger SA, Arena R, Bernhardt J, et al. (2014). Physical Activity and Exercise Recommendations for Stroke Survivors: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 45(8), 2532–2553. https://doi.org/10.1161/STR.0000000000000022

Church G, Ali A, Smith CL, et al. (2022). Examining Clinical Practice Guidelines for Exercise and Physical Activity as Part of Rehabilitation for People with Stroke: A Systematic Review. International Journal of Environmental Research and Public Health, 19(3), 1707. https://doi.org/10.3390/ijerph19031707

Moncion K, Allison EY, Al-Khazraji BK, et al. (2022). What are the effects of acute exercise and exercise training on cerebrovascular hemodynamics following stroke? A systematic review and meta-analysis. Journal of Applied Physiology, 132(3), 670–684. https://doi.org/10.1152/japplphysiol.00872.2021

Pogrebnoy D, Dennett A. (2020). Exercise Programs Delivered According to Guidelines Improve Mobility in People With Stroke: A Systematic Review and Meta-analysis. Archives of Physical Medicine and Rehabilitation, 101(1), 154–165. https://doi.org/10.1016/j.apmr.2019.06.015

Saunders DH, Sanderson M, Hayes S, et al. (2020). Physical fitness training for stroke patients. Cochrane Database of Systematic Reviews, Issue 3, CD003316. https://doi.org/10.1002/14651858.CD003316.pub7

Winstein CJ, Stein J, Arena R, et al. (2016). Guidelines for Adult Stroke Rehabilitation and Recovery. Stroke, 47(6), e98–e169. https://doi.org/10.1161/STR.0000000000000098

References (Part 1)

Cramer SC, Sur M, Dobkin BH, et al. (2011). Harnessing neuroplasticity for clinical applications. Brain, 134(6), 1591–1609.

Kleim JA, Jones TA. (2008). Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage. Journal of Speech, Language, and Hearing Research, 51(1), S225–S239.

Saunders DH, Sanderson M, Hayes S, et al. (2020). Physical fitness training for stroke patients. Cochrane Database of Systematic Reviews, Issue 3.

Winstein CJ, Stein J, Arena R, et al. (2016). Guidelines for Adult Stroke Rehabilitation and Recovery. Stroke, 47(6), e98–e169.