WOW! And the stroke medical world is still incompetent in not creating recovery protocols. This guideline crapola needs to stop! This has been known forever. Totally useless research, but because of massive incompetence it was still printed!
Revitalizing recovery: the impact of acute exercise on stroke survivors through a physical therapy lens
1. Introduction
Stroke represents a major global health issue, resulting in substantial morbidity and mortality worldwide. Acute exercise has demonstrated efficacy in enhancing the outcomes of stroke rehabilitation by facilitating brain repair, motor relearning, and cognitive function [1–3].
This disruption results in destruction of the brain tissue, causing various neurological abnormalities, including motor, sensory, and cognitive problems [4–7]. Research has delineated two primary categories of stroke: ischemic and hemorrhagic. Ischemic stroke, comprising roughly 85% of all strokes, transpires when a thrombus obstructs a cerebral blood vessel, restricting the blood supply to the impacted region. This may result from atherosclerosis (the constriction of the arteries due to plaque accumulation) or embolism (the migration of a clot or a fat globule from another body region to the brain). An insufficient blood supply to cerebral cells causes cellular demise, perhaps resulting in enduring functional deficits [8]. A hemorrhagic stroke transpires when a cerebral blood artery ruptures, resulting in bleeding and the development of a hematoma that exerts pressure on the adjacent brain tissue. This stroke variant is rarer yet generally more lethal. Hemorrhagic strokes are frequently induced by factors such as hypertension, aneurysms, arteriovenous malformations, and cranial trauma. The pathophysiology of stroke encompasses a range of intricate biological processes. Following an ischemia event, the impacted cerebral tissue experiences a series of metabolic alterations, encompassing excitotoxicity, oxidative stress, and inflammation. These mechanisms result in neuronal damage that may spread beyond the initially impacted area (the ischemia penumbra), leading to enduring functional impairments [9, 10]. In hemorrhagic stroke, the accumulation of blood and the consequent pressure on the adjacent tissues lead to neuronal death. A fundamental factor in post-stroke recovery is neuroplasticity, which refers to the brain’s capacity to restructure by establishing new neural connections [11, 12]. Studies indicate that rehabilitation initiatives, such as exercise, can enhance neuroplasticity by activating brain areas that offset its diminished functionality. The timing, intensity, and nature of therapy are essential for optimizing recovery potential [13–15]. Multiple risk factors contribute to stroke, including hypertension, tobacco use, diabetes mellitus, hyperlipidemia, and a sedentary lifestyle. Comprehending these risk factors has resulted in public health initiatives and therapeutic interventions designed to diminish stroke occurrence. The primary prevention measures encompass lifestyle adjustments, including the adoption of a nutritious diet, consistent physical activity, and the management of underlying diseases such as hypertension and diabetes [16–18]. Stroke rehabilitation seeks to enhance patients’ recovery by augmenting their motor and cognitive abilities. Traditionally, physical therapy has emphasized muscle strengthening, balance enhancements, and mobility restoration.
Acute exercise has demonstrated efficacy in enhancing outcomes such as gait, strength, and cardiovascular health, rendering it a vital instrument in stroke rehabilitation. Stroke survivors often face persistent motor, cognitive, and cardiovascular challenges that impede their daily function and quality of life. Rehabilitation strategies have traditionally emphasized chronic, long-term exercise programs; however, acute exercise defined as short-duration (a single session to seven days), moderate- to high-intensity activity (60–85% of one’s maximum heart rate) may elicit several physiological adaptations that may expedite the recovery in stroke survivors. These encompass enhancements in motor function, muscular strength, equilibrium, cardiovascular health, and neuroplasticity. The central nervous system has significant flexibility after a stroke, and acute exercise may act as a stimulus for improving neurorehabilitation by facilitating brain repair and cognitive function [19].
Emerging modalities such as robotic-assisted treadmill training exercise and aquatic high-intensity interval training have shown a good trend in maximizing acute benefits [20, 21]. A recent systematic review of robotic upper limb rehabilitation reported moderate to large effect sizes for motor recovery, highlighting the potential of technology-driven acute protocols [20–23]. Furthermore, intensive gait training therapy designed for spinal cord injury patients has demonstrated applicability to stroke survivors, yielding significant improvements in walking speed and endurance after only a few sessions [24–26].
Recent research indicates that specialized therapies like acute exercise can significantly improve stroke recovery by facilitating brain repair and enhancing neuroplasticity [27–29]. More recent evidence supports this, including the findings from [30, 31], which demonstrate that targeted acute exercise regimens can enhance neurofunctional outcomes and motor recovery.
In particular, high-intensity protocols improve the cardiorespiratory fitness among stroke survivors [32], while acute bouts of aerobic exercise appear to prime the central nervous system for more efficient motor memory encoding [33, 34]. Emerging data also suggest that exercise-induced as demonstrated in Figure 1 increases in cerebral blood flow and shear stress positively influence cerebrovascular hemodynamics even in the subacute and chronic phases post-stroke [35, 36]. Furthermore, balance and postural control are key determinants of functional independence, which improves significantly when acute exercise is integrated into standard physiotherapy regimens [37]. Physical therapists are progressively investigating exercise-based therapies, emphasizing how particular forms of acute exercise might enhance functional recovery, mitigate stroke-related deficits, and prevent secondary health consequences, including cardiovascular disease and muscle atrophy [38].
Finally, aerobic training shortly after ischemic stroke may confer cognitive benefits, mitigating post-stroke cognitive impairments [39, 40]. This systematic review and meta-analysis aims to synthesize this evidence, focusing on the mechanistic and clinical implications of acute exercise within a physical therapy framework.
Figure 1
A conceptual model illustrating how acute exercise promotes cardiovascular improvements, neuroplasticity, and psychosocial well-being, which lead to functional recovery in stroke survivors [41–43].
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