Thursday, August 12, 2010


Exercise, does it help after stroke? Of course it does, but the word exercise is so broad it's darned near meaningless.

One of the things that's confusing is the way that clinicians have historically used the word exercise. They have almost always meant "doing a movement against resistance." The focus is generally on muscle building. But, although they're weakened, the muscles of stroke survivors are usually strong enough to do whatever. And the peripheral neurology is still intact. All the nerves outside of the brain injury are doing just fine.
So the question becomes, why all the emphasis on muscle building?

The muscles are working. What's not working is the brain. Can exercise be directed at the brain? Yup. But the emphasis should come off of muscle strengthening and onto repetitive practice.
Part of the confusion is that both kind of exercises (muscle building and repetitive practice) crossover. For instance, just working on muscle building will also drive some changes in the brain. Conversely, repetitive practice of movement will build muscle. Another thing that adds confusion is that fatigue is such a huge issue among stroke survivors. So exercise for the sake of building muscle (as well as cardiovascular exercise) is important. Still, the emphasis should be on the brain. I suppose you could simplify it as that old athletic training saying: "Less weight, more reps." Sort of. For more clarity please see this article.


oc1dean said...

Usually when I go to the gym I havbe to laugh at the grunters who are trying to impress everyone with their efforts while I am working on the lightest weights possible. As I tell others I am here to build my brain rather than build muscles.

Ross said...

Hi Pete,
Nice blog.I agree, "maximum reps, minimum weight".After my stroke in 2001 it took me 2 years to get back on my bike. I trained for another 2 years, then rode 19000klms around Australia - a lot of reps!!Have a look at the on the road blog I agree, you can get stronger, you can improve your balance, you can improve your proprioception, you can improve many things - plasticity is the key to lifelong rehab. Cheers, Ross

Peter G Levine said...


Thanks for the input. It's great that you're able to ride a bike after stroke; so many folks are not able to. The link you sent provides the dreaded "Server not found" message.

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