Exercise

							Exercise
Risks of not exercising after stroke
• Reduced muscle strength and power
• VO2 max: about 50% of age-matched controls
• Difficulty with activities of daily living, e.g.
  hoovering, shopping
• Unable to cross the road fast enough
• ↑ risk of further vascular events
• ↑ risks of falls
• ↓ community integration
• ↑ Risk of hospitalisation
• ↑ Risk of long term complications.
   Risks associated with exercise
            after stroke
• The same risks which are associated with
  other co-morbidities e.g. Cardiac and OA
• The risks associated with stroke
  impairment e.g. weakness, fatigue,
  comprehension
• The risks associated with activities and
  stroke e.g. falls, pain
Benefits of exercise after stroke
• Improves physical fitness
• Improves walking performance (as long as
  walking is included)
• Benefits are exercise-specific
• Subjective evidence of mood /
  socialisation improvements
  Current service models

 There are 3 different stroke-specific service
 models for Exercise after Stroke in Scotland:
– Rehabilitation extensions (NHS run)
– Leisure services (e.g. Glasgow “Vitality”
   service)
– NGO’s e.g. Different strokes, CHSS groups
             Pathways into Exercise after Stroke
Discharge from hospital rehabilitation             Community stroke survivors



                 Screening for absolute contraindications
                         Functional Assessment
                         Referral to EAS service
                        Complete a referral form                      Health care
                                                                      professional
    Feedback
                         Pre-exercise assessment
                                                                      Exercise
                                                                      professional


             Exercise after stroke sessions in leisure centre




Continue exercise after stroke sessions       Mainstream exercise services
                                 COMMUNITY PHYSICAL ACTIVITY PATHWAY
                  Patient identified who would benefit from increasing physical activity levels

               No                                                                                 Yes
                            Is patient ready to increase physical activity levels?

May not be ready now. Offer information on              Does patient have any absolute contraindications?
Physical Activity and leave ‘open-door’ for             e.g. BP ≥ 180/100mmHg, unstable angina, acute or
discussion in the future.                               chronic heart failure, uncontrolled tachycardia or
                                                        arrhythmia, uncontrolled diabetes etc.
Not for community physical activity                                               No
                                                             Yes
programme until stable /reviewed by GP or
cardiologist as appropriate. Consider                            Would patient benefit from/wishes
Cardiac/Pulmonary rehab Services.                                behavioural change support?
                                                      No                                                   Yes
Does patient have a history of
heart disease or stroke?
                                                        Offer Live Active Referral Scheme
                                                        12 months 1:1 behavioural change support via face to
        No          Yes - Re-emphasis role of           face & telephone consultations & tailored activity goals.
                    Live Active Programme               Use referral form or contact 0141 287 9873

         Is patient interested in a                     Offer Vitality Programme
No                                             Yes
         structured group activity?                     Suitable for individuals with long-term conditions & low
                                                        aerobic fitness/functional ability.
                                                        Offer help to complete PAR-Q form if required.
Signpost to Local Leisure Providers                     Individuals with established heart disease or stroke can
for info on activities e.g. gym, health                 only access this programme via the Live Active referral
walks, swimming. Reinforce ‘active                      scheme.
options’, e.g. walking, using the stairs etc            Please Note: Vitality classes are group based only.
              Instructor training
• Recommended by Skills Active
• Currently only 1 course endorsed – Later Life Training 6 day
  course with qualification (& therefore insurance!)
• Available to AHPs & Exercise Instructors.
• Includes some workforce planning
• Ensures basic competencies
              Resources
• Live Active Administrator
  0141 287 9873
• Vitality Programme Co-ordinator
  0141 287 9882
• Walk Glasgow Co-ordinator
  0141 287 0963
• Culture and Sport Glasgow
  0141 287 4350