Life after stroke: the influence of physical fitness and exercise


New research into exercise training is giving stroke survivors the chance to improve their quality of life.

What was the problem? 

Every year 15 million people worldwide experience a stroke. Of these, five million die and five million are permanently disabled. Life after stroke is never the same for many survivors.

Physical fitness is reduced after stroke. Impaired fitness is associated with post-stroke disability. Many stroke survivors require rehabilitation, but most programmes have not included fitness training.

Research by Professor Gillian Mead and Dr David Saunders from 2001 to 2012 has shown that exercise training can improve the physical fitness and physical function of stroke survivors.

What did we do? 

Why exercise after a stroke?

The research demonstrated that aerobic fitness is substantially impaired after a stroke. This is important because low aerobic fitness can increase the risk of recurrent stroke and can also worsen post-stroke disability.


Gathering the evidence

In association with the Cochrane Collaboration, Mead and Saunders produced a series of reviews. They compared all the available evidence from clinical trials of exercise training after stroke. This helped them to find out whether exercise interventions can help.

Working with such a large amount of data was important for the project. Individual trials do not provide enough evidence to form clinical guidelines. For the last 10 years, Mead and Saunders have led the production and updating of this vast body of evidence.


Analysing the evidence

The research identified the benefits of physical fitness training for patients. For example, cardiorespiratory training can improve mobility in stroke patients. Mobility is named as especially important by stroke patients themselves.


Practical application

The research programme also looked at how to put this evidence into practice. Key barriers to exercise were lack of motivation, environmental factors (such as transport), health concerns and stroke impairments. Things which helped to motivate patients included social support and the need to be able to perform daily tasks.

We're working with fitness experts to determine the best 'exercise prescription' for stroke survivors. It's also important that we understand more about the factors that put patients off from taking part in exercise programs, and how we can motivate them to take advantage of the benefits.
Professor Gillian Mead
What happened next? 

The Cochrane Review

Cochrane systematic reviews help providers, practitioners and patients make informed decisions about healthcare. The 2012 update of Mead and Saunders’ Cochrane systematic review of fitness training is the 4th most cited and 7th most accessed about stroke.

Influencing Clinical Practice

This life-changing research has influenced stroke rehabilitation policy and practice. It has directly informed clinical practice in the UK via a number of National Clinical Guidelines for stroke. It has also been cited as evidence in clinical guidance in Australia, New Zealand and Canada.

The Scottish Government funded the development of ‘Exercise after Stroke’ services. This guidance uses Mead and Saunders’ research as evidence for fitness training, and to guide people in choosing the best type of training for them. The guidance appears on the ‘Exercise After Stroke’ website and has been accessed over 15,000 times.

Helping Practitioners

The research is now used to inform the training of healthcare practitioners involved in stroke rehabilitation. Mead and Saunders contributed to Exercise and Fitness Training After Stroke: a handbook for evidence-based practice (2012). This handbook helps health professionals to design safe and effective programmes for stroke survivors.

It also forms the basis of the only UK course for exercise professionals which is endorsed by SkillsActive. Approved by the Chartered Society of Physiotherapists, and the UK Stroke Forum for training, the course has already been completed by over 200 practitioners.

About the researcher(s)

Personal Chair of Stroke and Elderly Care Medicine

Research unit

Subject area:
  • Education


  • The University of Edinburgh

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