Physical activity, cognitive health and stroke prevention

An active lifestyle promotes a healthy body, which of course includes the brain, that organ both so complex and so fragile that ensures the cognitive functioning of human beings. The 10th Quebec Stroke Summit described recent advances in the effects of physical activity on cognitive functions and the prevention of stroke.

As we age, cognitive abilities such as memory, attention, and executive functions, which include planning and problem solving, begin to decline. There are changes that take place in the brain; important structures are beginning to atrophy. Physical activity is one strategy that can be used to help prevent and manage this decline.

The best type of exercise for cognitive health

An excellent exercise for healthy brain structures is aerobic exercise because it increases blood flow to the brain, increases growth factors in the brain, and reduces inflammation. These are all forms of exercise that cause your heart rate to increase, shortness of breath, and a feeling of body heat that can make you sweat. For example, walking and running, cycling, swimming, elliptical, and dancing are activities that fall into this category. The changes induced by aerobic physical activity can lead to improvements in memory and executive function.

Muscle building exercises are also very beneficial for brain health. This type of exercise produces chemical phenomena that increase the release of substances in the brain such as a protein called brain-derived neurotrophic factor and other neurotransmitters, thereby inducing structural and functional changes that improve cognition. Muscle building exercises can be done with very little or even without any equipment, including lunges and squats, push-ups, and the abdominal plank.

Both types of exercise are therefore recommended for brain health. It only takes four weeks of stopping physical activity for these effects to wear off! But it only takes a few sessions to regain the benefits. Regularity and long-term maintenance are very important.

How can physical activity be used for stroke prevention and management?

A stroke occurs when blood flow to the brain is interrupted by a blockage (ischemic stroke), or when blood flow is interrupted by an artery in the brain that has weakened, ruptured, and begins to bleed (hemorrhagic stroke). Although ischemic stroke is more common, both can cause severe damage to the brain.

There are five main risk factors that can lead to a stroke:

1. High blood pressure
2. Hypercholesterolemia
3. Type 2 diabetes
4. Smoking
5. A previous transient ischemic attack

Physical activity can be used as a strategy for preventing stroke because it has a beneficial effect on the first three risk factors. Indeed, physical activity is an excellent treatment for high blood pressure, hypercholesterolemia and type 2 diabetes. Combined with pharmacological treatment, its practice helps prevent these diseases or control them when they are present. Smoking cessation and stroke education are also strategies to put in place to avoid a stroke or a recurrence.

Recommendations for physical activity following a stroke

A combination of aerobic physical activity and strengthening is recommended after a stroke. The time from stroke to starting exercise can be as short as a week, but at this point, sessions should be guided by the medical team. They aim to regain mobility. After a few weeks or months, longer and more complete sessions can be introduced into the routine.
Structured aerobic type sessions of more than 20 minutes and 3 times a week are recommended. It is important to plan for a warm-up and gradually increase the duration and intensity of the workout. The prescribed intensity of the session depends on the person’s heart and neurological health, as well as the length of the planned sessions. The intensity of physical activity can be light, moderate or vigorous. It is important to call in a health professional in physical activity, a kinesiologist, to fully understand the perception of effort and to choose the appropriate intensity.

Strengthening physical activity sessions are recommended 2 to 3 times a week. It is important to allow the muscles to recover, which is why it is advisable to wait 48 hours between each strengthening session. The number of repetitions should be between 8 and 15 for 1 to 4 sets. The frequency, duration and intensity of the sessions should gradually increase.

Strategies for implementing a physical activity program

Here are some strategies that were recommended at the 10th Quebec Stroke Summit to help improve and maintain adherence to a physical activity program for stroke management:

• Determine your disposition and willingness to change. Do you have all the information you need to make a change in your lifestyle? Consider the advantages and disadvantages and then come up with a plan of action.
• Set goals that challenge you while being realistic. For example:

“I’ll take a 30-minute walk 3 times a week. ”

“I will do 20 minutes of strengthening exercises twice a week”

• Be prepared and participate actively: put your sessions in your calendar, have a bottle of water, exercise clothes, choose music that you will listen to during your workouts, etc.
• Involve your family to help you achieve your goals. They might even participate in your workouts with you!
• Do group exercises, it will benefit your physical and mental health.

Sources :

https://www.heartandstroke.ca/stroke/what-is-stroke

ACSM’s Guidelines for Exercise Testing and Prescription, 2017

MacKay-Lyons, M, 10e Sommet québécois sur l’AVC, 30 octobre 2020

MacKay-Lyons, M., S. A. Billinger, J. J. Eng, A. Dromerick, N. Giacomantonio, C. Hafer-Macko, R. Macko, E. Nguyen, P. Prior, N. Suskin, A. Tang, M. Thornton and K. Unsworth (2020). « Aerobic Exercise Recommendations to Optimize Best Practices in Care After Stroke: AEROBICS 2019 Update. » Phys Ther 100(1): 149-156.