A stroke disrupts the brain’s ability to communicate with the body, often leading to weakness or paralysis that makes movement difficult. Post-stroke exercise is a fundamental component of rehabilitation, aiming to help the brain relearn lost movement patterns through repeated, focused activity. This process is driven by neuroplasticity, the brain’s ability to reorganize itself by forming new neural connections. Engaging in physical activity consistently helps to reinforce these new pathways, allowing survivors to recover function and regain independence.
Exercises for Restoring Mobility
The initial phase of recovery focuses on regaining the full range of motion (ROM) in affected joints to prevent stiffness and painful tightening of muscles, known as contractures. This work is divided into passive and active movement. Passive range of motion (PROM) involves an external force, such as a caregiver or the unaffected limb, moving the weakened limb through its natural arc without effort from the affected muscles. This manipulation maintains joint health and provides sensory feedback to the brain, helping re-establish connection.
As muscle activation returns, the focus shifts to active range of motion (AROM) exercises, where the survivor initiates the movement, even if it is small or incomplete. Upper body AROM may involve assisted cane stretches, where the unaffected hand helps push the affected arm overhead to stretch the shoulder joint. A simple forearm stretch involves interlacing the fingers and gently bending the affected wrist forward.
Lower body mobility exercises often begin with simple movements like heel slides, where the heel is slowly slid up and down the shin while seated or lying down. Ankle pumps, which involve repeatedly pointing the foot up and down, are performed to improve circulation and flexibility in the lower leg. These movements encourage the nervous system to re-engage with the muscles and joints. Consistent, repetitive practice increases joint flexibility and prepares the muscles for future strengthening work.
Exercises for Building Functional Strength
Building strength after a stroke focuses on “functional” movements that directly translate to daily activities, helping survivors navigate their environment with greater ease and safety. This training rebuilds the muscle power and endurance required for tasks like standing up, walking, and gripping objects. The sit-to-stand exercise is a foundational movement that strengthens the leg and core muscles necessary for transferring from a chair or bed. This involves sitting near the front edge of a sturdy chair, leaning forward, and pushing up through the legs to stand, using arms minimally for support.
For the upper body, functional strength is developed through simple, repetitive actions, such as grip strength exercises using a soft stress ball or a rolled towel. Squeezing the object for a few seconds and releasing helps rebuild the hand and forearm muscles necessary for holding utensils or opening jars. Arm curls, performed while seated and using light household objects like a can of food, strengthen the biceps and shoulder muscles.
Lower body strength is addressed through modified exercises like knee extensions, where the leg is slowly straightened from a seated position, and leg lifts, performed while lying on the back. These exercises work the quadriceps and hip flexors, which are necessary for lifting the foot and clearing the ground while walking. Incorporating light resistance, such as a therapy band or ankle weights, can gradually increase the challenge as muscle strength improves.
Exercises for Improving Balance and Coordination
Impairments in balance and coordination significantly increase the risk of falls for stroke survivors, making targeted exercises essential for improving stability and gait. Training often starts with seated weight shifts, where the individual gently leans their trunk side-to-side or forward-and-back on a firm chair to control their center of gravity. As stability improves, this progresses to standing supported balance exercises, holding onto a counter or parallel bars while attempting to stand with equal weight on both feet.
To challenge dynamic balance (stability during movement), exercises like marching in place are introduced, first while seated and then while standing with support. This activity forces the body to constantly shift weight, practicing the fundamental motion of walking. A more advanced exercise is tandem walking, or heel-to-toe walking, which requires placing the heel of the front foot directly against the toe of the back foot while walking a straight line. This drill improves the coordination needed for a stable gait.
Coordination exercises include stepping over small, visible objects, which helps the brain and legs coordinate the necessary foot lift and placement to prevent tripping. As confidence grows, the level of support is reduced, and complexity is increased, such as attempting to stand on one leg for a short duration while holding onto a stable surface. These challenges encourage the nervous system to refine the integration of visual, vestibular, and sensory information required to maintain equilibrium.
Safety, Preparation, and Professional Guidance
Before starting any exercise program, a licensed professional, such as a Physical Therapist (PT) or Occupational Therapist (OT), should create a customized plan. These specialists assess specific deficits, determine appropriate intensity, and ensure exercises are performed correctly to maximize gains and prevent injury. PTs focus on mobility, balance, and strength, while OTs help adapt exercises to improve daily living activities.
Safety is paramount during post-stroke rehabilitation; all exercises should be stopped immediately if pain occurs. Overexertion must be avoided, and individuals should monitor their body’s response, including checking blood pressure and heart rate as advised by a physician, especially if they have pre-existing cardiovascular conditions. Maintaining adequate hydration is also important during exercise sessions.
The home environment must be prepared to support safe practice, ensuring all exercises are performed near a sturdy surface like a countertop or wall for immediate support in case of a loss of balance. Starting with low-intensity, high-repetition tasks is key, gradually increasing the duration and difficulty as strength and control improve. Professional guidance is an important resource for long-term success.