If you are in the chronic phase and exercise does not help anymore, there is something you need to know now

February 5, 2018

The conventional wisdom about stroke rehabilitation is that most recovery happens early. Most improvement occurs within the first few days to weeks after injury. As time progresses, one sees less recovery. Doctors often tell stroke patients to start recovery right away because the benefits of rehabilitation decrease over time. You can’t blame recovering stroke patients for feeling depressed or giving up after a few months. Since they learned not to expect much improvement in their condition after a particular time, feelings of despair are understandable. But the reality is different. This finding is good news for stroke patients. A recent study found that motor function can improve even months after a stroke. The key, it turns out, is varying the rehabilitation routine.

The period of recovery from three to six months after a stroke is termed the chronic phase and is often a time of frustration for stroke patients and their caregivers. Rehabilitation of motor function that was progressing well in the weeks just after the stroke hits a wall. It may suddenly seem like progress has stopped. Patients face the prospect of living their lives in their current condition. This possibility can lead to feeling depressed and giving up on rehabilitation efforts.

Is recovery still possible in the chronic phase?

One theory for the lack of progress in the chronic phase is that the brain and muscles adapt to a standard routine of exercise. If you do the same task over and over, your brain and body adjust to it. Therefore, signals that improve function are not sent to the nervous system and muscles. The solution is super simple: change workout routines to get the brain adapting to new signals.

Researchers from Canada and Spain discovered this – they examined 339 independent trials conducted more than six months after a stroke – during the chronic phase when recovery is thought to plateau.

They found that motor function improved when patients trained with a new exercise routine. One particularly hopeful finding is that many types of motor function improved – upper arm and lower leg movements, cardiovascular strength, and walking. These improvements indicate that stroke patients with different types of injury will benefit from new routines.

The vast majority of studies that the team examined related to motor function. So, the researchers only reached conclusions regarding that aspect of recovery. But there is every reason to believe that other aspects of stroke rehabilitation such as cognitive function and psychosocial issues (depression, personal interactions) can also improve by challenging the brain with new routines. After all, the brain controls all of these things. Therefore, it makes sense to assume that the brain can be retrained to improve thought, movement, and emotion as well.

Change your routine

What is the best advice for stroke patients and their caregivers? Invest the effort to develop workout routines that challenge the brain and muscles. Be creative. If one exercise isn’t showing benefits, try another. Don’t give up when it seems like progress has stopped! Many resources are available online that describe workout routines for stroke rehabilitation. Read the descriptions, watch the videos, and give them some time to play out. If they help—great! Keep at it. If they don’t work, find another routine. There is greater hope for recovery from stroke than patients have been led to believe.


The leading author of this study is Dr. Teasell from the Department of Aging, Rehabilitation, and Geriatric Care, Lawson Health Research Institute, St. Joseph’s Parkwood Hospital, London, Canada.

Editorial note:

We published this article to make you aware that recovery can still happen beyond 6 months following a stroke. Stay motivated and keep on training!

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