Journal of Cardiac and Pulmonary Rehabilitation
Open Access

Stroke; Exercise; Cardiac rehabilitation

Introduction

Hypertension (high blood pressure) is a major risk factor for stroke. Engaging in regular physical activity has been shown to have a positive impact on blood pressure levels. Exercise stimulates the cardiovascular system, leading to improved heart function and greater blood vessel flexibility [1]. This helps reduce arterial stiffness and peripheral resistance, resulting in better blood pressure control. Several studies have demonstrated that individuals who exercise regularly have a lower risk of developing hypertension and subsequently stroke.

Obesity is another significant risk factor for stroke. Maintaining a healthy weight through exercise and proper diet can reduce the risk of stroke by lowering the likelihood of conditions such as type 2 diabetes, heart disease, and high cholesterol levels. Exercise plays a crucial role in calorie expenditure, fat metabolism, and muscle building, contributing to weight loss and overall weight management.

High levels of low-density lipoprotein cholesterol (LDL-C) and triglycerides are associated with an increased risk of atherosclerosis and stroke. Regular exercise can help improve cholesterol levels by increasing high-density lipoprotein (HDL) cholesterol, which is considered beneficial for heart health. By reducing LDL-C and triglycerides, exercise contributes to the prevention of stroke and other cardiovascular diseases [2].

Type 2 diabetes is a significant risk factor for stroke. Engaging in physical activity helps improve insulin sensitivity, glucose metabolism, and overall glycemic control. Regular exercise reduces the likelihood of developing type 2 diabetes, thereby indirectly lowering the risk of stroke.

Physical activity has been shown to have antithrombotic effects, meaning it helps prevent blood clot formation. Blood clots in the brain can lead to an ischemic stroke, where a clot blocks blood flow to the brain. Exercise enhances the release of endogenous antithrombotic agents and improves fibrinolytic activity, reducing the likelihood of clot formation and potential stroke occurrence.

Chronic stress has been associated with an increased risk of stroke through mechanisms such as hypertension and inflammation. Regular exercise is known to reduce stress levels by promoting the release of endorphins, which act as natural mood enhancers. Stress reduction through exercise can indirectly contribute to stroke prevention by mitigating potential risk factors [3].

Exercise and endothelial function

The endothelium is a thin layer of cells lining the blood vessels. It plays a critical role in maintaining vascular health, regulating blood flow, and preventing the formation of blood clots. Endothelial dysfunction is associated with an increased risk of atherosclerosis and stroke. Regular exercise has been shown to improve endothelial function, promoting healthier blood vessels and reducing the risk of stroke [4].

Exercise and brain health

Apart from its cardiovascular benefits, exercise has a direct impact on brain health, which can also contribute to stroke prevention. Physical activity stimulates the release of neurotrophic factors, such as brain-derived neurotrophic factor (BDNF), which promote the growth and maintenance of brain cells.

A meta-analysis published in the British Journal of Sports Medicine found that individuals who engaged in regular physical activity had a reduced risk of developing cognitive impairment and dementia, both of which are linked to an increased risk of stroke. Exercise also enhances cognitive function, memory, and attention, which may lead to better decision-making regarding lifestyle choices that affect stroke risk.

Type of exercise and stroke prevention

While any form of physical activity can have positive effects on stroke prevention, certain types of exercise may provide additional benefits. Aerobic exercises, such as brisk walking, jogging, cycling, and swimming, have been particularly well-studied for their cardiovascular benefits. Aerobic activities increase heart rate and improve lung capacity, promoting overall cardiovascular health [5].

Strength training exercises, such as weightlifting and resistance training, can also be beneficial. They help build lean muscle mass, which is metabolically active and aids in weight management. Moreover, increased muscle strength can improve overall physical function and reduce the risk of falls, a common risk factor for stroke in older adults.

Exercise intensity and duration: The intensity and duration of exercise also play crucial roles in stroke prevention. The American Heart Association recommends at least 150 minutes of moderateintensity aerobic exercise or 75 minutes of vigorous-intensity aerobic exercise per week, along with muscle-strengthening activities at least two days a week.

Literature Review

Atrial fibrillation is an irregular heartbeat that can lead to blood clots forming in the heart. If these clots travel to the brain, they can cause an ischemic stroke. Regular exercise has been shown to reduce the risk of developing AF, thus indirectly decreasing the likelihood of stroke.

Chronic inflammation is a significant factor in the development of atherosclerosis, a condition where plaque builds up inside arteries, potentially leading to stroke. Exercise has anti-inflammatory effects, reducing the production of inflammatory markers and promoting a healthier immune response [6].

A randomized controlled trial published in the journal Brain, Behavior, and Immunity demonstrated that a 12-week exercise program reduced levels of C-reactive protein (CRP), a well-known marker of inflammation, in sedentary overweight adults. Lowering CRP levels can contribute to reduced stroke risk.

Vascular auto regulation refers to the ability of blood vessels to maintain constant blood flow despite changes in blood pressure. Impaired auto regulation is associated with an increased risk of stroke. Exercise training has been shown to improve vascular auto regulation, which enhances blood flow to the brain and helps maintain stable cerebral perfusion [7].

A transient ischemic attack (TIA) is often referred to as a "ministroke" because it involves temporary blood flow disruption to the brain. TIAs are warning signs of an increased risk of stroke. Engaging in regular exercise after a TIA has been shown to significantly reduce the risk of subsequent strokes.

Clinical evidence continues to underscore the significant role of exercise in stroke prevention. Regular physical activity addresses multiple risk factors associated with stroke, including hypertension, obesity, high cholesterol, diabetes, atrial fibrillation, inflammation, and impaired vascular function. Exercise promotes overall cardiovascular health, brain health, and vascular auto regulation, all of which contribute to reducing the risk of stroke [8].

It is crucial to emphasize that stroke prevention through exercise is most effective when combined with other healthy lifestyle choices, such as maintaining a balanced diet, not smoking, and managing chronic health

Discussion

Exercise and atrial fibrillation (AF): Atrial fibrillation is an irregular heartbeat that can lead to blood clots forming in the heart. If these clots travel to the brain, they can cause an ischemic stroke. Regular exercise has been shown to reduce the risk of developing AF, thus indirectly decreasing the likelihood of stroke.

Chronic inflammation is a significant factor in the development of atherosclerosis, a condition where plaque builds up inside arteries, potentially leading to stroke. Exercise has anti-inflammatory effects, reducing the production of inflammatory markers and promoting a healthier immune response [9].

Exercise and risk reduction after transient ischemic attack (TIA): A transient ischemic attack (TIA) is often referred to as a "mini-stroke" because it involves temporary blood flow disruption to the brain. TIAs are warning signs of an increased risk of stroke. Engaging in regular exercise after a TIA has been shown to significantly reduce the risk of subsequent strokes [10].

Conclusion

Clinical evidence continues to underscore the significant role of exercise in stroke prevention. Regular physical activity addresses multiple risk factors associated with stroke, including hypertension, obesity, high cholesterol, diabetes, atrial fibrillation, inflammation, and impaired vascular function. Exercise promotes overall cardiovascular health, brain health, and vascular auto regulation all of which contribute to reducing the risk of stroke. By adopting a physically active lifestyle and adhering to stroke prevention guidelines, individuals can significantly decrease their risk of stroke and improve their overall health and well-being. As with any health-related decisions, consulting with healthcare professionals is essential to create a personalized and sustainable exercise plan for stroke prevention.

Acknowledgement

None

Conflict of Interest

None

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