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Exercise After Stroke: Why It Matters & What the Latest Guidelines Recommend

stroke patients exercising in the park using light weight dumbbells

Exercise after stroke is crucial for recovery, but knowing exactly what exercises to perform can feel overwhelming. Every stroke is different, and every survivor will experience different secondary effects. This means the best exercise to perform after a stroke varies from person to person. Your therapy team should develop exercise after stroke guidelines that are specific to your needs.

The type of stroke, the area of the brain affected, and symptom severity all impact the type of exercise that will be most beneficial for each survivor. For example, some survivors may be able to perform active exercise immediately after stroke, while others may need to focus on passive exercise first. In addition, some stroke survivors may be able to perform aerobic exercises in addition to walking, while gait training may be the primary focus for others.

It is important for every stroke survivor to work closely with their therapy team for the best recommendations. This will help you create a plan that is specific to your recovery journey so you can reach your own unique goals. To help you navigate that conversation, it can be useful to know the benefits and types of exercise available after stroke.

Why Exercise After Stroke Is Important

Exercise after stroke is critical for two main reasons: rehabilitating the physical effects of a stroke and preventing another stroke from happening. For these reasons, it is important to perform exercise that addresses mobility, strength, and overall cardiovascular health.

Often, a stroke leads to physical impairments such as hemiplegia or hemiparesis. This refers to paralysis or weakness on one side of the body, which can affect many aspects of a survivor’s life. These impairments increase the risk of falling after stroke and reduce efficiency with activities of daily living (ADLs). Therefore, a customized post-stroke exercise regimen should be created to help improve safety and independence.

Stroke prevention is another reason why exercise after stroke is vital. According to the American Stroke Association, 1 in 4 survivors will experience a second stroke. Stroke is usually not an isolated incident, and risk factors often precede the stroke. These stroke risk factors can include high blood pressure, high cholesterol, diabetes, and obesity. Fortunately, all of these conditions can be improved with exercise and other stroke prevention practices.

While exercise is necessary for good health and recovery after stroke, survivors should be mindful of safe techniques to avoid overexercising. Pushing the body too hard can potentially result in regression after stroke or exacerbate conditions like post-stroke fatigue. Stroke patients will see the best results with a balanced regimen created with the help of a therapist.

To get an idea of which exercises your therapy team may recommend, let’s look at the latest guidelines. We will review recommendations on exercise repetition and frequency to help maximize your recovery.

Exercise After Stroke Guidelines

Since stroke causes injury to the brain, survivors can experience physical, cognitive, and even emotional secondary effects. Therefore, the best exercises after stroke depend on your unique symptoms and ability levels, as well as any preexisting medical conditions. Many patients will receive exercise after stroke guidelines and recommendations that prioritize stroke rehabilitation and stroke prevention to help address these concerns.

Here are the current exercise after stroke guidelines as recommended by the American Heart Association:

  • Early mobilization is a valuable tool for those in the acute stage of stroke rehabilitation if the survivor is medically stable. Early-stage exercise should be performed to patient tolerance and can include sitting or standing, self-care activities, and low-level walking. Early mobilization can help reduce deconditioning, improve vitals, and decrease the risk of developing other medical complications such as pneumonia.
  • Aerobic exercise should be prioritized for a variety of reasons, including prevention of another stroke. Aerobic exercise such as walking or arm/leg cycling can improve walking efficiency, increase endurance, and even improve cognition. Experts recommend aerobic exercise after stroke for 20-60 minutes per day, 3-5 days per week. Dosage should be adjusted based on the individual’s level of fitness.
  • Strength training exercise is recommended to reverse muscle atrophy, which typically occurs during the hospital stay and days thereafter. Strengthening of the muscles can help increase independence, decrease secondary effects such as foot drop, and improve endurance. Strength training should be performed 2-3 days per week and consist of 8-10 exercises involving major muscle groups. These exercises should be performed for at least one set of 10-15 repetitions and resistance should be increased over time according to individual progress.
  • Stretching and range of motion exercises are necessary components of post-stroke exercise programs. These exercises can improve flexibility, decrease risk of injury, and help prevent contractures after stroke. Range of motion exercises should be performed 2-3 days per week and each exercise should be held for at least 10-30 seconds.
  • Balance exercises and core exercises after stroke are recommended to increase safety during activities of daily living and to decrease fall risk. These exercises should be incorporated into a stroke exercise program at least 2-3 days per week.
  • Gait training exercises refer to exercises that address walking and should be a top priority to help patients get back to “pre-stroke” levels of activity as soon as possible. Gait training can help increase independence with activities of daily living and improve tolerance of prolonged physical activity. Your physical therapist will help you get started with gait training, even if you require assistance at first.

It is important to work with your therapy team to set your post-stroke exercise goals. Your team will likely include your physical therapist, occupational therapist, and speech therapist. While your PT and OT can provide exercises for your arms, legs, and balance, a speech therapist can provide exercises to improve your speech and swallowing after stroke

Some patients may need to prioritize gait training to develop the motivation for consistent aerobic exercise after stroke. Other patients with mild secondary effects might be able to accommodate both gait training and other forms of aerobic exercise. No matter what your doctor or therapist recommends, one thing remains true throughout the stroke recovery process: consistency and repetition matter.

Repetition is Key for Exercise After Stroke

Some therapists refer to rehabilitation exercises as neuromuscular training, which focuses on training the nerves and muscles to communicate. After a stroke disrupts the pathways between the brain and muscles (resulting in impaired movement patterns), neuromuscular training can help restore movement by activating neuroplasticity.

Neuroplasticity is the brain’s natural ability to reorganize itself and learn new skills. This is how stroke patients can recover lost abilities like walking, dressing, and moving throughout daily life. By practicing therapy exercises after stroke, survivors can rewire these connections to healthy areas of the brain to promote recovery of lost functions.

When discussing the best exercises after stroke with your therapist, you may hear them refer to something called massed practice. This refers to the large number of repetitions used to stimulate neuroplasticity during therapy exercises after stroke.

The brain requires intense repetition to learn new skills because it likes to be efficient. When something is done frequently, the brain learns that the task is important and responds by making that task easier to accomplish. Many therapists emphasize high repetition to help encourage neuroplasticity during rehabilitation. The more you practice an exercise or a task consistently, the easier that task will become.

Getting Ready for Exercise After Stroke

It is important for stroke patients to work closely with their therapy team to develop an exercise plan that accommodates their specific needs and goals. Exercise after stroke guidelines generally includes a unique combination of aerobic exercise, strength training, range of motion, and balance. Exercise after stroke (along with other healthy habits) can maximize recovery and help prevent another stroke.

For an extra boost of motivation, try incorporating gamified rehab equipment like Flint Rehab’s FitMi home therapy into your rehabilitation program. This device is designed to help with neuromuscular training at home and can motivate survivors to perform high repetition of therapy exercises after stroke.

Flint Rehab also has a free eBook with stroke recovery exercises that you can download below:

Want 25 pages of stroke recovery exercises in a PDF? Click here to download our free Stroke Rehab Exercise ebook now (link opens a pop up for uninterrupted reading)

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Get Inspired with This Stroke Survivor Story

Mom gets better every day!

“When my 84-year-old Mom had a stoke on May 2, the right side of her body was rendered useless. In the past six months, she has been blessed with a supportive medical team, therapy team, and family team that has worked together to gain remarkable results.

While she still struggles with her right side, she can walk (with assistance) and is beginning to get her right arm and hand more functional. We invested in the FitMi + MusicGlove + Tablet bundle for her at the beginning of August.

She lights up when we bring it out and enjoys using it for about 20 to 30 minutes at a time. While she still doesn’t have enough strength to perform some of the exercises, she rocks the ones she can do! Thanks for creating such powerful tools to help those of us caring for stroke patients. What you do really matters!”

-David H.

FitMi is a neurorehab device that you can use from the comfort of home. It works by motivating you to accomplish high repetition of therapeutic exercises.

As you work through the program, you’ll unlock more difficult exercises when you’re ready. It’s like having a virtual therapist available anytime you need it.

See how quickly Sudhir was able to notice improvements:

Saw results within a few days

“I bought FitMi about a month and a half ago. Quite impressed with the range of exercises for hand, arm, leg and foot. I suffered a stroke about 2 years ago which paralyzed my right side. I do walk now with a cane or walker, but my right hand curls up and my right arm is also weak. Within a few days of trying it out, I could note a distinct improvement in stamina before tiring. So, I am looking forward to continued improvement.”


Not only is FitMi approved by survivors, but it’s also approved by therapists, too. FitMi is used in some of the top clinics in the world, including the Shirley Ryan Ability Lab, the #1 ranked rehab hospital in America. Plus, two PTs on YouTube with over 3 million subscribers (you may know them as Bob & Brad) gave FitMi the thumbs up, too.

To learn more about this motion-sensing, game-changing recovery tool, click the button below: