It is imperative to check with your primary physician before starting an exercise program; an exercise stress test is highly recommended to ensure that your heart is in condition to exercise. Once you have gotten physician consent and recommendations, consider the following additional safety measures as you begin to exercise

• Use a trained exercise professional to help establish a safe and effective program. Note that before beginning a full exercise program, motor recovery for your involved side should be nearly complete (six to 12 months post-injury).
• Are you prepared for your workout? Have you taken necessary medications (i.e., hypertension medications, water pills)? Are you drinking enough water and other fluids? Are you wearing proper exercise clothing, such as cotton material that breathes and a good pair of exercise shoes?
• Monitor your blood pressure periodically throughout an exercise program. Stop exercising if your blood pressure rises above 200/110 mmHg.
• Know how the medications you are taking affect your body's ability to exercise. Some may affect your heart rate and your trainer needs to be aware of that.
• Mental confusion: Ask your exercise physiologist to repeat any information or instructions you do not understand or cannot remember.
• Be aware of occurrences of orthostatic hypotension, which is dizziness, nausea and lightheadedness from suddenly sitting or standing up. Lie in a supine position with feet elevated until the symptoms have passed, avoid quick movements and drink plenty of water.
• Balance: Make sure you have adequate support while using the machines to avoid dangerous falls.
• Spasticity: Consult with your exercise physiologist as to the extent a spastic muscle can be strengthened and/or stretched. Avoid increasing abnormal muscle tone. Resistance training can be indicated for spastic muscles if you have full isolated control of all movements. Immediately stop exercises that limit movement.
• Reciprocal inhibition: If muscle groups are not functional because of spasticity, the opposing muscle groups may be strengthened and help normalize the spasticity. For example, tricep muscles may be strengthened to support spastic bicep muscles. Any muscle groups incapable of being strengthened should be stretched. Spasticity can affect the respiratory muscles of the involved side. Cardiovascular exercise and deep rhythmical breathing can help strengthen respiratory muscles. Note that spasticity and spasms may increase following exercise/strengthening of the noninvolved side and should not last.