Stroke is the third leading cause of death in the United States and affects 731,000 people annually of whom 570,000 survive (National Stroke Association, 1999). There are currently four million stroke survivors living in the United States (Gorelick et al., 1999). The newer term for stroke is brain attack. This has been adopted by the American Heart Association to denote the same level of urgency in seeking emergency medical care as a heart attack. Stroke is also referred to as a cerebrovascular accident or CVA.

Strokes occur through the interruption of the blood supply to the brain. There are generally two types of stroke. The first is called an ischemic stroke, which results from a blood clot, while the second type of stroke is called a hemorrhagic stroke, which results from a ruptured blood vessel in the brain. Either of these conditions will result in a disruption to the motor and sensory pathways that are involved in voluntary movement (Sharp & Brouwer, 1997). Approximately, 83 percent of all strokes are of the ischemic type (National Stroke Association, 1999).

Aside from the emotional setback resulting from stroke, there is often complete or partial loss of muscle function on either the right (right hemiplegia) or left side (hemiplegia) of the body depending on where the injury occurs in the brain (the right brain controls the left side of the body and vice versa). The severity of stroke can vary from person to person. Some individuals who have had a mild stroke, or what is commonly referred to as a trans-ischemic attack (TIA), will often maintain full function after the injury, while others who have suffered a severe stroke, will often lose significant physical function on the right, left, or both sides of the body.

Resistance Training Guidelines

1. Blood pressure must be monitored very closely in persons with stroke. Since a common associated condition is hypertension, follow the resistance training guidelines for persons with hypertension as noted in Chapter X. It is especially important to make sure that the person's hypertension is under control before initiating the resistance training program. If blood pressure fluctuates during the first few weeks of the training program, contact the client's physician to determine how to proceed with a safe program. Under no circumstances should a person who has had a stroke and continues to have difficulty maintaining a stable blood pressure be permitted to exercise.

2. A recent paper noted that persons with stroke and hypertension can safely participate in rehabilitation therapy provided blood pressure does not fluctuate widely. The investigators recommended that mean arterial pressure (MAP = diastolic pressure + 1/3 [systolic pressure - diastolic pressure]) not go above 130 mm Hg until blood pressure is under better control (Black-Schaffer, Kirsteins, & Harvey, 1999). During the early stages of the program, blood pressure should be monitored before, during and at the end of the exercise to assure that wide variations are not occurring. Once the client adjusts to the program and there are no complications, blood pressure can be taken before and after each set (Rimmer & Hedman, 1999).

3. The amount of recovery that will occur after a stroke is often a question that many stroke survivors and family members ask (American Heart Association, 1994). Most persons with stroke go through a significant recovery period during the first six months after having a stroke, while others can see significant recovery up to a year or longer (Lockette & Keys, 1994). The goal of resistance training is to maximize recovery. Since most stroke survivors will return home shortly after their injury, the fitness instructor should work closely with the client's physician or physical therapist in developing a safe and effective program.