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Stroke
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Take up tai chi, a gentle, flowing form of martial arts, Levine recommends. A recent study shows that it improves balance in stroke survivors, as well as builds strength.
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Exercise to Rebuild Your Mind
By Jill Provost 
Published 9/8/2009 
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Despite the physical challenges you may be facing, physical activity may be the top way to regain abilities that were impaired by your stroke. “You can rewire the brain quickly and robustly, and in a way that has profound changes,” says Peter G. Levine, codirector of the Drake Center’s Neuromotor Recovery and Rehabilitation Laboratory at the University of Cincinnati Academic Medical Center and author of Stronger After Stroke: Your Roadmap to Recovery. Essential to that mental remapping, he states, is exercise.

Think a stroke means you can’t exercise? Think again, advises Joel Stein, MD, of Columbia University’s Department of Rehabilitation and chief of rehabilitation at New York Presbyterian Hospital. “Even for people who are significantly weakened on one side,” he continues, “there are ways that they can do more sustained exercise — by using a modified bicycle or just by walking.”

Stretch Your Mind
Our brain cells are constantly rearranging themselves. When we learn something, a cluster of neurons gets assigned to that activity, and they forge pathways with one another in order to communicate. Exercise helps our brain cells become more flexible and make those connections, explains John J. Ratey, MD, author of Spark: The Revolutionary New Science of Exercise and the Brain.

During a stroke, you lose a small percentage of your neurons and whatever function was associated with those cells. If you’ve lost the ability to walk, for instance, you can regain that ability by reassigning the task to new neurons. The more flexible your brain is, the easier time it will have doing this — studies show that those who exercised regularly prior to their stroke have an easier time recovering.

Train Your Brain
So how do you reassign your neurons? The same way you get to Carnegie Hall: Practice, practice, practice. Repetition is essential to regaining function. The more often you perform a task, the more brain cells that will get assigned to that activity and the deeper the memory will get wired into the brain. If it’s not done often enough, though, the neurons will disconnect from one another and the memory will be lost. That’s why, for stroke survivors, exercise also means practicing task-specific movements as often as possible, like opening and closing a hand that has lost its ability to grasp.

Keep It Conditioned
When you walk out of rehab, that’s not the end of the recovery road. “Patients are told they’ve plateaued, and they read this as, ‘I’m not going to get any better,’” says Levine. From there, many patients go home, stop doing their exercises, become sedentary, gain weight and lose the ability to walk. “It can turn into a downward spiral very rapidly,” he says. Levine emphasizes that you can continue to learn and improve as long as you keep yourself challenged with increasingly difficult repetitive tasks. For example, once you’ve mastered opening and closing the fist, now you want to do it with speed, and then using only the forefinger and thumb, and on and on until you have full hand mobility.

Exercise to Increase Energy
Just like rebuilding a bridge or laying a new highway, remapping the pathways of your brain is energy intensive. Everything a stroke survivor does takes twice the energy than it normally would, and stroke survivors, who often suffer from fatigue and depression, have only half the energy. That’s where doing cardiovascular exercise and weight-training activities can help — by increasing stamina, building muscle and flooding your brain with those “feel-good” hormones, endorphins.
 
Regular exercise will also improve your cardiovascular health, and is critical to avoid a second stroke. The American Heart Association recommends 30 minutes of moderate activity a day for stroke survivors. Walking — which Levine reminds us is essential to our lives — is one simple and accessible form of exercise. Even if it poses difficulties for you at the outset, the more you do it, the better you’ll get at it. And that’s a step in the right direction.



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