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Cardiovascular Fitness and Health Behavior Change for Individuals Post-Stroke

In this episode of Kessler Foundation's podcast, Arielle Resnick, PT, DPT, NCS, of Kessler Institute for Rehabilitation presents, “The Heart of the Matter: Cardiovascular Fitness and Health Behavior Change for Individuals Post-Stroke.”



This is part three of an eight part series. Listen to the series as it's posted. 

Listen to the podcast, view the transcript and download this episode and others for free on Apple PodcastsSoundCloudPodbeanor where ever you get your podcasts.

Below is an excerpt from the lecture.



I'm Arielle Resnick, I'm one of the physical therapists here working primarily on the neural floor. And what I wanted to talk to you about today is the importance of realizing that stroke is more than just a brain problem. I think a lot of us sort of enter into that mindset in rehab that a stroke obviously is a problem that originated in the brain, but it originated in a blood vessel in the brain. Therefore, it is a cardiovascular issue as well as a neurological issue. So some of the things we're going to talk about today are just providing definitions for health and wellness, fitness, as well as the differences between exercise and physical activity.

We're going to talk a lot about the status of health and wellness in both disabled and non disabled adults in the US and worldwide and kind of provide you with some possibly staggering statistics, review models of health behavior change as they pertain to exercise along with barriers and facilitators to change, and then highlight some cardiovascular exercise prescription for individuals specifically post-stroke. So looking at definitions of health and wellness, it is important to realize that they are two different things. And I think a lot of people can define them in very different ways. What I really liked is the World Health Organization's definition of health in 1940. A state of complete physical, mental, and social well being and not merely the absence of disease.

So what I think is really important about that is we oftentimes conceptualize health as the absence of disease. But that doesn't necessarily mean that we can't be healthy in spite of disease. And I think that's a really important thing to really drive home to our patients because they're facing a life altering diagnosis, but that doesn't necessarily mean that they're never going to be "healthy" again. And so I think that's something we really have to drive home early on and from the beginning because we are not going to get the kind of buy-in that we need for lifelong change if we don't sort of instill that early on in our patients. And when we look at a definition of wellness, The Guide to Physical Therapist Practice in 2016 said it really well.

A state of being that incorporates all facets and dimensions of human existence, including physical health, emotional health, spirituality, and social connectivity. And what I think is really interesting about each of those points is stroke in particular, but many other types of diagnoses and disabilities really do target all of those things kind of all at once. And so a person's life really is completely changed from the time that they have some sort of diagnosis or injury. So when we look at something as simple as social connectivity, somebody who now has a communication deficit or a mobility deficit, it can really alter the way that they interact with society, their family, their friends. So it's something that we just kind of need to think about sort of on a multidimensional way that we are-- a lot of us in this room are therapists so we think about the physical end of it a lot, but we don't necessarily think about sort of all of the other implications of that diagnosis.


Definition of Fitness

Definition of fitness from the ABTA is a dynamic physical state comprising cardiovascular, pulmonary endurance, muscle strength, power endurance and flexibility, relaxation and body composition with the overall goal of allowing optimal and efficient performance of daily and leisure activities. And really I think the key here is that it's a dynamic physical state. So at any given time, we may be less fit or more fit but that doesn't mean that we can't someday be less fit or more fit again. So again, just thinking about instilling sort of these definitions with your patients and sort of comprising the fact that it is dynamic and it is changing and they have the ability to create that change in themselves. Looking at physical activity versus exercise, you'll see across the two columns that they do share a lot in common.

They are both defined as bodily movement via skeletal muscles that results in some sort of energy expenditure ranging from high to low. They are correlated with physical fitness where exercise is very positively correlated with physical fitness. Physical activity not as much. And the primary difference between exercise and physical activity is that exercise is planned, structured, and repetitive body movement. So it is purposeful, it has a goal in mind, and it's meant to be done in a structured way.

And its primary objective is to improve or maintain physical fitness components where physical activity doesn't necessarily address fitness but it does enhance the overall health of the person. So now we'll talk about some pretty scary facts. Less than 5% of adults participate in 30 minutes of physical activity every day. That's pretty staggering considering we live in a country that has a significant amount of young people that are also incorporated in that less than 5%. Less than 30 minutes per day puts you in the sedentary category. That's kind of a dangerous place to be. And when we look at physical activity per week, only one in three adults achieve the recommended amount of physical activity each week according to the CDC.