Exercise After a Stroke at Home

Start with the stroke team

Before and while exercising at home, make sure you have:

• A diagnosis and a clear understanding of the type of stroke and what has been affected: arm, leg, face, speech, vision, swallowing, attention, memory or balance. See stroke recovery at home guide and caring for a parent after stroke.
• A physiotherapist and occupational therapist who have assessed your parent, and a written home exercise programme, with pictures, if possible. Ask for it.
• Clear safety instructions: how much help is needed for standing and walking, which aids to use, how to support the weak arm, whether lifting or straining is allowed and what to avoid.
• Blood pressure and medicine advice, including blood thinners and the targets your doctor has set; see preventing a second stroke and hypertension home care guide.
• Knowledge of warning signs and what to do.
• A follow-up plan with the team, and outpatient or community therapy where available.

If you do not have these, ask the doctor for a referral to a rehabilitation service. Do not invent exercises or follow general videos in place of a therapist's plan.

Why exercise and practice matter

• Brain adaptation (neuroplasticity). The brain can re-wire, but it needs repeated, purposeful, progressively challenging practice.
• Muscle strength and fitness decline quickly after a stroke from inactivity, and rebuilding them helps walking and daily tasks.
• Fewer complications: pressure sores, stiff joints, chest infections, clots, constipation and falls are less likely when a person is active.
• Heart health: exercise helps blood pressure and reduces the risk of another stroke.
• Mood and fatigue: gentle activity can help with low mood and tiredness, though fatigue itself needs managing.
• Independence and confidence.

Many people see gains for months and even years after a stroke, though the pace slows.

Safety first: general principles

These are general safety points commonly taught to families. Follow your therapist's instructions where they differ.

1. Protect the weak arm and shoulder. - Never pull the person up or move them by the weak arm. - Support the arm on a pillow or armrest when sitting, and do not let it hang. - In bed, support the arm with a pillow. - Be gentle with shoulder movements. Shoulder pain after a stroke is common and can be reduced by correct handling. - Do not use overhead pulleys or heavy resistance on the affected arm unless a therapist has taught them.

2. Protect the weak leg. - Check that the knee does not lock backward or collapse when standing. - Make sure the foot is supported when sitting, with the whole sole on the floor. - Use a brace or splint only if prescribed, and check the skin.

3. Help standing and walking safely. - Use the walking aid prescribed; see walking aids after a stroke, quad stick after a stroke and how to use a walking frame correctly. - A helper stands on the weaker side, slightly behind, holds a transfer belt if advised, and does not lift; see how to use a transfer belt and how to lift and transfer safely. - Transfers (bed to chair, chair to commode) follow the method taught by the therapist; see bed transfer techniques. - Clear floors, non-slip shoes and good light; see falls risk assessment at home.

4. Watch for neglect and vision loss. Some people ignore one side of the body or space, or lose part of the visual field. Approach and place objects on the side they notice, and cue them gently to look to the weak side. Keep walkways clear on that side.

5. Check sensation. Reduced feeling in the weak side means burns, pressure and injuries may go unnoticed; avoid hot packs and check the skin; see hot water and scald safety for older skin.

6. Keep blood pressure and heart safe. Avoid straining and breath-holding. Do not exercise with chest pain, dizziness or very high readings. Check with the doctor what readings are safe for exercise; see how to measure blood pressure at home.

7. Use short, frequent sessions. Fatigue is a hallmark of stroke. Several 10 to 15 minute sessions across the day are better than one long one.

8. Support swallowing and speech safety: do not exercise straight after meals, and keep upright for eating; follow the speech therapist's advice; see swallowing problems and dysphagia.

9. Avoid doing it for them. Let the person do as much as they can, with encouragement and safe support.

The kind of activity therapists commonly use

These are examples of types of activity, not a programme. A therapist chooses and teaches the specifics.

• Repetitive, task-focused practice: practising a movement that matters, such as standing from a chair, reaching for a cup, stepping, stairs with a rail, buttoning a shirt, folding a towel. Doing it again and again, with feedback, is what retrains the brain.
• Positioning and gentle range of motion to prevent stiffness and shoulder problems.
• Strengthening, seated or standing, with the unaffected and affected sides, as appropriate; resistance bands may be used under guidance; see resistance bands guide.
• Balance practice, at first seated and then supported standing; see balance exercises for seniors.
• Walking practice, with the right aid and a helper; as ability grows, gradually longer and on varied surfaces; see walking programme for older adults.
• Aerobic fitness: seated or supported cycling, walking, arm or leg pedalling under advice; see pedal exerciser guide.
• Hand and arm practice, using everyday objects, therapy putty and games; see grip strength and hand exercises.
• Mirror and imagery techniques, used by therapists for some people.
• Functional electrical stimulation or other devices only if prescribed.
• Stretching to counter tightness (spasticity), taught by the therapist; do not force stiff joints.

For dressing and daily tasks, see dressing after a stroke and simple gadgets for one-handed living.

Setting up the home

• A sturdy chair with arms, and a firm seat at a height where feet are flat; see choosing a chair for an older person.
• A clear space and a safe route to the bathroom; see bathroom safety after a stroke.
• A rail or counter at hip height for standing practice, on the strong side where needed.
• Mirror for posture feedback, if useful.
• A quiet, uncluttered environment for people who are distracted easily.
• A timer and a simple chart to track sessions.
• A phone and call method nearby; see panic pendant buying guide.
• A helper present for standing and walking practice, particularly in the early months.

Fatigue, mood and thinking

• Pacing: plan the hardest activity for the best time of day, with rest breaks.
• Sleep: protect sleep; see sleep problems in older adults.
• Mood: depression and anxiety are common after stroke and can reduce participation. Speak to the doctor; see depression in older adults.
• Attention and memory: use simple, repeated instructions, one at a time; demonstrate; keep a routine.
• Frustration: celebrate small gains, and avoid comparing with before.
• Communication difficulties: use gestures, pictures and patience; see a speech and language therapist.

Stop and call for help if

Call 112 immediately if there is a sudden new weakness, numbness, face droop, slurred speech, vision loss, severe headache, confusion or collapse, as it may be another stroke; see stroke warning signs and first hour. Also for chest pain, fainting, severe breathlessness or a seizure.

Stop exercising and contact the doctor or therapist for:

• new or worsening shoulder, arm or leg pain, or a swollen, red, warm or painful calf (possible clot);
• dizziness, a racing or irregular heartbeat, or blood pressure outside the agreed range;
• a fall, even without injury;
• a new pressure mark or skin problem;
• worsening spasm, stiffness or swelling of the hand or foot;
• coughing or choking during meals;
• increasing confusion or drowsiness.

What not to do without a therapist

• Pull the person by the weak arm or use an overhead pulley on the weak shoulder.
• Force stiff joints or stretch against spasm.
• Practise stairs or outdoor walking without assessment and a helper.
• Use heavy weights or straining exercises.
• Use heat, electrical devices or massage on numb limbs.
• Stop prescribed medicines because the person feels better.
• Ignore pain.
• Push through severe fatigue.
• Rely on unproven treatments or remedies instead of therapy.

Carers: look after yourself too

Supporting someone through stroke recovery is demanding. Learn safe handling from the therapist, share the load, rest and seek support; see caregiver burnout signs and prevention, respite care and taking a break and sharing care among siblings. Stroke support groups can help. Encourage but do not nag; see motivating a parent to exercise.

When to ask a professional

The stroke team, including the doctor, physiotherapist, occupational therapist and speech and language therapist, should direct recovery and teach safe home practice. A nurse can advise on skin, continence and medicines. A dietician can advise on food and swallowing. A psychologist or counsellor can help with mood. In an emergency, call 112.