Helping someone become active after stroke
Returning to activity after a stroke can be frightening for the survivor and for the people who love them. Support doesn't have to mean pushing someone harder — or trying to protect them from doing anything. Sometimes it simply means helping them find the confidence to start.
For me, recovery didn't begin in a gym
When I first came home after my stroke, I wasn't thinking about workouts or fitness programmes.
I was pottering around the house, resting, reading and doing jigsaws because I wanted to keep my brain occupied.
I had been an active person before the stroke, but physically and mentally I was nowhere near my normal level.
At that stage, recovery itself was enough.
Walking was my first deliberate exercise
When I did start deliberately becoming more active, walking was the obvious place for me to begin.
There was no complicated programme.
I simply started moving more and paid attention to how I felt.
I didn't immediately try to prove that I was as fit as I'd been before the stroke.
I eased myself in gently.
Most people were actually telling me to slow down
Motivation wasn't really my problem.
I wanted to get moving.
If anything, my wife, family, friends and even doctors were more likely to tell me to slow down than encourage me to do more.
That was understandable.
Everybody around me had just seen something completely unexpected happen to somebody they considered fit and healthy.
I wanted some independence back
Temporarily losing my driving licence after the stroke reduced my independence.
I was also becoming bored sitting at home.
Eventually I started walking into work.
It was roughly three miles each way, so around a six-mile round trip.
Understandably, people weren't particularly enthusiastic about me heading off on my own.
I carried my phone and people knew where I was.
For me, however, walking wasn't only physical exercise. It represented some independence returning.
My experience isn't a timetable for somebody else
This is important.
My physical recovery from stroke was relatively quick, and I was already active before it happened.
A six-mile walk would be completely inappropriate for many people in the early stages after stroke.
Some survivors may initially be working towards standing independently, walking across a room or completing basic everyday activities.
The principle is to start from the survivor's own abilities and build from there with appropriate professional guidance.
I still wanted medical reassurance before harder exercise
Walking was one thing. Returning to proper exercise was another.
After my stroke, I'd been told not to return to exercise until further assessment had taken place.
Eventually I underwent a monitored treadmill exercise test while wired up to medical equipment.
I remember being nervous about pushing myself too hard during the test because part of me still associated hard exercise with what had happened.
Once I was given the go-ahead to exercise again, it was a huge psychological relief.
Medical clearance wasn't a signal to go flat out
Even after being told I could exercise, I knew I wasn't physically or mentally ready to return immediately to my old level.
I started conservatively.
When I returned to running, I chose relatively easy local routes and kept the pace slow.
I paid attention to how I felt and gradually learned where my tolerances were.
Start where they are
Don't base today's activity on what the person could do before their stroke.
Begin gently
Where medically appropriate, easier and more predictable activity can help rebuild confidence.
Build gradually
Progress doesn't need to happen in one workout, one week or even one month.
My wife didn't push me — she came with me
When I first returned to running, my wife accompanied me.
She wasn't there to coach me or make me run faster.
She was there because both of us knew that if I became unwell again, I wouldn't be alone.
That provided something I needed at the time: confidence.
Over the following weeks, as I exercised without anything happening, that confidence gradually returned.
Exercise helped my mind as much as my body
Returning to activity wasn't only about cardiovascular fitness or rebuilding physical strength.
Exercise gave me confidence.
Every walk, run or workout I completed without a problem provided a little more evidence to myself that my body still worked.
That mattered enormously after an experience that had suddenly made me question a body I'd trusted for my entire life.
So what can a partner or family member actually do?
Every stroke is different, but there are several principles from my own experience that I think are worth considering.
Listen
The survivor often knows when something feels wrong, exhausting or frightening. Don't dismiss that.
Reassure
Having somebody nearby can provide enough confidence for a person to attempt something they are nervous about.
Accompany
Where appropriate, walk with them or be present rather than turning activity into a performance test.
Notice progress
Improvement may be measured in metres, minutes, confidence or independence rather than gym statistics.
Don't compare
Their progress shouldn't be judged against another survivor — and certainly not against mine.
Know your role
A partner can provide support and encouragement without trying to become the person's doctor, physiotherapist or personal trainer.
Encourage — don't force
There is a difference between somebody being frightened to try and somebody genuinely not being ready.
A loved one shouldn't assume that reluctance is laziness or lack of motivation.
Stroke fatigue, weakness, balance problems, pain, cognitive changes, fear and many other factors can affect activity.
Listen to the survivor and, where needed, involve the relevant rehabilitation or medical professionals.
Don't only look for dramatic progress
Becoming active after stroke doesn't necessarily mean returning to a gym or running.
Depending on the person, progress might initially mean:
Moving more confidently
Becoming less frightened of movement itself can be progress.
Walking further
A small increase in comfortable walking can represent a meaningful improvement.
Doing more independently
Everyday physical independence can matter more than conventional fitness numbers.
Recovery doesn't always mean returning to the old version of you
This is something I wish I'd understood earlier.
After a stroke, it's natural to measure everything against the person you were before.
But that doesn't have to be the only goal.
My own exercise changed considerably. Eventually I became more interested in strength and functional fitness, researched training much more deeply and qualified as a personal trainer.
In some respects, I'm physically better now than I was before my stroke.
What I'd say to somebody helping a stroke survivor
Once the appropriate medical or rehabilitation professionals are happy for them to become more active, help them start from where they are.
Don't worry about where they think they should be.
Start gently.
Listen to them.
Give them confidence.
Celebrate improvement.
And remember that activity may be doing something for their confidence and mental wellbeing as well as their physical fitness.
Activity after stroke needs to be individual
My experience shouldn't be treated as an exercise programme for another survivor.
The effects of stroke vary enormously. Other medical conditions, medications, mobility, balance and cardiovascular health can all affect what activity is appropriate.
Particularly early in recovery, follow the advice of the person's stroke team, physiotherapist, GP or other relevant healthcare professionals.
Trying to help someone become active again?
You don't need to know exactly where to begin. Stroke Health Fitness is being built to help survivors and the people supporting them understand their starting point, their goals and the possibilities ahead.
START HERE