PHILA TODAY · LIVE WELL · EAT WELL · MOVE WELL
STROKE SERIES · ARTICLE 9 OF 12
Moving back
Exercise after stroke and to prevent stroke.
Exercise is one of the most powerful interventions in stroke care. It supports the rewiring process during recovery (article 7), lowers the risk of a second stroke by about 25%, improves mood and sleep, reduces fatigue, and rebuilds the confidence that stroke takes from people. It is also free.
This article covers two related plans. The first is a modified walking and movement plan for the months after a stroke — slower, gentler, more partnered than the standard plan. The second is the broader walking-and-movement work for everyone wanting to lower their stroke risk (whether or not they've had one). The plans converge at about month six.
Before starting any exercise after stroke
Get clearance from your stroke team. Most patients are cleared to start gentle activity within days of discharge, but the timing and intensity depend on the kind of stroke, what's left to recover, and your other conditions. The physiotherapist will usually give you a specific plan.
Why exercise matters after stroke
The evidence is strong. Stroke survivors who exercise regularly:
• Have about a 25 – 30% lower risk of a second stroke.
• Have lower BP, better blood sugar control, better cholesterol.
• Have less depression and better cognitive function.
• Have less fatigue (counterintuitively — exercise reduces post-stroke fatigue).
• Walk further, balance better, fall less.
• Use less rehab and care over time.
After stroke, motion is medicine. Almost everything in the body works better with regular movement.
The modified walking plan — after stroke
This builds gradually over 12 weeks. The starting point assumes the patient has been cleared to walk by the team, can stand with support, and has some ability to walk indoors. If the patient is in a wheelchair, the principles still apply — wheelchair propulsion, transfers, and seated exercise all count.
Week What to do How often Weeks 1 – 2 Walk indoors with support, 3 – 5 minutes at a time, 4 – 6 short walks a day. Even just standing and walking to the bathroom counts. Most days Weeks 3 – 4 Build to 5 – 10 minutes per walk, fewer times a day. Try short walks outside on level ground (with a walking partner). 5 – 6 days Weeks 5 – 6 10 – 15 minutes per walk, twice a day. Add a slight slope or longer route. Start using a stick instead of a frame if appropriate. 5 days Weeks 7 – 8 15 – 20 minutes per walk, twice a day. Try walking at a slightly brisker pace for parts of the walk. 5 days Weeks 9 – 10 20 – 30 minutes once a day, plus shorter active walks. Aim to feel slightly breathless but able to talk. 5 days Weeks 11 – 12 30 minutes daily walks, briskly enough to feel a slight effort. This is the long-term target — keep going from here. 5 – 7 days
Walking safely after stroke
Specific considerations:
• Use the aid the physio prescribed. Frame, stick, splint, ankle-foot orthosis — all are tools, not weaknesses.
• Walk with someone in the first weeks. Falls are common; a hand on the arm prevents most of them.
• Choose level, well-lit routes. Uneven pavements and dim light are the biggest fall hazards.
• Wear well-fitting shoes with grip. Loose slippers and bare feet are a fall risk.
• Carry water and your phone. Hydration matters; phone for emergencies.
• Take rests as needed. Sitting on a bench for 2 minutes is not failure — it is normal.
• Watch for signs to stop: chest pain, severe shortness of breath, dizziness, new weakness, severe headache. Any of these — sit down, call the clinic.
Walking partners change everything
The single biggest predictor of whether a stroke survivor keeps walking past the first few weeks is whether they have a partner. A spouse, a sibling, a neighbour, even a phone-buddy. Daily walks become much harder to skip when someone is showing up. Build this into the plan early.
The prevention walking plan — same shape, less modification
If you have not had a stroke but are wanting to lower your risk, the plan is essentially the same as in the BP Series Article 7 and the Cholesterol Series Article 7. The 12-week build:
Week What to do Frequency Weeks 1 – 2 10 minutes at any comfortable pace 5 days Weeks 3 – 4 20 minutes at any comfortable pace 5 days Weeks 5 – 6 20 – 25 minutes, briskly for at least 10 of those minutes 5 days Weeks 7 – 8 30 minutes brisk — the target dose 5 days Weeks 9 – 10 Add a hill, stairs, or a faster patch 5 days Weeks 11 – 12 Lock it in. 30 minutes brisk most days for life. 5 – 7 days
Strength work — for the affected side and for everyone
Walking alone isn't enough. Adding two short strength sessions a week makes a real difference. You don't need a gym. Bodyweight exercises and basic equipment work fine.
For stroke survivors — strengthening the affected side
• Sit-to-stand from a chair. 3 sets of 10. Start with hands on knees for help; progress to no hands.
• Wall push-ups. Stand a metre from a wall, hands on it, lean in and push back. 3 sets of 8 – 10.
• Heel raises. Hold a counter for balance, rise onto the balls of the feet, lower slowly. 3 sets of 10.
• Affected-arm work. Holding a small can of beans in the weaker hand, slow bicep curls. Or lift the arm above the head with the help of the other hand. 3 sets of 8.
• Affected-leg work. Lying on your back, lift the weaker leg straight up a small distance and back down. Start with 5; build up.
For general stroke prevention
• Lunges — step forward into a lunge, return. 3 sets of 8 each leg.
• Modified plank — on knees if needed. Hold 20 – 60 seconds.
• Push-ups — wall, knee or full depending on level. 3 sets of 8 – 12.
• Squats — sit-to-stand if needed. 3 sets of 10.
• Resistance bands for arm and leg work. R150 – R400 at any sports shop.
Two sessions of 15 – 20 minutes a week, on non-walking days, is enough.
Balance and fall prevention
Falls are common after stroke and prevent recovery — every fall costs time, confidence and sometimes a hospital admission. Specific balance work:
• Stand on one leg (holding a counter if needed) for 10 – 30 seconds. Repeat on the other side.
• Tandem stand — one foot directly in front of the other. Hold for 30 seconds.
• Walking in a straight line — heel-to-toe along a real or imaginary line.
• Walking backwards — in a clear space, with a wall behind you for safety.
• Walking sideways — sliding sideways for 5 – 10 metres.
• Tai chi — well-researched for balance and fall prevention in older adults. Several community classes in SA cities.
What if walking outdoors isn’t safe?
South African walking conditions aren't always friendly — bad weather, unsafe streets, no pavements, dogs. Alternatives:
• Mall walking. Quiet, flat, air-conditioned, safe. Two laps of a typical mall is roughly 30 minutes.
• Treadmill at home. Second-hand entry-level R2 000 – R4 000.
• March in place. 30 minutes of marching in your sitting room counts.
• Seated cycling — a recumbent exercise bike is safer than walking for some stroke survivors.
• Swimming / water aerobics — particularly good for stroke survivors with joint problems or balance issues.
• Stationary cycling — either at a gym or with a basic home model.
Exercise and other conditions
If you have AFib
Moderate exercise is safe and recommended. Avoid extreme exertion if your AFib is poorly controlled. Talk to your clinic.
If you have heart failure
Special exercise programmes exist (cardiac rehabilitation). Ask your clinic for a referral.
If you are on anticoagulants
Exercise is safe. Avoid contact sports and activities with high fall risk (rock climbing, downhill skiing, motorcycling). Walking, cycling, swimming and gym work are all fine.
If you are diabetic
Check blood sugar before and after exercise in the first weeks. Have a glucose source nearby in case of hypoglycaemia. Adjust insulin doses with your clinic if you change activity levels.
Mental health benefits
Exercise has antidepressant effects on the same scale as some medications. For stroke survivors with post-stroke depression (article 6), regular walking is part of the treatment — not a substitute for therapy or antidepressants in moderate depression, but a meaningful add-on. Even 20 minutes of walking, 3 times a week, measurably improves mood within 4 – 6 weeks.
How to make it stick
The same habit-design tricks from the BP and cholesterol series apply:
• Pair it with something you already do. “After breakfast I walk for 20 minutes.” “After my morning coffee I do my home exercises.”
• Track it. A tick on a calendar, a phone step counter, anything visible.
• Walk with someone. See the green callout above. This is the single most important habit factor.
• Allow rest days. 5 days a week. Don’t try for 7 every week.
• If you miss a week, just restart. Drop back a week or two in the plan.
The bigger picture
The movement work after stroke is the foundation of both recovery and prevention. It is the single intervention that improves nearly every outcome — BP, cholesterol, blood sugar, fatigue, mood, sleep, fall risk, second-stroke risk, cognitive function. It costs nothing beyond comfortable shoes.
The walking partner — the family member who shows up at the same time every day — is the secret ingredient. Find one. Keep one. Become one for someone else if you can.
The next article in the series moves to medication — the anti-clotting drugs, BP tablets, statins, AFib management, and the “never stop on your own” rule that determines so much of long-term outcome.
Where to get more help
Heart and Stroke Foundation South Africa — heartfoundation.co.za · 021 422 1586 — exercise resources for stroke survivors.
South African Society of Physiotherapy — for guided exercise programmes.
Phila Today High Blood Pressure Series Article 7 and Cholesterol Series Article 7 — companion walking-plan articles.
Phila Today Stroke Series — next: stroke medications — anti-clotting, BP, statin and AFib drugs.
Phila Today · Article 9 of 12 in the Stroke Series