EnableMe Podcast episode 12 transcript—Physical activity

Announcer:	Welcome to the EnableMe podcast series, where we bring together stroke survivors, health professionals and researchers providing you with practical advice to enable you on your journey to reclaim your life after stroke.
	
	You can join the conversation at enableme.org.au.
	
	This series is presented by Australia's national Stroke Foundation.
	
Chris:
[00:00:30]	A common thread that you hear in a lot of these podcasts is the importance of exercise and being physically active. Whether it's for reducing your risk of another stroke, or building up strength in your limbs, or even improving your memory, exercise seems to be constantly recommended. But do stroke survivors get the level of activity that they need?

In this special episode for Stroke Week, we're going to be talking to neurological physiotherapist, Natalie Fini, who has recently published a scientific paper on just this question.

[00:01:00]	Natalie is a lecturer at the University of Melbourne and she's currently doing a PhD through La Trobe University and Alfred Health. She's also deputy chair of the National Neurology Group at the Australian Physiotherapy Association.
	
	Later on, we will also speak to occupational therapist, Leah Pett from StrokeLine, about what you can do about incorporating more activity into your daily life. But first we'll talk to Natalie.
	
	Natalie, welcome to the podcast.
	
Natalie:	Great to be here. Thanks, Chris.
	
Chris:	Now in that introduction, I did touch on the fact that physical activity is important for stroke survivors. Can you tell us a bit more about why it is so important?
	
Natalie:
[00:01:30]	Physical activity is important for everyone. It's known to be beneficial for preventing a range of chronic health conditions, including stroke and heart disease, diabetes and some cancers. Physical activity also helps us to lower our blood pressure and our cholesterol, which we know are risk factors for things like having another stroke or heart attack.

And of course, being physically active also makes you feel really good. It can improve your mood and also decrease your fatigue.
	
Chris:	But how much physical activity or exercise should people be doing?
	
Natalie:
[00:02:00]

[00:02:30]	Well, we've got some Australian recommendations that tell us we should be doing about 30 minutes of moderate intensity physical activity five days a week. Interestingly, though, most Australians don't make these recommendations and there's new guidelines that have been expanded to say that we should be breaking up our sitting time and not be sitting for long periods.

And the American Heart and Stroke Association have also released guideline specific to stroke survivors. They say that they should be doing about 20–60 minutes of aerobic activity, three to five days a week, and they should also be doing strength and neuromuscular and flexibility training two to three times a week.
	
	Now, I know these targets seem really quite hard to achieve for some people, but don't despair because even increasing your physical activity by really small amounts can have beneficial effects for your health. There's actually some more research that's coming out that's telling us about the benefits of doing light intensity physical activity. This is just things like increasing the amount of chores you do around your house.	
[00:03:00]
Chris:	
Now, in terms of research, you have just published your own research, which I believe was funded by the Heart Foundation. Now, what did that project involve?
	
Natalie:	We conducted what's called a systematic review. That's where we review a whole lot of research that's already out there. We reviewed over 100 papers that looked at physical activity in stroke survivors. These papers measured physical activity using either devices, so activity monitors that people wear, or by observation where stroke survivors were observed at regular intervals throughout the day.
	
[00:03:30]	The review included over 5,000 participants with a large range – age range from 21 to 96. What we did was we pooled all the data to see on average how active stroke survivors are.
	
Chris:	What did you find?
	
Natalie:

[00:04:00]	Probably not so surprisingly, we found that people with stroke aren't that active. This was no matter if they were in the acute phase after stroke, so straight after stroke, or in that chronic phase more than six months after their stroke.

We found that stroke survivors spent at least 78% of their waking hours of their waking day inactive or sedentary. That's quite a large period of their day not doing very much. They spent less than 10% of their time on their feet, so standing or walking.

[00:04:30]	We also found that in the chronic stage after stroke, so more than six months after stroke, stroke survivors only took 4,078 steps a day. We also looked at the amount of steps that age-matched controls, so healthy people were taking, and we found that they took over 8,000 steps a day. So stroke survivors were actually taking less than half the amount of steps per day that healthy people were.
	
Chris:	Wow. Why do you think that stroke survivors don't get enough physical activity? What makes a big ... What's making the difference there?
	
Natalie:

[00:05:00]

[00:05:30]	This is a really complex question and there has been a lot of research into this area. I guess an obvious one is that stroke results in physical limitations and physical disabilities, so it is harder for these people to be more physically active. Along with that people with stroke have cognitive impairment sometimes and also things like anxiety and depression, which are really highly prevalent understandably after stroke.

Some other things are we all know about the debilitating fatigue that stroke survivors can suffer and also things like having a bit of a lack of transportation to get to exercise options or a lack of social support. I think a really big one is a loss of confidence for stroke survivors. You don't think you can exercise or be active anymore.
	
Chris:	Okay, what about ... I guess, one thing that I have heard people talk about is the fear that if they do exercise, they might push themselves too far, maybe raise their heart rate too much, perhaps bring on another stroke. Is that a concern as well?
	
Natalie:

[00:06:00]	That's not as much of a concern, but it is why we do recommend that you see ... Get clearance from your doctor, usually your GP, but it could be your neurologist or your rehab specialist as well. Get clearance from them before embarking on a new exercise programme. This might involve formal exercise testing if they're concerned.
	
Chris:	Okay, so how do people go about that? What can they do to increase their exercise, including, I guess taking into account the obstacles like the fatigue and those other things that you mentioned?
	
Natalie:

[00:06:30]	Well really interesting, exercise and physical activity can help fatigue so don't let that be a barrier. It can actually be a positive ... have a positive effect on your fatigue.

I guess an easy place to start is just gradually increasing the amount of light jobs you do around the house, or increasing the amount you walk each day. It's okay to be, to start small. This could be as small as increasing your daily walk by one minute a day. It doesn't need to be a big change. I guess it is important to start small and always make sure that you can talk while you're doing any exercise or physical activity, that you're not working too, too hard.

I guess to address some of the other barriers ... This is where health professionals experienced in working with people with stroke can help out.
	
[00:07:00]

[00:07:30]	I've mentioned always getting some clearance before embarking on a new exercise program. That's not so necessary if you're just increasing your activity around the house and things like that. I guess physiotherapists are real experts in prescribing exercise and providing physical activity and exercise options for people with neurological diagnoses including stroke.

All physios have had theoretical and clinical training with people with neurological disorders, but there are some physiotherapists who have extensive experience working with people with stroke, and they've usually done further professional development courses or actual formal post-graduate education in neurology. They're usually called neurological physiotherapists.

If you feel your needs are quite complex, I would recommend seeing someone who's experienced with working with people with stroke.
	
Chris:	Okay. How do people find someone like that?	
[00:08:00]
Natalie:	
The Australian Physiotherapy Association has a website and you can find private practitioners through that. It'll say whether people are titled neurological physiotherapists. That's if you want to go down the private route.

There's also ... You can access some services through your local community rehabilitation centres, through your local hospital networks or community health settings. Often people in those settings have had more training in neurology. Obviously, if you're an inpatient, you’re usually seeing a neurological physiotherapist as well. Yeah, they do work in a variety of settings.	
[00:08:30]
Chris:	
Okay, and I suppose you could also ask your GP for a referral.
	
Natalie:	Absolutely, asking your GP for a referral. In terms of seeing a private physio, this can be expensive, but there are some rebates you can access, certainly through private health insurance if you've got that. But also, speak to your GP about accessing a Chronic Disease Management Plan, where there's a multi-disciplinary team approach.
	
Chris:
[00:09:00]	Fantastic. Okay, is there any other final advice that you would give to stroke survivors out there wanting to, I guess, get more physical activity?
	
Natalie:	Absolutely, just give it a go. Set yourself a goal. It doesn't really matter how small it is, small changes are important especially if that gets you started. But most importantly, choose a form of exercise or activity that you like, because you're more likely to stick at it if you're doing something that you enjoy.

[00:09:30]	Some other tips… I know from my exercise, I need to make it part of my routine so if you're part ... make it part of your weekly routine, once again, you're more likely to stick at it. Also, exercising with a friend, that might make you more accountable and more likely to turn up or go for that walk if you're doing it with someone else.
	
	And of course, try to break up your sitting time. Don't sit for too long in one position and just do more little jobs around the house. Remember that starting is hard for all of us, whether you've got a stroke or not. It's just important to get started.
	
Chris:	Is there anything else people should consider and think about before they start a new activity program?	
[00:10:00]
Natalie:	
Yeah, if you've had a stroke sometimes you're more at risk of having a fall. I guess everyone, as we age, we're all at risk of getting more musculoskeletal injuries as we do more exercise and physical activity, so this is where if you're not sure it's important to see your physiotherapist or health professional to make sure that your activity and exercise programme is the right one for you.
	
Chris:
[00:10:30]	Great. That is some fantastic advice there, Natalie. Now, we will put the links to the Australian Physiotherapy Association’s Find a physio website up on our podcast page. People can go there if they want to find the link.
	
	Thank you. Very good luck with your further research and thanks again for coming in.
	
Natalie:	Thank you. Thanks so much for having me.
	
Chris:	That was physiotherapist Natalie Fini.
	
Announcer:

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Chris:	Now, to give an occupational therapist’s perspective on exercise and physical activity, we have on the line Leah Pett from StrokeLine. Hello, Leah, welcome to the podcast.
	
Leah:	Hi, Chris. Hi Natalie. Good to be here.
	
Chris:	Now, I am interested in what you think about this topic. Tell me, how important do you think physical activity is after a stroke?
	
[00:11:30]
Leah:

[00:12:00]	
Physical activity is a really important part of stroke recovery. As Natalie mentioned, the latest research recommends that we need to all be doing some form of aerobic physical activity for 30 minutes a day at least five days a week, but not many of us are actually getting there with it. Physical activity has so many benefits. Not only does it help to reduced your risk of having another stroke, but it can also improve cardiovascular health, improve blood pressure, lower your cholesterol, increase your strength and balance, reduce stress, anxiety, and depression, reduce fatigue, and it also triggers those fantastic little chemicals called endorphins that can make you feel good and help increase your energy levels.
	
	What this does, physical activity can help get you back to doing the everyday activities you were doing before you had your stroke and make you stronger, and feel better doing them.
	
Chris:	Okay, now Natalie did mention a big part of it is just being more active in your daily life, so it's not just about an exercise program but being more active every day. How can people structure their lives and their activity to get more physical activity?	
[00:12:30]
Leah:

[00:13:00]	
Yeah, absolutely. Make physical activity part of your everyday routine. That is, try to sit less and try to move more. It can be as simple as parking the car a little bit further away than you normally would and just walking that little extra distance. If you find you are sitting a lot during the day, try to get up and move around or walk a short distance around every 30 minutes.

Your occupational therapist or your physiotherapist may suggest task-specific activities that can help improve your strength, coordination, sensation, balance and your fitness. This is incorporating specific activities during the daily things that you do, that's just standing or walking that can help with your recovery.
	
	To be effective, physical activity needs to gradually become more challenging. Try to stay active for 30 minutes on most days and then every other day add strength and balance activities and maybe some resistance exercises too. Setting yourself activity goals is a great way to gradually increase the amount of physical activity that you do.
	
Chris:
[00:13:30]	Okay, now we also talked a bit about the risk of falls when you're starting an exercise programme. I suppose a fear of falling could also hold people back from just getting more activity, say around the house even. Are there are things that people can do about that issue?
	
Leah:	Yeah, stroke can affect how well you sit, move, balance, stand and walk, which in turn can lead to an increased risk of falling. Balance exercises have been shown to reduce falls, so trying to include balance and strength exercises in your physical activity routine at least twice a week, such as Tai Chi or dancing, can really help.

[00:14:00]	You can also join one of the many falls prevention programs, which run across Australia. There's some called Steady Step, Finding your Feet, Older and Bolder and there's even chair yoga. Or speak to your physiotherapist or exercise physiologist to obtain professionally prescribed activities that are tailored for you to improve your strength and balance.

[00:14:30]	The majority of falls occur in and around the home as a result of tripping or slipping. Speak to your occupational therapist about assessing your home for hazards if you do have any concerns. Check that your paths are even, your floor coverings are in good condition, and try and remove anything that has holes, curled-up edges or frayed sections that could trip you up.
	
	For everyday activities, your occupational therapist may suggest equipment to help prevent falls, such as installing rails in your bathroom, the use of a shower chair, installing a ramp or even the addition of contrast strips for stair edges just to make them easier for you to navigate. All of these things are to reduce the risk of falls in your environment.

[00:15:00]	Look, if a fear of falls is holding you back from being active, look at a personal alarm that can be worn around your neck or in your pocket that can be activated for assistance in the event of a fall. Or, as we recommend with a lot of exercise, try and exercise with support around you, so do it with friends or family members.
	
Chris:	Great, that sounds like some good ways to increase your confidence there and get some more activity. Do you have any other top tips for getting more exercise and activity?
	
Leah:

[00:15:30]	Absolutely. My top tips are a bit like Natalie's and they're all around routine, enjoyment and motivation. Work on incorporating physical activity and exercise into your everyday tasks so that it becomes routine. Physical activity can include gardening, walking to the mailbox and back, and even pushing a trolley around the shopping centre. Try and build up your level of activity progressively by increasing the distance you walk, the weight or how heavy the things are that you carry, and the amount of time that you're doing it.
	
	For enjoyment, find something that you enjoy. It won't feel like another job or part of your rehabilitation if it is fun and enjoyable. It's recommended that we all do at least 30 minutes of exercise on most days, but you know even breaking this down into three lots of 10 minutes, will have really positive effects on your overall health and wellbeing.

[00:16:00]	Find a friend or family member who can help keep you motivated, from walking a dog on a beach to bike riding at lunch time with a work mate, or attending group Tai Chi lessons. Staying on track with physical activity is much easier when you're accountable for someone else and a lot more fun to do with a friend. Being physically active is essential for health and wellbeing.

[00:16:30]	Jump onto the Stroke Foundation website and join the Stride4Stroke movement to get moving. We've got this great “get moving Australia” program coming up in November, where you can join, set your target, put how many kilometres you're planning to do and join with a group of friends if you'd like to. So you can help fight stroke in November.
	
Chris:	Fantastic. Yeah, that is ... Stride4Stroke is a great tip. Yeah, so that is taking place this November. If you want to register, as Leah said, you can go to the Stroke Foundation website or you can go directly to stride4stroke.org.au. That was the numeral, "4."

[00:17:00]	Well, thank you very much, Leah, for that advice. Now, if you need to find out more for yourself, you can speak to a health professional on StrokeLine by calling 1800 787 653 or 1 800 STROKE and, of course, you can go onto the EnableMe website where you can also ask your question and get a response from health professionals and other stroke survivors.
	
	That is it for today for our Stroke Week episode. If you like what you've heard, please give us a good rating and review on iTunes as that helps other people to find our podcast. Thank you once again, to our guests Natalie Fini and Leah Pett.
	
Announcer:

[00:17:30]	That's all for today's EnableMe podcast. You can find out more on this topic and continue the conversation or listen to other podcasts in the series at our website enableme.org.au.
	
	It's free to sign up and you can talk with thousands of other stroke survivors, carers, and supporters. We also have health professionals from Stroke Line who can answer your questions and give evidence-based advice.

[00:18:00]	The advice given here is general in nature and you should discuss your own personal needs and circumstances with your health professional. If you would like to suggest a topic or provide feedback, contact us by the website enableme.org.au.

[00:18:30]	The music in this podcast is Signs, by stroke survivor, Antonio Iannella and his band The Lion Tamers. It was recorded at Antonio's studio, which you can find out more about at www.studiofour99.org.au.

This EnableMe podcast series is produced by the national Stroke Foundation in Australia.