OTTAWA, October 12, 2018– Lynne Stacey is a physiotherapist who has spent a good part of her career working with people who have had strokes, from infants to seniors.
But she didn’t recognize she had had a stroke herself one day in December 2015, just as she was getting ready to teach a fitness class in a swimming pool. Stacey couldn’t move her arm or leg.
“One of my clients called 911,” she said.
Within an hour and a half, Stacey underwent endovascular treatment to pull a blood clot from her brain. She was a motivated survivor. Within a few days, thanks to a vigorous exercise regime of her own design, she had function back to her arm and leg and was playing the piano again.
“We know it improves brain health, balance and strength,” said Stacey, now 80 and still working as a physiotherapist. “One of the challenges is that people get good rehabilitation in the hospital and in physiotherapy. Then they’re back at home.”
Researchers have recognized both the truth of this and the difficulty in connecting stroke patients with good-quality exercise programs. That’s why Brain Canada and Health Canada have given a team headed by Ottawa Hospital senior researcher Dr. Ian Graham $1.2 million to “translate” this knowledge into action in communities across Canada.
More than 80 per cent of people who have a stroke will survive, and they are more likely to live longer than ever before. But this means they are also more likely to live with chronic disability.
Even though survivors make initial gains in hospital and rehabilitation, research shows they lose that when they return home and become more disabled as time goes on.
It doesn’t have to be that way. Brain imaging studies show that stroke patients recruit undamaged brain networks to help restore lost functions. But neurons have high energy needs and the brain has a limited energy supply. Exercising enhances the brain’s connectivity and there’s strong scientific evidence that aerobic exercise helps survivors recover motor skills, and relieves and improves cognitive function.
“It’s not a magic bullet, but it’s pretty close,” said Graham.
In 2016, the Heart and Stroke Foundation’s Canadian Partnership for Stroke Recovery identified exercise programs as a priority area for knowledge translation through a committee made up of people who have had strokes, caregivers, stroke recovery experts, health-care providers and policy-makers.
“We see the need to scale up evidence-based programs. There’s a lot of things we know work, but we have to get there,” said Katie Lafferty, CEO of the foundation’s Canadian Partnership for Stroke Recovery.
But changing human behaviour is not straightforward.
“Our motto is, ‘If you don’t build it, they can’t come,’” said Graham, who is a medical sociologist with expertise in knowledge translation.
Many stroke survivors have little exercise history or are afraid of injuring themselves. They may not have the money to pay for classes, or need transportation or a caregiver. Fitness instructors may be reluctant to offer the programs.
There may be barriers but there are also solutions, said Graham. The answers will be different in every community. It could be enlisting a municipality’s recreation department, getting in contact with a charity or local foundation or offering a pay-as-you-can option.
“Our job is to pull all the pieces together,” he said.
“Some people want to take classes with other people who have had strokes,” said Stacey. “Other people want to be in a regular class. Others don’t want to exercise in public. They can do it in their own living room through a video-conference.”
By mid-winter, Graham and his colleagues hope to identify between nine and 12 communities from remote rural towns to large cities to run two cohorts of 12-week exercise classes. They will use three promising exercise programs used in cities across Canada for people who have had strokes — the Fitness and Mobility Exercise Program, the Fit for Function program which is offered by the YMCA in the Hamilton area, and the Together in Movement and Exercise program offered in some community centres in Ontario and B.C.
The researchers will also track whether the programs are able to enroll people, whether there is any improvement and whether the participants are satisfied. Then they hope to translate the strategies each of those communities uses to help other communities make the connections they need in order to get their own stroke exercise programs up and running.
Knowledge translation is different from a clinical trial, which seeks the answer to the question of whether a particular drug or treatment was successful, said Graham.
“This is about how to get people to think about decision-making.”
The resulting “toolkit” is slated to be completed in about three years and will be available through open-access for anyone who wants it. It must be relevant, useful and usable to any group that wants to start an exercise program anywhere in the country. The lessons learned have the potential to benefit stroke survivors all over the world, said Lafferty.
“We can help the community think through the barriers,” said Graham. “You can’t dictate what way to do it. People are resourceful when it comes to figuring out what they want to achieve.”
By the numbers:
15 million: Number of people around the world who have a stroke each year
One in six: Proportion of people who will experience a stroke in their lifetime
One in three: Proportion of those who will be permanently disabled
5: Where stroke stands on the list of leading causes of death, according to the U.S. Centres for Disease Control and Prevention
2: Where stroke stood on the list 20 years ago
405,000: Number of Canadians who were living with permanent stroke disability as of 2013
726,000: Projected number by 2038