Recovery, in broad strokes

Julie Cleary believes it was physical activity which enabled her to make an almost complete recovery from a stroke

STANDING IN her kitchen two years ago, Julie Cleary went to reach for something on the shelf and her hand decided not to respond. It was May 2006, and having represented Ireland at six orienteering World Championships, Cleary was in her prime, as fit and healthy as she had ever been. "I quickly felt everything going," she says, "by the time my husband got home from the city they were loading me into an ambulance. I would spend the next month in hospital."

Cleary later found out that she had a haemorrhagic stroke, caused by a bleed in her brain, and resulting in her left hand side being impaired.

"If I was to describe my right hand side as being like a motorway, in terms of its speed function, my left hand felt like a secondary road and sometimes, when I was very tired, more like a country lane!"

Cleary was determined to return to competitive sport and set about a regime of physical rehabilitation, assisted by her physiotherapist, herself a runner.

"At the start it was very difficult, and I got tired very easily. If I made a cup of tea for instance it took a lot out of me. I used to walk down to our local church, 300 yards away, and I would need to take a long break.

"I was adamant that at my age, having just won the Irish championships in orienteering, that the sport was such a big part of my life, I wanted to get back to it.

"Even if I could only walk the courses as opposed to run, I needed to be back out there competing. So I set about working toward that and training."

Cleary believes it was this regime of physical activity which enabled her make an almost 95 per cent recovery from her stroke. A year after her illness she won the British Short Course Championships, and now, two years on, she is back to competing at her pre-stroke level.

She says unless someone had prior knowledge of her illness it would be difficult to recognise the symptoms at first sight. The fingers in her left hand sometimes curl up, and she gets tingles after training, but apart from that she says she is feeling fine.

The physical regime she underwent was also key to Cleary maintaining her positive outlook at the lowest points of her illness.

"Three months after the stroke, not being able to get out and about, I began to feel very low. I went to my GP who said he could prescribe something, or if I could find another way to cope then I should do that. I started walking every chance I could and that helped enormously and began my road to recovery."

Cleary's personal assessment would seem to be confirmed by new studies that emerged from the US late last year outlining the benefits of walking for stroke patients. Physical activity has long been recognised as key to stroke recovery, but the studies now show that physical activity can also spur brain activity.

As part of the study, stroke patients were put through a walking programme to see who could walk better and faster after. The study found that repetitive movements activated different areas of the brain.

In total, 71 subjects with some movement disability were asked to walk on a treadmill three times a week for up to 40 minutes. The other subjects did stretching exercises for the same amount of time.

The outcome of the studies showed that the walking group increased its speed and aerobic capacity by 51 per cent while the aerobic group improved by 11 per cent. The study also showed that the walking group's fitness levels rose, while the aerobic group's fitness levels decreased slightly.

Prof Peter Kelly, a consultant neurologist and director of stroke services at the Mater Hospital in Dublin, says the studies are welcome.

"We have known that walking is excellent therapy for stroke patients. One of our prime considerations for patients after stroke is to get them back on their feet. We have a multidisciplinary approach here in Ireland and the physiotherapists are very much involved."

Walking is also excellent therapy to help prevent a second stroke. The US study showed that aerobic patients also increase their aerobic capacity by a fifth, which will have secondary benefits for the reduction of heart attacks.

"The other benefits is that exercise burns off calories and allow us to lose weight which in turn puts less strain on the heart and blood pressure. This should help prevent diabetes, which is a major factor in secondary strokes.

"There is also a positive psychological benefit to having an active rehabilitation programme. Walking can encourage social interaction, and it is essential in the aftermath of a stroke that people get out of feeling isolated and get to meet others on day-to-day activities."

Patients should exercise caution though, as Dr Morgan Crowe, a consultant physician at St Vincent's University Hospital in Dublin, notes, "One of the points I would make is that rehabilitation and exercise programmes for older patients have to be very much dictated by the individual patient needs. In other words, one size does not fit all. "Stroke teams involving physiotherapists, occupational therapists and others are very good in assessing the needs of individual patients.

"Simply saying that everybody should go out and exercise may not be appropriate although there are benefits," he says.