Professor Mead explained how her experiences in mountaineering in Scotland started her curiosity about the potential benefits of physical fitness training in reducing the adverse effects of prolonged immobility frequently observed in stroke survivors. What followed was a comprehensive exploration of the relationship between physical fitness training and stroke recovery, not only in a research setting but also in her role as a clinician.

Physical fitness, she explained, entails cardiorespiratory fitness, muscle strength, and power. After a stroke, these vital aspects of physical fitness are drastically reduced, often to 50-60% of levels seen in age-matched individuals. Stroke survivors frequently face the additional challenge of compensating for impaired balance and coordination or relying on walking aids, increasing the oxygen cost of daily activities by up to 300% compared to their peers. This decline in fitness leads to functional limitations and a vicious cycle of physical inactivity and further disability.

However, a systematic review conducted by D. H. Saunders et al. in 2020 analyzed 75 studies about cardiorespiratory and resistance training interventions for stroke patients. The results were encouraging, showing that these interventions could reduce disability, improve mobility, walking, and balance without serious adverse events. Additional reviews demonstrated improved fitness and reduced vascular risk factors in stroke survivors who engaged in physical fitness training. Moreover, exercise significantly lowered the risk of recurrent cardiovascular events, reducing mortality in cerebrovascular disease patients.

Regarding safety concerns, Professor Mead clarified that exercise training is generally safe, provided that high-risk patients with specific contraindications are appropriately screened out. She also highlighted that several countries have already integrated physical activity and exercise into their stroke recovery guidelines.

One of the challenges discussed was the implementation of physical fitness training in practice. Professor Mead and her team have developed training courses and a book for exercise professionals working with stroke survivors. However, practical implementation has proven to be more complex than anticipated. Especially in patients with fatigue, fear, and a lack of confidence, healthcare professionals must motivate patients and acquire more knowledge of safe and effective fitness training. Financial limitations as well as great distances to health care facilities can also pose a barrier when trying to put the interventions into practice. In the context of Nepal’s rural areas, one of the participants, Dr. Lekhjung Thapa proposed the innovative idea of enrolling patients in online physical training programs to increase access to interventions. Professor Mead offered valuable insights on optimizing this approach for patients.

In closing, Professor Mead’s lecture underscored the importance of exercise in stroke recovery. Her take-home message was clear: healthcare providers should advise patients and their families on the benefits of exercise and consider introducing exercise training into stroke unit rehabilitation. She recommended valuable resources like the book “Exercise and Fitness Training After Stroke” and the website “Self Help for Stroke” (http://selfhelp4stroke.org/) for further guidance.

The lecture talked about a very important topic and started a discussion about how to best implement this approach in the hospitals of Nepal.

Thank you, Prof. Mead for sharing your knowledge and experience with all participants! And thank you to Shirsho Shreyan for the moderation, as well as all participants for the great discussion.