Cardiovascular regulation after stroke: evidence of impairment, trainability, and implications for rehabilitation.

PURPOSE: To discuss the role of the vascular system and regulation of blood flow delivery in individuals with chronic stroke. This paper will discuss mechanisms of blood flow, vascular remodeling in chronic stroke, exercise as an intervention to improve blood flow delivery, and the role of physical therapy practice in promoting exercise. KEY POINTS: Evidence suggests that people with chronic stroke may experience reduced blood flow and decreased arterial diameter in the hemiparetic limb. These arterial changes may influence exercise performance and functional ambulation. However, exercise training can be an effective intervention for improving blood flow delivery in the hemiparetic limb. Statement of Recommendations: Physical therapists working with people post-stroke should routinely prescribe aerobic exercise training within the plan of care during stroke rehabilitation. This may minimize declines in the cardiorespiratory and vascular systems and provide greater functional capacity to perform functional activities during and after discharge from physical therapy services.