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Question When should exercise be introduced into a stroke survivor's recovery and what type of exercise should be done?

Answer Introducing physical activity shortly after a stroke appears to help patients regain their motor skills. The idea of taking a more aggressive approach to rehabilitation within the first two weeks after stroke is relatively new - and research suggests it speeds recovery. Exercise can stop the inactive cycle before it even begins. (A lack of activity could lead to further decline in the patient's condition.) The key is to start early and keep at it.

Typically, a person is in hospital after a stroke so there's the added benefit of being in an environment where activity can be safely monitored. Everything from aerobics, strength training and flexibility exercises can be started once the patient has left the acute stage of care and moved into a rehabilitation setting.

This isn't to say stroke patients should be immediately expected to whip up a sweat. And health care professionals need to carefully observe patients to make sure there's no risk of harm. The patient's heart rate and blood pressure should be checked regularly. Keep in mind, though, that with certain medications, these factors aren't always the most reliable signals of physical distress.

About 70 stroke patients were involved in research at the Toronto Rehabilitation Institute, and so far, not one has had any serious issues when aerobic exercise was introduced into their rehabilitation.

So what kind of aerobic exercise are we talking about? People vary in physical and mental ability right after a stroke, which is why it's important for health care providers to first do an assessment of physical abilities and develop a program designed specifically for the needs of the patient.

Let's say, for example, a patient's leg has limited mobility as a result of the stroke. In this case, a recumbent bike might be a suitable piece of exercise machinery. By strapping the weak leg in, the unaffected leg can help with the movement. This way, muscles in both legs are being used to some degree.

It's different for each person. People with generally good mobility can get on a treadmill and start walking. Others might want to start with a stationary bike or step machine where the other leg can lend strength. If the legs are too limited in movement, people can use their arms to exercise. It all depends on the patient, and this is why clinicians need to be diligent in assessing people and identifying their capabilities.

This is easier when the patient is under the constant supervision of health care providers. It is harder at home where specialized machines aren't as readily available. This is where the real challenge comes in.

Patients should try to find ways to continue with exercise when they go home, by going to a gym or to a facility in a community centre. Toronto Rehab is working with other community centres across Canada to enable stroke survivors to use its facilities.

Family members or caregivers can go work out with the patient. Partnering up when going to the gym means everyone gets some exercise.

Exercise has so many more benefits than just increasing patients' mobility. Research suggests it's good for countering depression and anxiety, and it's an all-around good picker-upper. So it's a great idea to incorporate it into rehabilitation programs, rather than stick with the old idea of rest. We just have to find a way to do it.

Dr. Dina Brooks is a scientist at the Toronto Rehabilitation Institute specializing in cardiac and respiratory rehabilitation and an associate professor of physical therapy at the University of Toronto.

We ask the experts to settle common questions we've all wondered about. If you've got a question, send it to seriously@globeandmail.com. Be sure to include your hometown and a daytime contact number so we can follow up with any queries.