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Review
. 2021 Aug 27;7(3):178-186.
doi: 10.4103/bc.bc_35_21. eCollection 2021 Jul-Sep.

Timing is everything: Exercise therapy and remote ischemic conditioning for acute ischemic stroke patients

Hangil Lee  1 , Ho Jun Yun  1 , Yuchuan Ding  1   2
Affiliations
Review

Timing is everything: Exercise therapy and remote ischemic conditioning for acute ischemic stroke patients

Hangil Lee et al. Brain Circ. .

Abstract

Physical exercise is a promising rehabilitative strategy for acute ischemic stroke. Preclinical trials suggest that exercise restores cerebral blood circulation and re-establishes the blood-brain barrier's integrity with neurological function and motor skill improvement. Clinical trials demonstrated that exercise improves prognosis and decreases complications after ischemic events. Due to these encouraging findings, early exercise rehabilitation has been quickly adopted into stroke rehabilitation guidelines. Unfortunately, preclinical trials have failed to warn us of an adverse effect. Trials with very early exercise rehabilitation (within 24 h of ischemic attack) found an inferior prognosis at 3 months. It was not immediately clear as to why exercise was detrimental when performed very early while it was ameliorative just a few short days later. This review aimed to explore the potential mechanisms of harm seen in very early exercise administered to acute ischemic stroke patients. To begin, the mechanisms of exercise's benefit were transposed onto the current understanding of acute ischemic stroke's pathogenesis, specifically during the acute and subacute phases. Then, exercise rehabilitation's mechanisms were compared to that of remote ischemic conditioning (RIC). This comparison may reveal how RIC may be providing clinical benefit during the acute phase of ischemic stroke when exercise proved to be harmful.

Keywords: Acute stroke; autoregulation; dysautoregulation; neuroprotection; stroke rehabilitation; subacute stroke.

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Conflict of interest statement

Dr. Yuchuan Ding is an Associate Editor of Brain Circulation. The article was subject to the journal’s standard procedures, with peer review handled independently of this Editor and their research groups.

Figures

Figure 1
Figure 1
Pathophysiology of acute and subacute phases of stroke
Figure 2
Figure 2
Subacute phase of stroke and the mechanism of exercise rehabilitation and remote ischemic conditioning
Figure 3
Figure 3
Acute phase of stroke and the mechanism of exercise
Figure 4
Figure 4
Acute phase of stroke and the mechanism of remote ischemic conditioning
See this image and copyright information in PMC

References

    1. Knecht T, Borlongan C, Dela Peña I. Combination therapy for ischemic stroke: Novel approaches to lengthen therapeutic window of tissue plasminogen activator. Brain Circ. 2018;4:99–108. - PMC - PubMed
    1. Ma Y, Liu Y, Zhang Z, Yang GY. Significance of complement system in ischemic stroke: A comprehensive review. Aging Dis. 2019;10:429–62. - PMC - PubMed
    1. Nguyen G, Cercy K, Johnson CO, Alam T, et al. GBD 2016 Lifetime Risk of Stroke Collaborators; Feigin VL. Global, Regional, and country-specific lifetime risks of stroke, 1990 and 2016. N Engl J Med. 2018;379:2429–37. - PMC - PubMed
    1. Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. Heart disease and stroke statistics-2021 update: A report from the American Heart Association. Circulation. 2021;143:e254–743. - PubMed
    1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50:e344–418. - PubMed