Exercise As Therapy for Depression in Stroke Survivors

Tee McNeill, MS

Stroke is the fifth leading cause of death in the United States. For those who survive, there are often several physical, cognitive, mental and emotional hurdles to overcome to restore optimal health. Rehabilitation from a stroke can be a tedious and lengthy (years-long) process requiring determination, discipline and consistency from the survivor and his or her caretaker(s). Having a positive mindset is crucial but, frequently, depression is one of the mental health challenges stroke survivors must contend with on their journey to restoration of body, mind and soul.

Depression is a common issue after a stroke and, quite often, it is a limiting factor in achieving lasting success in the body’s ongoing rehabilitative and restorative process. Although post-stroke depression may occur in up to 60% of survivors, the signs are often overlooked or mistaken as symptomatic of post-stroke brain dysfunctions. Oftentimes, survivors and their caretakers don’t realize that depression has set in; they will need guidance from a qualified medical professional to help identify the signs of depression and develop an effective treatment plan.

Attitude will, indeed, determine altitude!

The severity of the stroke and a person’s mental attitude towards the rehabilitation process will largely determine the speed at which physical recovery and cognitive restoration occur. In short, the stroke survivor’s mind must be “in it to win it” – he or she must be focused on recovery and willing to do what it takes to get better. In many cases, maintaining a positive mental attitude is easier said than done.

A predominantly positive mindset may be beyond the control of a stroke survivors, as biochemical reactions in his/her post-stroke brain, may make feelings of joy, happiness and positive emotions elusive and/or non-existent, leading to a depressed mental state. In addition, stroke survivors may fall into a depression during their recovery and rehabilitation process as they struggle to restore their physical strength, cognitive ability and mental acuity to pre-stroke levels.

According to Stroke.org and Healthline.com the symptoms of depression include:

  • irritability
  • constant feelings of sadness, pessimism, helplessness or anxiety
  • fatigue
  • difficulty staying focused
  • suicidal thoughts and feelings
  • anti-social behavior (specifically with family and friends)
  • overeating or under-eating

Exercise as therapy for depression in stroke survivors

There are several pharmaceutical treatments for post-stroke depression as well as therapy options such as cognitive behavioral therapy and participation in regular physical activity. A structured and consistent exercise routine (as well as the consumption of nutrient-dense, whole foods) has been shown to decrease the physiological symptoms and psychological effects of depression.

Studies suggest the production of nerve cells that positively affect our moods can be suppressed by a stressed mental state. Exercise for stroke survivors is especially important because exercise has been shown to improve brain function by releasing proteins that stimulate nerve cells in the brain to grow and make new connections. Serotonin (a mood regulator and pain inhibitor) and dopamine (partly responsible for our motivation) are neurotransmitters that are released during exercise that may help to uplift moods and positively influence a person’s perspectives.

A structured, low-intensity exercise program designed by a post-rehabilitation exercise professional may be incredibly beneficial to a depressed stroke survivor. In addition to the general benefits of exercising regularly (i.e., increased strength, improved cardiovascular endurance, increased balance, etc) other benefits of exercise that help combat depression include:

  • the release of endorphins (our “feel good hormones”) during and after moderate to vigorous physical activity
  • structure: an exercise program provides organization and structure to a stroke survivor’s day
  • increased self-esteem and self-confidence
  • increased self-efficacy over time
  • reduction of immune system chemicals that may increase the occurrence of depression
  • strength, endurance and balance restoration

Everyone likes seeing results! In my experience, the more physical improvements a stroke survivor makes by participating in a consistent exercise routine, the more likely that person will be to maintain a positive mental attitude and remain hopeful about their long-term progress.


References

Craft, L. L., & Perna, F. M. (2004). The Benefits of Exercise for the Clinically Depressed. Primary care companion to the Journal of clinical psychiatry6(3), 104–111. doi:10.4088/pcc.v06n0301

Depression and anxiety after stroke fact sheet — Stroke Foundation – Australia. (2019). Retrieved August 20, 2019, from Strokefoundation.org.au website: https://strokefoundation.org.au/About-Stroke/Help-after-stroke/Stroke-resources-and-fact-sheets/Depression-and-anxiety-after-stroke-fact-sheet

Depression and Stroke. (2018). Retrieved August 20, 2019, from http://www.stroke.org website: https://www.stroke.org/en/about-stroke/effects-of-stroke/emotional-effects-of-stroke/depression-and-stroke

Ginta, D. (2017, February 16). Stroke and Depression: What You Should Know. Retrieved August 20, 2019, from Healthline website: https://www.healthline.com/health/stroke/depression-after-stroke#symptoms

Harvard Health Publishing. (2018, April 30). Exercise is an all-natural treatment to fight depression – Harvard Health. Retrieved from Harvard Health website: https://www.health.harvard.edu/mind-and-mood/exercise-is-an-all-natural-treatment-to-fight-depression

Psych Central. (2018, October 8). Why Exercise Helps Depression. Retrieved August 20, 2019, from Psych Central website: https://psychcentral.com/lib/why-exercise-helps-depression/

Stroke Information. (2019). Retrieved August 20, 2019, from Center for Disease Control website: https://www.cdc.gov/stroke/index.htm

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