Cardiorespiratory Training

Cardiorespiratory training plays an important role in the rehabilitation of stroke and neurological patients. There is a growing body of evidence highlighting the impact of different types, amounts, and durations of physical activity on health outcomes, as well as the negative effects of sedentary behaviour. This has led to recommendations that incorporate physical activity guidance for individuals living with disabilities.

What are the recommendations?

The National Clinical Guideline for Stroke (2023) recommends that people with stroke should be offered cardiorespiratory training or mixed training, for at least 30-40 minutes, 3 to 5 times a week for 10-20 weeks regardless of age, time since stroke onset or severity of impairments, guided by their goals and preferences.

Many people with stroke have low cardiorespiratory fitness pre-morbidly (Kurl et al, 2003) which is exacerbated by the increased energy costs of moving, and by inactivity after stroke (Ivey et al, 2005; Smith et al, 2012; Tieges et al, 2015; Kramer et al, 2016). Low cardiorespiratory fitness is seen in all stages of recovery and can make it difficult for people with stroke to engage in rehabilitation and maintain basic mobility and daily activities (Kunkel et al, 2015). In turn, this feeds into further inactivity, limits participation and increases the risk of recurrent stroke (Mayo et al, 1999; Billinger et al, 2015) making cardiorespiratory fitness an important target for rehabilitation to both maximise recovery and to reduce the risk of recurrence. [2023]

Health care professionals also face barriers to implementing exercise after stroke. Many feel they lack the knowledge and skills to prescribe exercise effectively, are concerned about safety and have misconceptions about the capabilities and motivation of people with stroke. Lack of resources in terms of staffing, resources, knowledge and training are also an issue (Gaskins et al, 2021; Moncion et al, 2022). [2023].

Current practice in Greater Manchester

Currently, Greater Manchester inpatient and community stroke services do not routinely offer structured cardiorespiratory physical activity to patients post-stroke. There is no standardised approach to cardiorespiratory physical activity for stroke patients across the region including screening, monitoring and training approaches. Cardiac rehabilitation, respiratory and stroke services run in independent silos. There is no coordination of cardiorespiratory physical activity programmes for stroke patients across inpatient and community settings (including, NHS organisations, local authority leisure facilities and charitable organisations).

With increased education and training of staff in relation to cardiorespiratory physical activity, we aim to increase the confidence of staff to deliver structured cardiorespiratory physical exercise and improve the communication between NHS services and that of the local authority health and wellbeing services. This in turn should increase the deliverance and access to cardiorespiratory physical exercise in Greater Manchester stroke patients. It is hoped that with the development of safe and appropriate screening there will be increased identification of individuals who may benefit from cardiorespiratory exercise and may reduce the incident of primary and secondary cardiovascular disease complications in the stroke population.

The network co-hosted two workshops including local health and leisure professionals in 2024 and 2025, partnering with GM Active.

Useful resources

Cardiorespiratory Training

Stroke Association exercise leaflet

Keeping Active with Huntington's Disease - Cards

Keeping Active with Huntington's Disease - Booklet

Cardiorespiratory Workshop Slides (Oct 2024)

Cardiorespiratory Workshop Summary (Oct 2024)

Cardiorespiratory Workshop 2. Slides ( March 2026)

GM Cardiorespiratory Training Outcome Measures

Blank Screening Tool

Calculating Target Heart Rate Zones

GM Cardiorespiratory Risk Stratification Tool

GM Active Referral & Contact Directory