Strokes are the third leading cause of death and the leading cause of long-term disability in the United States. For example, those who intend to undergo neurological physiotherapy in Brazil through the Public Unique Health fine motor skills after stroke System - Sistema Único de Saúde, SUS - do not always start the service quickly (waiting list or reduced professional contingent) or are not attended more than once or twice a week, in sessions with minimum stimulation time.
The landmark RCT ‘Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis' demonstrated that, with respect to stroke or death, aggressive medical management, including exercise and activity counselling, outperformed the combination of angioplasty and stenting plus aggressive medical management in patients with severe intracranial atherosclerotic stenosis following a TIA or stroke.

While teaching self-regulation knowledge and skills is important, older patients, or those with worse executive impairments, may benefit from a programmatic shift of emphasis towards PA and exercise behaviour per se, for example, through modelling, structure and reinforcement.
62 Because increased levels of physical activity are associated with a reduced risk for stroke and cardiovascular disease and enhanced physical and psychosocial performance, such interventions performed in a stroke rehabilitation program may have a favorable effect on the prevention of recurrent stroke and cardiovascular events.
Using functional magnetic resonance imaging (fMRI), a team of researchers from USC monitored the brains of 24 individuals — 12 who had suffered strokes and 12 age-matched people who had not — as they watched others performing actions made using the arm and hand that would be difficult for a person who can no longer use their arm due to stroke — actions such as lifting a pencil or flipping a card.

There are no published investigations to support the assertion that the interventions with regard to activities of daily living that are included in stroke rehabilitation programs, as currently practiced, actually reduce the risk for recurrent stroke and cardiovascular disease.
They will use three promising exercise programs used in cities across Canada for people who have had strokes — the Fitness and Mobility Exercise Program, the Fit for Function program which is offered by the YMCA in the Hamilton area, and the Together in Movement and Exercise program offered in some community centres in Ontario and B.C.

Using the Montreal Cognitive Assessment test, researchers found that the combined training program resulted in a significant overall improvement in cognition (22 to 24, P<0.001), and specifically in attention and concentration (4.7 to 5.0, P=0.03) at 6 months post rehab.
Aerobic exercise, the main form of cardiac rehabilitation, may play an important role in improving aerobic fitness, cardiovascular fitness, cognitive abilities, walking speed and endurance, balance, quality of life, mobility, and other health outcomes among stroke patients.
Programmes seeking to promote exercise for secondary stroke prevention should use effective screening approaches to identify patients at risk of falling, fatigue related to obstructive sleep apnoea and other factors, pain and depression, which are prevalent after stroke.
As long as stroke patients have been cleared to exercise on their own, they may be able to do something as simple as take a daily walk. Exercise can help reduce the risk of an individual having a second stroke and helps survivors to overcome challenges they face following the physical impact of their stroke.