Advice On Being A Personal Trainer For Stroke Patients

When acting as a personal trainer for stroke patients, you will need to adapt their bespoke workout programme to suit their medical needs. 

A PT for stroke patients must develop a deeper understanding of the condition, and how exactly it affects their clients’ mobility and ability to exercise.

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What You Need To Know Before Becoming a Personal Trainer for Stroke Patients

Personal trainers who wish to work with these patients should be aware that there are two types of strokes, both of which affect the brain in different ways. The medical definition of these conditions are:

• Ischaemic Strokes - This is the more common of the two, occurring when a clot cuts off the brain’s blood and oxygen supply. This happens when arteries are narrowed, or blocked by fatty plaques. 
• Haemorrhagic Strokes - Whilst less common, this occurs when a blood vessel in the skull bursts and bleeds into the brain. This variation commonly occurs in patients with high blood pressure, which causes arteries in the brain to weaken increasing the risk of ruptures.

When working alongside patients who have suffered from a stroke as a PT, you should be aware that no two clients will be the same. This is because the effects of strokes can range from mild to severe, depending on which part(s) of the brain is affected. 

In mild cases, patients may suffer from prolonged facial drooping or a slurred speech pattern, and severe cases may see individuals struggling to speak, walk, or show visible signs of emotion.

In these severe instances, a stroke will kill around 2 billion of the brain’s 100 billion neurons. This leaves only 98% of the brain functioning correctly, which is the factor that could trigger issues with mobility.

Whilst this damage is obviously severe, medical experts believe that the brain can essentially heal itself through a process called neuroplasticity, which refers to thoughts, exercises and neural-pathway rerouting. 

For example, if the brain’s damaged left hemisphere shuts down mobility in the right leg, neuroplasticity training can help to improve the strength and mobility. 

How Can You Help Stroke Patients As A Personal Trainer?

A personal trainer for stroke patients will create a bespoke workout programme that seeks to act as a form of recovery, increasing the client’s ability to function independently. 

Research conducted in 2014 discovered that physical exercise can act as a form of neuroplasticity. Findings suggested that patients who worked out 3 times per week, for a total of 12-weeks, significantly enhanced their brain’s ability to learn new skills and retain information.

But this is merely one example of how stroke pts can benefit the lives of their clients. Bespoke training programmes have also shown to benefit a client’s physical health by:

• Speeding up their recovery process
• Helping to regain bodily strength 
• Increase overall endurance levels 
• Improving walking speed
• Preventing the recurrence of another stroke

PT exercises for stroke patients are also known to have several mental health benefits too, including: 

• Reduced risk of depression 
• Improved sense of worth due to the release of endorphins 
• Relieving general feelings of stress 

Therefore, whilst you may not be able to offer medical treatment to stroke patients, you can provide them with a service that will benefit the quality of their lives in the long run. 

6 Tips For Effectively Training A Client Recovering From A Stroke

Before you can provide this unique form of treatment, there are a number of things you must be made aware of as a personal trainer for stroke patients.

By following each of the tips provided in this section, you’ll be able to create an effective programme to benefit the patient's recovery.

#1 - A Stroke PT Must Know The Symptoms & Warning Signs Of A Stroke

When working as a stroke PT, you will still need to know the signs and symptoms associated with the condition. This is due to the fact that once a patient has suffered an initial stroke, they are more likely to suffer from another in their lifetime. 

In a report, the NHS provided the following stats:

Therefore, as a PT for stroke patients, knowing the signs and symptoms associated with the condition can allow you to act fast, and even save your clients’ lives. 

If you notice any of the following signs of stroke, call 999 immediately:

• Sudden trouble seeing in one or both eyes
• Sudden confusion, difficulty speaking, or difficulty understanding others’ speech
• Sudden numbness or weakness in the arm, face, or leg; especially on one side of the body
• Sudden severe headache without a cause
• Sudden trouble walking, lack of coordination, or dizziness

These symptoms are the same in first-time stroke victims and those patients in recovery. 

If you notice any of these symptoms occurring during your sessions together, follow the NHS’ advice and follow the F.A.S.T acronym:

If the symptoms of the stroke go away after a few minutes, your client may have experienced a transient ischemic attack (TIA), also referred to as a ‘mini-stroke’. 

This should not be brushed aside, as whilst brief, a TIA could be a sign of serious underlying issues among the client. If this ever occurs in your presence, call 999 immediately.

Another statistic to be made aware of is that 17% of stroke patients are likely to suffer from heart attacks. 

To learn more about the symptoms of this particular condition we have provided expert guidance on training clients in cardiac rehabilitation.

#2 - A Personal Trainer For Stroke Patients Must Know How to Track Vital Stats 

As a personal trainer for stroke patients, you should track vital stats in order to help prevent the risk of another stroke. 

For those who haven’t tracked these statistics before, the term ‘vital stats’ refers to:

• Body Temperature 
• Pulse Rate
• Respiration Rate 
• Blood Pressure 
• Glucose Levels 

Research conducted by the Centre of Disease Control & Prevention shows that 80% of strokes are preventable, as long as clients adapt their lifestyle accordingly. 

Monitoring vital stats such as blood pressure and glucose levels in particular can encourage clients to make these changes.

Tracking Blood Pressure Levels: 

As discussed within the introductory section of this article, high blood pressure is a leading cause of Haemorrhagic Strokes. This stat must be observed to monitor the pressure being placed on the client’s blood vessel.

To monitor the client’s blood pressure you will need a blood pressure machine and cuff. This may be available in your gym:

1. Place your fingers on the underside of the patient’s elbow to locate their pulse
2. Wrap the deflated cuff around their arm, one inch above where you found the pulse
3. Inflate the cuff until the dial pointer reaches 170
4. Deflate the cuff, and listen for a thumping sound as the pointer falls
5. Record the number displayed as the first thump is heard (systolic pressure)
6. Record the number displayed as the last thump is heard (diastolic pressure)
7. Deflate and remove the cuff from the patient
8. Document the results

The ideal blood pressure rate for stroke is 130/80 mmHg, and anything above this can be considered a ‘danger zone’ where the client is at a higher risk of suffering from a stroke.

Tracking Blood Sugar Levels:

Blood sugar levels may be harder to track during the exercise class itself as the client will need to observe this themselves with monitors. If left unchecked the glucose levels in your blood can damage vessels and cause strokes.

As reported in our article on training clients with diabetes, an average blood sugar level is 140 mg/dL. If the patient's levels are reported to be lower than 100 mg/dL, or rise above 300 mg/dL, the workout session should be avoided. 

As a personal trainer for stroke patients, you should ask your clients to test their blood sugar levels prior to every session in order to determine whether it’s safe for them to exercise or not.

To simplify, these vital stats must be monitored when working with stroke patients in order to guarantee their safety and wellbeing.

#3 -  Whilst Working As A PT For Stroke Patients Your Clients May Suffer From Mood Swings

One major thing to be aware of when operating as a personal trainer for stroke patients is that your clients may suffer from mood swings. 

Medical experts believe that this is the result of pseudobulbar affect (PBA), a condition that triggers an uncontrollable outburst of emotion:

Patients who suffer from strokes on the right side of their brain are more likely to suffer from PBA, as our emotions are processed in the right hemisphere. 

A client may already be diagnosed with this condition prior to signing up for your service, in which instance they should disclose this information in the initial PAR-Q form.

In other instances, they could be diagnosed at a later stage once other symptoms have been picked up by a medical professional.

The main symptoms of this condition are frequent and involuntary outbursts of crying or laughing. These will be highly exaggerated and not connected to a client’s current emotional state. 

For example, following a stroke, PT exercises that are challenging may trigger intense bouts of crying in the client. 

During this outburst you must remain calm and level headed, and approach these emotions from a place of:

• Interest 
• Empathy 
• Compassion

Politely ask you clients why they are feeling this way, before reassuring them that their feelings are validated. 

You can then communicate with each other in order to create a feasible solution that reduces the risk of triggering another outburst.

#4 - PT Exercises For Stroke Patients May Need to be Amended

As we have discussed at numerous stages in our article, patients who have recently suffered from a stroke will typically not be able to perform at the same level as able bodied individuals.

For this reason, PT exercises for stroke patients will need to be amended in order to suit their current level of physical fitness. 

For example, if you wish to incorporate an element of strength training, ensure that the client’s arm is physically supported during this motion. 

This will reduce the strain on the arm muscles, whilst allowing the patient to improve their range of motion. One common way of doing this is through supported wrist curls on an arm rest:

• Have your client sit up straight on a chair, placing their arms on the rest with palms facing upward.
• Their wrists should be dangling over the edge, as they firmly grasp their weights.
• Slowly they should bend their wrist up towards the forearm and lower it back down again.

Another simple workout that you can incorporate into training is the sit/stand technique.

This seeks to improve a client’s overall balance whilst strengthening their core, to conduct this safely follow the steps below:

• The client should sit tall in a chair with their feet a shoulder-width apart.
• Hinge at their waist and slowly shift their weight forward.
• Push through their heels, squeezing their quads and glutes until they bring themselves to a standing position.
• If clients struggle with their balance encourage them to use the chair’s arm rests for support.

As a personal trainer for stroke patients, you must be willing to make these amendments to better the lives of your clients. In some instances clients may require physical assistance in order to:

• Correct form and/or posture 
• Understand which muscle they should feel effort in during the workout
• Regain their balance and stability following an intense bout of exercise 

Before engaging with physical contact with a client, always ask for their consent and explain what you’re doing. 

#5 - Stroke PTs Should Set Achievable Goals

As a personal trainer for stroke patients, you must set goals that are dependent on a client's physical health, as well as their own personal wishes. 

Following a stroke, PT exercises are often viewed as way to facilitate a client’s desire to restore the lost functions of their body, returning to how they were before the condition.

But this is an example of a goal that is too broad, as ‘getting healthy again’ doesn’t offer any form of specificity. Instead, clients should try to aim for targets such as:  

• Walking independently
• Getting dressed independently
• Regaining the mobility to get in and out of the car safely
• Cutting a slice of bread unaided 
• To be able to type out an email correctly

To assist in this process, PTs for stroke patients should seek to incorporate SMART fitness goals into their clients programmes. This stands for:

An example of a SMART goal for stroke patients may be: To walk on a treadmill unaided for a total of 3 minutes in 2 months’ time.

This follows the SMART pattern as the goal is -

• Specific: The client has an exact idea of what they’re looking to achieve, there is no vague language used.
• Measurable: There is a set time that clients are working towards
• Achievable: The client has provided themselves with enough time to complete the task, ensuring that they can train with support rails of the treadmill if required. 
• Realistic: The goal is realistic as, following a stroke, a client will likely struggle with their balance, and will therefore not be able to walk unaided for long periods.
• Timely: An end goal is set, meaning the patient knows when they must complete this goal by.

Be sure to include short-term, mid-term, and longer-term goals - stroke rehabilitation is a journey that takes time, so your goals need to reflect this.

The example given above can be seen as a long-term goal. Shorter ones between this would be to walk without the support of treadmills bars for a total of one minute.

Hitting these smaller goals will fill a client with motivation, driving them forward both physically and emotionally in order to complete their goals. 

#6 - When Working as a PT For Stroke Patients You Should Familiarise Yourself With Their Medication

As their PT you should be aware of any and all medications that your clients are taking as this could affect their performance.

This topic can be approached during an initial consultation, in which you can ask the client to provide a list of their medications they are currently being prescribed.

For reference, some of the most common medications taken by stroke patients include:

• Anticoagulants - Prevent blood clots from forming by changing the blood’s chemical composition. 
• Statins - Can help to lower cholesterol production in the liver by blocking the chemical enzyme in the liver.
• Blood Pressure Medications - Reduce the risk of strokes from occurring by lowering the client's blood pressure.

A stroke PT should study these medications and any possible side effects that they may cause, as this can influence how a client performs during their session.

For example, the NHS lists the following conditions as possible side effects for anticoagulants:

Therefore, if a client is on one of these medications they may experience bouts of intense back pain or difficulty breathing, forcing the session to an immediate halt.

Knowing information about these medications can allow you to make informed decisions and calm during situations that may require further medical action.

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If learning how to be a personal trainer for stroke patients interests you, then you should check out these other OriGym articles:

• Advice on Being a Personal Trainer for Clients With MS
• How to Make Money As A Personal Trainer 
• Referring Clients to Another Professional as a PT

4 Skills To Prioritise When Working With Clients Recovering From A Stroke

Now that you have an informed idea of how you can effectively operate as a personal trainer for stroke patients, you should consider what skills will help to facilitate this role.

#1 - Acquire The Necessary Knowledge Required to Train Stroke Patients

After suffering a stroke pt exercises can be a primary form of rehabilitation for a patient. To ensure that the workout programme is effective you must ensure to develop a solid foundation of knowledge.

Achieving a diploma in personal training is an excellent starting point, but you will need to constantly build upon this knowledge by researching strokes, through real life case studies. 

From this information you can gain a deeper understanding of what kind of exercises will benefit the patients. For example, the American Heart Association recommends:

• Gait Training Exercises - This is a type of physical therapy which can improve the client’s daily independance, allowing them to engage with physical activities for prolonged periods. E.G. Walking on a treadmill to improve balance. 
• Aerobic Exercises - The AHA recommends that this occurs 3-7 days per week for a total of 20-60 minutes. 
• Strength Training - This is done to reverse muscle atrophy (muscle wastage) which occurs during a hospital stay. This should include light weights that allow for one set of 10-15 reps.
• Balance and Core Exercises - These are recommended by medical experts to reduce a patient's risk of falling.

Through dedicated research you will learn that the ideal pt exercises for stroke patients will incorporate forms of repetition. 

This is regarded as a form of neuroplasticity referred to as neuromuscular training, which focuses on training damaged muscles and nerves to communicate with one another. 

Repetition can stimulate neuroplasticity as when an action is done frequently the brain will learn how important the task is. In response, the stroke patient's brain will make the same task easier to accomplish. 

Researching and developing your knowledge of strokes as a medical condition can help to improve the kind of training your clients receive. With this you will be able to create bespoke programmes that help to facilitate their recovery.

#2 - Grow Your Nutrition Knowledge And Develop Meal Plans For Stroke Patients 

When a patient is recovering from a stroke, physical fitness is not the only resource that can help improve their wellbeing.

An informed knowledge on nutrition can help these client’s make positive choices that help their current condition, whilst also reducing the risk of another stroke from occurring. 

With an unhealthy diet and lifestyle clients run the risk of developing other health conditions such as:

• Hypertension
• High Cholesterol 
• Obesity 
• Diabetes 
• Coronary Heart Disease

All of these cardiac conditions can increase the likelihood of another stroke occuring, as they all affect your arteries. Foods that are known to increase the likelihood of developing these conditions include:

• Red Meat
• Processed Meats
• White Rice, Bread, and Pasta 
• Butter 

Instead, you should create a meal plan for your clients that heavily features foods that are good for their heart health. For example:

• Leafy Greens - Spinach, Kale, & Bok Choi
• Whole Grain Alternatives - Pasta, Bread & Rice 
• Fatty Fish - Salmon, Sardines & Mackerel 
• Almonds & Seeds 

One thing to keep in mind when creating these meal plans is dysphagia, which affects a patient's ability to chew and swallow.

To assist in this process the Academy of Nutrition and Dietetics created the Dysphagia Diet. This will consists of foods that will be manageable to eat, such as:

• Smooth Desserts - e.g. Yoghurts, Custards, Pureed Fruits
• Soufflés 
• Mashed Potatoes 
• Pureed soups
• Pureed vegetables without lumps

The dysphagia diet should only be implemented in severe cases in which the patient is in immense pain, or physically incapable of chewing. In this instance you should still try to make their meal plan as healthy as possible. 

To improve your knowledge in this field, you should consider enrolling on a Level 4 Sports Nutrition course. Upon graduating, you will be equipped with a plethora of specialist knowledge and skills required to create bespoke meal plans.

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If you're looking to expand your PT knowledge, why don't you read these articles as well?

• Can You Give Nutrition Advice As A PT?
• Training Autistic Clients
• Being A PT For Hypermobile Clients

#3 - Adapt The Way You Communicate With Stroke PT Clients 

The largest portion of the brain is the cerebral cortex, which has two hemispheres:

• The Right Hemisphere: Controls cognition, the sense of bodily position, and as we have already discussed emotions.
• The Left Hemisphere: Controls a person’s ability to express and understand language.

As a stroke PT, you must understand how the condition can affect the patient depending on which side of the brain the stroke occurs. 

We’ve already shared how damage on the right hemisphere can cause PBA, but if the left side is targeted then the client may be unable to communicate with you, or understand what you’re asking of them.

Clients who suffer from attacks on the left hemisphere will have issues with expressive abilities (getting their words out) and receptive abilities (understanding). This is referred to as aphasia.

As their trainer you must ensure to develop specialised skills that will assist in combating this issue. To overcome aphasia stroke experts recommend: 

• Keeping any question simple - Client’s will be able to answer in a straightforward manner e.g. Yes or No
• Keep instructions direct - Leave no room for interpretation as this can confuse patients 
• Provide Your Clients With Time - Don’t rush your clients, allow them time to process and understand your teachings. Resist temptation to talk over clients, be patient! 
• Eliminate All Distractions - Turn off the TV, music and anything that causes extraneous noise. This can only interfere with the client’s ability to communicate with you.

Other ways in which strokes can influence a client’s ability to communicate is through dysarthria. This largely influences verbal communication patterns through mouth weakness and slurred speech. 

If your client suffers from dysarthria, then the same advice can be applied. Remember to be patient and respectful as this could make the client feel self-conscious. 

#4 - Be A Considerate And Compassionate PT For Stroke Patients

When working with stroke patients as a personal trainer, you will have to demonstrate a certain level of composure and compassion.

From this article, you’ll be able to understand that these particular patients will require a lot more of your attention than able-bodied clients, even when performing tasks we take for granted every day.

A stroke is a traumatic experience that can be a difficult thing for people to come to terms with. With this in mind, you should try to be as friendly and caring as possible when dealing with stroke patients. 

Patience is particularly important because your sessions with patients recovering from stroke will likely take longer or feel slower because they are rebuilding their basic building blocks of movement and speech.

When working with stroke patients as a personal trainer, you will have to demonstrate a certain level of composure and compassion.

From this article, you’ll be able to understand that these particular patients will require a lot more of your attention than able-bodied clients, even when performing tasks we take for granted every day.

A stroke is a traumatic experience that can be a difficult thing for people to come to terms with. With this in mind, you should try to be as friendly and caring as possible when dealing with stroke patients. 

Patience is particularly important because your sessions with patients recovering from stroke will likely take longer or feel slower because they are rebuilding their basic building blocks of movement and speech.

Before You Go! 

Now that you have all the knowledge you need to be a personal trainer for stroke patients, it’s time to go out there and apply that knowledge in person.

Whilst this is a niche career, specialising in this area will be incredibly emotionally fulfilling. By going the extra mile for stroke patients you can change their life, helping them to recover in ways they may not believe possible.

Don't Forget that OriGym's Level 4 Nutrition qualification can advance your fitness career and expand your client base. You can also download our FREE course prospectus here.

References 

• Doidge, N. (2007). The brain that changes itself: Stories of personal triumph from the frontiers of brain science. Viking.
• Tarumi, T., & Zhang, R. (2014). Cerebral hemodynamics of the ageing brain: risk of Alzheimer disease and benefit of aerobic exercise. Frontiers in physiology, 5, 6.
• Dhamoon, M. S., Tai, W., Boden-Albala, B., Rundek, T., Paik, M. C., Sacco, R. L., & Elkind, M. S. (2007). Risk of myocardial infarction or vascular death after first ischemic stroke: the Northern Manhattan Study. Stroke, 38(6),