Stroke and fatigue - Heart 2 Heart Cardiac physiotherapy

Fatigue associated with stroke is unusual in that it does not go away simply by resting. There can be many causes of this fatigue but as of yet, it is poorly understood. There are a number of factors to consider in relation to fatigue post-stroke. Firstly, your entire cardiovascular system has been in crisis during the stroke period. Even if you have made a full recovery from a motor control point of view i.e. you are able to walk normally or use your hands efficiently again you may still be left with significant fatigue after receiving the clot busting agent.

Fatigue is defined as an inability to produce enough energy to meet the demands of your body’s daily activity. When we look at fatigue as physiotherapists, we look at all the systems in your body that contribute to your bodies ability to produce energy. This is particularly important when we are
considering and planning your stroke rehabilitation regime.

Below is an image showing the three systems that work together to produce energy. All cogs in the 3 wheels have to work together to improve energy levels, or in other words to reduce fatigue levels.

While this image may look complicated, we can break it down to better understand how we can get these three systems to work together to improve our energy levels through stroke rehab. Let’s start on the right:


Breathing difficulties during sleep can contribute to fatigue – you may often wake feeling unrefreshed in the morning. You may also demonstrate an altered breathing pattern after a stoke that can be linked to diaphragmatic dysfunction. The diaphragm is a large muscle located under the rib cage (see image) and is the most efficient muscle for you to use when you are breathing. If this is not operating optimally it means you have to work harder to maintain your oxygen levels. Our physiotherapists will work with you during your stroke rehabilitation programme to help improve your breathing pattern and reduce diaphragmatic dysfunction..

Cardiovascular System/Circulation

Post-stroke, your cardiovascular system will be slightly sluggish and lack responsiveness to activity. This means that the system carrying the oxygenated blood around your body can be less responsive to your activity needs.

It is hard for your arteries to transport the oxygen to your muscle so that energy can be produced. You will feel like you have a lack of get up and go and get tired with very little exertion.

Here at Heart 2 Heart we will build an exercise regime for you as part of your stroke rehabilitation to overcome these challenges.


Your muscles will have become deconditioned and will be unable to produce the required energy that you need for a particular activity. Our stroke rehab programme tailored to your specific needs will help to recondition your muscles leading to a greater level of energy production and less fatigue.

At Heart 2 Heart we examine all three systems to pinpoint where your challenges are and furnish you with an exercise programme as part of your stroke rehab that will not over or under exert you. You will be challenged to a level where you will see and feel benefit. We will combine a breathing circulation and strength training regime for you. Improving your exercise endurance can help you to tolerate your other stroke rehabilitation therapies such as speech and language therapy or occupational therapy for longer periods therefore enhancing your overall recovery.

Additional causes of fatigue

Some additional causes of fatigue that you may need to explore are depression and dietary intake.

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