Stroke is the leading cause of serious long-term disability in adults. In the United States, > 700,000 people experience a stroke annually, and approximately 4 million Americans are currently alive after experiencing a cerebrovascular event.1 Two thirds of individuals require rehabilitation, and the majority of stroke survivors have residual disability, with equal proportions having mild, moderate, or severe impairment.
All stroke survivors expect to receive appropriate interventions directed at improving outcomes and preventing a recurrent event. In addition to addressing hypertension, predisposing cardiac conditions, and hypercoagulable states, secondary prevention should be directed toward improving other risk factors that contribute to the development of atherosclerosis, including lifestyle modifications. Over the past 2 decades, exercise capacity and activity status have become well-established predictors of cardiovascular and overall mortality.2–3 In both healthy subjects and those with cardiovascular disease, peak exercise capacity is a stronger predictor of an increased risk of death than other clinical variables or established risk factors. In one trial,4 the risk of death from any cause in subjects whose exercise capacity was < 5 metabolic equivalents was roughly double that of subjects whose exercise capacity was > 8 metabolic equivalents.