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More neighborhood fitness spaces linked to higher physical activity levels after stroke

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More neighborhood fitness spaces linked to higher physical activity levels after stroke

Research Highlights:

  • Living in neighborhoods with more recreational and fitness centers may influence people’s engagement in physical activity during the first year after a stroke.
  • A small study found that people in New York City who survived a mild stroke were more likely to maintain the same level of physical activity as they did prior to the stroke, or even increase that activity, if they lived in areas with more recreational centers and fitness resources nearby.

Embargoed until 4 a.m. CT/5 a.m. ET, Thursday, Feb. 1, 2024

DALLAS, Feb. 1, 2024 — Stroke survivors were more likely to remain physical activity or even exercise more after their stroke if they lived in neighborhoods with easy access to recreational centers and gyms, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

“We know that stroke survivors need to be physically active as part of their recovery. Our findings suggest that it’s important to have a conversation with stroke patients about physical activity resources available in their area so they are able to continue their recovery after hospital discharge,” said lead study author Jeffrey Wing, Ph.D., M.P.H., an assistant professor of epidemiology at The Ohio State University in Columbus, Ohio. “If their neighborhood does not offer fitness resources, neurologists should consider discharging the patient to a rehabilitation facility where they can participate in physical activities.”

In this study, researchers examined the potential link between available fitness/exercise centers, pools and gyms and physical activity among 333 people living in New York City who had a mild stroke.The data was geocoded, assigned to the U.S. census tracts, and merged with data from the National Neighborhood Data Archive (collects information about the number of physical activity resources at the census tract level). Geocoding is the process of transforming a description of a location — such as an address or a name of a place — to a location on the earth’s surface. Researchers then examined the association between the number of fitness and recreational centers, such as pools, gyms and skating rinks per square mile, and the self-reported change in physical activity levels — more active, about the same or less active — one year after stroke.

The analysis found:

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  • About 17% of participants reported being more physically active one year after stroke, and 48% reported having about the same level of physical activity as before the stroke.
  • The odds of being more active were 57% higher among participants who lived in areas with more recreational and fitness resources (about 58 fitness resources) compared to people living in neighborhoods with fewer or no fitness resources, after controlling for age, gender, race, ethnicity, education, health insurance and body mass index.
  • Similarly, the odds of reporting the same level of physical activity one year after stroke were 47% higher in participants who lived in areas with more recreational centers and fitness resources compared to those who lived in areas with fewer or no resources available.

Previous research has shown that even moderate physical activity is beneficial for stroke recovery and can include walking, Wing said. “However, it’s important to recognize the availability or limited availability of exercise resources in a person’s immediate neighborhood and to be able to feel safe while participating in exercise activities.”

Previous research has found that the characteristics of the built environment of a neighborhood, such as access to healthy food or recreational spaces promoting physical activity, were also linked to lower incidence of stroke, Wing noted.

“The takeaway from this analysis is that it’s not that people should move to a location where there are more resources to engage in physical activity, but to urge people to find ways to be active in their own neighborhood,” said study co-author Julie Strominger, a Ph.D. student of epidemiology at The Ohio State University. “It’s the action that will lead to better outcomes, so just the action of being physically active is what really matters.”

“This study is consistent with prior research on the importance of physical activity for optimal health. The new aspect is the focus on stroke survivors,” said American Stroke Association volunteer expert and EPI and Stroke Council member Daniel T. Lackland, Dr.P.H., FAHA, professor of epidemiology and director of the Division of Translational Neurosciences and Population Studies in the department of neurology at the Medical University of South Carolina in Charleston. “It’s important for health care professionals to discuss maintaining physical activity with stroke survivors: find out if they know of a safe place to exercise, and if they do not, have that information readily available.” Lackland was not involved in the study.

Study details and background:

  • The analysis included 333 adults hospitalized for mild stroke and enrolled in the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study.
  • The DESERVE study was a randomized clinical trial of 546 stroke survivors and conducted in New York City from 2012-2016.
  • Participants were 52% women, with an average age of 65 years; they self-identified as 35% Hispanic adults, 31% Black adults, 28% white adults and 6% as “other” race.

The main limitations of the study, according to the authors, are that the findings may not be generalizable to non-urban neighborhoods in the U.S. In addition, the data was extracted from a clinical trial that included only stroke survivors who had a mild stroke, therefore, this association may not hold true for survivors of severe stroke. Also, while people in certain neighborhoods reported more physical activity, that does not necessarily mean that they used the fitness and recreational resources in their neighborhood.

Co-authors, disclosures and funding sources are listed in the abstract.  

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Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

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About the American Stroke Association

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The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, X.

For Media Inquiries and AHA Expert Perspective:

AHA Communications & Media Relations in Dallas: 214-706-1173; ahacommunications@heart.org

Karen Astle: 214-706-1392, Karen.Astle@heart.org

For Public Inquiries: 1-800-AHA-USA1 (242-8721)

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Fitness

How the 3-3-3 Rule Helped Me Stick to an Exercise Routine

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How the 3-3-3 Rule Helped Me Stick to an Exercise Routine

If you’ve ever started a new workout routine with the best intentions only to find yourself skipping sessions by week two, you’re not alone. I’m the type to get trapped in the same cycle of burnout, where I go hard for a couple of weeks, feel exhausted, feel guilty, and repeat. For me, what finally broke that cycle wasn’t a new gym membership or a fancy fitness app, but a simple scheduling hack: the “3-3-3 rule.” I’d seen this rule applied it to general productivity, and all the same principles can apply to your fitness habits, too. Here’s how you can use the 3-3-3 rules to structure your workouts and create a habit that sticks.

What is the 3-3-3 rule?

The 3-3-3 “rule” (or “method,” or “gentle suggestion”) is essentially a weekly workout framework built around three types of movement, each done three times per week:

  • Three strength training sessions. This includes lifting weights, bodyweight circuits, resistance bands, whatever builds muscle and challenges your body.

  • Three cardio sessions. This includes running, cycling, swimming, jump rope, a dance class—what counts as “cardio” is up for debate, but here, I think of it as anything that gets your heart pumping.

  • Three active recovery days. This includes light walking, yoga, stretching, foam rolling, and so on.

And yes, I realize this math adds up to nine intentional days of movement across a seven-day week. Here’s the thing: You do double duty some days, or skip workouts here and there, or adjust to a nine-day cycle, because the point isn’t rigid scheduling. The point is rhythm over a strict structure. For me, the 3-3-3 rule provides a sense of momentum that’s flexible enough to fit into real life, but consistent enough to actually stick to.

Why the 3-3-3 rule works for me

Before I get into how the 3-3-3 rule helped me specifically, let’s talk about why so many workout plans fall apart in the first place. I believe most of them make two classic mistakes. The first is doing too much, too soon. You go from zero to six days a week at the gym, you get burnt out, and the whole thing unravels. The second mistake is having no real structure at all—just vague intentions, like “I’ll work out when I can,” which never materializes into anything real for a lot of people.

For me, the 3-3-3 rule solves both of those problems. It gives me enough structure to build habit and momentum, but not so much intensity that my body and brain feel overwhelmed. I personally adore running, but I struggle to motivate myself to lift weights; the 3-3-3 rhythm here helped me find a middle ground between those two workouts. When I know I have three strength sessions to hit in a week (or nine-ish day cycle), I can look at my calendar and find three slots without too much drama or dread.

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There’s also plenty of breathing room built into the plan, which was the biggest game changer for me. I used to have the (toxic) thought that my rest days were wasted days, which is a mentality that led to either overtraining or complete inactivity with pretty much no middle ground.

Plus, there’s something psychologically satisfying about the number three. I know and love the rule of threes in photography, comedy, survival tips, and all over the place.

How to make a 3-3-3 workout schedule work for you

The 3-3-3 rule has a ton of wiggle room for customization. Here are some ideas for how you can approach it:


What do you think so far?

For strength days, pick a format you actually enjoy. That might be a full-body circuit, a push/pull/legs split, or a class at your gym. (Boxing, anyone?) Your focus on these days should be a progressive challenge—push yourself, yes, but don’t obliterate yourself.

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For cardio days, variety helps. Mix a longer, easier effort with a shorter, more intense session (like a 20-minute interval run). I know I’m biased, but cardio really shouldn’t feel like punishment.

For recovery days, resist the urge to “make them count” by sneaking in extra work. The whole point is to let your body consolidate the gains from your harder days. Walk, stretch, breathe, and trust the process.

Another practical tip: Pick a night to map out your 3-3-3 week ahead of time. You’ll probably find that the week arranges itself pretty naturally once you’re looking for those nine windows.

The bottom line

As always, consistency should always be your priority in fitness. If you’ve been struggling to find a rhythm, if your past workout plans have always fizzled out around week three, give the 3-3-3 rule an honest four-week try. Maybe start with a 1-1-1 month! After all, the 3-3-3 rule isn’t a hack to totally transform your physique, but I do think it can provide something way more valuable. Finding a routine that works for you—like the 3-3-3 rule works for me—is the first step to make exercise a reliable, sustainable part of your life.

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I’m a running coach — I’ve just tested shoes actually designed for women’s feet, and they’re a total game changer

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I’m a running coach — I’ve just tested shoes actually designed for women’s feet, and they’re a total game changer

Why you can trust TechRadar


We spend hours testing every product or service we review, so you can be sure you’re buying the best. Find out more about how we test.

QLVR ENDVR: Two minute review

Most running shoes feel familiar for a reason: the formula has barely changed in millennia. We have archaeological evidence of shoes being fastened with “shoelaces” as far back as around 3,500 BC, yet the basic lace-up running trainer remains the default.

QLVR (pronounced “clever”) set out to challenge that. Its debut shoe, the ENDVR, is a laceless “running slipper” built around a women-specific mechanical structure, with a slip-on Wing Fit system inspired by the way a bird’s wing opens and closes around movement.

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Mere minutes of daily vigorous exercise can cut your risk of 8 diseases | CNN

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Mere minutes of daily vigorous exercise can cut your risk of 8 diseases | CNN

Move more. Sit less. For many years, that’s been accepted guidance for people wanting to get healthier.

Now that message is getting refined, with a growing body of research suggesting that certain types of movements may be more beneficial than others when it comes to health benefits.

The intensity of your exercise may matter as well. A new study published in the European Heart Journal found that a small amount of vigorous activity may be linked to lower risk of eight different chronic diseases.

The findings raise questions about why intensity matters and how people can incorporate more intense exercise routines into everyday life. To better understand the study’s implications, I spoke with CNN wellness expert Dr. Leana Wen, an emergency physician and clinical associate professor at George Washington University. She previously served as Baltimore’s health commissioner.

Before beginning any new exercise program, consult your doctor. Stop immediately if you experience pain.

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CNN: What did this study examine about exercise and its relationship to chronic disease?

Dr. Leana Wen: This investigation looked at how the intensity of physical activity is related to the risk of developing a range of chronic diseases. Researchers analyzed data from two very large groups in the UK Biobank, which is a long-term health study in the United Kingdom that tracks medical and lifestyle information from hundreds of thousands of participants. One group included about 96,000 people who wore wrist activity trackers that objectively measured their movement, and the other included more than 375,000 people who self-reported their activity.

The researchers followed participants over an average of about nine years and examined the development of eight conditions: major cardiovascular events, atrial fibrillation, type 2 diabetes, immune-related inflammatory diseases, fatty liver disease, chronic respiratory disease, chronic kidney disease and dementia, as well as overall mortality.

The key finding was that the proportion of activity done at vigorous intensity mattered. People who had more than about 4% of their total activity classified as vigorous had substantially lower risks of developing these conditions compared with people who had no vigorous activity at all. The numbers were stunning, with the participants having the following results:


  • 63% lower risk of dementia,

  • 60% lower risk of type 2 diabetes,

  • 48% lower risk of fatty liver disease,

  • 44% lower risk of chronic respiratory disease,

  • 41% lower risk of chronic kidney disease,

  • 39% lower risk of immune-mediated inflammatory diseases,

  • 31% lower risk of major cardiovascular events,

  • 29% lower risk of atrial fibrillation, and

  • 46% lower risk of death from any cause.

These results are amazing. Imagine if someone invented a medication that could reduce the risks of all these diseases at once — it would be very popular! Crucially, even people who exercised a lot still benefited if the proportion of time they spent doing vigorous physical activity was increased. Conversely, people who were relatively inactive also benefited from adding just a little bit of higher-intensity exercise to their daily routines.

CNN: What counts as “vigorous” physical activity?

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Wen: Vigorous activity is generally defined as exercise that substantially raises your heart rate and breathing. A simple way to gauge it is the “talk test.” If you can speak comfortably in full sentences while exercising, you are likely in the low to moderate range. If you are so out of breath that you can only say a few words at a time, that is vigorous.

Running, cycling, lap swimming or climbing stairs quickly could count. But this also depends on people’s baseline fitness. For some individuals, taking longer strides with walking can be vigorous exercise. Others who are already fairly fit would need to do more. It’s also important to remember that vigorous activity doesn’t have to be in the context of a structured exercise plan. Short bursts of effort in daily life, such as rushing to catch a bus or carrying heavy groceries upstairs, can also qualify if they raise your heart rate and make you breathless.

CNN: Why might higher intensity exercise provide additional health benefits?

Wen: Higher intensity activity places greater demands on the body in a shorter period. This type of movement can improve cardiovascular fitness, increase insulin sensitivity and support metabolic health more efficiently than lower-intensity activity alone. Some studies have also linked vigorous activity with cognitive benefits.

Greater intensity may have distinct benefits across different organ systems. The researchers found that some conditions, such as immune-mediated inflammatory diseases, appeared to be more strongly linked to the intensity of activity than to the total amount. On the other hand, type 2 diabetes and kidney disease were influenced by both how much activity people did and how intense it was. Why this is the case is not yet known, but intensity appears to have a significant impact across diseases affecting multiple organs.

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CNN: How much vigorous activity do people need?

Wen: The threshold for people seeing a benefit appears to be relatively low. The researchers found that once people reached more than about 4% of their total activity as vigorous, their risk of developing chronic diseases dropped substantially.

To put that into practical terms, we are not talking about professional athletes dedicating their lives to hours of high-intensity training. Everyday people may see benefits from just doing a few minutes of vigorous effort daily.

CNN: How can people realistically incorporate vigorous activity into their daily routines?

Wen: One helpful way to think practically is that vigorous activity does not have to happen all at once. It can be accumulated in short bursts throughout the day.

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People can take the stairs instead of the elevator and do so at a faster pace than usual. When they are heading to work, they can add some speed walking. They can park farther away when grocery shopping and walk briskly while carrying groceries.

Structured exercise also can incorporate intervals where people alternate between moderate and more intense effort. If you’re swimming laps, you can warm up at a more leisurely pace, then do a few laps at a faster pace, then again at a leisurely pace and repeat. This suggestion applies to any other aerobic exercise: Aim for multiple intervals of at least 30 seconds to a minute each where your body is working hard enough that you feel noticeably out of breath.

CNN: What about someone who is older or has mobility issues?

Wen: Not everyone can or should engage in high-intensity activity in the same way. Vigorous activity is relative to that person’s baseline. For someone who is not used to exercise, even a short period of slightly faster walking or standing up repeatedly from a chair could be considered high intensity. And not everyone may be able to walk. In that case, some exercises from the chair can have aerobic benefits.

Individuals who have specific medical conditions should consult with their primary care clinicians before embarking on a new exercise routine. People with mobility issues also may benefit from working with a physical therapist who can help to tailor exercises appropriate to their specific situation.

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CNN: What is the key takeaway for people trying to improve their health?

Wen: To me, the main takeaway from this study is that it’s not only how much total exercise you get but also how hard you push yourself that matters. And you don’t have to have a lot of high-intensity exercise: Adding just a little has substantial health benefits across a wide range of chronic health conditions.

At the same time, exercise needs be practical. People should look for opportunities to safely increase intensity in ways that fit their daily lives. The most effective approach to physical activity is a balanced one: Exercise regularly, incorporate more challenging activities when you can and build habits that are sustainable over time.

Get inspired by a weekly roundup on living well, made simple. Sign up for CNN’s Life, But Better newsletter for information and tools designed to improve your well-being.

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