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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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heart.org and stroke.org

Fitness

A 3-Step Plan to Give Your Diet, Fitness Routine and Mindset a Reset for Spring

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A 3-Step Plan to Give Your Diet, Fitness Routine and Mindset a Reset for Spring

To help you do this, we’ve tapped our Start TODAY experts for simple tips to lighten up meals, move in ways that boost metabolism and and refocus our mindset to get motivated to keep working toward your goals. Apply their strategies and finish the month feeling lighter, more energized and motivated to move forward. Here’s the plan to make it happen:

>>Download the 31-day calendar here

31-Day HIIT & Walking Challenge

This month’s workout plan is focused on short workouts that pack a punch. “HIIT workouts give you a bigger bang for your workout buck! They provide a more efficient workout because you’re alternating the pace and intensity rather than sticking to a steady, moderate pace,” says Mansour. “Changing things up with HIIT prevents boredom and keeps your muscles guessing. This is how we can get the body to change — whether that change is speeding up your metabolism, burning more calories, building muscle, losing weight, or just improving overall health — keeping your body guessing is the magic ticket to seeing results!”

Active recovery days include stretching to improve flexibility and walking for a cardiovascular workout that aids muscle recovery. When weather permits, Mansour encourages people to get outside on walking days. “Walking outdoors isn’t just a workout, it’s a chance to breathe in fresh air and get out of the house to change your environment,” she says. “Each time you go outside on a walk, even if you go on the same path, you’ll see or feel something different. Maybe it’s a change in weather, plants or flowers, people or things. Prioritizing taking your walk outside can hugely benefit your mental health. Getting out of your regular environment and into nature can be a form of meditation, too.”

Get the full 31-day workout plan with unique workouts sent to you daily — plus, walking podcasts, healthy spring recipes and mindfulness tools — in the Start TODAY app!

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Start TODAY Spring Asparagus Pasta recipe
Lighten up comfort food favorites by adding seasonal ingredients, like in this Spring Asparagus Pasta.

3 Simple Spring Diet Tips

In addition to mixing up your workout routine, use spring as an opportunity to start lightening up your meals by packing them with seasonal ingredients. Start TODAY dietitian Natalie Rizzo shares her top tips:

  1. Incorporate more seasonal foods. After a long winter of eating the same foods, your palate is ready for a change! Aim to add at least one spring fruit or vegetable to your meals each day, like asparagus, peas, spinach, radishes, citrus or strawberries. This Spring Asparagus Pasta is a simple weeknight dinner that feels both light and comforting. Seasonal produce is fresher, more flavorful, and an easy way to naturally boost vitamins and fiber. Plus, seasonal produce is more affordable than other items in the produce section.
  2. Use fresh herbs to brighten up your dishes. Fresh herbs like basil, cilantro, parsley, mint, or dill can instantly upgrade simple meals without extra salt or heavy sauces. Sprinkle them on salads, roasted veggies, eggs, soups, or grain bowls for a burst of spring flavor. Cilantro is the perfect finish to this Mexican Stuffed Sweet Potato, while herbs are blended into cottage cheese in this Herby Cottage Cheese Toast with Tomato recipe for a pop of fresh flavor.
  3. Shift from heavy comfort meals to balanced plates. As the weather warms up, it’s time to move away from heavy comfort foods and embrace lightened up spring dishes. Build plates with a mix of lean protein, whole grains or starchy veggies, and plenty of colorful produce. Think roasted veggie grain bowls, hearty salads like this BBQ Chicken Quinoa Salad, or simple stir-fries instead of creamy casseroles or heavy stews.
Start TODAY Mexican Stuffed Sweet Potato
A sprinkle of fresh cilantro is the perfect finish to this Mexican Stuffed Sweet Potato.

Spring Clean Your Mindset with This Mental Health Exercise

Yes, we are working to propel ourselves forward toward our health goals, but an important part of that process is slowing down and reflecting.

Getting permission not to rush in a world that feels like it’s moving faster than we can keep up is a reminder that most of us need.

Yasmine Cheyenne, start TODAY mindfulness expert

“Getting permission not to rush in a world that feels like it’s moving faster than we can keep up is a reminder that most of us need, but how often would we admit that?” says Cheyenne. “ When the to-do list feels long, and we’re trying to get everything done, we often say the opposite, disregarding how we feel, and push ourselves. Yes, we all have deadlines and things that need to be done. But we also need the reminder to take care while handling our responsibilities.”

This can be easier said than done. So Cheyenne offers up a simple exercise to help: Write down the words you need to hear each day to make yourself a priority and work toward your goals. Put them somewhere you see often, like your fridge or bathroom mirror, and recite them out loud daily.

“This is a perfect example of a reminder that seems small, but can come at the perfect time and help us care for ourselves,” she explains. “One of my favorite examples is: Take it slow and don’t rush, your nervous system deserves peace.”

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“When you tell yourself the thing you’ve been needing to hear, it allows you to admit the quiet rumbling within you and take the steps you need. It might be admitting ‘I’m tired and will give myself an early night this week.’ Or you’re saying ‘I’m so proud of the way I’ve committed to moving my body everyday.’ Whether you’re cheering yourself on or reminding yourself of what you need, we don’t always slow down enough to hear what we need from ourselves, and this practice is a great way to start.”

Talking out loud to yourself may feel strange at first, but Cheyenne says over time it will help shift your mindset and translate those words into action. “When we hear ourselves recite these words, it’s like we’re planting positive seeds within us. The more we say what we need, the more we remember it, and we’re more likely to follow through and care for ourselves,” she says. “Our actions really start with the words we say to ourselves. Reading them out loud helps us rewire the way we talk to ourselves and that inner shift is exactly what opens the door to transformation.”

Join our live “Spring Reset Workshop” on March 22 to get one-on-one coaching from Yasmine Cheyenne and connect with other Start TODAY members. Sign up here!

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Exercise scientist says ‘eating more’ is key to losing weight in perimenopause – here’s why

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Exercise scientist says ‘eating more’ is key to losing weight in perimenopause – here’s why

If you’ve ever wanted to lose weight, you’ve probably heard the phrase ‘calories in versus calories out’. While it’s true to a degree, losing weight in menopause isn’t about eating less, but rather eating differently.

Speaking to fitness coach Loretta Hogg, Dr Stacy Sims says: “One of the first things that women often do, because we grew up in an era of calories in, calories out, less calories means fat loss. That is not true because if you are not eating enough, your body holds on to fat.”

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Building the No Neck Army: The Army’s Holistic Health and Fitness Program – Modern War Institute

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Building the No Neck Army: The Army’s Holistic Health and Fitness Program – Modern War Institute

Editor’s note: This article is the seventh in an eight-part series led by retired General James Mingus, the thirty-ninth vice chief of staff of the Army, on transforming the Army to meet the challenges of tomorrow’s battlefield. You can read other articles in the series here.


The battlefield in America’s next war will offer no sanctuary. The war won’t be fought from forward operating bases equipped with elaborate gyms, contractor-provided dining facilities, or coffee shops. The battlefield will be austere, harsh, and unrelentingly violent, with victory only possible by combining physical strength, endurance, and a will to prepare.

The Army’s Holistic Health and Fitness (H2F) program is the bedrock upon which this preparation begins. Winning America’s next war requires an Army that can get to the fight, win the fight, and get home from the fight—a mission profile that demands not just fit soldiers built for endurance, but warrior athletes built for endurance and able to leverage strength, speed, and power, and grounded in sound sleep and nutrition.

Culture Shift Begins with Mindset Shift

For the last several decades, the Army took pride in fielding formations rooted in a physical fitness culture relying heavily on push-ups, sit-ups, and miles of running and ruck marching. Physical training began predictably after saluting the flag at 0630 and ended promptly when the basic exercises, calisthenics, and formation run were complete. It was one-dimensional, unimaginative, boring, and, ironically, lazy. Army fitness during this period was solely focused on physical endurance.

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In the early 2000s, however, Army fitness began to change, led by special operations units like the 75th Ranger Regiment, which began experimenting with trending fitness regimens like Gym Jones, CrossFit, and Mountain Athlete. By combining emerging principles from several of these programs, special operations units began designing their own programs, such as the Ranger Athlete Warrior program. The rest of the active Army quickly started to model these programs, and the first H2F pilot kicked off in 2018.

Advances in exercise science and twenty years of war helped reframe the Army’s fitness mindset to encompass mental, physical, nutritional, and sleep dimensions. This mindset shift forms the basis of the H2F culture, changing how we train and care for soldiers. The focus is now on building strength and resilience like professional athletes—or more fittingly, warrior athletes. Where mission endurance was the goal before, tactical athleticism is now the goal, with an emphasis on strength, speed, power, and agility.

You Can’t Fake Results

A key part of any fitness program is the ability to measure its effectiveness, and in only a few short years, the return on investment for the H2F program has been profound. Currently sixty-six brigades have an H2F performance team, which consists of twenty-two professionals: a program director, dietitian, physical therapist, and occupational therapist; seven strength and conditioning coaches; four athletic trainers; one cognitive performance specialist; and six military personnel. By 2029, the program will expand to cover the entire active Army, as well as four states of Army National Guard and two Army Reserve commands.

According to analysis from the US Army Research Institute of Environmental Medicine, if H2F had been implemented across the entire Army, over a five-year period it would have added 1,080 deployable soldiers to the fighting force. If that’s not compelling enough, also consider these complementary H2F data points compiled by the Center for Initial Military Training Research and Analysis team after analyzing data from 2019 to 2023:

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  • 61 percent decrease in musculoskeletal injury referrals
  • 44 percent decrease in behavioral health profiles
  • 79 percent decrease in substance abuse cases
  • 22 percent decrease in fitness test failures
  • 33 percent increase in expert rifle marksmanship qualification

Expanding the Tools

As part of continuous transformation, the Army is looking for unique ways to leverage technology to enhance the H2F program. Several units are experimenting with wearables like rings and watches that measure sleep efficiency, heart rate variability, and blood oxygen saturation—providing rich data to inform approaches to physical, nutritional, and sleep aspects of fitness. Today, entire Army divisions are turning physiological data into leader decision-making information. A company commander who knows his or her soldiers’ sleep scores, for example, is equipped with data to combine with other information to help select the most well-rested platoon to lead a dangerous mission. Individual soldiers will also learn the correlations that exist between their fueling, recovery, and performance habits, which will help in multiple facets of their personal lives.

The Army is also continually working to improve facilities and services that support H2F. Most units now have access to twenty-four-hour functional fitness gyms on post and many units utilize fitness containers—effectively, gyms in a box. Plans are also in place to build additional facilities to ensure soldiers at every post have adequate equipment to train. To improve nutrition, the Army is experimenting with campus-style dining facilities that will supplement, and in some cases replace, traditional dining facilities—affording soldiers a myriad of quick, 24/7 accessible healthy food options. A no excuse not to work out and no excuse not to eat healthy mentality now abounds across the Army.

Soldiering has no offseason and no time-outs, and wars wait on no one. When America calls, the Army responds. Unlike professional athletes who can vary training volume, intensity, and specific exercises over planned cycles or offseasons, a practice known as performance periodization, soldiers have no such luxury. Tactical athleticism via compound periodization is the goal for soldiers—ensuring peak performance at all times by developing key physical attributes (e.g., strength, endurance, and power) year-round to maximize efficiency, prevent burnout, and improve overall warfighting readiness. The H2F tools highlighted above aid in measuring and maximizing this readiness.

What’s Next?

Imagine two Army squads ascending Colorado’s Pikes Peak carrying fifty-pound fighting loads. Squad A trained to get to the top through push-ups, sit-ups, and miles of running. The soldiers of Squad B are warrior athletes who took the H2F approach. When Squad A’s soldiers finally struggle to the top, they’re just happy to be mission complete and they flop on the ground. The soldiers of Squad B assault the mountain, and when they get to the top, they still have enough juice to rip the arms off their adversaries and steamroll into the next mission. In their post-hike squad photo, they’re all standing tall—straight backs, satisfied smiles, and trap muscles extending inches above their shoulders so they almost appear to have no necks. For them the mission is just getting started, and their smirks seem to say, “Is that it? What’s next?”

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Welcome to the No Neck Army.

Retired General James Mingus served as the thirty-ninth vice chief of staff of the Army.

Colonel Graham White is an infantry officer and the executive officer to the vice chief of staff of the Army.

The views expressed are those of the authors and do not reflect the official position of the United States Military Academy, Department of the Army, or Department of Defense.

Image credit: KCpl. GeonWoo Park, US Army

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