Rapid response and good access to rehab can greatly improve stroke outcomes. But prevention is best of all, says neurophysio Richard Sealy...
Many of us still imagine that strokes only happen in old age. The reality is more sobering: one in four strokes now occurs in people of working age, while hospital admissions have risen by almost 30% in the past two decades, with the greatest increase among those in their 50s.
Increased obesity, type 2 diabetes and hypertension are part of the issue, but so too is risk displacement: a better survival rate from heart disease means that many people are now living longer, thereby exposing themselves to the risk of stroke. As a physiotherapist specialising in neurological rehabilitation, I meet people whose lives have been changed overnight. But I also see the remarkable potential for recovery when individuals receive the right support.
Our best tool, however, is prevention. While genetics and age play a role, many of the biggest contributors to stroke are modifiable. High blood pressure, smoking, physical inactivity, high cholesterol, excess alcohol and poorly controlled diabetes are among the most significant risk factors.
Richard Sealy
Know your blood pressure
High blood pressure is the leading cause of stroke, yet many people do not realise that their blood pressure is raised. Checks are quick, simple and widely available at GP practices and pharmacies.
Move more
Regular physical activity helps control weight, blood pressure, stress and blood sugar. Brisk walking, cycling, swimming, gardening or home workouts all count. Consistency makes the difference.
Smoking and alcohol
Smoking doubles stroke risk. Reducing alcohol to within recommended limits also protects brain and heart health.
Richard Sealy
Eat for vascular health
A balanced diet with vegetables, fruit, whole grains, lean protein and oily fish reduces the risk of stroke.
Sleep and stress
Prolonged stress and poor sleep increase inflammation and blood pressure. Taking regular breaks, moving your body, spending time outdoors and protecting rest can all support long-term wellbeing.
The FAST signs
The acronym FAST – Face, Arms, Speech and Time to call 999 – is the most effective way for the public to recognise and respond to stroke. Fast action reduces disability by allowing access to time-critical treatments such as clot-busting medication or mechanical thrombectomy.
Unequal access
Sadly, the care someone receives after a stroke often depends on where they live. Fewer than 5% of eligible patients in England receive mechanical thrombectomy, a highly effective procedure for certain strokes. Across England, only 26 hospitals can perform MT – one of which is St George’s in Tooting – and the rate of MT remains below the European average.
These geographic inequalities extend into rehabilitation. NICE (National Institute for Health and Care Excellence) recommends three hours or more of motor function therapy on 5 of 7 days per week. Very few patients receive this.
Recovery continues
A common misconception is that recovery stops six months after a stroke. Modern neuroscience strongly disagrees. The brain retains the ability to change throughout life, a property known as neuroplasticity. Through meaningful, repetitive activity, the brain can form new pathways and strengthen existing ones. With the right type of rehab, progress is possible months and even years after a stroke.
Richard Sealy is the founder of Neuro Rehab Practice in Hampton, TW12 2HD; neurorehabpractice.co.uk.
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Local services
- Companion Cycling in Bushy Park: Companion Cycling offers adapted cycles such as side-by-side bikes and wheelchair-accessible ‘rickshaws’, enabling people with limited mobility to enjoy safe cycling in the traffic-free paths of Bushy Park. Learn more.
- Dyscover: Dyscover exists to support people with aphasia, which is often caused by stroke. Through structured group programmes, communication-focused activities, personalised support and family education, the specialist Leatherhead charity helps members rebuild confidence, reconnect socially and develop practical communication strategies. Learn more.
- Woking Strokeability: Founded by David and Edna Balcombe, Woking Strokeability is a charity affiliated with the Stroke Association. It offers stroke survivors opportunities to rebuild strength, mobility and confidence through specialist-led gym and aqua exercise sessions, personalised rehab and a supportive community that includes carers and fosters social connection. Learn more.
