The role of physical activity in the prevention of stroke is of great interest due to the high mortality and significant impact of stroke-related morbidity on the individual and on healthcare resources. The use of physical activity as a therapeutic strategy to maximise functional recovery in the rehabilitation of stroke survivors has a growing evidence base. This narrative review examines the existing literature surrounding the use of exercise and physical therapy in the primary and secondary prevention of stroke. It explores the effect of gender, exercise intensities and the duration of observed benefit. It details the most recent evidence for physical activity in improving functional outcome in stroke patients. The review summaries the current guidelines and recommendations for exercise therapy and highlights areas in which further research and investigation would be useful to determine optimal exercise prescription for effective prevention and rehabilitation in stroke. 1. Introduction Stroke is a leading cause of mortality and morbidity worldwide. In the UK stroke is the third most common cause of death and the main cause of acquired disability. Approximately 130,000 individuals experience a first ever stroke per annum [1]. In addition to widely applicable pharmacological treatment for acute stroke, effective prevention and rehabilitation strategies are crucial. The development of such strategies is a major challenge for the 21st century medicine. Exercise and physical activity have an increasing evidence base in the primary and secondary prevention of stroke and in stroke rehabilitation. The interface between physical activity and cerebrovascular disease is complex and of broad interest to clinicians, therapists, and epidemiologists. The importance of the relationship is becoming clearer: physical inactivity has been implicated by the INTERSTROKE study as one of the 5 key risk factors which account for more than 80% of the global burden of stroke [2]. Physical fitness training is increasingly being recommended as a component of stroke rehabilitation programmes due to the emerging body of evidence surrounding the benefits in improving the function after stroke [3]. The role of long-term physical activity in patients who have had a stroke in the prevention of further stroke is less clear. This paper provides a narrative review of the literature which addresses the interface between physical activity and cerebrovascular disease with specific reference to prevention of stroke and poststroke rehabilitation. 2. Search Strategy A computer-assisted
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