When Should You Start Physical Therapy After a Stroke?

By: Zach Crump, PT, DPT, NCS

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Patient receiving physical therapy after stroke on the Hocoma Andago at Sheltering Arms Institute

After a stroke, one of the biggest questions patients and families face is: “What is my likelihood of recovery?” When the patient begins physical therapy can be an important part of that answer. Is there a window when recovery is most likely? And what happens if that window has passed?

The answer is more encouraging than you might think. Timing plays an important role in stroke rehabilitation, but what you practice during therapy matters, too.

When is the Best Time to Start Physical Therapy?

In many cases, rehabilitation can begin soon after a stroke, once a person is medically ready. The first few months can be an especially important period as the brain adapts to injury and relearns skills. Research suggests that many of the brain’s responses to rehabilitation occur in the early period, from the first week through approximately three months after a stroke (De Las Heras et al., 2025; Zeiler and Krakauer, 2013).

That does not mean recovery ends at three months. People can continue making meaningful progress toward their goals well beyond that point (Richards et al., 2026). A physical therapist can help tailor rehabilitation to each stage of recovery.

How Does The Brain Relearn Movement?

After a stroke, signals between the brain and body may not travel as they once did. The brain has an ability called experience-dependent neuroplasticity: it can adapt in response to what we practice.

Imagine a bridge connecting the brain and the body. A stroke can disrupt that connection, making it harder for messages to travel back and forth. Targeted physical therapy uses the right amount of practice, challenge, and repetition to help the nervous system strengthen or reorganize pathways that support everyday movements, such as walking to another room or reaching for a glass of water.

Three Things That Make Stroke Rehabilitation Count

Effective rehabilitation is about more than simply moving. Three principles help make practice meaningful:

1. The right level of challenge: Therapy should offer an appropriate challenge. One way a physical therapist may measure that challenge during walking is by monitoring heart rate. For example, a target range for some 60-year-olds recovering from stroke may be 116–141 beats per minute, depending on individual circumstances (Hornby et al., 2020; Richards et al., 2026).

That range is not a goal for everyone. Before starting more demanding exercise, speak with your physician and therapist. An exercise test may be recommended to determine a safe, appropriate intensity.

2. Practice, practice, practice: Repeating meaningful movements gives the brain and body more opportunities to relearn. Even when a person cannot move independently, a therapist may provide assistance so they can keep practicing.

For walking rehabilitation, therapists may track daily steps or distance. Research has associated approximately 1,200–1,500 steps per day during inpatient rehabilitation with improved walking outcomes in some people recovering from stroke (Hornby et al., 2015; Henderson et al., 2022). For people further along in recovery, around 7,500 daily steps has been associated with greater community walking activity (Fulk et al., 2017). These are research findings, not universal step prescriptions.

3. It takes time, but not just time: What would you like to do again at home or in your community? Your personal goals help shape what you practice in therapy. Progress takes time, but the quality of that practice matters, too.

Current stroke rehabilitation guidance discusses 150–300 minutes of aerobic activity per week alongside strength and balance training two to three days per week, as appropriate for the individual (Richards et al., 2026). Your rehabilitation team can help determine how much activity is right for you and how to make each session count through purposeful repetition and suitable intensity.

What if it Has Been Months, or Years, Since a Stroke?

The early months matter, but recovery does not necessarily stop at a particular date. Balance, walking endurance, and walking speed are just a few abilities people may continue working to improve years after a stroke.

“I recall reconnecting with a patient I first treated 10 years earlier, soon after the patient’s stroke. Over the years, the patient returned to therapy as needed to support the things that mattered most to him: going on dates with his wife and participating fully in his community. Those personal goals continued to motivate him to stay active.” – Zach

If you are wondering whether therapy could still help, a rehabilitation professional can assess your abilities and help identify meaningful next steps.

Finding The Right Next Step

There is no single recovery timeline that fits everyone. Starting rehabilitation when medically appropriate, practicing with purpose, and working toward goals that matter to you can help shape a plan for where you are today.

Learn more about stroke rehabilitation at Sheltering Arms Institute, or contact us to see how we may be able to help you continue recovery after a stroke. 

References:

  1. De Las Heras B, Rodrigues L, Cristini J, et al. Investigating the Acute and Chronic Effects of Cardiovascular Exercise on Brain-Derived Neurotrophic Factor in Early Subacute Stroke. Neurorehabil Neural Repair. 2025;39(8):653–665. doi:10.1177/15459683251342150

  2. Fulk GD, He Y, Boyne P, Dunning K. Predicting Home and Community Walking Activity Poststroke. Stroke. 2017;48(2):406–411. doi:10.1161/STROKEAHA.116.015309

  3. Henderson CE, Fahey M, Brazg G, Moore JL, Hornby TG. Predicting Discharge Walking Function With High-Intensity Stepping Training During Inpatient Rehabilitation in Nonambulatory Patients Poststroke. Arch Phys Med Rehabil. 2022;103(7S):S189–S196. doi:10.1016/j.apmr.2020.10.127

  4. Hornby TG, Holleran CL, Leddy AL, et al. Feasibility of Focused Stepping Practice During Inpatient Rehabilitation Poststroke and Potential Contributions to Mobility Outcomes. Neurorehabil Neural Repair. 2015.

  5. Hornby TG, Reisman DS, Ward IG, et al. Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury. J Neurol Phys Ther. 2020;44(1):49–100. doi:10.1097/NPT.0000000000000303

  6. Richards LG, Ifejika NL, Stein J, et al. 2026 Guideline for Adult Stroke Rehabilitation and Recovery: A Guideline From the American Heart Association and American Stroke Association. Stroke. 2026;57(10):e514–e658. doi:10.1161/STR.0000000000000536

  7. Zeiler SR, Krakauer JW. The interaction between training and plasticity in the poststroke brain. Curr Opin Neurol. 2013;26(6):609–616. doi:10.1097/WCO.0000000000000025

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