Evidence is growing on the efficacy of exercise models for improving multiple domains of physiological health and fitness in people with chronic stroke. The Adaptive Physical Activity exercise program in Italy illustrates how geographic dispersion can increase access to such programs. A partnership between local agencies of the Veterans Health Administration and Administration on Aging suggests ways to increase access to exercise programs for veterans and other citizens with chronic stroke in the United States. The use of a structure-process-outcome framework is suggested to facilitate exchange between international research teams regarding development of evolving stroke exercise models.