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Goncalves S, Mandigout S, Le Bourvellec M, Duclos NC. Comparison of motion sensor and heart rate monitor for assessment of physical activity intensity in stroke outpatient rehabilitation sessions: an observational study. J Rehabil Med 2024; 56:jrm40559. [PMID: 38915294 PMCID: PMC11218675 DOI: 10.2340/jrm.v56.40559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024] Open
Abstract
OBJECTIVE To compare the estimation of time spent on 4 categories of physical activity intensity (sedentary behaviour, light physical activity, moderate physical activity, and vigorous physical activity) between a motion sensor and a heart rate monitor during a stroke outpatient rehabilitation session. DESIGN A multicentre cross-sectional observational study. SUBJECTS/PATIENTS Participants with stroke (> 6 months) undergoing outpatient rehabilitation sessions. METHODS Participants wore the SenseWear Armband motion sensor and the Polar H10 heart rate monitor during 2 rehabilitation sessions. The times estimated by each device were compared using a generalized linear mixed model and post-hoc tests. RESULTS Ninety-nine participants from 29 clinics were recruited and data from 146 sessions were included in the analysis. The estimated times depended on the devices and the physical activity intensity category (F = 135, p < 0.05). The motion sensor estimated more time spent in sedentary behaviour and less time spent in moderate physical activity and vigorous physical activity than the heart rate monitor. CONCLUSION The motion sensor and heart rate monitor provide different estimates of physical activity intensity during stroke rehabilitation. Further research is needed to establish the most appropriate device for each physical activity category.
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Cuccurullo SJ, Fleming TK, Petrosyan H, Hanley DF, Raghavan P. Mechanisms and benefits of cardiac rehabilitation in individuals with stroke: emerging role of its impact on improving cardiovascular and neurovascular health. Front Cardiovasc Med 2024; 11:1376616. [PMID: 38756753 PMCID: PMC11096558 DOI: 10.3389/fcvm.2024.1376616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
Human and animal studies have demonstrated the mechanisms and benefits of aerobic exercise for both cardiovascular and neurovascular health. Aerobic exercise induces neuroplasticity and neurophysiologic reorganization of brain networks, improves cerebral blood flow, and increases whole-body VO2peak (peak oxygen consumption). The effectiveness of a structured cardiac rehabilitation (CR) program is well established and a vital part of the continuum of care for people with cardiovascular disease. Individuals post stroke exhibit decreased cardiovascular capacity which impacts their neurologic recovery and extends disability. Stroke survivors share the same risk factors as patients with cardiac disease and can therefore benefit significantly from a comprehensive CR program in addition to neurorehabilitation to address their cardiovascular health. The inclusion of individuals with stroke into a CR program, with appropriate adaptations, can significantly improve their cardiovascular health, promote functional recovery, and reduce future cardiovascular and cerebrovascular events thereby reducing the economic burden of stroke.
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Affiliation(s)
- Sara J. Cuccurullo
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute at Hackensack Meridian Health, Edison, NJ, United States
| | - Talya K. Fleming
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute at Hackensack Meridian Health, Edison, NJ, United States
| | - Hayk Petrosyan
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute at Hackensack Meridian Health, Edison, NJ, United States
| | - Daniel F. Hanley
- Brain Injury Outcomes, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Preeti Raghavan
- Department of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Legasto-Mulvale JM, Inness EL, Thompson AN, Chandran N, Mathur S, Salbach NM. Adverse Events During Submaximal Aerobic Exercise Testing in People With Subacute Stroke: A Scoping Review. J Neurol Phys Ther 2024; 48:27-37. [PMID: 37184472 DOI: 10.1097/npt.0000000000000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND PURPOSE Concern for adverse cardiovascular events and limited guidance regarding how to conduct aerobic exercise (AEx) testing for individuals poststroke are key barriers to implementation by physical therapists in stroke rehabilitation. This study aimed to describe the nature and safety of submaximal AEx testing protocols for people with subacute stroke (PwSS) and the nature of comorbidity of PwSS who underwent submaximal AEx testing. METHODS We conducted a scoping review and searched MEDLINE, EMBASE, PsycINFO, CINAHL, and SPORTDiscus from inception to October 29, 2020. Studies involving submaximal AEx testing with PwSS, reporting on participant comorbidity and on adverse events during testing, were eligible. Two reviewers independently conducted title and abstract and full-text screening. One reviewer extracted data; a second reviewer verified data. RESULTS Thirteen studies involving 452 participants and 19 submaximal AEx testing protocols (10 field test, 7 incremental, and 2 constant load) were included. Hypertension (41%), diabetes (31%), and dyslipidemia (27%) were the most common comorbidities reported. No protocols resulted in a serious adverse event. The most common test termination criterion was a heart rate (HR) limit (9 protocols); a limit of 85% age-predicted maximal HR (APM-HR) most frequently reported. Average APM-HR achieved, computed using mean age and mean peak HR, ranged from 59% to 88% across 13 protocols. DISCUSSION AND CONCLUSION Diverse submaximal AEx testing protocols with conservative test termination criteria can be safely implemented with PwSS. Results can inform clinical practice guidelines and address physical therapists' concerns with the occurrence of serious adverse events during submaximal AEx testing.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A430 ).
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Affiliation(s)
- Jean Michelle Legasto-Mulvale
- Rehabilitation Sciences Institute (J.M.L.M., E.L.I., A.N.T., N.C., S.M., N.M.S.) and Department of Physical Therapy (J.M.L.M., E.L.I., S.M., N.M.S), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; The KITE Research Institute, Toronto Rehabilitation Institute (E.L.I., N.M.S), University Health Network, Toronto, Ontario, Canada; and School of Rehabilitation Therapy (S.M.), Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
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Kim MS, Kim HY, Park G, Kim TL, Shin JH. Cardiopulmonary Response to Robot-Assisted Tilt Table With Regard to Its Components. BRAIN & NEUROREHABILITATION 2023; 16:e9. [PMID: 37033003 PMCID: PMC10079472 DOI: 10.12786/bn.2023.16.e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 04/05/2023] Open
Abstract
Cardiopulmonary function is exceptionally critical during the early stages of rehabilitation after neurological disorders such as stroke, spinal cord injury and Parkinson's disease. This study aimed to demonstrate how robot-assisted and tilt table exercises affect cardiopulmonary function. In this study, ten healthy young adults performed six combinations of conditions according to robot-assisted mode (on/off), angle of tilt table (20°/60°), and functional electrical stimulation (FES) mode (on/off). Four conditions had FES mode off with combinations of robot-assisted mode (on/off) and tilt angle (20°/60°) and two conditions had robot-assisted mode and FES on with tilt angle (20°/60°). Cardiopulmonary effects (oxygen uptake [VO2], peak oxygen uptake [VO2peak], metabolic energy cost [MET], rate pressure product [RPP], heart rate [HR], maximum heart rate [%HRmax], and minute ventilation [VE]) were compared in each condition. As a result, in the angle and FES mode effect, VO2, VO2peak, MET, RPP, HR, and %HRmax, unlike that for VE, showed major effects in angle. In addition, in the robot-assisted mode and angle effect, when the FES was switched off, VO2, METs, and VE values showed major effects in the robot-assisted mode, whereas all other values showed major effects in angle. Compared to earlier reported findings, we can expect that robot-assisted tilt table training can lead to changes in the cardiopulmonary function.
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Affiliation(s)
- Myeong Sun Kim
- Department of Rehabilitative and Assistice Techonology, Rehabilitation Research Institute, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea
| | - Ha Yeon Kim
- Department of Healthcare and Public Health Research, Rehabilitation Research Institute, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea
| | - Gyulee Park
- Department of Rehabilitative and Assistice Techonology, Rehabilitation Research Institute, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea
| | - Tae-Lim Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea
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5
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Rodrigues L, Moncion K, Eng JJ, Noguchi KS, Wiley E, de Las Heras B, Sweet SN, Fung J, MacKay-Lyons M, Nelson AJ, Medeiros D, Crozier J, Thiel A, Tang A, Roig M. Intensity matters: protocol for a randomized controlled trial exercise intervention for individuals with chronic stroke. Trials 2022; 23:442. [PMID: 35610659 PMCID: PMC9127488 DOI: 10.1186/s13063-022-06359-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
Rationale Cardiovascular exercise is an effective method to improve cardiovascular health outcomes, but also promote neuroplasticity during stroke recovery. Moderate-intensity continuous cardiovascular training (MICT) is an integral part of stroke rehabilitation, yet it may remain a challenge to exercise at sufficiently high intensities to produce beneficial adaptations to neuroplasticity. High-intensity interval training (HIIT) could provide a viable alternative to achieve higher intensities of exercise by using shorter bouts of intense exercise interspersed with periods of recovery. Methods and design This is a two-arm, parallel-group multi-site RCT conducted at the Jewish Rehabilitation Hospital (Laval, Québec, Canada) and McMaster University (Hamilton, Ontario, Canada). Eighty participants with chronic stroke will be recruited at both sites and will be randomly allocated into a HIIT or MICT individualized exercise program on a recumbent stepper, 3 days per week for 12 weeks. Outcomes will be assessed at baseline, at 12 weeks post-intervention, and at an 8-week follow-up. Outcomes The primary outcome is corticospinal excitability, a neuroplasticity marker in brain motor networks, assessed with transcranial magnetic stimulation (TMS). We will also examine additional markers of neuroplasticity, measures of cardiovascular health, motor function, and psychosocial responses to training. Discussion This trial will contribute novel insights into the effectiveness of HIIT to promote neuroplasticity in individuals with chronic stroke. Trial registration ClinicalTrials.govNCT03614585. Registered on 3 August 2018 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06359-w.
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Affiliation(s)
- Lynden Rodrigues
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Québec, Montréal, Canada.,Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Montréal, Québec, Canada.,Feil/Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval, Laval, Québec, Canada
| | - Kevin Moncion
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth S Noguchi
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Elise Wiley
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Bernat de Las Heras
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Québec, Montréal, Canada.,Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Montréal, Québec, Canada.,Feil/Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval, Laval, Québec, Canada
| | - Shane N Sweet
- Feil/Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval, Laval, Québec, Canada.,Department of Kinesiology and Physical Education, McGill University, Montréal, Québec, Canada
| | - Joyce Fung
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Québec, Montréal, Canada.,Feil/Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval, Laval, Québec, Canada
| | | | - Aimee J Nelson
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Diogo Medeiros
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Québec, Montréal, Canada.,Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Montréal, Québec, Canada
| | - Jennifer Crozier
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Alexander Thiel
- Department of Neurology & Neurosurgery, McGill University, Montréal, Québec, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Marc Roig
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Québec, Montréal, Canada. .,Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Montréal, Québec, Canada. .,Feil/Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval, Laval, Québec, Canada.
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6
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Brauer SG, Kuys SS, Paratz J, Ada L. IMproving Physical ACtivity after stroke via Treadmill training (IMPACT) and self-management: a randomised trial. Int J Stroke 2022; 17:1137-1144. [DOI: 10.1177/17474930221078121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: To determine if treadmill training embedded in self-management education commencing during stroke inpatient rehabilitation results in more physical activity than usual gait training. Method: A prospective, parallel-group, randomised trial with concealed allocation, blinded measurement and intention-to-treat analysis involving 119 stroke survivors undergoing rehabilitation who were able to walk independently was undertaken. The experimental group undertook treadmill training (40-60% heart rate reserve) and self-management education for 30 minutes, three times a week for 8 weeks and the control group undertook the same amount of usual gait training. Outcomes were measured at baseline (Week 0), on completion of the intervention (Week 8) and beyond the intervention (Week 26). The primary outcome was physical activity measured as steps/day using an activity monitor. Secondary outcomes were walking ability, cardiorespiratory fitness, cardiovascular risk, depression, self-efficacy, perception of physical activity, participation, and quality of life. Results: After 8 weeks, the experimental group took 1436 more steps/day (95% CI 229 to 2643) than the control group. By 6 months, they took 871 more steps/day (95% CI -385 to 2129) than the control group. There was no difference between groups in any other outcome. Conclusions: In individuals undergoing rehabilitation after stroke, 8 weeks of treadmill training embedded in self-management resulted in more physical activity than usual gait training and this was largely maintained at 6 months, despite little effect on walking or cardiorespiratory fitness, suggesting the self-management was responsible. Trial Registration: ACTRN12613000744752. Data Access: Data are available from the corresponding author.
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Affiliation(s)
- Sandra G Brauer
- The University of Queensland, Division of Physiotherapy, Brisbane, Australia
| | - Suzanne S Kuys
- Australian Catholic University, School of Physiotherapy, Faculty of Health Sciences, Banyo, Australia
| | - Jenny Paratz
- Griffith University Faculty of Health, School of Health Sciences and Social Work, Gold Coast, Australia
| | - Louise Ada
- The University of Sydney Faculty of Medicine and Health, Sydney, Australia
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7
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Marilyn ML, Gordon G, Stephen P, Nicholas G, Wanda F, Kara T, Chris T, Howard W, Sharon S, David M, Gail E, Fiona P, Chris B, Judy D. Program of Rehabilitative Exercise and Education to Avert Vascular Events After Non-Disabling Stroke or Transient Ischemic Attack (PREVENT Trial): A Randomized Controlled Trial. Neurorehabil Neural Repair 2021; 36:119-130. [PMID: 34788569 PMCID: PMC9066689 DOI: 10.1177/15459683211060345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Non-disabling stroke (NDS) and transient ischemic attack (TIA) herald the possibility of future, more debilitating vascular events. Evidence is conflicting about potency of exercise and education in reducing risk factors for second stroke. Methods Three-site, single-blinded, randomized controlled trial with 184 participants <3 months of NDS or TIA (mean age, 65 years; 66% male) randomized to usual care (UC) or UC + 12-week program of exercise and education (PREVENT). Primary (resting systolic blood pressure) and secondary outcomes (diastolic blood pressure [DBPrest], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], total cholesterol [TC], TC/HDL, triglycerides, fasting glucose, and body mass index) were assessed at baseline, post-intervention, and 6- and 12-month follow-up. Peak oxygen consumption (VO2peak) was measured at baseline, post-intervention, 12-month assessments. Results Significant between-group differences at post-intervention favored PREVENT group over UC: DBPrest (mean difference [MD]: −3.2 mmHg, 95% confidence interval [CI]: −6.3, −.2, P = .04) and LDL-C (MD: −.31 mmol/L, 95% CI: −.42, −.20, P = .02). Trends of improvement in PREVENT group were noted in several variables between baseline and 6-month follow-up but not sustained at 12-month follow-up. Of note, VO2 peak did not change over time in either group. Conclusion Impact of PREVENT on vascular risk factor reduction was more modest than anticipated, possibly because several outcome variables approximated normative values at baseline and training intensity may have been sub-optimal. Further investigation is warranted to determine when exercise and education programs are viable adjuncts to pharmaceutical management for reduction of risk factors for second stroke. Clinical Trial Registration-URL:http://www.clinicaltrials.gov. Unique identifier: #NCT00885456
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Affiliation(s)
- MacKay-Lyons Marilyn
- School of Physiotherapy, 3688Dalhousie University, Halifax, NS, Canada.,Physical Medicine, Nova Scotia Health Authority, 3688Dalhousie University, Halifax, NS, Canada
| | - Gubitz Gordon
- Neurology, 3688Dalhousie University, Halifax, NS, Canada
| | | | - Giacomantonio Nicholas
- QEII Health Sciences Centre, Halifax, NS, Canada.,Cardiac Rehabilitation, QEII Community Cardiovascular Hearts-in-Motion, Halifax, NS, Canada
| | - Firth Wanda
- Cardiac Rehabilitation, QEII Community Cardiovascular Hearts-in-Motion, Halifax, NS, Canada
| | - Thompson Kara
- Nova Scotia Health, Research Methods Unit, Halifax, NS, Canada
| | - Theriault Chris
- Nova Scotia Health, Research Methods Unit, Halifax, NS, Canada
| | - Wightman Howard
- Cardiology Associates, Valley Regional Hospital, Kentville, NS, Canada
| | - Slipp Sharon
- Cardiac Rehabilitation, Valley Regional Hospital, Kentville, NS, Canada
| | - Marsters David
- Internal Medicine, Valley Regional Hospital, Kentville, NS, Canada
| | - Eskes Gail
- Physical Medicine, Nova Scotia Health Authority, Halifax, NS, Canada.,Psychiatry, 3688Dalhousie University, Halifax, NS, Canada.,Medicine, Nova Scotia Health, Halifax, NS, Canada
| | - Peacock Fiona
- Cardiac Specialty Clinic, Valley Regional Hospital, Kentville, Canada
| | | | - Dewolfe Judy
- Cardiac Specialty Clinic, Valley Regional Hospital, Kentville, Canada
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Sharpe A, Boyes V, Lee C, Murtha C, Mah J, Yoshida K, Marzolini S, Inness EL. Cardiopulmonary Exercise Testing in Stroke Rehabilitation: Benefits and Clinical Utility Perceived by Physiotherapists and Individuals with Stroke. Physiother Can 2021; 73:110-117. [PMID: 34456420 DOI: 10.3138/ptc-2019-0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The purpose of this study was to understand the perceived benefits and clinical utility of cardiopulmonary exercise testing (CPET) from the perspectives of physiotherapists and patients and to explore the factors that influence adopting CPET in a stroke rehabilitation setting. Method: A qualitative descriptive study was conducted. Physiotherapists (n = 6) participated in a focus group to discuss the use of CPET in practice. Patients (n = 8) who had completed CPET during stroke rehabilitation participated in a semi-structured interview to explore their experiences. Thematic analysis was performed. Results: CPET increased the physiotherapists' confidence in prescribing exercise, especially for medically complex patients. Ongoing medical management early post-stroke was a barrier to referral. Physiotherapists expressed decreased confidence in interpreting test results. Consultation with local experts facilitated the use of CPET. Patients described how CPET increased their confidence to participate in exercise. They desired more information before and after CPET to better understand the purpose and results and their relation to their rehabilitation goals. Conclusions: Both physiotherapists and patients described the benefit of having CPET available to support them as they participated in exercise in a stroke rehabilitation setting. Physiotherapists would benefit from having educational tools to support their interpretation and application of test results, and patients would benefit from improved communication and education to support their understanding of the relevance of CPET to their rehabilitation goals. Future research should explore these findings in other stroke rehabilitation settings.
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Affiliation(s)
| | - Valerie Boyes
- Department of Physical Therapy, University of Toronto
| | - Calvin Lee
- Department of Physical Therapy, University of Toronto
| | | | - Justin Mah
- Department of Physical Therapy, University of Toronto
| | - Karen Yoshida
- Department of Physical Therapy, University of Toronto
| | - Susan Marzolini
- Department of Physical Therapy, University of Toronto.,Cardiovascular Prevention and Rehabilitation Program.,The KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ont
| | - Elizabeth L Inness
- Department of Physical Therapy, University of Toronto.,Brain & Spinal Cord Rehabilitation Program.,The KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ont
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Effects of Aquatic Exercise and Land-Based Exercise on Cardiorespiratory Fitness, Motor Function, Balance, and Functional Independence in Stroke Patients-A Meta-Analysis of Randomized Controlled Trials. Brain Sci 2021; 11:brainsci11081097. [PMID: 34439716 PMCID: PMC8394174 DOI: 10.3390/brainsci11081097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to evaluate the efficacy of aquatic exercise (AE) and land-based exercise (LE) on cardiorespiratory fitness, motor function, balance, and functional independence in stroke patients. Design: Through searching PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP and Wanfang Database, only randomized controlled trials (RCTs) were collected to study the effects of AE and LE on cardiorespiratory fitness, motor function, balance, and functional independence in patients with stroke. The included studies were evaluated for methodological quality by the Cochrane bias risk assessment tool, and statistical analysis was carried out by the Review Manage 5.3 and Stata 15.1 software. Results: The RCTs were collected between the earliest available date and April 2021. Eleven RCTs were included, including five studies with low risk and six studies with moderate risk. The total sample size used in the study was 369, which included 187 patients undertaking AE and 182 patients undertaking LE. The results of the meta-analysis showed that AE can significantly improve patients’ Berg Balance Scale (BBS) (MD = 5.19, 95% CI: 2.66 to 7.71, p < 0.0001), peak oxygen uptake (VO2peak) (MD = 3.49, 95% CI: 0.17 to 6.8, p = 0.04), Fugl–Meyer Assessment (FMA) (MD = 3.84, 95% CI: 1.64 to 6.04, p = 0.0006), and Functional Independence Measure (FIM) (MD = 6.1, 95% CI: 4.05 to 8.15, p < 0.00001). However, there was no statistically significant difference between the two exercise modes in the Timed Up and Go Test (TUGT) (MD = −2.52, 95% CI: −5.95 to 0.91, p = 0.15) or the Functional Ambulation Category scale (FAC) (MD = 0.28, 95% CI: −0.21 to 0.76, p = 0.26). Conclusion: Based on the improvement in the Berg Balance Scale, peak oxygen uptake, Fugl–Meyer Assessment, and Functional Independence Measure, we can state that aquatic exercise offers better advantages than land-based exercise for patients’ balance, motor function, cardiorespiratory fitness, and functional independence.
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10
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Mustafa E, Aytür YK. Assessment for cardiovascular fitness in patients with stroke: which cardiopulmonary exercise testing method is better? Top Stroke Rehabil 2021; 29:347-355. [PMID: 34027834 DOI: 10.1080/10749357.2021.1929010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Assessment for cardiovascular disease (CVD) is important in stroke patients, both being one of the main factors limiting success in stroke rehabilitation and its increased risk in stroke patients. Reduced exercise capacity after stroke decreases patients' functionality and further increases the risk of CVD. Carefully selected cardiopulmonary exercise testing (CPET) can be safely used to determine the risk of CVD and to prescribe exercise program in stroke rehabilitation.Objectives: The primary purpose of this study is to determine the most appropriate CPET in patients with stroke. The secondary aim is to determine the relationship between cardiorespiratory fitness and functional status of the patients.Methods: Two CPETs using treadmill and bicycle ergometer protocols determined with a preliminary study were performed on participants. The main outcome measure was VO2peak. Patients were also evaluated according to Brunnstrom motor staging, Modified Ashworth Scale, Berg Balance Scale, and Functional Independence Measure.Results: In total, 38 patients reached higher VO2peak values at treadmill test compared to bicycle test (p < 0.001). The mean VO2peak reached at treadmill CPET was 62% of the control group where mean VO2peak reached at bicycle was 76% of the control group. No significant correlation was found between Brunnstrom staging, spasticity, Berg Balance Scale, and VO2peak .Discussion: The results of this study indicate that CPET can be performed safely in stroke patients when appropriate protocol was selected and that treadmill was more appropriate to determine cardiorespiratory fitness in this study population.
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Affiliation(s)
- Esra Mustafa
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Yesim Kurtais Aytür
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
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11
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Inness EL, Aqui A, Foster E, Fraser J, Danells CJ, Biasin L, Brunton K, Howe JA, Poon V, Tang A, Mansfield A, Marzolini S, Oh P, Bayley M. Determining Safe Participation in Aerobic Exercise Early After Stroke Through a Graded Submaximal Exercise Test. Phys Ther 2020; 100:1434-1443. [PMID: 32494824 PMCID: PMC7462052 DOI: 10.1093/ptj/pzaa103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/01/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The benefits of aerobic exercise early after stroke are well known, but concerns about cardiovascular risk are a barrier to clinical implementation. Symptom-limited exercise testing with electrocardiography (ECG) is recommended but not always feasible. The purpose of this study was to determine the frequency of and corresponding exercise intensities at which ECG abnormalities occurred during submaximal exercise testing that would limit safe exercise prescription beyond those intensities. METHODS This study was a retrospective analysis of ECGs from 195 patients who completed submaximal exercise testing during stroke rehabilitation. A graded submaximal exercise test was conducted with a 5- or 12-lead ECG and was terminated on the basis of predetermined endpoint criteria (heart rate, perceived exertion, signs, or symptoms). ECGs were retrospectively reviewed for exercise-induced abnormalities and their associated heart rates. RESULTS The peak heart rate achieved was 65.4% (SD = 10.5%) of the predicted maximum heart rate or 29.1% (SD = 15.5%) of the heart rate reserve (adjusted for beta-blocker medications). The test was terminated more often because of perceived exertion (93/195) than because of heart rate limits (60/195). Four patients (2.1%) exhibited exercise-induced horizontal or downsloping ST segment depression of ≥1 mm. Except for 1 patient, the heart rate at test termination was comparable with the heart rate associated with the onset of the ECG abnormality. CONCLUSION A graded submaximal exercise test without ECG but with symptom monitoring and conservative heart rate and perceived exertion endpoints may facilitate safe exercise intensities early after stroke. Symptom-limited exercise testing with ECG is still recommended when progressing to higher intensity exercise. IMPACT Concerns about cardiovascular risk are a barrier to physical therapists implementing aerobic exercise in stroke rehabilitation. This study showed that, in the absence of access to exercise testing with ECG, submaximal testing with conservative heart rate and perceived exertion endpoints and symptom monitoring can support physical therapists in the safe prescription of aerobic exercise early after stroke. LAY SUMMARY It is recommended that people with stroke participate in aerobic exercise as early as possible during their rehabilitation. A submaximal exercise test with monitoring of heart rate, perceived exertion, blood pressure, and symptoms can support physical therapists in safely prescribing that exercise.
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Affiliation(s)
| | - Anthony Aqui
- Toronto Rehabilitation Institute, University Health Network–KITE Research Institute
| | - Evan Foster
- Toronto Rehabilitation Institute, University Health Network–KITE Research Institute
| | - Julia Fraser
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Cynthia J Danells
- Toronto Rehabilitation Institute, University Health Network–KITE Research Institute; and Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Louis Biasin
- Toronto Rehabilitation Institute, University Health Network–Brain and Spinal Cord Rehab Program; and Department of Physical Therapy, University of Toronto
| | - Karen Brunton
- Toronto Rehabilitation Institute, University Health Network–Education; and Department of Physical Therapy, University of Toronto
| | - Jo-Anne Howe
- Toronto Rehabilitation Institute, University Health Network–Education
| | - Vivien Poon
- Toronto Rehabilitation Institute, University Health Network–Brain and Spinal Cord Rehab Program; and Department of Physical Therapy, University of Toronto
| | - Ada Tang
- School of Rehabilitation Science, Institute of Applied Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network–KITE Research Institute; Department of Physical Therapy, University of Toronto; and Sunnybrook Research Institute–Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada
| | - Susan Marzolini
- Toronto Rehabilitation Institute, University Health Network–KITE Research Institute and Cardiovascular Prevention and Rehabilitation Program; and Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto
| | - Paul Oh
- Toronto Rehabilitation Institute, University Health Network–KITE Research Institute and Cardiovascular Prevention and Rehabilitation Program
| | - Mark Bayley
- Toronto Rehabilitation Institute, University Health Network–KITE Research Institute; and Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto
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12
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Barriers and Facilitators to Aerobic Exercise Implementation in Stroke Rehabilitation: A Scoping Review. J Neurol Phys Ther 2020; 44:179-187. [DOI: 10.1097/npt.0000000000000318] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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13
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Peng QF, Zhou J, Jiang H. Effect of Community Exercise for Patients with Stroke: A Systematic Review and
Meta-analysis. PHYSIKALISCHE MEDIZIN, REHABILITATIONSMEDIZIN, KURORTMEDIZIN 2020. [DOI: 10.1055/a-0979-4114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Background Community exercise might be beneficial to stroke recovery. However, the
results remained controversial. We conducted a systematic review and meta-analysis to explore
the effect of community exercise on stroke patients.
Methods PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were
systematically searched. Randomized controlled trials (RCTs) assessing the effect of community
exercise vs. usual care on stroke were included. Two investigators independently searched
articles, extracted data, and assessed the quality of included studies. The primary outcome
were 6-Minute walk test and walking speed. Metaanalysis was performed using random-effect
model.
Results Four RCTs involving 497 patients were included in the metaanalysis. Overall,
compared with control intervention, community exercise intervention was found to significantly
improve 6-Minute walk distance (Std. mean difference=0.48; 95% CI=0.22
to 0.74; P=0.0003), and walking speed (Std. mean difference=0.40; 95%
CI=0.10 to 0.70; P=0.009) in stroke patients, but resulted in no influence on
Berg Balance Scale (Std. mean difference=0.39; 95% CI=−0.29 to
1.07; P=0.26), muscle strength (Std. mean difference=0.05; 95%
CI=-0.34 to 0.43; P=0.82) and mental quality of life (Std. mean
difference=0.04; 95% CI=−0.25 to 0.34; P=0.77).
Conclusions Compared to control intervention, community exercise was found to
significantly increase 6-Minute walk test, walking speed and Berg Balance Scale, but showed no
influence on Berg Balance Scale, muscle strength and mental quality of life.
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Affiliation(s)
- Qi-feng Peng
- Department of Rehabilitation, Chongqing Hospital of Traditional Chinese
Medicine
| | - Jie Zhou
- Department of Rehabilitation, Chongqing Hospital of Traditional Chinese
Medicine
| | - Heng Jiang
- Department of Rehabilitation, Chongqing Hospital of Traditional Chinese
Medicine
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14
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Abstract
BACKGROUND AND PURPOSE Aerobic training (AT) is recommended for people after stroke, yet uptake and operationalization of AT in clinical practice in Canada have not been measured. We surveyed inclusion of structured AT and barriers to implementation in public inpatient/outpatient stroke rehabilitation programs across Canada. METHODS A Web-based questionnaire was sent to 89 stroke rehabilitation program leads. RESULTS Forty-six programs from 7 of 9 eligible Canadian provinces/territories completed the questionnaire. Seventy-eight percent of programs reported including AT, with most (75%) excluding participants with severe physical impairments, and 28% excluding those with coexisting cardiac conditions. A greater proportion of dedicated stroke rehabilitation programs prescribed AT, compared to nondedicated stroke units (68.8% vs 31.3%, P = 0.02). The top 2 challenges for programs that included and did not include AT were "insufficient time within therapy sessions" and "length of stay in rehabilitation." Programs that did not include AT ranked "not a goal of most patients" and "not an organizational/program priority" as third and fourth, whereas they were ranked eighth and thirteenth by programs with AT. Best practice recommendations were inconsistently followed for conducting preparticipation exercise testing (36.1%) and for monitoring patients from higher-risk populations, specifically people with diabetes at risk for hypoglycemia (78.8%) and hypertension (36.6%). Of programs conducting preparticipation exercise testing, 91% did not monitor electrocardiography. DISCUSSION AND CONCLUSIONS Most stroke rehabilitation programs across Canada include AT. People with severe physical impairment and those with cardiac, metabolic, and hemodynamic comorbidities may be excluded or not appropriately monitored during exercise. More detailed guidelines and training practices are needed to address these challenges.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A233).
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15
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da Silva Rodrigues JC, Luvizutto GJ, da Costa RDM, Prudente RA, da Silva TR, de Souza JT, da Silveira CFDSMP, Rossi DAA, Winckler FC, Modolo GP, Valadão TFC, de Oliveira Antunes LC, Martin LC, Bazan R, Bazan SGZ. Influence of an exercise program on cardiac remodeling and functional capacity in patients with stroke (CRONuS trial): study protocol for a randomized controlled trial. Trials 2019; 20:298. [PMID: 31138281 PMCID: PMC6540544 DOI: 10.1186/s13063-019-3328-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/25/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cardiovascular rehabilitation is one of the treatment options for post-stroke individuals in order to improve functional independence in activities of daily life and reduce energy expenditure. The aim of this trial is to evaluate the effect of an exercise program on the echocardiographic variables, functional capacity, inflammatory response, neurological status, nutritional status, cardiologic evaluation, and quality of life of patients after stroke. METHODS/DESIGN This is a randomized controlled trial including patients with ischemic stroke in the chronic phase. The patients will be evaluated at the beginning of the study and after 16 weeks. This will include clinical and physical evaluation, 6-min walk test, neurological assessment, nutritional assessment, ambulatory blood pressure monitoring, transthoracic echocardiography, and assessment of the quality of life. The sample size has been determined as 40 patients, who will be divided into two groups: control group (CG; n = 20) and intervention group (IG; n = 20). The CG will undergo conventional physiotherapy for 45 min, three times a week, up to 16 weeks, while the IG will be put on a cardiovascular rehabilitation program consisting of heating, aerobic exercise, and muscle strengthening for 45 min, three times a week, for 16 weeks. The primary endpoint will be functional capacity following a 6-min walk test (delta maxVO2) and morphofunctional echocardiographic variables (indexed left ventricular mass) before and after the intervention. DISCUSSION We expect to observe an improvement in cardiac structural and functional abnormalities in the IG, on echocardiography and biochemical examination, and that the improvement of these parameters after cardiovascular rehabilitation will have a favorable impact on the functional capacity and quality of life of patients after stroke. TRIAL REGISTRATION REBEC, RBR-4wk4b3. Registered on 19 September 2016.
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Affiliation(s)
| | - Gustavo José Luvizutto
- Department of Applied Physiotherapy, Triangulo Mineiro Federal University, Uberaba, Brazil
| | - Rafael Dalle Molle da Costa
- Department of Rehabilitation, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Robson Aparecido Prudente
- Department of Rehabilitation, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Taís Regina da Silva
- Department of Rehabilitation, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Juli Thomaz de Souza
- Department of Internal Medicine, Botucatu Medical School (UNESP), São Paulo State University, District of Rubião Junior, Botucatu, SP, 18618-687, Brazil
| | | | - Daniele Andreza Antonelli Rossi
- Department of Internal Medicine, Botucatu Medical School (UNESP), São Paulo State University, District of Rubião Junior, Botucatu, SP, 18618-687, Brazil
| | - Fernanda Cristina Winckler
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Gabriel Pinheiro Modolo
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Tainá Fabri Carneiro Valadão
- Department of Internal Medicine, Botucatu Medical School (UNESP), São Paulo State University, District of Rubião Junior, Botucatu, SP, 18618-687, Brazil
| | | | - Luis Cuadrado Martin
- Department of Internal Medicine, Botucatu Medical School (UNESP), São Paulo State University, District of Rubião Junior, Botucatu, SP, 18618-687, Brazil
| | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School (UNESP), São Paulo State University, São Paulo, Brazil
| | - Silméia Garcia Zanati Bazan
- Department of Internal Medicine, Botucatu Medical School (UNESP), São Paulo State University, District of Rubião Junior, Botucatu, SP, 18618-687, Brazil.
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16
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Compendium of Physical Activities Strongly Underestimates the Oxygen Cost During Activities of Daily Living in Stroke Patients. Am J Phys Med Rehabil 2019; 98:299-302. [DOI: 10.1097/phm.0000000000001077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Shea-Shumsky NB, Schoeneberger S, Grigsby J. Executive functioning as a predictor of stroke rehabilitation outcomes. Clin Neuropsychol 2019; 33:854-872. [DOI: 10.1080/13854046.2018.1546905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | | | - Jim Grigsby
- Departments of Psychology and Medicine, University of Colorado Denver, Denver, CO, USA
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18
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Woodward JL, Connolly M, Hennessy PW, Holleran CL, Mahtani GB, Brazg G, Fahey M, Maganti K, Hornby TG. Cardiopulmonary Responses During Clinical and Laboratory Gait Assessments in People With Chronic Stroke. Phys Ther 2019; 99:86-97. [PMID: 30476281 DOI: 10.1093/ptj/pzy128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 07/16/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND The 6-Minute Walk Test (6MWT) is a common clinical assessment used to evaluate locomotor function in patients after stroke. Previous work suggests the 6MWT can estimate peak metabolic capacity (VO2peak) without cardiorespiratory assessments during graded exercise tests (GXTs), which may assist with exercise prescription. However, selected research also indicated increased heart rates (HRs) during 6MWTs beyond levels considered safe without GXTs. OBJECTIVE The goal of this study was to examine cardiorespiratory responses during 6MWTs and GXTs in individuals with chronic stroke and their associations with demographic or clinical characteristics. DESIGN The study used a cross-sectional observational design. METHODS Cardiorespiratory responses were assessed during 6MWTs at self-selected velocity (SSV) and fastest velocity (FV), and during GXTs. Secondary assessments included the lower extremity Fugl-Meyer Assessment, Functional Gait Assessment, gait speeds, and daily stepping activity. Correlation and regression analyses were used to evaluate associations between locomotor performance, cardiorespiratory responses, and clinical and demographic characteristics. RESULTS Average HRs during 6MWT-FV were 72% to 76% of the age-predicted maximum (HRmax), with 20% of participants exceeding 85% predicted HRmax. When normalized to HRs during GXTs, HRs during 6MWT-FV were 86% to 88% of observed HRmax. Primary predictors of increased HRs during 6MWTs were resting HR, body mass index, and daily stepping. Distance during 6MWT-FV was a significant predictor of VO2peak in combination with other variables. Electrocardiographic abnormalities were observed in >80% of participants at rest and 31% demonstrated distinct abnormalities during GXTs, which were not related to 6MWT or GXT performance. LIMITATIONS In addition to sample size, a primary limitation involved the ability to accurately predict or measure HRmax in patients with motor dysfunction after stroke. CONCLUSIONS Cardiac responses were higher than anticipated during 6MWTs and often exceeded recommended HR thresholds. Clinicians should closely monitor cardiorespiratory responses during 6MWTs.
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Affiliation(s)
- Jane L Woodward
- Shirley Ryan AbilityLab, Chicago, Illinois. She is a board-certified neurologic clinical specialist
| | | | - Patrick W Hennessy
- Infiniti Rehab Inc, Portland, Oregon. He is a board-certified neurologic clinical specialist
| | - Carey L Holleran
- Division of Physical Therapy, Washington University of St. Louis, St. Louis, Missouri. He is a board-certified neurologic clinical specialist
| | | | - Gabrielle Brazg
- Shirley Ryan AbilityLab. She is a board-certified neurologic clinical specialist
| | - Meghan Fahey
- Shirley Ryan AbilityLab. She is a board-certified neurologic clinical specialist
| | - Kameswari Maganti
- Department of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN 46524 (USA)
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19
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Grilletti JVF, Scapini KB, Bernardes N, Spadari J, Bigongiari A, de Andrade e Souza Mazuchi F, Caperuto EC, Sanches IC, Rodrigues B, De Angelis K. Impaired baroreflex sensitivity and increased systolic blood pressure variability in chronic post-ischemic stroke. Clinics (Sao Paulo) 2018; 73:e253. [PMID: 30304297 PMCID: PMC6152139 DOI: 10.6061/clinics/2018/e253] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 03/21/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Acute post-stroke patients present cardiovascular autonomic dysfunction, which manifests as lower heart rate variability and impaired baroreflex sensitivity. However, few studies performed to date have evaluated cardiovascular autonomic function in chronic post-stroke patients. The aim of this study was to evaluate cardiovascular autonomic modulation in chronic post-ischemic stroke patients. METHODS The seventeen enrolled subjects were divided into a stroke group (SG, n=10, 5±1 years after stroke) and a control group (CG, n=7). Non-invasive curves for blood pressure were continuously recorded (Finometer®) for 15 minutes while the subject was in a supine position. Heart rate variability and blood pressure variability were analyzed in the time and frequency domains. RESULTS No differences were observed in systolic and diastolic pressure and heart rate between post-stroke patients and healthy individuals. The SG group had lower indexes for heart rate variability in the time domain (standard deviation of normal to normal R-R intervals, SDNN; variance of normal to normal R-R intervals, VarNN; and root mean square differences of successive R-R intervals, RMSSD) and a lower high-frequency band for heart rate variability than was observed in the CG. Systolic blood pressure variability and the low-frequency band for systolic pressure were higher in post-stroke patients, while the alpha index was lower in the SG than in the CG. CONCLUSION After ischemic stroke, affected patients present chronically reduced heart rate variability, impaired cardiac vagal modulation, increased systolic blood pressure variability and higher sympathetic vascular modulation along with impaired baroreflex sensitivity, which can increase the risk of cardiovascular events, despite adequate blood pressure control.
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Affiliation(s)
| | - Katia Bilhar Scapini
- Laboratorio do Movimento Humano, Universidade Sao Judas Tadeu (USJT), Sao Paulo, SP, BR
| | - Nathalia Bernardes
- Laboratorio de Fisiologia Translacional, Universidade Nove de Julho (UNINOVE), Sao Paulo, SP, BR
| | | | | | | | - Erico Chagas Caperuto
- Laboratorio do Movimento Humano, Universidade Sao Judas Tadeu (USJT), Sao Paulo, SP, BR
| | - Iris Callado Sanches
- Laboratorio do Movimento Humano, Universidade Sao Judas Tadeu (USJT), Sao Paulo, SP, BR
| | - Bruno Rodrigues
- Departamento de Educacao Fisica Adaptada, Faculdade de Educacao Fisica, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Kátia De Angelis
- Departamento de Fisiologia, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
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20
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Lim H, Azurdia D, Jeng B, Jung T. Influence of water depth on energy expenditure during aquatic walking in people post stroke. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23:e1717. [DOI: 10.1002/pri.1717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/05/2017] [Accepted: 02/16/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Hyosok Lim
- Department of Kinesiology; California State University, Northridge; Northridge CA USA
| | - Daniel Azurdia
- Department of Kinesiology; California State University, Northridge; Northridge CA USA
| | - Brenda Jeng
- Department of Kinesiology; California State University, Northridge; Northridge CA USA
| | - Taeyou Jung
- Department of Kinesiology; California State University, Northridge; Northridge CA USA
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Brauer SG, Kuys SS, Paratz JD, Ada L. Improving physical activity after stroke via treadmill training and self management (IMPACT): a protocol for a randomised controlled trial. BMC Neurol 2018; 18:13. [PMID: 29382298 PMCID: PMC5791375 DOI: 10.1186/s12883-018-1015-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/03/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The level of physical activity undertaken by stroke survivors living in the community is generally low. The main objectives of the IMPACT trial are to determine, in individuals undergoing rehabilitation after stroke, if 8 weeks of high-intensity treadmill training embedded in self-management education (i) results in more physical activity than usual physiotherapy gait training and (ii) is more effective at increasing walking ability, cardiorespiratory fitness, self-efficacy, perception of physical activity, participation, and health-related quality of life as well as decreasing cardiovascular risk, and depression, at 8 and 26 weeks. METHODS A prospective, two-arm, parallel-group, randomised trial with concealed allocation, blinded measurement and intention-to-treat analysis, will be conducted. 128 stroke survivors undergoing rehabilitation who are able to walk independently will be recruited and randomly allocated to either the experimental or control group, who will both undergo gait training for 30 min, three times a week for 8 weeks under the supervision of a physiotherapist. Outcomes will be measured at baseline (Week 0), on completion of the intervention (Week 8) and beyond the intervention (Week 26). This study has obtained ethical approval from the relevant Human Research Ethics Committees. DISCUSSION Improving stroke survivors' walking ability and cardiorespiratory fitness is likely to increase their levels of physical activity. Furthermore, if education in self-management results in sustained high levels of physical activity, this should result in improved participation and quality of life. TRIAL REGISTRATION This trial was registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12613000744752 ) on 4th July, 2013.
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Affiliation(s)
- Sandra G. Brauer
- Discipline of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD Australia
| | - Suzanne S. Kuys
- School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Banyo, QLD Australia
| | - Jennifer D. Paratz
- School of Allied Health Sciences, Griffith University, Southport, QLD Australia
| | - Louise Ada
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW Australia
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22
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Richardson J, Tang A, Guyatt G, Thabane L, Xie F, Sahlas D, Hart R, Fleck R, Hladysh G, Macrae L. FIT for FUNCTION: study protocol for a randomized controlled trial. Trials 2018; 19:39. [PMID: 29335013 PMCID: PMC5769391 DOI: 10.1186/s13063-017-2416-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/15/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The current state of evidence suggests that community-based exercise programs are beneficial in improving impairment, function, and health status, and are greatly needed for persons with stroke. However, limitations of these studies include risk of bias, feasibility, and cost issues. METHODS/DESIGN This single-blinded, randomized controlled trial (RCT) of 216 participants with stroke will compare the effectiveness of a 12-week YMCA community-based wellness program (FIT for FUNCTION) specifically designed for community-dwelling persons with stroke to persons who receive a standard YMCA membership. The primary outcome will be community reintegration using the Reintegration to Normal Living Index at 12 and 24 weeks. Secondary outcomes include measurement of physical activity level using the Rapid Assessment of Physical Activity and accelerometry; balance using the Berg Balance Scale; lower extremity function using the Short Physical Performance Battery; exercise capacity using the 6-min walk test; grip strength and isometric knee extension strength using hand held dynamometry; and health-related quality of life using the European Quality of Life 5-Dimension Questionnaire. We are also assessing cardiovascular health and lipids; glucose and inflammatory markers will be collected following 12-h fast for total cholesterol, insulin, glucose, and glycated hemoglobin. Self-efficacy for physical activity will be assessed with a single question and self-efficacy for managing chronic disease will be assessed using the Stanford 6-item Scale. The Patient Activation Measure will be used to assess the patient's level of knowledge, skill, and confidence for self-management. Healthcare utilization and costs will be evaluated. Group, time, and group × time interaction effects will be estimated using generalized linear models for continuous variables, including relevant baseline variables as covariates in the analysis that differ appreciably between groups at baseline. Cost data will be treated as non-parametric and analyzed using a Mann-Whitney U test. DISCUSSION This is a RCT with broad study eligibility criteria intended to recruit a wide spectrum of individuals living in the community with stroke. If positive benefits are demonstrated, results will provide strong research evidence to support the implementation of structured, community-based exercise and education/self-management programs for a broad range of people living in the community with stroke. TRIAL REGISTRATION ClinicalTrials.gov, NCT02703805 . Registered on 14 October 2014.
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Affiliation(s)
- Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact and Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact and Department of Medicine, McMaster University, Hamilton, ON Canada
- Centre for Evaluation of Medicine, St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact and Department of Medicine, McMaster University, Hamilton, ON Canada
- Programs for Assessment of Technology in Health Research Institute, St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Demetrios Sahlas
- Department of Medicine, McMaster University, Hamilton, ON Canada
- Central South Regional Stroke Centre, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, ON Canada
| | - Robert Hart
- Department of Medicine, McMaster University, Hamilton, ON Canada
- Population Health Research Institute, Hamilton, ON Canada
| | - Rebecca Fleck
- Central South Regional Stroke Centre, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, ON Canada
| | | | - Louise Macrae
- Central South Regional Stroke Centre, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, ON Canada
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23
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Compagnat M, Salle JY, Mandigout S, Lacroix J, Vuillerme N, Daviet JC. Rating of perceived exertion with Borg scale in stroke over two common activities of the daily living. Top Stroke Rehabil 2017; 25:145-149. [PMID: 29105582 DOI: 10.1080/10749357.2017.1399229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background The Borg Scale for the rating of perceived exertion (RPE) is recommended to measure the intensity of physical exercise during stroke rehabilitation, but its reliability in activities of daily living is not explored. Objective To evaluate the correlation between the RPE using the Borg Scale (6-20) and the intensity of effort as measured by the Total Energy Expenditure per minute (TEE.min-1) in a post-stroke population for two tasks: walking at spontaneous comfortable speed and walking up and down stairs. Methods A cross-sectional study has been conducted. Any post-stroke subjects able to walk without being helped were recruited. Subjects were asked to walk at their spontaneous comfortable walking speed for 6 min and then to walk up and down stairs with a portable gas analyzer to measure the TEE.min-1. The RPE was evaluated by the Borg scale (6-20). The correlation between the RPE and the TEE.min-1 for each subject's walking task and stairs task was calculated with the Pearson coefficient. Results Twenty subjects were included. TEE.min-1 averaged at 5.6 (±1.2 kcal.min-1) for the walking task and 9.58 (±4.3 kcal.min-1) for the stairs task. The median RPE was 11 (min 6; max 15) for the walking task and 11 (min 6; max 16) for the stairs task. The correlation coefficient between the RPE and TEE.min-1 was r = 0.12 (p = 0.25). Conclusion Our work has not determined a correlation between the RPE and TEE.min-1 for two common activities of daily living in post-stroke subjects.
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Affiliation(s)
- Maxence Compagnat
- a HAVAE EA6310 (Handicap, Aging, Autonomy, Environment) , University of Limoges , Limoges , France.,b Department of Physical Medicine and Rehabiliation , University Hospital Center of Limoges , Limoges , France
| | - Jean Yves Salle
- a HAVAE EA6310 (Handicap, Aging, Autonomy, Environment) , University of Limoges , Limoges , France.,b Department of Physical Medicine and Rehabiliation , University Hospital Center of Limoges , Limoges , France
| | - Stephane Mandigout
- a HAVAE EA6310 (Handicap, Aging, Autonomy, Environment) , University of Limoges , Limoges , France
| | - Justine Lacroix
- c EA 4324 ORPHY, Biology Department , European University of Brittany, University of Brest , Brest , France
| | - Nicolas Vuillerme
- d University Grenoble Alpes, AGEIS, Grenoble, France & Institut Universitaire de France , Paris , France
| | - Jean Christophe Daviet
- a HAVAE EA6310 (Handicap, Aging, Autonomy, Environment) , University of Limoges , Limoges , France.,b Department of Physical Medicine and Rehabiliation , University Hospital Center of Limoges , Limoges , France
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24
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Bailey RR. Promoting Physical Activity and Nutrition in People With Stroke. Am J Occup Ther 2017; 71:7105360010p1-7105360010p5. [PMID: 28809663 PMCID: PMC5557223 DOI: 10.5014/ajot.2017.021378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The prevalence of cardiovascular disease, diabetes, and obesity is high in people with stroke. Risk factors for these conditions include hypertension, high cholesterol, and physical inactivity. These risk factors are common in people with stroke and often go unmanaged. Engagement in healthy behaviors is important for managing and preventing these risk factors and comorbid conditions. More specifically, physical activity and nutrition are key health behaviors for the management and maintenance of health in people with stroke. These health behaviors, by their very nature, are also occupations; thus, they are influenced by client factors, performance skills and patterns, and environments and contexts. This article discusses physical activity and nutrition within the context of the Occupational Therapy Practice Framework: Domain and Process and proposes potential roles for occupational therapy practitioners and researchers in developing, testing, and providing physical activity and nutrition interventions for people with stroke.
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Affiliation(s)
- Ryan R Bailey
- Ryan R. Bailey, PhD, OTR/L, is Postdoctoral Fellow, Washington University School of Medicine in St. Louis, St. Louis, MO;
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Morone G, Paolucci S, Cherubini A, De Angelis D, Venturiero V, Coiro P, Iosa M. Robot-assisted gait training for stroke patients: current state of the art and perspectives of robotics. Neuropsychiatr Dis Treat 2017; 13:1303-1311. [PMID: 28553117 PMCID: PMC5440028 DOI: 10.2147/ndt.s114102] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
In this review, we give a brief outline of robot-mediated gait training for stroke patients, as an important emerging field in rehabilitation. Technological innovations are allowing rehabilitation to move toward more integrated processes, with improved efficiency and less long-term impairments. In particular, robot-mediated neurorehabilitation is a rapidly advancing field, which uses robotic systems to define new methods for treating neurological injuries, especially stroke. The use of robots in gait training can enhance rehabilitation, but it needs to be used according to well-defined neuroscientific principles. The field of robot-mediated neurorehabilitation brings challenges to both bioengineering and clinical practice. This article reviews the state of the art (including commercially available systems) and perspectives of robotics in poststroke rehabilitation for walking recovery. A critical revision, including the problems at stake regarding robotic clinical use, is also presented.
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Affiliation(s)
- Giovanni Morone
- Private Inpatient Unit
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Stefano Paolucci
- Private Inpatient Unit
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | | | | | | | - Marco Iosa
- Private Inpatient Unit
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
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Peak Cardiorespiratory Responses of Patients with Subacute Stroke During Land and Aquatic Treadmill Exercise. Am J Phys Med Rehabil 2017; 96:289-293. [DOI: 10.1097/phm.0000000000000603] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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High-Intensity Interval Training Versus Moderate-Intensity Continuous Training in the Prevention/Management of Cardiovascular Disease. Cardiol Rev 2016; 24:273-281. [DOI: 10.1097/crd.0000000000000124] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Prout EC, Mansfield A, McIlroy WE, Brooks D. Physiotherapists' perspectives on aerobic exercise early after stroke: A preliminary study. Physiother Theory Pract 2016; 32:452-460. [PMID: 27459027 DOI: 10.1080/09593985.2016.1204402] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aerobic exercise is recognized as part of comprehensive stroke rehabilitation in best-practice and clinical guidelines, yet many individuals remain physically inactive during their hospitalization. The purpose of this study was to identify the perspectives of physiotherapists on aerobic exercise prescription and implementation at in-patient stroke rehabilitation centers with and without a structured aerobic exercise program. A survey was conducted at three Canadian rehabilitation centers to evaluate physiotherapist perceptions of individuals recovering from stroke, the practice environment, and their training on aerobic exercise in stroke. Physiotherapists at centers without a structured aerobic exercise program (n = 10) reported the lack of necessary resources and therapeutic support staff and the individuals' physical impairment as the greatest barriers. In contrast, physiotherapists at the center with a structured aerobic exercise program (n = 6) reported therapy selection (insufficient time in a single physiotherapy session) and concern for the individuals' cardiovascular risk and cognitive impairment as the greatest barriers. Both groups of physiotherapists indicated that fatigue was a barrier. Only physiotherapists at the center with a structured aerobic exercise program had received continuing education on aerobic exercise in stroke. The lack of resources at rehabilitation centers without a structured aerobic exercise program needs to be addressed. There remains a need for continuing education on aerobic training in stroke, specifically on assessment and prescription using a standardized approach.
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Affiliation(s)
- Erik C Prout
- a Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,b Toronto Rehabilitation Institute (University Health Network) , Toronto , ON , Canada
| | - Avril Mansfield
- a Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,b Toronto Rehabilitation Institute (University Health Network) , Toronto , ON , Canada.,c Department of Physical Therapy , University of Toronto , Toronto , ON , Canada.,d Heart and Stroke Foundation Canadian Partnership for Stroke Recovery , ON , Canada.,e Sunnybrook Health Sciences Center , Toronto , ON , Canada
| | - William E McIlroy
- a Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,b Toronto Rehabilitation Institute (University Health Network) , Toronto , ON , Canada.,c Department of Physical Therapy , University of Toronto , Toronto , ON , Canada.,d Heart and Stroke Foundation Canadian Partnership for Stroke Recovery , ON , Canada.,e Sunnybrook Health Sciences Center , Toronto , ON , Canada.,f Department of Kinesiology , University of Waterloo , Waterloo , ON , Canada
| | - Dina Brooks
- a Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,b Toronto Rehabilitation Institute (University Health Network) , Toronto , ON , Canada.,c Department of Physical Therapy , University of Toronto , Toronto , ON , Canada.,d Heart and Stroke Foundation Canadian Partnership for Stroke Recovery , ON , Canada.,e Sunnybrook Health Sciences Center , Toronto , ON , Canada
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Prout EC, Mansfield A, McIlroy WE, Brooks D. Patients’ perspectives on aerobic exercise early after stroke. Disabil Rehabil 2016; 39:684-690. [DOI: 10.3109/09638288.2016.1161833] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Erik C. Prout
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute (University Health Network), Toronto, Canada
| | - Avril Mansfield
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute (University Health Network), Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - William E. McIlroy
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute (University Health Network), Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Dina Brooks
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute (University Health Network), Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Canada
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Partial body weight support treadmill training speed influences paretic and non-paretic leg muscle activation, stride characteristics, and ratings of perceived exertion during acute stroke rehabilitation. Hum Mov Sci 2016; 47:16-28. [PMID: 26845732 DOI: 10.1016/j.humov.2016.01.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/12/2016] [Accepted: 01/20/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intensive task-specific training is promoted as one approach for facilitating neural plastic brain changes and associated motor behavior gains following neurologic injury. Partial body weight support treadmill training (PBWSTT), is one task-specific approach frequently used to improve walking during the acute period of stroke recovery (<1month post infarct). However, only limited data have been published regarding the relationship between training parameters and physiologic demands during this early recovery phase. OBJECTIVE To examine the impact of four walking speeds on stride characteristics, lower extremity muscle demands (both paretic and non-paretic), Borg ratings of perceived exertion (RPE), and blood pressure. DESIGN A prospective, repeated measures design was used. METHODS Ten inpatients post unilateral stroke participated. Following three familiarization sessions, participants engaged in PBWSTT at four predetermined speeds (0.5, 1.0, 1.5 and 2.0mph) while bilateral electromyographic and stride characteristic data were recorded. RPE was evaluated immediately following each trial. RESULTS Stride length, cadence, and paretic single limb support increased with faster walking speeds (p⩽0.001), while non-paretic single limb support remained nearly constant. Faster walking resulted in greater peak and mean muscle activation in the paretic medial hamstrings, vastus lateralis and medial gastrocnemius, and non-paretic medial gastrocnemius (p⩽0.001). RPE also was greatest at the fastest compared to two slowest speeds (p<0.05). CONCLUSIONS During the acute phase of stroke recovery, PBWSTT at the fastest speed (2.0mph) promoted practice of a more optimal gait pattern with greater intensity of effort as evidenced by the longer stride length, increased between-limb symmetry, greater muscle activation, and higher RPE compared to training at the slowest speeds.
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Moore SA, Jakovljevic DG, Ford GA, Rochester L, Trenell MI. Exercise Induces Peripheral Muscle But Not Cardiac Adaptations After Stroke: A Randomized Controlled Pilot Trial. Arch Phys Med Rehabil 2016; 97:596-603. [PMID: 26763949 PMCID: PMC5813708 DOI: 10.1016/j.apmr.2015.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 12/22/2022]
Abstract
Objective To explore the physiological factors affecting exercise-induced changes in peak oxygen consumption and function poststroke. Design Single-center, single-blind, randomized controlled pilot trial. Setting Community stroke services. Participants Adults (N=40; age>50y; independent with/without stick) with stroke (diagnosed >6mo previously) were recruited from 117 eligible participants. Twenty participants were randomized to the intervention group and 20 to the control group. No dropouts or adverse events were reported. Interventions Intervention group: 19-week (3times/wk) progressive mixed (aerobic/strength/balance/flexibility) community group exercise program. Control group: Matched duration home stretching program. Main Outcome Measures (1) Pre- and postintervention: maximal cardiopulmonary exercise testing with noninvasive (bioreactance) cardiac output measurements; and (2) functional outcome measures: 6-minute walk test; timed Up and Go test, and Berg Balance Scale. Results Exercise improved peak oxygen consumption (18±5 to 21±5mL/(kg⋅min); P<.01) and peak arterial-venous oxygen difference (9.2±2.7 to 11.4±2.9mL of O2/100mL of blood; P<.01), but did not alter cardiac output (17.2±4 to 17.7±4.2L/min; P=.44) or cardiac power output (4.8±1.3 to 5.0±1.35W; P=.45). A significant relation existed between change in peak oxygen consumption and change in peak arterial-venous oxygen difference (r=.507; P<.05), but not with cardiac output. Change in peak oxygen consumption did not strongly correlate with change in function. Conclusions Exercise induced peripheral muscle, but not cardiac output, adaptations after stroke. Implications for stroke clinical care should be explored further in a broader cohort.
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Affiliation(s)
- Sarah A Moore
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Djordje G Jakovljevic
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Research Councils UK, Newcastle Centre for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Gary A Ford
- University of Oxford, Oxford, United Kingdom
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael I Trenell
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Research Councils UK, Newcastle Centre for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
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Marzolini S, Balitsky A, Jagroop D, Corbett D, Brooks D, Grace SL, Lawrence D, Oh PI. Factors Affecting Attendance at an Adapted Cardiac Rehabilitation Exercise Program for Individuals with Mobility Deficits Poststroke. J Stroke Cerebrovasc Dis 2016; 25:87-94. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.08.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/18/2015] [Accepted: 08/26/2015] [Indexed: 11/28/2022] Open
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Francica JV, Bigongiari A, Mochizuki L, Scapini KB, Moraes OA, Mostarda C, Caperuto EC, Irigoyen MC, De Angelis K, Rodrigues B. Cardiac autonomic dysfunction in chronic stroke women is attenuated after submaximal exercise test, as evaluated by linear and nonlinear analysis. BMC Cardiovasc Disord 2015; 15:105. [PMID: 26420632 PMCID: PMC4587902 DOI: 10.1186/s12872-015-0099-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/18/2015] [Indexed: 12/19/2022] Open
Abstract
Background We evaluated cardiac autonomic modulation in women with chronic ischemic stroke (at least 4 years post-stroke) at rest and in response to submaximal exercise test. Methods Fourteen post-stroke women (S group) and 10 healthy women (C group) participated in this study. Autonomic modulation (using linear and nonlinear analysis), blood pressure and metabolic variables at rest were evaluated immediately after the exercise test and during the recovery period (20 min). All participants underwent submaximal exercise test on cycle ergometer with gas analysis. Results At rest, the S group displayed higher lactate concentration, systolic (SBP) and diastolic blood pressure (DBP) values when compared to C group. Furthermore, the S group had lower heart rate variability (HRV) in time domain (SDNN: S = 30 ± 5 vs. 40 ± 8 ms; rMSSD: S = 14 ± 2 vs. C = 34 ± 3 ms), decreased high frequency band of pulse interval (S = 8.4 ± 2 vs. 33.1 ± 9 %) and 2V pattern of symbolic analysis (S = 17.3 ± 1 vs. 30 ± 3 %) (both indicators of cardiac vagal modulation) when compared to C group. Immediately after exercise, S group presented higher values of lactate, SBP, DBP and double product when compared to C group, as well as decreased heart rate recovery (HRR) measured at the first, second and third minutes. At recovery time, all HRV parameters in time and frequency domains improved in the S group; however, HF band remained lower when compared to C group. Conclusions After the exercise test, women with chronic stroke presented reduced heart rate variability, reduced cardiac vagal modulation, as well as reduced HRR, while displayed an improvement of heart rate variability and cardiac vagal modulation when compared to their baseline. These results reinforce the importance of a physically active lifestyle for cardiovascular autonomic disorders observed in chronic stroke women.
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Affiliation(s)
| | - Aline Bigongiari
- Human Movement Laboratory, São Judas Tadeu University (USJT), São Paulo/SP, Brazil.
| | - Luís Mochizuki
- School of Arts, Sciences and Humanities, University of São Paulo, São Paulo/SP, Brazil.
| | - Kátia Bilhar Scapini
- Hypertension Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, São Paulo/SP, Brazil.
| | - Oscar Albuquerque Moraes
- Hypertension Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, São Paulo/SP, Brazil.
| | | | | | - Maria Cláudia Irigoyen
- Hypertension Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, São Paulo/SP, Brazil.
| | - Katia De Angelis
- Translational Physiology Laboratory, Universidade Nove de Julho (UNINOVE), São Paulo/SP, Brazil.
| | - Bruno Rodrigues
- Human Movement Laboratory, São Judas Tadeu University (USJT), São Paulo/SP, Brazil. .,Faculty of Physical Education, University of Campinas (UNICAMP), Av. Érico Veríssimo, 701. Cidade Universitária "Zeferino Vaz". Barão Geraldo, Campinas, SP. CEP, 13.083-851, Brazil.
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Ivey FM, Stookey AD, Hafer-Macko CE, Ryan AS, Macko RF. Higher Treadmill Training Intensity to Address Functional Aerobic Impairment after Stroke. J Stroke Cerebrovasc Dis 2015; 24:2539-46. [PMID: 26303787 DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 06/27/2015] [Accepted: 07/07/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Peak aerobic capacity (VO2 peak) is severely worsened after disabling stroke, having serious implications for function, metabolism, and ongoing cardiovascular risk. Work from our laboratory and others has previously shown that modest improvements in VO2 peak are possible in stroke participants with aerobic exercise training. The purpose of the current investigation was to test the extent to which greater enhancements in VO2 peak after stroke are possible using a treadmill protocol with far greater emphasis on intensity progression compared with a protocol without such emphasis. METHODS Using a randomized design, we compared stroke survivors engaged in higher intensity treadmill training (HI-TM, 80% heart rate reserve [HRR]) with those undergoing lower intensity treadmill training (LO-TM, 50% HRR). Measured outcomes were change in VO2 peak, 6-minute walk distance (6MWD), 30-ft walk times (30WT), and 48-hour step counts (48SC). LO-TM participants trained for a longer period of time per session in an effort to approximately match workload/caloric expenditure. Participants were randomized with stratification according to age and baseline walking capacity. RESULTS HI-TM participants (n = 18) had significantly greater gains in VO2 peak (+34%) than LO-TM participants (n = 16; +5%) across the 6-month intervention period (P = .001, group × time interaction). Conversely, there was no statistical difference between groups in the changes observed for 6MWD, 30WT, or 48SC. CONCLUSIONS HI-TM is far more effective than LO-TM for improving VO2 peak after disabling stroke. The magnitude of relative improvement for HI-TM was double compared with previous reports from our laboratory with probable clinical significance for this population.
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Affiliation(s)
- Frederick M Ivey
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Alyssa D Stookey
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland
| | - Charlene E Hafer-Macko
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alice S Ryan
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Richard F Macko
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
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Contreras-Vidal JL, Grossman RG. NeuroRex: a clinical neural interface roadmap for EEG-based brain machine interfaces to a lower body robotic exoskeleton. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:1579-82. [PMID: 24110003 DOI: 10.1109/embc.2013.6609816] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In this communication, a translational clinical brain-machine interface (BMI) roadmap for an EEG-based BMI to a robotic exoskeleton (NeuroRex) is presented. This multi-faceted project addresses important engineering and clinical challenges: It addresses the validation of an intelligent, self-balancing, robotic lower-body and trunk exoskeleton (Rex) augmented with EEG-based BMI capabilities to interpret user intent to assist a mobility-impaired person to walk independently. The goal is to improve the quality of life and health status of wheelchair-bounded persons by enabling standing and sitting, walking and backing, turning, ascending and descending stairs/curbs, and navigating sloping surfaces in a variety of conditions without the need for additional support or crutches.
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Gäverth J, Parker R, MacKay-Lyons M. Exercise Stress Testing After Stroke or Transient Ischemic Attack: A Scoping Review. Arch Phys Med Rehabil 2015; 96:1349-1359.e12. [DOI: 10.1016/j.apmr.2015.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 02/02/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
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Lucas SJE, Cotter JD, Brassard P, Bailey DM. High-intensity interval exercise and cerebrovascular health: curiosity, cause, and consequence. J Cereb Blood Flow Metab 2015; 35:902-11. [PMID: 25833341 PMCID: PMC4640257 DOI: 10.1038/jcbfm.2015.49] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 01/25/2015] [Accepted: 03/01/2015] [Indexed: 12/14/2022]
Abstract
Exercise is a uniquely effective and pluripotent medicine against several noncommunicable diseases of westernised lifestyles, including protection against neurodegenerative disorders. High-intensity interval exercise training (HIT) is emerging as an effective alternative to current health-related exercise guidelines. Compared with traditional moderate-intensity continuous exercise training, HIT confers equivalent if not indeed superior metabolic, cardiac, and systemic vascular adaptation. Consequently, HIT is being promoted as a more time-efficient and practical approach to optimize health thereby reducing the burden of disease associated with physical inactivity. However, no studies to date have examined the impact of HIT on the cerebrovasculature and corresponding implications for cognitive function. This review critiques the implications of HIT for cerebrovascular function, with a focus on the mechanisms and translational impact for patient health and well-being. It also introduces similarly novel interventions currently under investigation as alternative means of accelerating exercise-induced cerebrovascular adaptation. We highlight a need for studies of the mechanisms and thereby also the optimal dose-response strategies to guide exercise prescription, and for studies to explore alternative approaches to optimize exercise outcomes in brain-related health and disease prevention. From a clinical perspective, interventions that selectively target the aging brain have the potential to prevent stroke and associated neurovascular diseases.
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Affiliation(s)
- Samuel J E Lucas
- 1] School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK [2] Department of Physiology, University of Otago, Dunedin, New Zealand
| | - James D Cotter
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Patrice Brassard
- 1] Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada [2] Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Damian M Bailey
- 1] Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, South Wales, UK [2] Université de Provence Marseille, Sondes Moléculaires en Biologie, Laboratoire Chimie Provence UMR 6264 CNRS, Marseille, France
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Patient Characteristics That Influence Enrollment and Attendance in Aerobic Exercise Early After Stroke. Arch Phys Med Rehabil 2015; 96:823-30. [DOI: 10.1016/j.apmr.2014.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 11/25/2014] [Accepted: 12/01/2014] [Indexed: 11/21/2022]
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Abstract
Stroke patients have profound cardiovascular and muscular deconditioning, with metabolic fitness levels that are about half those found in age-matched sedentary controls. Physical deconditioning, along with elevated energy demands of hemiparetic gait, define a detrimental combination termed diminished physiological fitness reserve that can greatly limit that can greatly limit performance of activities of daily living. The physiological features that underlie worsening metabolic fitness in the chronic phase of stroke include gross muscular atrophy, altered muscle molecular phenotype, increased intramuscular area fat, elevated tissue inflammatory markers, and diminished peripheral blood flow dynamics. Epidemiological evidence further suggests that the reduced cardiovascular fitness and secondary biological changes in muscle may propagate components of the metabolic syndrome, conferring added morbidity and mortality risk. This article reviews some of the consequences of poor fitness in chronic stroke and the potential biological underpinnings that support a rationale for more aggressive approaches to exercise therapy in this population.
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Affiliation(s)
- F M Ivey
- Department of Medicine, Division of Gerontology, University of Maryland School of Medicine and Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA
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Macko RF, Ivey FM, Forrester LW. Task-Oriented Aerobic Exercise in Chronic Hemiparetic Stroke: Training Protocols and Treatment Effects. Top Stroke Rehabil 2015; 12:45-57. [PMID: 15736000 DOI: 10.1310/pjqn-kan9-ttvy-hyqh] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Stroke is the leading cause of disability in older Americans. Each year 750,000 Americans suffer a stroke, two thirds of whom are left with neurological deficits that persistently impair function. Principal among them is hemiparetic gait that limits mobility and increases fall risk, promoting a sedentary lifestyle. These events propagate disability by physical deconditioning and "learned non-use," with further functional declines accelerated by the sarcopenia and fitness decrements of advancing age. Conventional rehabilitation care typically provides little or no structured therapeutic exercise beyond the subacute stroke recovery period, based on natural history studies showing little or no further functional motor recovery beyond 6 months after stroke. Emerging evidence suggests that new models of task-oriented exercise have the potential to improve motor function even years after stroke. This article presents treadmill as a task-oriented training paradigm to optimize locomotor relearning while eliciting cardiovascular conditioning in chronic stroke patients. Protocols for exercise testing and longitudinal aerobic training progression are presented that provide fundamental formulas that safely approach the complex task of customizing aerobic training to gait deficit severity in the high CVD risk stroke population. The beneficial effects of 6 months task-oriented treadmill exercise on cardiovascular-metabolic fitness, energy cost of hemiparetic gait, ADL mobility task performance, and leg strength are discussed with respect to the central and peripheral neuromuscular adaptations targeted by the training. Collectively, these findings constitute one initial experience in a much broader neuroscience and exercise rehabilitation development of task-oriented training paradigms that offer a multisystems approach to improving both neurological and cardiovascular health outcomes in the chronic stroke population.
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Affiliation(s)
- R F Macko
- Department of Neurology, Division of Gerontology, Baltimore Veterans Affairs Medical Center and University of Maryland School of Medicine, Baltimore, MD, USA
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Zorowitz RD, Smout RJ, Gassaway JA, Horn SD. Usage of Pain Medications During Stroke Rehabilitation: The Post-Stroke Rehabilitation Outcomes Project (PSROP). Top Stroke Rehabil 2015; 12:37-49. [PMID: 16698736 DOI: 10.1310/c7mf-vlr0-ckdl-3c44] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pain remains one of the most common, yet most challenging, medical problems in health care today, and it is one of the most common complications that occurs after a stroke. Pain can affect the course of stroke rehabilitation adversely, and it occasionally may be a cause for transfer back to an acute care hospital. The Post-Stroke Rehabilitation Outcomes Project (PSROP) database was used to describe the incidence of pain by body location and trends in the use of different classifications of medications to treat pain. Of the 1,122 participants in the PSROP database, the most common locations of pain in stroke survivors were the head, leg, back, and shoulder. The most frequently prescribed classifications of pain medications were other analgesics (acetaminophen and tramadol), followed by narcotic analgesics, non-steroidal antiinflammatory drugs (NSAIDs), anticonvulsants, and tricyclic antidepressants. After acetaminophen, the most frequently prescribed medications in each classification, respectively, include hydrocodone APAP, cox-2 inhibitors, gabapentin, and amitriptyline. Other frequently prescribed pain medications included sumatriptan (migraine analgesic), cyclobenzaprine (muscle relaxant), and baclofen (antispasticity muscle relaxant). Medications should be chosen based upon the medical condition causing pain, the ability of the stroke survivor to comply with administration of the medication, and the cost of the medication. Appropriate and timely treatments of painful conditions result in maximum function and the ability to lead active lives and maintain an adequate quality of life.
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Affiliation(s)
- Richard D Zorowitz
- Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Moore SA, Hallsworth K, Jakovljevic DG, Blamire AM, He J, Ford GA, Rochester L, Trenell MI. Effects of Community Exercise Therapy on Metabolic, Brain, Physical, and Cognitive Function Following Stroke. Neurorehabil Neural Repair 2014; 29:623-35. [DOI: 10.1177/1545968314562116] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background. Exercise therapy could potentially modify metabolic risk factors and brain physiology alongside improving function post stroke. Objective. To explore the short-term metabolic, brain, cognitive, and functional effects of exercise following stroke. Methods. A total of 40 participants (>50 years, >6 months post stroke, independently mobile) were recruited to a single-blind, parallel, randomized controlled trial of community-based exercise (19 weeks, 3 times/wk, “exercise” group) or stretching (“control” group). Primary outcome measures were glucose control and cerebral blood flow. Secondary outcome measures were cardiorespiratory fitness, blood pressure, lipid profile, body composition, cerebral tissue atrophy and regional brain metabolism, and physical and cognitive function. Results. Exercise did not change glucose control (homeostasis model assessment 1·5 ± 0·8 to 1·5 ± 0·7 vs 1·6 ± 0·8 to 1·7 ± 0·7, P = .97; CI = −0·5 to 0·49). Medial temporal lobe tissue blood flow increased with exercise (38 ± 8 to 42 ± 10 mL/100 g/min; P < .05; CI = 9.0 to 0.1) without any change in gray matter tissue volume. There was no change in medial temporal lobe tissue blood flow in the control group (41 ± 8 to 40 ± 7 mL/100 g/min; P = .13; CI = −3.6 to 6.7) but significant gray matter atrophy. Cardiorespiratory fitness, diastolic blood pressure, high-density lipoprotein cholesterol, physical function, and cognition also improved with exercise. Conclusion. Exercise therapy improves short-term metabolic, brain, physical, and cognitive function, without changes in glucose control following stroke. The long-term impact of exercise on stroke recurrence, cardiovascular health, and disability should now be explored.
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Affiliation(s)
- Sarah A. Moore
- Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Kate Hallsworth
- Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Djordje G. Jakovljevic
- Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew M. Blamire
- Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Jiabao He
- Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Gary A. Ford
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Michael I. Trenell
- Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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Sullivan JE, Espe LE, Kelly AM, Veilbig LE, Kwasny MJ. Feasibility and Outcomes of a Community-Based, Pedometer-Monitored Walking Program in Chronic Stroke: A Pilot Study. Top Stroke Rehabil 2014; 21:101-10. [DOI: 10.1310/tsr2102-101] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Stoller O, de Bruin ED, Schindelholz M, Schuster-Amft C, de Bie RA, Hunt KJ. Cardiopulmonary exercise testing early after stroke using feedback-controlled robotics-assisted treadmill exercise: test-retest reliability and repeatability. J Neuroeng Rehabil 2014; 11:145. [PMID: 25306061 PMCID: PMC4271449 DOI: 10.1186/1743-0003-11-145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exercise capacity is seriously reduced after stroke. While cardiopulmonary assessment and intervention strategies have been validated for the mildly and moderately impaired populations post-stroke, there is a lack of effective concepts for stroke survivors suffering from severe motor limitations. This study investigated the test-retest reliability and repeatability of cardiopulmonary exercise testing (CPET) using feedback-controlled robotics-assisted treadmill exercise (FC-RATE) in severely motor impaired individuals early after stroke. METHODS 20 subjects (age 44-84 years, <6 month post-stroke) with severe motor limitations (Functional Ambulatory Classification 0-2) were selected for consecutive constant load testing (CLT) and incremental exercise testing (IET) within a powered exoskeleton, synchronised with a treadmill and a body weight support system. A manual human-in-the-loop feedback system was used to guide individual work rate levels. Outcome variables focussed on standard cardiopulmonary performance parameters. Relative and absolute test-retest reliability were assessed by intraclass correlation coefficients (ICC), standard error of the measurement (SEM), and minimal detectable change (MDC). Mean difference, limits of agreement, and coefficient of variation (CoV) were estimated to assess repeatability. RESULTS Peak performance parameters during IET yielded good to excellent relative reliability: absolute peak oxygen uptake (ICC =0.82), relative peak oxygen uptake (ICC =0.72), peak work rate (ICC =0.91), peak heart rate (ICC =0.80), absolute gas exchange threshold (ICC =0.91), relative gas exchange threshold (ICC =0.88), oxygen cost of work (ICC =0.87), oxygen pulse at peak oxygen uptake (ICC =0.92), ventilation rate versus carbon dioxide output slope (ICC =0.78). For these variables, SEM was 4-13%, MDC 12-36%, and CoV 0.10-0.36. CLT revealed high mean differences and insufficient test-retest reliability for all variables studied. CONCLUSIONS This study presents first evidence on reliability and repeatability for CPET in severely motor impaired individuals early after stroke using a feedback-controlled robotics-assisted treadmill. The results demonstrate good to excellent test-retest reliability and appropriate repeatability for the most important peak cardiopulmonary performance parameters. These findings have important implications for the design and implementation of cardiovascular exercise interventions in severely impaired populations. Future research needs to develop advanced control strategies to enable the true limit of functional exercise capacity to be reached and to further assess test-retest reliability and repeatability in larger samples.
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Affiliation(s)
- Oliver Stoller
- />Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- />Department of Epidemiology, Maastricht University and Caphri Research School, Maastricht, Netherlands
- />Research Department, Reha Rheinfelden,, Rheinfelden, Switzerland
| | - Eling D de Bruin
- />Department of Epidemiology, Maastricht University and Caphri Research School, Maastricht, Netherlands
- />Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- />Centre for Evidence Based Physiotherapy, Maastricht University, Maastricht, Netherlands
| | - Matthias Schindelholz
- />Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- />Research Department, Reha Rheinfelden,, Rheinfelden, Switzerland
| | - Corina Schuster-Amft
- />Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- />Research Department, Reha Rheinfelden,, Rheinfelden, Switzerland
| | - Rob A de Bie
- />Department of Epidemiology, Maastricht University and Caphri Research School, Maastricht, Netherlands
- />Centre for Evidence Based Physiotherapy, Maastricht University, Maastricht, Netherlands
| | - Kenneth J Hunt
- />Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- />Research Department, Reha Rheinfelden,, Rheinfelden, Switzerland
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Tang A, Eng JJ, Krassioukov AV, Madden KM, Mohammadi A, Tsang MYC, Tsang TSM. Exercise-induced changes in cardiovascular function after stroke: a randomized controlled trial. Int J Stroke 2014; 9:883-9. [PMID: 24148695 PMCID: PMC4486377 DOI: 10.1111/ijs.12156] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 05/22/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Cardiovascular co-morbidities are prevalent after stroke, with heart disease, hypertension and impaired glucose tolerance present in the majority of cases. Exercise has the potential to mediate cardiovascular risk factors commonly present in people with stroke. This single-blinded randomized controlled trial compared the effects of high versus low intensity exercise on fitness, cardiovascular risk factors, and cardiac function after stroke. METHODS Fifty participants (age 50-80 y, >1 y post-stroke) were randomized to a high-intensity Aerobic Exercise (AE) or low-intensity non-aerobic Balance/Flexibility (BF) program (6 months, 3 60-min sessions/week). Outcomes assessed by VO2 peak (primary outcome), arterial stiffness, ambulatory capacity, hemodynamics and cardiac function using echocardiography, and lipid, glucose and homocysteine levels. Assessors were blinded to group allocation. RESULTS Twenty-three (92%) of 25 AE group participants (withdrawals unrelated to the intervention) and all BF group participants completed the program. One BF group participant experienced 2 non-injurious falls during class. No other adverse events occurred. There were no changes in VO2 peak in either group (AE 16·9±7 to 17·4±7 ml●kg(-1) ●min(-1) vs. BF 16·9±6 to 16·6±5 ml●kg(-1) ●min(-1) , P=0·45), but AE group demonstrated greater improvement in right atrial emptying fraction (AE 30±22 to 37±22% vs. BF 35±20 to 31±20%, P=0·04). Both groups demonstrated improvements in lipid profiles, glucose and homocysteine levels, and ambulatory capacity (P<0·04). CONCLUSIONS This was the first study to examine the effects of aerobic exercise after stroke on cardiovascular hemodynamics. High-intensity exercise improved right-sided function and early myocardial relaxation. Low-intensity exercise may also benefit plasma lipid, glucose and inflammatory markers, and ambulatory capacity. This study is an important step towards understanding mechanisms by which exercise may reduce cardiovascular risk and function.
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Affiliation(s)
- Ada Tang
- Faculty of Medicine, Department of Physical Therapy, Vancouver Coastal Health, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
Physical rehabilitation post stroke is key to minimizing impairments, restoring functional mobility, and returning individuals to their life roles. The reimbursable time allotted to attain those goals in the current health care environment is limited and is not projected to increase. It is critical, therefore, for rehabilitation professionals to re-evaluate how they use their limited time with clients. Repetition is the foundation for changes in representational organization of the motor cortex and for motor skill learning. Drawing from animal and human motor learning literature as well as completed clinical trials, we delineate strategies that can be implemented with individual patients to most prudently redeem the time spent with them and to best steward their recovery.
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Affiliation(s)
- Dorian K Rose
- Department of Physical Therapy, University of Florida, Gainesville, Florida Malcom Randall VA Medical Center, Gainesville, Florida
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Billinger SA, Arena R, Bernhardt J, Eng JJ, Franklin BA, Johnson CM, MacKay-Lyons M, Macko RF, Mead GE, Roth EJ, Shaughnessy M, Tang A. Physical Activity and Exercise Recommendations for Stroke Survivors. Stroke 2014; 45:2532-53. [PMID: 24846875 DOI: 10.1161/str.0000000000000022] [Citation(s) in RCA: 826] [Impact Index Per Article: 82.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Concurrent validity of Physiological Cost Index in walking over ground and during robotic training in subacute stroke patients. BIOMED RESEARCH INTERNATIONAL 2014; 2014:384896. [PMID: 24967363 PMCID: PMC4055170 DOI: 10.1155/2014/384896] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/10/2014] [Accepted: 04/23/2014] [Indexed: 11/18/2022]
Abstract
Physiological Cost Index (PCI) has been proposed to assess gait demand. The purpose of the study was to establish whether PCI is a valid indicator in subacute stroke patients of energy cost of walking in different walking conditions, that is, over ground and on the Gait Trainer (GT) with body weight support (BWS). The study tested if correlations exist between PCI and ECW, indicating validity of the measure and, by implication, validity of PCI. Six patients (patient group (PG)) with subacute stroke and 6 healthy age- and size-matched subjects as control group (CG) performed, in a random sequence in different days, walking tests overground and on the GT with 0, 30, and 50% BWS. There was a good to excellent correlation between PCI and ECW in the observed walking conditions: in PG Pearson correlation was 0.919 (p < 0.001); in CG Pearson correlation was 0.852 (p < 0.001). In conclusion, the high significant correlations between PCI and ECW, in all the observed walking conditions, suggest that PCI is a valid outcome measure in subacute stroke patients.
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Zehr EP. Evidence-based risk assessment and recommendations for physical activity clearance: stroke and spinal cord injury. Appl Physiol Nutr Metab 2013; 36 Suppl 1:S214-31. [PMID: 21800943 DOI: 10.1139/h11-055] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Physical activity (PA) has potential benefits after stroke or spinal cord injury (SCI), especially in improving efficiency and functional capacity in activities of daily living. Currently, many who could benefit from PA may be routinely excluded from participation because of myths related to functional capacity and the concern for harm. The purpose of this review was to evaluate the literature for reports of adverse events during exercise after stroke or SCI, and to provide recommendations regarding exercise participation in supervised and unsupervised environments. Studies were evaluated for quality, and the summary level and quality of evidence were evaluated using the AGREE rubric, modified to address the main outcome measure of adverse events. Levels of exercise stress were evaluated for aerobic activities, using an established rubric. Included in the current analysis were 32 studies for stroke and 4 for SCI. In aggregate, this yielded a total of 730 experimental participants with stroke and 143 with SCI. It should be noted that almost all studies were not designed to examine naturally occurring adverse events from PA. Significant contraindications to unsupervised exercise include manifestation of autonomic dysreflexia in SCI and cardiovascular comorbidity after stroke. There are clear benefits of exercise training on physiological outcomes in stroke and SCI, but the relation between outcomes and safety remains unclear. However, taken on balance, the risk-to-benefit ratio favors the recommendation of exercise. This recommendation is based on studies in which participants were almost universally screened for participation in supervised environments. Thus, the grading of evidence for finding adverse events to support this conclusion is inadequate.
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Affiliation(s)
- E Paul Zehr
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, BC, Canada.
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50
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Stoller O, de Bruin ED, Schuster-Amft C, Schindelholz M, de Bie RA, Hunt KJ. Cardiovascular rehabilitation soon after stroke using feedback-controlled robotics-assisted treadmill exercise: study protocol of a randomised controlled pilot trial. Trials 2013; 14:304. [PMID: 24053609 PMCID: PMC3849994 DOI: 10.1186/1745-6215-14-304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 09/11/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND After experiencing a stroke, most individuals also suffer from cardiac disease, are immobile and thus have low endurance for exercise. Aerobic capacity is seriously reduced in these individuals and does not reach reasonable levels after conventional rehabilitation programmes. Cardiovascular exercise is beneficial for improvement of aerobic capacity in mild to moderate stroke. However, less is known about its impact on aerobic capacity, motor recovery, and quality-of-life in severely impaired individuals. The aim of this pilot study is to explore the clinical efficacy and feasibility of cardiovascular exercise with regard to aerobic capacity, motor recovery, and quality-of-life using feedback-controlled robotics-assisted treadmill exercise in non-ambulatory individuals soon after experiencing a stroke. METHODS/DESIGN This will be a single-centred single blind, randomised control trial with a pre-post intervention design. Subjects will be recruited early after their first stroke (≤20 weeks) at a neurological rehabilitation clinic and will be randomly allocated to an inpatient cardiovascular exercise programme that uses feedback-controlled robotics-assisted treadmill exercise (experimental) or to conventional robotics-assisted treadmill exercise (control). Intervention duration depends on the duration of each subject's inpatient rehabilitation period. Aerobic capacity, as the primary outcome measure, will be assessed using feedback-controlled robotics-assisted treadmill-based cardiopulmonary exercise testing. Secondary outcome measures will include gait speed, walking endurance, standing function, and quality-of-life. Outcome assessment will be conducted at baseline, after each 4-week intervention period, and before clinical discharge. Ethical approval has been obtained. DISCUSSION Whether cardiovascular exercise in non-ambulatory individuals early after stroke has an impact on aerobic capacity, motor recovery, and quality-of-life is not yet known. Feedback-controlled robotics-assisted treadmill exercise is a relatively recent intervention method and might be used to train and evaluate aerobic capacity in this population. The present pilot trial is expected to provide new insights into the implementation of early cardiovascular exercise for individuals with severe motor impairment. The findings of this study may guide future research to explore the effects of early cardiovascular activation after severe neurological events. TRIAL REGISTRATION This trial is registered with the Clinical Trials.gov Registry (NCT01679600).
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Affiliation(s)
- Oliver Stoller
- Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Pestalozzistrasse 20, 3400, Burgdorf, Switzerland
- Department of Epidemiology, Maastricht University and Caphri Research School, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
- Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Wolfgang-Pauli-Strasse 27, 8093, Zurich, Switzerland
| | - Corina Schuster-Amft
- Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Pestalozzistrasse 20, 3400, Burgdorf, Switzerland
- Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland
| | - Matthias Schindelholz
- Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Pestalozzistrasse 20, 3400, Burgdorf, Switzerland
- Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland
| | - Rob A de Bie
- Department of Epidemiology, Maastricht University and Caphri Research School, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Kenneth J Hunt
- Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Pestalozzistrasse 20, 3400, Burgdorf, Switzerland
- Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland
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