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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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Carl DL, Whitesel D, Meyrose C, Westover J, Khoury J, Gerson M, Kissela B, Dunning K, Boyne P. A 3-minute recumbent stepper test in chronic stroke. PM R 2023; 15:1258-1265. [PMID: 36580538 PMCID: PMC10307922 DOI: 10.1002/pmrj.12940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 11/27/2022] [Accepted: 12/16/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Persons with stroke often have difficulty achieving target heart rate (HR) during graded exercise testing (GXT), which is known to limit test sensitivity for detecting clinically relevant cardiac conditions. A novel Recumbent Stepper 3-minute (RS 3Min) "all out" test may increase sensitivity of stress testing after stroke. OBJECTIVE To determine the feasibility of adding the RS 3Min test after GXT among persons after stroke. DESIGN A within-participant, nonrandomized, repeated measures design. SETTING Rehabilitation research laboratory and cardiovascular stress laboratory PARTICIPANTS: Fifteen participants with chronic stroke (56.7 ± 9.6 years; 6.4 ± 4.3 years post stroke; 8 male). INTERVENTIONS All participants randomly completed (1) a symptom-limited treadmill GXT and (2) a symptom-limited RS GXT followed by RS 3Min critical power test. MAIN OUTCOME MEASURES HR, ratings of perceived exertion, oxygen consumption, respiratory exchange ratio, and power output measured continuously during each test. Blood pressure measured every 2 minutes and or immediately post exercise. P value set at p < .05 from omnibus test for a significant difference among protocols. RESULTS The RS 3Min test had a significantly higher rate of achieving target HR compared to the RS GXT (9/14 vs 4/14, p = .02) and was not significantly different from the treadmill GXT (9/14 vs 5/14, p = .09). Minimum power output during the RS 3Min was significantly higher than peak power output during the RS GXT (110 ± 41 W vs. 84 ± 22 W, p = .02) with 12/15 participants reaching a VO2 plateau. CONCLUSIONS Although additional studies with randomized designs are needed, a novel RS 3Min "all out" test appears to be a promising method for enhancing test sensitivity in cardiovascular screening after stroke, while providing a potentially valid measure of critical power.
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Affiliation(s)
- Daniel L Carl
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Dustyn Whitesel
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Colleen Meyrose
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jennifer Westover
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jane Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Myron Gerson
- Departments of Internal Medicine and Cardiology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kari Dunning
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Pierce Boyne
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio, USA
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Machado N, Williams G, Olver J, Johnson L. The safety and feasibility of early cardiorespiratory fitness testing after stroke. PM R 2023; 15:291-301. [PMID: 35156779 DOI: 10.1002/pmrj.12787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiorespiratory fitness testing is recommended as part of a pre-exercise evaluation to aid the programming of safe, tailored cardiorespiratory fitness training after stroke. But there is limited evidence for its safety and feasibility in people with stroke with varying impairment levels in the early subacute phase of stroke recovery. OBJECTIVE To assess the safety and feasibility of cardiorespiratory fitness testing in the early subacute phase after stroke. DESIGN A sub-study of a larger single service, multi-site, prospective cohort feasibility study (Cardiac Rehabilitation in Stroke Survivors to Improve Survivorship [CRiSSIS]). SETTING Private subacute inpatient rehabilitation facilities. PARTICIPANTS Consecutive admissions of people with ischemic stroke admitted to subacute rehabilitation facilities. INTERVENTION Not applicable. MAIN OUTCOME(S) Safety was determined by the occurrence of adverse or serious adverse events. Feasibility was determined by assessing the (1) number of participants recruited and (2) number of participants able to complete the fitness test. RESULTS Between April 2018 and December 2019, a total of 165 people with stroke were screened to participate; 109 were eligible and 65 were recruited. Of the 62 who completed testing, 41 participants were able to complete a submaximal fitness test at a median of 12 days post-stroke. One minor adverse event was recorded. Of the 21 participants unable to complete the fitness test; 4 declined to complete the test, 9 were unable to commence the test, and 8 were unable to complete the first stage of the protocol due to stroke-related impairments. Participants with mild stroke, greater motor and cognitive function, and fewer depressive symptoms were more likely to be able to complete the cardiorespiratory fitness test. CONCLUSION Cardiorespiratory fitness testing was safe for most people with mild-to-moderately severe ischemic stroke and transient ischemic attack in the early subacute phase, but only two-thirds of the participants could complete the test.
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Affiliation(s)
- Natasha Machado
- Rehabilitation, Epworth Healthcare, 89 Bridge Road, Richmond, Victoria
- Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, Victoria
| | - Gavin Williams
- Rehabilitation, Epworth Healthcare, 89 Bridge Road, Richmond, Victoria
- Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, Victoria
| | - John Olver
- Rehabilitation, Epworth Healthcare, 89 Bridge Road, Richmond, Victoria
- Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, Victoria
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Liam Johnson
- Rehabilitation, Epworth Healthcare, 89 Bridge Road, Richmond, Victoria
- Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, Victoria
- Faculty of Exercise Science, Australian Catholic University, Fitzroy, Victoria, Australia
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The relationship between relative aerobic load, energy cost, and speed of walking in individuals post-stroke. Gait Posture 2021; 89:193-199. [PMID: 34332288 DOI: 10.1016/j.gaitpost.2021.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 07/14/2021] [Accepted: 07/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals post-stroke walk slower than their able-bodied peers, which limits participation. This might be attributed to neurological impairments, but could also be caused by a mismatch between aerobic capacity and aerobic load of walking leading to an unsustainable relative aerobic load at most economic speed and preference for a lower walking speed. RESEARCH QUESTION What is the impact of aerobic capacity and aerobic load of walking on walking ability post-stroke? METHODS Forty individuals post-stroke (more impaired N = 21; preferred walking speed (PWS)<0.8 m/s, less impaired N = 19), and 15 able-bodied individuals performed five, 5-minute treadmill walking trials at 70 %, 85 %, 100 %, 115 % and 130 % PWS. Energy expenditure (mlO2/kg/min) and energy cost (mlO2/kg/m) were derived from oxygen uptake (V˙O2). Relative load was defined as energy expenditure divided by peak aerobic capacity (%V˙O2peak) and by V˙O2 at ventilatory threshold (%V˙O2-VT). Relative load and energy cost at PWS were compared with one-way ANOVA's. The effect of speed on these parameters was modeled with Generalized Estimating Equations. RESULTS Both more and less impaired individuals post-stroke showed lower PWS than able-bodied controls (0.44 [0.19-0.76] and 1.04 [0.81-1.43] vs 1.36 [0.89-1.53] m/s) and higher relative load at PWS (50.2 ± 14.4 and 51.7 ± 16.8 vs 36.2 ± 7.6 %V˙O2peak and 101.9 ± 20.5 and 97.0 ± 27.3 vs 64.9 ± 13.8 %V˙O2-VT). Energy cost at PWS of more impaired (0.30 [.19-1.03] mlO2/kg/m) was higher than less-impaired (0.19[0.10-0.24] mlO2/kg/m) and able-bodied (0.15 [0.13-0.18] mlO2/kg/m). For post-stroke individuals, increasing walking speed above PWS decreased energy cost, but resulted in a relative load above endurance threshold. SIGNIFICANCE Individuals post-stroke seem to reduce walking speed to prevent unsustainably high relative aerobic loads at the expense of reduced economy. When aiming to improve walking ability post-stroke, it is important to consider training aerobic capacity.
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The Use of Samsung Health and ECG M-Trace Base II Applications for the Assessment of Exercise Tolerance in the Secondary Prevention in Patients after Ischemic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115753. [PMID: 34071967 PMCID: PMC8199294 DOI: 10.3390/ijerph18115753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022]
Abstract
Background and objectives: The aim of the study was to use the mobile application Samsung Health for the assessment of parameters of exercise tolerance and the ECG (electrocardiogram) M-Trace Base II for the assessment of cardiological parameters. Materials and Methods: The measurements were conducted during rest and after performing SMWT (Six Minute Walk Test) and SCT (Stair Climb Test) in 26 patients after ischemic stroke (IS) and 26 healthy individuals. Results: In the SMWT, the post-stroke group (SG) walked a shorter distance (p < 0.001), achieving lower mean gait velocity (p < 0.001) and lower maximum gait velocity (p = 0.002). In the SCT, SG achieved a lower mean gait velocity (p < 0.001) and lower maximum gait velocity (p < 0.001) when compared to the control group (CG). In SG, myocardial ischemia in ECG was noted in four patients after SMWT and in three patients following SCT. Both in SG and in CG the increase in SBP (systolic blood pressure) value measured after SMWT and SCT compared to at rest (p < 0.001) was observed. In SG, in the compared ratios rest to SMWT and SCT as well as SMWT to SCT, there was an increase in HR (heart rate) (p < 0.001). Conclusions: ECG M-Trace Base II and Samsung Health are mobile applications that can assess cardiological parameters and exercise tolerance parameters in patients after IS, so they can be used to plan the intensity of exercise in rehabilitation programs.
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Pereira AS, Aguiar LT, Quintino LF, de Brito SAF, Britto RR, Faria CDCDM. Effects of detraining on cardiorespiratory fitness of individuals with chronic stroke. Top Stroke Rehabil 2020; 28:321-330. [PMID: 32881640 DOI: 10.1080/10749357.2020.1816074] [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: 10/23/2022]
Abstract
BACKGROUND Aerobic training can improve cardiorespiratory fitness in individuals after stroke. However, the effects of short-term and long-term detraining are not well known. OBJECTIVE To determine the effects of short-term (1-month) and long-term (6-month) detraining on cardiorespiratory fitness (VO2peak) of individuals after stroke, who participated in aerobic training. METHODS A cohort study was developed. Twenty adults (57 ± 11 years old) with stroke were included. After completing an outpatient aerobic training, participants were divided into gain group (VO2peak increase >1.3 ml.kg-1.min-1 from before to immediately after the training) or non-gain group (VO2peak change ≤1.3 ml.kg-1.min-1). Cardiorespiratory fitness (VO2peak), obtained by the cardiopulmonary exercise test was assessed one and 6 months after the end of the training (short- and long-term detraining, respectively), or collected retrospectively from patient chart (before and after the training). RESULTS There was found a significant interaction effect (time*group) for VO2peak (F= 6.108;p < 0,001). Higher values in the VO2peak observed in the gain group with the aerobic training (F = 25.86; p< .001) were significantly reduced with short-term detraining, reaching values similar to that observed before the training and to that of the non-gain group (F = 14.81;p= .001). Both groups had similar VO2peak values within long-term detraining (F = 2.70;p= .12), with no significant differences from the values observed before the training and after short-term detraining (0.11 ≤ p≤ 1.00). CONCLUSIONS Detraining on cardiorespiratory fitness of individuals after chronic stroke occurred within only 1 month. Therefore, it is important to maintain aerobic training throughout life.
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Affiliation(s)
- Amanda Santos Pereira
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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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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Affiliation(s)
- Qiwei Fan
- From the Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China (Q.F., J.J.)
| | - Jie Jia
- From the Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China (Q.F., J.J.)
- School of Life and Environmental Sciences, University of Sydney, Australia (J.J.)
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Dunn A, Marsden DL, Barker D, van Vliet P, Spratt NJ, Callister R. Evaluation of three measures of cardiorespiratory fitness in independently ambulant stroke survivors. Physiother Theory Pract 2018; 35:622-632. [DOI: 10.1080/09593985.2018.1457746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ashlee Dunn
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
| | - Dianne L. Marsden
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Daniel Barker
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
- Hunter Medical Research Institute,New Lambton, NSW, Australia
| | - Paulette van Vliet
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
- Hunter Medical Research Institute,New Lambton, NSW, Australia
| | - Neil J. Spratt
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
- Hunter Medical Research Institute,New Lambton, NSW, Australia
- Department of Neurology, John Hunter Hospital, New Lambton, NSW, Australia
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy, University of Newcastle, NSW, Australia
- Hunter Medical Research Institute,New Lambton, NSW, Australia
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Heron N, Kee F, Mant J, Reilly PM, Cupples M, Tully M, Donnelly M. Stroke Prevention Rehabilitation Intervention Trial of Exercise (SPRITE) - a randomised feasibility study. BMC Cardiovasc Disord 2017; 17:290. [PMID: 29233087 PMCID: PMC5727948 DOI: 10.1186/s12872-017-0717-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/21/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The value of cardiac rehabilitation (CR) after a transient ischaemic attack (TIA) or minor stroke is untested despite these conditions sharing similar pathology and risk factors to coronary heart disease. We aimed to evaluate the feasibility of conducting a trial of an adapted home-based CR programme, 'The Healthy Brain Rehabilitation Manual', for patients following a TIA/minor stroke, participants' views on the intervention and, to identify the behaviour change techniques (BCTs) used. METHODS Clinicians were asked to identify patients attending the Ulster Hospital, Belfast within 4 weeks of a first TIA or minor stroke. Those who agreed to participate underwent assessments of physical fitness, cardiovascular risk, quality of life and mental health, before random allocation to: Group (1) standard/usual care; (2) rehabilitation manual or (3) manual plus pedometer. All participants received telephone support at 1 and 4 weeks, reassessment at 6 weeks and an invitation to a focus group exploring views regarding the study. Two trained review authors independently assessed the manual to identify the BCTs used. RESULTS Twenty-eight patients were invited to participate, with 15 (10 men, 5 women; 9 TIA, 6 minor stroke; mean age 69 years) consenting and completing the study. Mean time to enrolment from the TIA/stroke was 20.5 days. Participants completed all assessment measures except VO2max testing, which all declined. The manual and telephone contact were viewed positively, as credible sources of advice. Pedometers were valued highly, particularly for goal-setting. Overall, 36 individual BCTs were used, the commonest being centred around setting goals and planning as well as social support. CONCLUSION Recruitment and retention rates suggest that a trial to evaluate the effectiveness of a novel home-based CR programme, implemented within 4 weeks of a first TIA/minor stroke is feasible. The commonest BCTs used within the manual revolve around goals, planning and social support, in keeping with UK national guidelines. The findings from this feasibility work have been used to further refine the next stage of the intervention's development, a pilot study. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02712385 . This study was registered prospectively on 18/03/2016.
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Affiliation(s)
- Neil Heron
- Department of General Practice and Primary Care, Queen’s University, Belfast, UK
- Centre for Public Health Research, Queen’s University, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research (NI), Belfast, Northern Ireland
- Department of General Practice, Queen’s University, Dunluce Health Centre, Level 4, 1 Dunluce Avenue, Belfast, BT9 7HR UK
| | - Frank Kee
- Department of General Practice and Primary Care, Queen’s University, Belfast, UK
- Centre for Public Health Research, Queen’s University, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research (NI), Belfast, Northern Ireland
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Philip M. Reilly
- Patient and Public Involvement (PPI) Representative for SPRITE Studies, Belfast, Northern Ireland
| | - Margaret Cupples
- Department of General Practice and Primary Care, Queen’s University, Belfast, UK
- Centre for Public Health Research, Queen’s University, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research (NI), Belfast, Northern Ireland
| | - Mark Tully
- Department of General Practice and Primary Care, Queen’s University, Belfast, UK
- Centre for Public Health Research, Queen’s University, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research (NI), Belfast, Northern Ireland
| | - Michael Donnelly
- Department of General Practice and Primary Care, Queen’s University, Belfast, UK
- Centre for Public Health Research, Queen’s University, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research (NI), Belfast, Northern Ireland
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Marsden DL, Dunn A, Callister R, McElduff P, Levi CR, Spratt NJ. Interval circuit training for cardiorespiratory fitness is feasible for people after stroke. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.5.190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aims: To determine if community-dwelling stroke survivors can achieve exercise intensities sufficient to improve cardiorespiratory fitness during a single session of circuit training using an interval training approach. Methods: Thirteen independently ambulant participants within 1 year of stroke were included in this observational study (females=54%; median age=65.6 years; interquartile range=23.9). Exercise intensities were assessed throughout an individually tailored circuit of up to seven 5-minute workstations from a selection of nine functional (e.g. walking, stairs, balance) and three ergometer (upright cycle, rower, treadmill) workstations. The interval durations ranged from 5–60 seconds. Oxygen consumption (VO2) was recorded continuously using a portable metabolic system. The average VO2 during each 30-second epoch was determined. VO2≥10.5 mL/kg/min was categorised as ≥moderate intensity. Findings: Participants exercised at VO2≥10.5 mL/kg/min for the majority of the time on the workstations [functional: 369/472 epochs (78%), ergometer: 170/204 epochs (83%)]. Most (69%) participants exercised for ≥30 minutes. No serious adverse events occurred. Conclusions: Applying interval training principles to a circuit of functional and ergometer workstations enabled ambulant participants to exercise at an intensity and for a duration that can improve cardiorespiratory fitness. The training approach appears feasible, safe and a promising way to incorporate both cardiorespiratory fitness and functional training into post-stroke management.
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Affiliation(s)
- Dianne L Marsden
- Manager, Professional Education and Development, Hunter Stroke Service, Hunter New England Local Health District; post-doctoral researcher, University of Newcastle, New South Wales, Australia
| | - Ashlee Dunn
- Research assistant/casual academic, University of Newcastle, New South Wales, Australia
| | - Robin Callister
- Professor of Human Physiology, University of Newcastle, New South Wales, Australia
| | - Patrick McElduff
- Professor of Biostatistics, University of Newcastle, New South Wales, Australia
| | - Christopher R Levi
- Director of Clinical Research and Translation, Hunter New England Local Health District, New South Wales, Australia
| | - Neil J Spratt
- Professor, University of Newcastle; senior staff specialist neurologist, Department of Neurology, John Hunter Hospital, New South Wales, Australia
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Marzolini S, Oh P, Corbett D, Dooks D, Calouro M, MacIntosh BJ, Goodman R, Brooks D. Prescribing Aerobic Exercise Intensity without a Cardiopulmonary Exercise Test Post Stroke: Utility of the Six-Minute Walk Test. J Stroke Cerebrovasc Dis 2016; 25:2222-31. [PMID: 27289183 DOI: 10.1016/j.jstrokecerebrovasdis.2016.04.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/07/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The cardiopulmonary exercise test (CPET) is an established method for determining target exercise training intensity (ventilatory threshold [VAT]) and cardiovascular risk; unfortunately, CPET is not readily accessible to people post stroke. The objective of this study was to determine the utility of the 6-minute walk test (6MWT) as a less resource-intensive alternative to CPET for prescribing exercise intensity to people post stroke with motor impairments. METHODS Sixty participants (male, 71.7%; 13.5 ± 22.5 [mean ± standard deviation] months post stroke; age 64.5 ± 12.5 years, with a Chedoke-McMaster Stroke Assessment score of 4.9 ± .9 of the leg) underwent 6MWT, CPET, balance, strength, and cognition assessments. RESULTS 6MWT heart rate (hr) was significantly lower than VAT-hr (92.3 ± 14.8 beats⋅min(-1) versus 99.8 ± 15.7 beats⋅min(-1), respectively, P < .001; correlation r = .7, P < .001). Bland-Altman analysis revealed that the 6MWT underestimated the VAT-hr by 7.7 ± 11.5%. The 95% confidence interval of the mean bias was large (14.8% and -30.3%), reflecting poor agreement, with 71.7% (n = 43) of the participants unable to reach a walking intensity at or above the VAT-hr. Lower oxygen uptake at the VAT (β = .655, P = .004), higher 6MWT-hr (β = 1.07, P = .01), and better balance (β = 1.128, P = .04) were associated with greater utility of the 6MWT for prescribing exercise. CONCLUSIONS The 6MWT-hr was not interchangeable with the target training VAT-hr determined by CPET. However, in combination with CPET, the 6MWT will indicate when deficits preclude walking alone as the primary exercise modality for optimizing cardiovascular fitness. Future studies to develop a less resource-intensive, multimodal alternative to the CPET for prescribing exercise are needed. A modality that minimizes the effect of stroke deficits, specifically poor balance, should be included.
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Affiliation(s)
- Susan Marzolini
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehab/University Health Network, Toronto, Ontario, Canada.
| | - Paul Oh
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehab/University Health Network, Toronto, Ontario, Canada; Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
| | - Dale Corbett
- Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Daryl Dooks
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehab/University Health Network, Toronto, Ontario, Canada
| | - Marcella Calouro
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehab/University Health Network, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rachel Goodman
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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