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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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2
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Machado N, Williams G, Olver J, Johnson L. Is early initiated cardiorespiratory fitness training within a model of stroke-integrated cardiac rehabilitation safe and feasible? J Stroke Cerebrovasc Dis 2024; 33:107493. [PMID: 38061183 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107493] [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: 06/14/2023] [Revised: 09/21/2023] [Accepted: 11/15/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE To investigate the safety and feasibility of an early initiated stroke-integrated Cardiac Rehabilitation program. METHODS People with acute first or recurrent ischaemic stroke, admitted to Epworth HealthCare were screened for eligibility and invited to participate. In addition to usual care neurorehabilitation, participants performed 1) cardiorespiratory fitness training 3-days/week during inpatient rehabilitation (Phase 1), and/or 2) 2-days/week centre-based cardiorespiratory fitness training plus education and 1-day/week home-based cardiorespiratory fitness training for 6-weeks during outpatient rehabilitation (Phase 2). Safety was determined by the number of adverse and serious adverse events. Feasibility was determined by participant recruitment, retention, and attendance rates, adherence to exercise recommendations, and participant satisfaction. RESULTS There were no study-related adverse or serious adverse events. Of 117 eligible stroke admissions, 62 (53%) were recruited, while 10 (16.1%) participants withdrew. Participants attended 189 of 201 (94%) scheduled cardiorespiratory fitness training sessions in Phase 1 and 341/381 (89.5%) scheduled sessions in Phase 2. Only 220/381 (58%) scheduled education sessions were attended. The minimum recommended cardiorespiratory fitness training intensity (40% heart rate reserve) and duration (20 minutes) was achieved by 57% and 55% of participants respectively during Phase 1, and 60% and 92% respectively during Phase 2. All respondents strongly agreed (69%) or agreed (31%) they would recommend the stroke-integrated Cardiac Rehabilitation program to other people with stroke. CONCLUSION Cardiorespiratory fitness training in line with multiple clinical practice guidelines included within a model of stroke-integrated Cardiac Rehabilitation appears to be safe and feasible in the early subacute phase post-stroke.
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Affiliation(s)
- Natasha Machado
- Rehabilitation, Epworth HealthCare, Victoria, Australia; Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia.
| | - Gavin Williams
- Rehabilitation, Epworth HealthCare, Victoria, Australia; Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia
| | - John Olver
- Rehabilitation, Epworth HealthCare, Victoria, Australia; Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia; Department of Medicine, Monash University, Victoria, Australia
| | - Liam Johnson
- Rehabilitation, Epworth HealthCare, Victoria, Australia; Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia; Faculty of Health Sciences, School of Behavioural and Health Sciences, Australian Catholic University, Victoria, Australia
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Jiang H, Mei Y, Lin B, Wang W, Wang X, Zhao Z, Zhang ZX. Perspectives of cardiac rehabilitation in patients who had a stroke: a protocol for a qualitative study review. BMJ Open 2023; 13:e071964. [PMID: 37536962 PMCID: PMC10401236 DOI: 10.1136/bmjopen-2023-071964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION Stroke has a high incidence and disability rate, and its recurrence and readmission rates are rising, making it the second-leading cause of mortality in the globe. Cardiac rehabilitation is a well-known, evidence-based strategy that might serve as an additional preventative programme. Prior quantitative research has proven the positive results and high practicability of cardiac rehabilitation for patients who had a stroke, however, cardiac rehabilitation is not yet a routine component of stroke rehabilitation worldwide. It might be useful to conduct meta-integration of previous qualitative studies to understand if existing cardiac rehabilitation programme meets the needs of patients who had a stroke. Therefore, the purpose of this study is to combine systematically the perspectives on benefits, barriers and facilitating factors of cardiac rehabilitation in patients who had a stroke. METHODS AND ANALYSIS There will be a search of PubMed, Web of Science, Embase, Scopus, CINAHL and PsycINFO databases. In addition, grey literature from Google Scholar, OpenGrey, PyARXiv, bioRxiv and medRxiv will also be searched. Included studies will be qualitative studies or findings from mixed-method research involving patients who engage in CR after a stroke. Regardless of the publishing date and context, English-language articles will be reviewed. Two impartial reviewers will screen studies and extract data from the included studies. According to the Joanna Briggs Institute Centre for Evidence-Based Health Care Quality Evaluation Criteria for qualitative research, the methodology of the included literature will be examined. For data synthesis, the pooling meta-integration approach and Noblit and Hare's seven steps of meta-ethnography will be used. ETHICS AND DISSEMINATION Because there will be no collection of primary data, this systematic review is exempt from the need that gets ethical approval. The findings of the review will be made public by publishing them in scholarly journals and presenting them at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42023387534.
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Affiliation(s)
- Hu Jiang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
- The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China
| | - Yongxia Mei
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Beilei Lin
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Wenna Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Xiaoxuan Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Zhixin Zhao
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Zhen-Xiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
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Lennon O, Crystal A, Kwan M, Tierney C, Gallagher A, Murphy S. Perspectives and Experiences of Cardiac Rehabilitation after Stroke—A Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10081579. [PMID: 36011236 PMCID: PMC9408632 DOI: 10.3390/healthcare10081579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022] Open
Abstract
Cardiac rehabilitation (CR) after stroke has been proven to be a safe and feasible secondary prevention intervention. Limited qualitative data capture people’s experiences and perceptions of attending CR following stroke, but with none addressing translational aspects when CR is delivered as routine clinical care. Using a phenomenological, qualitative approach, four semi-structured focus groups were conducted with 15 individuals (60% male) who had completed CR during their stroke care pathway. Our inductive thematic analysis identified five themes. The first centred on recognising stroke as a cardiovascular disease and the applicability of CR post-stroke. The second addressed how peer understanding, camaraderie, and medical supervision created a safe and supportive environment. The third identified how the programme-built confidence supported longer-term healthy lifestyle choices in physical activity, diet, and smoking. The penultimate theme addressed the period from hospital discharge to attending CR as a time of uncertainty where many participants experienced cognitive difficulties, mood disturbances, and mental fatigue without adequate support. Lastly, participants identified unmet needs in their care pathway that included a lack of information about their referral to CR, the programme content, and accessing local supports ahead of CR. Ongoing and unmet needs both during and after CR related to self-management of secondary prevention medications, neurological issues, post-stroke fatigue, and the lack of structured support following CR completion.
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Affiliation(s)
- Olive Lennon
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
- Correspondence: ; Tel.: +35-31-7166-508
| | - Alexandra Crystal
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Michelle Kwan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Caoimhe Tierney
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Anne Gallagher
- Heart House, Mater Misericordiae University Hospital, D07 KH4C Dublin, Ireland
| | - Sean Murphy
- Stroke Services, Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland
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Inness EL, Jagroop D, Andreoli A, Bayley M, Biasin L, Danells C, Hall J, Mansfield A, McDonald A, Nishri D, Salbach NM, Taylor D, Wong K, Tang A. Factors That Influence the Clinical Implementation of Aerobic Exercise in Stroke Rehabilitation: A Theory-Informed Qualitative Study. Phys Ther 2022; 102:6534400. [PMID: 35194641 DOI: 10.1093/ptj/pzac014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 10/14/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Best practice guidelines recommend that aerobic exercise (AEx) be implemented as early as possible poststroke, yet the prescription of AEx remains limited in stroke rehabilitation settings. This study used theoretical frameworks to obtain an in-depth understanding of barriers and enablers to AEx implementation in the stroke rehabilitation setting. METHODS A qualitative, descriptive study was conducted. Participants were recruited from 4 stroke rehabilitation settings in Ontario, Canada, that have participated in an implementation study to provide structured AEx programming as part of standard care. Six clinician focus groups (with 19 physical therapists and 5 rehabilitation assistants) and one-to-one interviews with 7 managers and 1 physician were conducted to explore barriers and enablers to AEx implementation. The Theoretical Domains Framework and Consolidated Framework for Implementation Research informed content analysis for clinician and manager perspectives, respectively. RESULTS Barriers specific to resource constraints and health care system pressures, combined with patient goals, led to interventions to improve function being prioritized over AEx. Successful implementation was enabled through an interprofessional approach and team engagement in the planning and implementation process. Health care providers described concerns about patient safety, but confidence and capability for implementing AEx were enabled by education, skill development, use of exercise tests, and consultation with individuals with content expertise. Participants described the development of supportive processes that enabled AEx implementation within team workflows and shared resources. CONCLUSION Strategies to support implementation of AEx in stroke rehabilitation should incorporate knowledge and skills, the provision of clinical decision-making tools, access to expert consultation, the roles and social influence of the interprofessional team and formal and informal leaders, and supportive processes adapted to the local context. IMPACT Results from this study will inform the development of a clinical implementation toolkit to support clinical uptake of AEx in the stroke rehabilitation setting.
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Affiliation(s)
- Elizabeth L Inness
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David Jagroop
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Angie Andreoli
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Mark Bayley
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Louis Biasin
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Cynthia Danells
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jayne Hall
- Regional Rehabilitation Outpatient Services, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Avril Mansfield
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Evaluative Clinical Sciences, Hurvtiz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Alison McDonald
- Nova Scotia Rehabilitation & Arthritis Centre, Halifax, NS, Canada
| | - Diane Nishri
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Nancy M Salbach
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Denise Taylor
- St Joseph's Care Group, Thunder Bay, ON, Canada.,Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Karl Wong
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Ada Tang
- McMaster University, School of Rehabilitation, Hamilton ON, Canada
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Stroke Recovery Program with Modified Cardiac Rehabilitation Improves Mortality, Functional & Cardiovascular Performance. J Stroke Cerebrovasc Dis 2022; 31:106322. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/14/2021] [Accepted: 01/11/2022] [Indexed: 11/21/2022] Open
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Kelly LP, Basset FA, McCarthy J, Ploughman M. Normobaric Hypoxia Exposure During Treadmill Aerobic Exercise After Stroke: A Safety and Feasibility Study. Front Physiol 2021; 12:702439. [PMID: 34483958 PMCID: PMC8415265 DOI: 10.3389/fphys.2021.702439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the safety and feasibility of performing treadmill aerobic exercise in moderate normobaric hypoxia among chronic hemiparetic stroke survivors. Design Observational study using convenience sampling. Setting Research laboratory in a tertiary rehabilitation hospital. Participants Chronic hemiparetic stroke survivors who could walk at least 10-m with or without assistance and had no absolute contraindications to exercise testing. Intervention Participants (three male and four female) were asked to complete three normobaric hypoxia exposure protocols within a single session. First, they were passively exposed to normobaric hypoxia through gradual reductions in the fraction of inspired oxygen (FIO2 = 20.9, 17.0, and 15.0%) while seated (5-min at each level of FIO2). Participants were then exposed to the same reductions in FIO2 during constant-load exercise performed on a treadmill at 40% of heart rate reserve. Finally, participants completed 20-min of exercise while intermittently exposed to moderate normobaric hypoxia (5 × 2-min at FIO2 = 15.0%) interspaced with 2-min normoxia intervals (FIO2 = 20.9%). Outcome Measures The primary outcome was occurrence of adverse events, which included standardized criteria for terminating exercise testing, blood oxygen saturation (SpO2) <80%, or acute mountain sickness score >2. The increased cardiovascular strain imposed by normobaric hypoxia exposure at rest and during exercise was evaluated by changes in SpO2, heart rate (HR), blood pressure, and rating of perceived exertion (RPE). Results One participant reported mild symptoms of nausea during exercise in normobaric hypoxia and discontinued participation. No other adverse events were recorded. Intermittent normobaric hypoxia exposure was associated with reduced SpO2 (MD = −7.4%, CI: −9.8 to −5.0) and increased HR (MD = 8.2, CI: 4.6 to 11.7) compared to intervals while breathing typical room air throughout the 20-min constant-load exercise period. The increase in HR was associated with a 10% increase in relative effort. However, reducing FIO2 had little effect on blood pressure and RPE measurements. Conclusion Moderate normobaric hypoxia appeared to be a safe and feasible method to increase the cardiovascular strain of submaximal exercise in chronic hemiparetic stroke survivors. Future studies evaluating the effects of pairing normobaric hypoxia exposure with existing therapies on secondary prevention and functional recovery are warranted.
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Affiliation(s)
- Liam P Kelly
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.,School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Fabien Andre Basset
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jason McCarthy
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Michelle Ploughman
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Regan EW, Handlery R, Stewart JC, Pearson JL, Wilcox S, Fritz S. Feasibility of integrating survivors of stroke into cardiac rehabilitation: A mixed methods pilot study. PLoS One 2021; 16:e0247178. [PMID: 33780477 PMCID: PMC8007047 DOI: 10.1371/journal.pone.0247178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/02/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Survivors of stroke are often deconditioned and have limited opportunities for exercise post-rehabilitation. Cardiac Rehabilitation (CR), a structured exercise program offered post-cardiac event in the United States (U.S.), may provide an opportunity for continued exercise. The purpose of this study was to examine the feasibility of integrating survivors of stroke into an existing, hospital-based CR program through an assessment of (1) recruitment, uptake and retention, (2) adherence and fidelity, (3) acceptability and (4) safety. METHODS A mixed methods design combined a single group, pre-post design, pilot feasibility study with an imbedded qualitative inquiry. Survivors of stroke were recruited into a standard 12-week, 36 visit CR program. RESULTS Fifty-three survivors were referred, 29 started and 24 completed the program. Program uptake rate was 55% and completion rate was 83%. Eleven completers and one non-completer participated in the qualitative interviews. Program completers attended an average of 25.25 (SD 5.82) sessions with an average of 38.93 (SD 5.64) exercise minutes per session while reaching targeted rate of perceived exertion levels. Qualitative themes included perceived benefits of an individualized program in a group setting, positive interactions with qualified staff, opportunities for socialization, and regular monitoring and staff attentiveness promoting feelings of safety. CONCLUSIONS Survivors of stroke were able to meet Medicare standard dosage (frequency and session duration) and rate of perceived intensity goals, and perceived the program as needed regardless of their mobility limitations or previous exercise experience. Primary challenges included managing referrals and uptake. Results support feasibility and benefit for survivors to integrate into U.S. CR programs.
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Affiliation(s)
- Elizabeth W. Regan
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States of America
| | - Reed Handlery
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States of America
| | - Jill C. Stewart
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States of America
| | - Joseph L. Pearson
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, South Carolina, United States of America
| | - Sara Wilcox
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States of America
| | - Stacy Fritz
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States of America
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Lee SC, Ko EJ, Lee JY, Hong AL. Safety and effectiveness of early cardiac rehabilitation in a stroke patient with heart failure and atrial fibrillation. Yeungnam Univ J Med 2021; 38:361-365. [PMID: 33752276 PMCID: PMC8688783 DOI: 10.12701/yujm.2020.00885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/06/2021] [Indexed: 11/14/2022] Open
Abstract
Stroke patients have reduced aerobic capacity. Therefore, intensive structured exercise programs are needed. We report the case of a patient with stroke and cardiac disease who underwent early inpatient cardiac rehabilitation (CR). A 38-year-old male patient with atrial fibrillation, heart failure, and cerebral infarction underwent a symptom-limited exercise tolerance test (ETT) without any problems on day 45 after admission. He completed a 2-week inpatient program and an 8-week home-based CR program. Follow-up ETT showed increased exercise capacity. The present case might be the first to report a safely performed CR program in a patient with stroke and cardiac comorbidity in Korea. Systematic guidance is needed for post-stroke patients to receive safe and effective CR for the secondary prevention of stroke and cardiovascular risk.
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Affiliation(s)
- Sang Cheol Lee
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju Yeon Lee
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.,Cardiac Rehabilitation Center, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ae Lee Hong
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.,Cardiac Rehabilitation Center, University of Ulsan College of Medicine, Ulsan, Korea
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Jeffares I, Merriman NA, Doyle F, Horgan F, Hickey A. Inclusion of stroke patients in expanded cardiac rehabilitation services: a cross-national qualitative study with cardiac and stroke rehabilitation professionals. Disabil Rehabil 2021; 44:3610-3622. [PMID: 33529535 DOI: 10.1080/09638288.2021.1874548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE This qualitative study explored healthcare professionals' views in relation to the potential expansion of cardiac rehabilitation services to include stroke patients, thereby becoming a cardiovascular rehabilitation model. DESIGN AND METHODS 23 semi-structured interviews were completed with hospital and community-based stroke and cardiac rehabilitation professionals in Switzerland (n = 7) and Ireland (n = 19). The sample comprised physiotherapists, occupational therapists, speech and language therapists, stroke physicians, cardiologists, psychologists, dieticians and nurses. Interviews were audio-recorded and the transcripts were analysed in NVivo using inductive Thematic Analysis. RESULTS Barriers and facilitators to cardiovascular rehabilitation were captured under four broad themes; (i) Cardiac rehabilitation as "low-hanging fruit," (ii) Cognitive impairment ("the elephant in the room"), (iii) Adapted cardiac rehabilitation for mild stroke, and (iv) Resistance to change. CONCLUSIONS Hybrid cardiac rehabilitation programmes could be tailored to deliver stroke-specific education, exercises and multidisciplinary expertise. Post-stroke cognitive impairment was identified as a key barrier to participation in cardiac rehabilitation. A cognitive rehabilitation intervention could potentially be delivered as part of cardiac rehabilitation, to address the cognitive needs of stroke and cardiac patients.Implications for rehabilitationThe cardiac rehabilitation model has the potential to be expanded to include mild stroke patients given the commonality of secondary prevention needs.Up to half of stroke survivors are affected by post-stroke cognitive impairment, consequently mild stroke patients may not be such an "easy fit" for cardiac rehabilitation.A cardiovascular programme which includes common rehabilitation modules, in addition to stroke- and cardiac-specific content is recommended.A cognitive rehabilitation module could potentially be added as part of the cardiac rehabilitation programme to address the cognitive needs of stroke and cardiac patients.
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Affiliation(s)
- Isabelle Jeffares
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh A Merriman
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Regan EW, Handlery R, Stewart JC, Pearson JL, Wilcox S, Fritz S. Integrating Survivors of Stroke Into Exercise-Based Cardiac Rehabilitation Improves Endurance and Functional Strength. J Am Heart Assoc 2021; 10:e017907. [PMID: 33499647 PMCID: PMC7955427 DOI: 10.1161/jaha.120.017907] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Cardiac rehabilitation (CR) is a structured exercise program prevalent in the United States for people with cardiovascular disease that has been shown to increase cardiovascular endurance and improve quality of life. Despite similar cardiovascular risk factors, stroke is not among the covered diagnoses for CR. The purpose of this study was to examine the participant impact of integrating survivors of stroke into the exercise portion of an existing hospital‐based CR program through measures of physical function and other health impacts and through qualitative evaluation of participant perception. Methods and Results Subacute and chronic survivors of stroke were integrated into a standard 12‐week, 3 sessions per week, exercise‐based CR program. A total of 29 began the program, 24 completed the program, and 18 were available for 6‐month follow‐up. Quantitative measures were compared preprogram with postprogram with t‐test or equivalent, and preprogram with postprogram to 6‐month follow‐up with ANOVA or equivalent. Semistructured interviews were completed with 11 participants postprogram. Exercise‐based CR had significant impacts on cardiovascular endurance preprogram to postprogram, with maintenance at 6‐month follow‐up. The participants improved on the 6‐minute walk test on average by 61.92 m(95% CI, 33.99–89.84 m), and maximum metabolic equivalents improved by a median of 3.6 (interquartile range, 2.35). Five times sit to stand (functional strength) improved preprogram to postprogram by a median of 2.85 s (interquartile range, 4.03 s). Qualitative findings highlight additional health improvements. Most participants (83% [15/18]) reported continued exercise at follow‐up. Conclusions Exercise‐based CR has the potential to improve cardiovascular endurance, health status, and quality of life for survivors of stroke. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03706105.
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Affiliation(s)
| | - Reed Handlery
- Exercise Science University of South Carolina Columbia SC
| | - Jill C Stewart
- Exercise Science University of South Carolina Columbia SC
| | - Joseph L Pearson
- Health Promotion, Education and Behavior University of South Carolina Columbia SC
| | - Sara Wilcox
- Exercise Science University of South Carolina Columbia SC
| | - Stacy Fritz
- Exercise Science University of South Carolina Columbia SC
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Acute Medical Conditions: Cardiopulmonary Disease, Medical Frailty, and Renal Failure. BRADDOM'S PHYSICAL MEDICINE AND REHABILITATION 2021. [PMCID: PMC7530618 DOI: 10.1016/b978-0-323-62539-5.00027-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jung C, Ye DH, Lee SH. Integrating Cardiac Rehabilitation with Neurorehabilitation in a Patient with Ischemic Stroke after Cardiac Surgery: a Case Report. BRAIN & NEUROREHABILITATION 2020; 14:e2. [PMID: 36742109 PMCID: PMC9879410 DOI: 10.12786/bn.2021.14.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/01/2020] [Accepted: 11/03/2020] [Indexed: 11/08/2022] Open
Abstract
Stroke and cardiac disorders are difficult to approach separately. Stroke survivors commonly have cardiovascular comorbidities and vice versa. These patients often need both neurorehabilitation and cardiac rehabilitation; therefore, this is an important issue in the rehabilitation process. However, no consensus has been reached on the integration of cardiac rehabilitation and neurorehabilitation. We report the case of a 52-year-old male patient who had ischemic stroke after mitral valvuloplasty. The patient underwent 3 weeks of inpatient neurorehabilitation, and then transited to 6 weeks of outpatient cardiac rehabilitation and occupational therapy. After 9 weeks of well-integrated rehabilitation, the patient experienced neurologic recovery and improvement in his cardiopulmonary fitness. Like this case, successful integrated rehabilitation will contribute to enhancing patients' functional recovery.
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Affiliation(s)
- Chul Jung
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Ye
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Baig S, Moyle B, Redgrave J, Majid A, Ali A. Exercise referral to promote cardiovascular health in stroke and TIA patients: a pilot feasibility study. BMJ Open Sport Exerc Med 2020; 6:e000929. [PMID: 33178448 PMCID: PMC7642611 DOI: 10.1136/bmjsem-2020-000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 11/06/2022] Open
Abstract
Objectives Exercise programmes studied after stroke often involve specialist supervision. Determine the feasibility and safety for people with stroke (PwS) or transient ischaemic attack (TIA) participating in readily accessible, non-stroke specialised, community-based exercise programmes. Methods Participants were recruited into a structured, group-based, 12-week programme of aerobic and resistance exercise delivered two times per week at one of five local leisure centres. Completion rates, successful attainment of intended exercise intensity (Borg Rating of Perceived Exertion (RPE)) and safety outcomes were recorded. Measures of physical activity (International Physical Activity Questionnaire), health-related quality of life (EQ-5D) and blood pressure (BP) were recorded at baseline and day 1 post intervention. Results 79% of participants completed >75% of the intended sessions, with >90% attainment of intended RPE. Exercise was safe with no serious and very few minor adverse events related to exercise. Exercise led to significant increases in EQ-5D (Best of Health p<0.001), levels of weekly moderate physical activity (p<0.001) and decreases in systolic BP (mean change [95% CI]=−5.4 mmHg [−2.84 to −7.96]; p<0.001). Conclusion Generalised exercise programmes delivered through existing local services, appears feasible, safe and may improve quality of life, physical activity and systolic BP, for PwS and TIA.
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Affiliation(s)
- Sheharyar Baig
- Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Bethany Moyle
- Department of Neurosciences, Sheffield NIHR Biomedical Research Centre, University of Sheffield, Sheffield, UK
| | - Jessica Redgrave
- Geriatrics and Stroke Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Arshad Majid
- Department of Neurosciences, Sheffield NIHR Biomedical Research Centre, University of Sheffield, Sheffield, UK
| | - Ali Ali
- Department of Neurosciences, Sheffield NIHR Biomedical Research Centre, University of Sheffield, Sheffield, UK.,Geriatrics and Stroke Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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A Gap in Post-Stroke Blood Pressure Target Attainment at Entry to Cardiac Rehabilitation. Can J Neurol Sci 2020; 48:487-495. [PMID: 33059775 DOI: 10.1017/cjn.2020.231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Recurrent events account for approximately one-third of all strokes and are associated with greater disability and mortality than first-time strokes. Blood pressure (BP) is the most important modifiable risk factor. Objectives were to determine the proportion of post-stroke patients enrolled in cardiac rehabilitation (CR) meeting systolic and diastolic BP (SBP/DBP) targets and to determine correlates of meeting these targets. METHODS A retrospective study of 1,804 consecutively enrolled post-stroke patients in a CR program was conducted. Baseline data (database records 2006-2017) included demographics, anthropometrics, clinical/medication history, and resting BP. Multivariate analyses determined predictors of achieving BP targets. RESULTS Mean age was 64.1 ± 12.7 years, median days from stroke 210 (IQR 392), with most patients being male (70.6%; n = 1273), overweight (66.8%; n = 1196), and 64.2% diagnosed with hypertension (n = 1159), and 11.8% (n = 213) with sleep apnea. A mean of 1.69 ± 1.2 antihypertensives were prescribed, with 26% (n = 469) of patients prescribed 3-4 antihypertensives. SBP target was met by 71% (n = 1281) of patients, 83.3% (n = 1502) met DBP target, and 64.3% (n = 1160) met both targets. Correlates of meeting SBP target were not having diabetes, younger age, fewer prescribed antihypertensives, and more recent program entry. Correlates of meeting DBP target were not having diabetes, older age, fewer prescribed antihypertensives, and more recent stroke. CONCLUSIONS Up to one-third of patients were not meeting BP targets. Patients with diabetes, and those prescribed multiple antihypertensives are at greater risk for poorly controlled SBP and DBP. Reasons for poor BP control such as untreated sleep apnea and medication non-adherence need to be investigated.
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Toma J, Hammond B, Chan V, Peacocke A, Salehi B, Jhingan P, Brooks D, Hébert AA, Marzolini S. Inclusion of People Poststroke in Cardiac Rehabilitation Programs in Canada: A Missed Opportunity for Referral. CJC Open 2020; 2:195-206. [PMID: 32695969 PMCID: PMC7365786 DOI: 10.1016/j.cjco.2020.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/29/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Evidence supports establishing a continuum of care from stroke rehabilitation (SR) to cardiac rehabilitation programs (CRPs). It is not known to what extent people poststroke are being integrated. This study aimed to determine the proportion of CRPs that accept referrals poststroke, barriers/facilitators, and eligibility criteria. METHODS A web-based questionnaire was sent to CRPs across Canada. RESULTS Of 160 questionnaires sent, 114 representatives (71%) of 130 CRPs responded. Of respondents, 65% (n = 74) reported accepting people with a diagnosis of stroke and doing so for a median of 11 years, 11 offering stroke-specific classes and an additional 6 planning inclusion. However, 62.5% of CRPs reported that < 11 patients participated in the last calendar year despite 88.5% reporting no limit to the number they could enroll. Among CRPs, 25% accepted only patients with concurrent cardiac diagnoses, living in the community (47.8%), and without severe mobility (70.1%), communication (80.6%), or cognitive (85.1%) deficits. The 2 most influential barriers and facilitators among all CRPs were funding and staffing. The fourth greatest barrier was lack of poststroke referrals, and third to sixth facilitators were SR/CRP collaboration to ensure appropriate referrals (third) and to increase referrals (sixth), toolkits for prescribing resistance (fourth), and aerobic training (fifth). CRP characteristics associated with accepting stroke were a hybrid program model, a medium program size, and having a falls prevention component. CONCLUSIONS Most CRPs accept patients poststroke, but few participate. Therefore, establishing SR/CRP partnerships to increase appropriate referrals, using a toolkit to help operationalize exercise components, and allocating funding/resources to CRPs may significantly increase access to secondary prevention strategies.
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Affiliation(s)
- Jelena Toma
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Brittany Hammond
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Vito Chan
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Alex Peacocke
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Baharak Salehi
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Prateek Jhingan
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada
- Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
| | | | - Susan Marzolini
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada
- Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
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17
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Institutional Guidelines for Resistance Exercise Training in Cardiovascular Disease: A Systematic Review. Sports Med 2020; 49:463-475. [PMID: 30701461 DOI: 10.1007/s40279-019-01059-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Institutional position stands are useful for practitioners when designing exercise routines for specific populations. Resistance training has been included in programs for patients with cardiovascular disease. OBJECTIVE The objective of this systematic review was to analyze institutional guidelines providing recommendations for resistance training applied to cardiovascular disease. METHODS PubMed, Web of Science, and Scopus databases were searched from inception until 30 April, 2018. RESULTS Of 994 articles initially found, 13 position stands were retained. Consensual indications occurred only for number of sets (one to three sets) and training frequency (two to three sessions/week). Recommendations concerning other major training variables were discordant regarding workload (none or loads ranging from < 30% up to 80% 1 repetition maximum) and exercise order (none or vaguely indicating alternation of muscle groups or circuit format), or insufficient regarding intervals between sets and exercises or number and type of exercises. Overall, guidelines lack recommendations of specific procedures for each type of disease at different severity levels, cardiovascular risk during exercise, or criteria for training progression. CONCLUSIONS Recommendations provided by institutional guidelines appear to be insufficient to support adequate resistance training prescription in the context of cardiovascular disease.
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Marzolini S, Fong K, Jagroop D, Neirinckx J, Liu J, Reyes R, Grace SL, Oh P, Colella TJF. Eligibility, Enrollment, and Completion of Exercise-Based Cardiac Rehabilitation Following Stroke Rehabilitation: What Are the Barriers? Phys Ther 2020; 100:44-56. [PMID: 31588512 DOI: 10.1093/ptj/pzz149] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/09/2019] [Accepted: 06/09/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND People after stroke benefit from comprehensive secondary prevention programs including cardiac rehabilitation (CR), yet there is little understanding of eligibility for exercise and barriers to use. OBJECTIVE The aim of this study was to examine eligibility for CR; enrollment, adherence, and completion; and factors affecting use. DESIGN This was a prospective study of 116 consecutive people enrolled in a single outpatient stroke rehabilitation (OSR) program located in Toronto, Ontario, Canada. METHODS Questionnaires were completed by treating physical therapists for consecutive participants receiving OSR and included reasons for CR ineligibility, reasons for declining participation, demographics, and functional level. CR eligibility criteria included the ability to walk ≥100 m (no time restriction) and the ability to exercise at home independently or with assistance. People with or without hemiplegic gait were eligible for adapted or traditional CR, respectively. Logistic regression analyses were used to examine factors associated with use indicators. RESULTS Of 116 participants receiving OSR, 82 (70.7%) were eligible for CR; 2 became eligible later. Sixty (71.4%) enrolled in CR and 49 (81.7%) completed CR, attending 87.1% (SD = 16.6%) of prescribed sessions. The primary reasons for ineligibility included being nonambulatory or having poor ambulation (52.9%; 18/34 patients) and having severe cognitive deficits and no home exercise support (20.6%; 7/34). Frequently cited reasons for declining CR were moving or travel out of country (17.2%; 5/29 reasons), lack of interest (13.8%; 4/29), transportation issues (10.3%; 3/29), and desiring a break from therapy (10.3%; 3/29). In a multivariate analysis, people who declined CR were more likely to be women, have poorer attendance at OSR, and not diabetic. Compared with traditional CR, stroke-adapted CR resulted in superior attendance (66.1% [SD = 22.9%] vs 87.1% [SD = 16.6%], respectively) and completion (66.7% vs 89.7%, respectively). The primary reasons for dropping out were medical (45%) and moving (27%). LIMITATIONS Generalizability to other programs is limited, and other, unmeasured factors may have affected outcomes. CONCLUSIONS An OSR-CR partnership provided an effective continuum of care, with approximately 75% of eligible people participating and more than 80% completing. However, just over 1 of 4 eligible people declined participation; therefore, strategies should target lack of interest, transportation, women, and people without diabetes. An alternative program model is needed for people who have severe ambulatory or cognitive deficits and no home exercise support.
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Affiliation(s)
- Susan Marzolini
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada; University of Toronto, Ontario, Canada; and York University, Toronto, Ontario, Canada
| | - Karen Fong
- Toronto Rehabilitation Institute, University Health Network
| | - David Jagroop
- Toronto Rehabilitation Institute, University Health Network
| | | | - Jean Liu
- Toronto Rehabilitation Institute, University Health Network
| | - Rina Reyes
- Toronto Rehabilitation Institute, University Health Network
| | - Sherry L Grace
- Toronto Rehabilitation Institute, University Health Network; and York University
| | - Paul Oh
- Toronto Rehabilitation Institute, University Health Network; and Canadian Partnership for Stroke Recovery
| | - Tracey J F Colella
- Toronto Rehabilitation Institute, University Health Network; and University of Toronto
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Lavie CJ, Ozemek C, Carbone S, Kachur S. Sustaining Improvements in Cardiorespiratory Fitness and Muscular Strength in Cardiac Rehabilitation. Can J Cardiol 2019; 35:1275-1277. [DOI: 10.1016/j.cjca.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/09/2019] [Accepted: 06/10/2019] [Indexed: 01/07/2023] Open
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Regan EW, Handlery R, Beets MW, Fritz SL. Are Aerobic Programs Similar in Design to Cardiac Rehabilitation Beneficial for Survivors of Stroke? A Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 8:e012761. [PMID: 31409176 PMCID: PMC6759893 DOI: 10.1161/jaha.119.012761] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/18/2019] [Indexed: 01/17/2023]
Abstract
Background Survivors of stroke face movement disability and increased cardiovascular disease and stroke risk. Treatment includes rehabilitation focused on functional movement with less emphasis on aerobic capacity. After rehabilitation, survivors of stroke must self-manage activity with limited appropriate community programs. Lack of structured activity contributes to sedentary behavior. The objective of this systematic review and meta-analysis is to review aerobic programs for stroke survivors similar in activity and dosage to cardiac rehabilitation programs to determine their efficacy for improving aerobic and walking capacity. Methods and Results Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to review 5 databases. Group interventions for survivors of stroke with a primary aerobic component and dosage from 18 to 36 visits over 8 to 18 weeks (matching cardiac rehabilitation requirements in the United States) were included. The 6-minute walk test, maximal oxygen consumption (VO2) peak, and walking speed were included as measures of aerobic capacity. Summary effect sizes and outcome measure mean differences were calculated for preintervention to postintervention, and summary effect sizes were calculated for preintervention to follow-up. Activity type and initial 6-minute walk test moderator analyses were performed. Nineteen studies with 23 eligible groups were selected. Survivors of stroke improved their composite aerobic capacity with an effect size of 0.38 (95% CI, 0.27-0.49). Studies including 6-minute walk test demonstrated a pooled difference in means of 53.3 m (95% CI, 36.8-69.8 m). Follow-up data were inconclusive. Conclusions Survivors of stroke benefit from aerobic programs with similar dosing to cardiac rehabilitation in the United States. The potential integration into existing programs could expand the community exercise options.
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Affiliation(s)
| | - Reed Handlery
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSC
| | - Michael W. Beets
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSC
| | - Stacy L. Fritz
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSC
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