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Chen X, Yin L, Hou Y, Wang J, Li Y, Yan J, Tao J, Ma S. Effect of robot-assisted gait training on improving cardiopulmonary function in stroke patients: a meta-analysis. J Neuroeng Rehabil 2024; 21:92. [PMID: 38816728 PMCID: PMC11138000 DOI: 10.1186/s12984-024-01388-9] [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: 12/12/2023] [Accepted: 05/20/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE Understanding the characteristics related to cardiorespiratory fitness after stroke can provide reference values for patients in clinical rehabilitation exercise. This meta- analysis aimed to investigate the effect of robot-assisted gait training in improving cardiorespiratory fitness in post-stroke patients, compared to conventional rehabilitation training. METHODS PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, CBM, CNKI and Wanfang databases were searched until March 18th, 2024. Randomized controlled trials (RCTs) comparing the effectiveness of robot-assisted gait training versus control group were included. The main outcome variable was peak oxygen uptake. 6-minute walking test, peak heart rate, peak inspiratory expiratory ratio as our secondary indicators. RevMan 5.3 software was used for statistical analysis. RESULTS A total of 17 articles were included, involving 689 subjects. The results showed a significant effect for robot-assisted gait training to improve VO2peak (MD = 1.85; 95% CI: -0.13 to 3.57; p = 0.04) and 6WMT (MD = 19.26; 95% CI: 10.43 to 28.08; p < 0.0001). However, no significant difference favouring robot-assisted gait training were found in HRpeak (MD = 3.56; 95% CI: -1.90 to 9.02; p = 0.20) and RERpeak (MD = -0.01; 95% CI: -0.04 to 0.01; p = 0.34). CONCLUSION These results showed that robot-assisted gait training may have a beneficial effect in improving VO2peak and 6WMT, with a moderate recommendation level according to the GRADE guidelines.
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Affiliation(s)
- Xiao Chen
- Department of Rehabilitation Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lu Yin
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yangbo Hou
- Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Wang
- Rehabilitation department of traditional Chinese Medicine, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Yongyi Li
- Rehabilitation department of traditional Chinese Medicine, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Juntao Yan
- Department of Tuina, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Jiming Tao
- Department of Rehabilitation Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Shujie Ma
- Rehabilitation department of traditional Chinese Medicine, The Second Rehabilitation Hospital of Shanghai, Shanghai, China.
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Wang C, Xu Y, Zhang L, Fan W, Liu Z, Yong M, Wu L. Comparative efficacy of different exercise methods to improve cardiopulmonary function in stroke patients: a network meta-analysis of randomized controlled trials. Front Neurol 2024; 15:1288032. [PMID: 38313560 PMCID: PMC10836840 DOI: 10.3389/fneur.2024.1288032] [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: 09/03/2023] [Accepted: 01/05/2024] [Indexed: 02/06/2024] Open
Abstract
Background Although some studies have shown that exercise has a good effect on improving the cardiopulmonary function of stroke patients, it still needs to be determined which exercise method does this more effectively. We, therefore, aimed to evaluate the effectiveness of different exercise methods in improving cardiovascular function in stroke patients through a network meta-analysis (NMA), providing a basis to select the best treatment plan for stroke patients. Methods We systematically searched CNKI, WanFang, VIP, CBM, PubMed, Embase, Web of Science, and The Cochrane Library databases from establishment to 30 April 2023. Randomized controlled trials (RCTS) on exercise improving cardiopulmonary function in stroke patients were included, and we screened the included articles and extracted the relevant data. RevMan (version 5.4) and Stata (version 17.0) were used for data analysis. Results We included 35 RCTs and a total of 2,008 subjects. Intervention measures included high-intensity interval training (HIIT), aerobic training (AT), resistance training (RT), combined aerobic and resistance exercise (CE), and conventional therapy (CT). In the network meta-analysis, the surface under the cumulative ranking area (SUCRA) ranking result indicated that HIIT improved peak oxygen uptake (VO2peak) and 6 mins walking distance (6MWD) optimally, with rankings of HIIT (100.0%) > CE (70.5%) > AT (50.2%) > RT (27.7%) > CT (1.6%), and HIIT (90.9%) > RT (60.6%) > AT (48.9%) > RT (48.1%) > CT (1.5%), respectively. The SUCRA ranking result showed that CE improved systolic blood pressure (SBP) and diastolic blood pressure (DBP) optimally, with rankings of CE (82.1%) > HIIT (49.8%) > AT (35.3%) > CT (32.8%), and CE (86.7%) > AT (45.0%) > HIIT (39.5%) > CT (28.8%), respectively. Conclusion We showed that exercise can effectively improve the cardiopulmonary function of stroke patients. HIIT was the most effective in improving VO2peak and 6MWD in stroke patients. CE was the most effective in improving SBP and DBP in stroke patients. However, due to the limitations of existing clinical studies and evidence, larger sample size, multi-center, and high-quality RCTs are needed to verify the above conclusions in the future. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier [CRD42023436773].
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Affiliation(s)
- Chengshuo Wang
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise & Health, Tianjin University of Sport, Tianjin, China
- Beijing Xiaotangshan Hospital, Beijing, China
| | - Yanan Xu
- Beijing Xiaotangshan Hospital, Beijing, China
| | - Linli Zhang
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise & Health, Tianjin University of Sport, Tianjin, China
| | - Weijiao Fan
- Beijing Xiaotangshan Hospital, Beijing, China
| | - Zejian Liu
- Beijing Xiaotangshan Hospital, Beijing, China
| | - Mingjin Yong
- Department of Rehabilitation, Lianyungang Hospital of Traditional Chinese Medicine, Lianyungang, China
| | - Liang Wu
- Beijing Xiaotangshan Hospital, Beijing, China
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Rodríguez A, Amaya-Pascasio L, Gutiérrez-Fernández M, García-Pinteño J, Moreno M, Martínez-Sánchez P. Non-invasive brain stimulation for functional recovery in animal models of stroke: A systematic review. Neurosci Biobehav Rev 2024; 156:105485. [PMID: 38042359 DOI: 10.1016/j.neubiorev.2023.105485] [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: 09/26/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
Motor and cognitive dysfunction occur frequently after stroke, severely affecting a patient´s quality of life. Recently, non-invasive brain stimulation (NIBS) has emerged as a promising treatment option for improving stroke recovery. In this context, animal models are needed to improve the therapeutic use of NIBS after stroke. A systematic review was conducted based on the PRISMA statement. Data from 26 studies comprising rodent models of ischemic stroke treated with different NIBS techniques were included. The SYRCLE tool was used to assess study bias. The results suggest that both repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) improved overall neurological, motor, and cognitive functions and reduced infarct size both in the short- and long-term. For tDCS, it was observed that either ipsilesional inhibition or contralesional stimulation consistently led to functional recovery. Additionally, the application of early tDCS appeared to be more effective than late stimulation, and tDCS may be slightly superior to rTMS. The optimal stimulation protocol and the ideal time window for intervention remain unresolved. Future directions are discussed for improving study quality and increasing their translational potential.
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Affiliation(s)
- Antonio Rodríguez
- Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Torrecárdenas University Hospital, Almería, Spain; Stroke Unit, Department of Neurology, Torrecárdenas University Hospital, Almería, Spain
| | - Laura Amaya-Pascasio
- Stroke Unit, Department of Neurology, Torrecárdenas University Hospital, Almería, Spain
| | - María Gutiérrez-Fernández
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, Neurology and Cerebrovascular Disease Group, Neuroscience Area of Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - José García-Pinteño
- Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Torrecárdenas University Hospital, Almería, Spain; Stroke Unit, Department of Neurology, Torrecárdenas University Hospital, Almería, Spain
| | - Margarita Moreno
- Department of Psychology, Faculty of Health Science, University of Almería, Spain; Health Research Center (CEINSA), University of Almería, Spain.
| | - Patricia Martínez-Sánchez
- Stroke Unit, Department of Neurology, Torrecárdenas University Hospital, Almería, Spain; Health Research Center (CEINSA), University of Almería, Spain; Department of Nursing, Physiotherapy and Medicine, Faculty of Health Science, University of Almería, Spain.
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Gutierrez-Arias R, González-Mondaca C, Marinkovic-Riffo V, Ortiz-Puebla M, Paillán-Reyes F, Seron P. Measures to ensure safety during telerehabilitation of people with stroke: A scoping review. J Telemed Telecare 2023:1357633X231181426. [PMID: 37321644 DOI: 10.1177/1357633x231181426] [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: 06/17/2023]
Abstract
BACKGROUND Measures used to prevent adverse events during the implementation of exercise sessions delivered via telerehabilitation can be varied, ranging from simple telephone monitoring to synchronous therapist-led sessions. However, this information is scattered in the literature, as evidence synthesis studies have only addressed the safety, satisfaction, and effectiveness aspects of exercise delivered via telerehabilitation. AIMS This scoping review aims to describe that measures are used to ensure safety during exercise sessions delivered to people with stroke through telerehabilitation, as reported by authors of primary studies. Secondarily, it describes the designs most frequently used to notify the effects of telerehabilitation and evidence level, the characteristics of the participants and type of stroke, and the characteristics of telerehabilitation. SUMMARY OF REVIEW A scoping review was conducted according to the Joana Briggs Institute (JBI) recommendations. A systematic search of MEDLINE (Ovid), Embase (Ovid), CENTRAL, and CINHAL was conducted from inception to August 2022, and a review of systematic review references on the topic. We included primary studies that enrolled adults with stroke who underwent exercise delivered via telerehabilitation. Two independent reviewers performed study selection and data extraction, and disagreements were resolved by consensus or a third reviewer. A qualitative analysis of the information was performed. One hundred seven primary studies (3991 participants) published between 2002 and 2022 were included. Most studies were case series (43%) and rated with an Oxford level of evidence of "4" (55.3%). Regarding randomized clinical trials, half included 53 or more participants (IQR 26.75 to 81). Most studies applied the exercises via asynchronous telerehabilitation (55.1%), of which only ten reported measures to avoid adverse events. Some of the measures included assessing the location where exercises are to be performed, only using a seated position, and using live warning systems that prevent or stop exercises when they are risky. CONCLUSIONS Reporting of measures implemented to prevent adverse events during exercise delivery via asynchronous telerehabilitation is scarce. Future primary studies should always consider reporting adverse events related to exercise delivery via telerehabilitation and strategies implemented to decrease the incidence of these unwanted safety events. REGISTRATION NUMBER INPLASY202290104.
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Affiliation(s)
- Ruvistay Gutierrez-Arias
- Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago, Chile
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences,Universidad Andres Bello, Santiago, Chile
| | - Camila González-Mondaca
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences,Universidad Andres Bello, Santiago, Chile
| | - Vinka Marinkovic-Riffo
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences,Universidad Andres Bello, Santiago, Chile
| | - Marietta Ortiz-Puebla
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences,Universidad Andres Bello, Santiago, Chile
| | - Fernanda Paillán-Reyes
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences,Universidad Andres Bello, Santiago, Chile
| | - Pamela Seron
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
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Blokland IJ, Schiphorst LFA, Stroek JR, Groot FP, van Bennekom CAM, van Dieen JH, de Koning JJ, Houdijk H. Relative Aerobic Load of Daily Activities After Stroke. Phys Ther 2023; 103:pzad005. [PMID: 37172129 PMCID: PMC10071588 DOI: 10.1093/ptj/pzad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/31/2022] [Accepted: 01/16/2023] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Individuals after stroke are less active, experience more fatigue, and perform activities at a slower pace than peers with no impairments. These problems might be caused by an increased aerobic energy expenditure during daily tasks and a decreased aerobic capacity after stroke. The aim of this study was to quantify relative aerobic load (ie, the ratio between aerobic energy expenditure and aerobic capacity) during daily-life activities after stroke. METHODS Seventy-nine individuals after stroke (14 in Functional Ambulation Category [FAC] 3, 25 in FAC 4, and 40 in FAC 5) and 22 peers matched for age, sex, and body mass index performed a maximal exercise test and 5 daily-life activities at a preferred pace for 5 minutes. Aerobic energy expenditure (mL O2/kg/min) and economy (mL O2/kg/unit of distance) were derived from oxygen uptake ($\dot{\mathrm{V}}{\mathrm{O}}_2$). Relative aerobic load was defined as aerobic energy expenditure divided by peak aerobic capacity (%$\dot{\mathrm{V}}{\mathrm{O}}_2$peak) and by $\dot{\mathrm{V}}{\mathrm{o}}_2$ at the ventilatory threshold (%$\dot{\mathrm{V}}{\mathrm{o}}_2$-VT) and compared in individuals after stroke and individuals with no impairments. RESULTS Individuals after stroke performed activities at a significantly higher relative aerobic load (39%-82% $\dot{\mathrm{V}}{\mathrm{o}}_2$peak) than peers with no impairments (38%-66% $\dot{\mathrm{V}}{\mathrm{o}}_2$peak), despite moving at a significantly slower pace. Aerobic capacity in individuals after stroke was significantly lower than that in peers with no impairments. Movement was less economical in individuals after stroke than in peers with no impairments. CONCLUSION Individuals after stroke experience a high relative aerobic load during cyclic daily-life activities, despite adopting a slower movement pace than peers with no impairments. Perhaps individuals after stroke limit their movement pace to operate at sustainable relative aerobic load levels at the expense of pace and economy. IMPACT Improving aerobic capacity through structured aerobic training in a rehabilitation program should be further investigated as a potential intervention to improve mobility and functioning after stroke.
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Affiliation(s)
- Ilse J Blokland
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Heliomare Research and Development, Heliomare, Wijkaan Zee, The Netherlands
| | - Linda F A Schiphorst
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Heliomare Research and Development, Heliomare, Wijkaan Zee, The Netherlands
| | - Jessie R Stroek
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Heliomare Research and Development, Heliomare, Wijkaan Zee, The Netherlands
| | | | - Coen A M van Bennekom
- Coronel Institute of Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap H van Dieen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Jos J de Koning
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Han Houdijk
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
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Hyngstrom AS, Nguyen JN, Uhrich TD, Wright MT, Gutterman DD, Schmit BD, Durand MJ. Quantification of Tissue Oxygen Saturation in the Vastus Lateralis Muscle of Chronic Stroke Survivors during a Graded Exercise Test. Cardiopulm Phys Ther J 2023; 34:39-50. [PMID: 36816465 PMCID: PMC9937433 DOI: 10.1097/cpt.0000000000000208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose This study examined tissue oxygen saturation (StO2) of the vastus lateralis (VL) muscles of chronic stroke survivors during a graded exercise test (GXT). We hypothesized the reduction in StO2 will be blunted in the paretic vs. non-paretic VL during a maximum-effort GXT. Methods Chronic stroke survivors performed a GXT and StO2 of the VL in each leg was measured using near infrared spectroscopy. Twenty-six stroke survivors performed a GXT. Results At rest, there was no difference in StO2 between the paretic and non-paretic VL (65±9% vs. 68±7%, respectively, p=0.32). The maximum change in StO2 from rest during the GXT was greater in the non-paretic vs. the paretic VL (-16±14% vs. -9±10%, respectively, p<0.001). The magnitude of the oxygen resaturation response was also greater in the non-paretic vs. the paretic VL (29±23% vs. 18±15%, respectively, p<0.001). VO2 Peak was associated with the magnitude of the VL StO2 change during (r2=0.54, p<0.0001) and after (r2=0.56, p<0.001) the GXT. Conclusions During a GXT there is a blunted oxygen desaturation response in the paretic vs. the non-paretic VL of chronic stroke survivors. In the paretic VL there was a positive correlation between the oxygen desaturation response during the GXT and VO2 Peak.
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Affiliation(s)
| | - Jennifer N. Nguyen
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Toni D. Uhrich
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
| | - Michael T. Wright
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David D. Gutterman
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brian D. Schmit
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Matthew J. Durand
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA
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Lee KE, Choi M, Jeoung B. Effectiveness of Rehabilitation Exercise in Improving Physical Function of Stroke Patients: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12739. [PMID: 36232038 PMCID: PMC9566624 DOI: 10.3390/ijerph191912739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/24/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Rehabilitation is a crucial part of recovery for stroke survivors, and numerous studies have examined various exercises and treatments of stroke. In addition, it is very important for patients to choose the timing of rehabilitation and what kind of rehabilitation they will proceed with. The purpose of the current study is to examine research investigating the effects of rehabilitation exercise programs in recovery of physical function in patients with stroke, based on aspects of their physical function, physical strength, and daily activities, and systematically examine their effects. Therefore, through systematic review, we have investigated the effects of interventions in rehabilitation exercise programs for recovery of physical function in patients with stroke. We collected relevant publications through the databases MEDLINE/PubMed and Google scholar. Twenty-one articles were ultimately selected for the analysis. We classified the rehabilitation programs and identified the trends of treatment for stroke survivors. Our review indicated that task-oriented therapy is still dominant, but various types of combined rehabilitations have been attempted. In addition, it was identified that physical and active rehabilitation were required rather than unconditional rest, even at an early stage. Home-based treatment was used for rapid recovery and adaptation to daily life during the mid-term period.
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Affiliation(s)
- Kyung Eun Lee
- Department Sport Industry Studies, Yonsei University, Seoul 03722, Korea
| | - Muncheong Choi
- Department Exercise Rehabilitation, Gachon University, Incheon 21936, Korea
| | - Bogja Jeoung
- Department Exercise Rehabilitation, Gachon University, Incheon 21936, Korea
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Huang SC, Hsu CC, Fu TC, Chen CPC, Liao MF, Hsu CY, Wang JS. Stepper-Based Training Improves Monocyte-Platelet Aggregation and Thrombin Generation in Nonambulatory Hemiplegic Patients. Med Sci Sports Exerc 2022; 54:821-829. [PMID: 34935707 DOI: 10.1249/mss.0000000000002846] [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: 11/21/2022]
Abstract
PURPOSE Nonambulatory stroke patients are extremely sedentary, but most available data concerning exercise training in stroke patients are related to ambulatory patients. This study aimed to investigate the efficacy of stepper-based exercise training on cardiopulmonary fitness, monocyte subtypes, and associated monocyte-platelet aggregates (MPA) and thrombin generation (TrG) in nonambulatory hemiplegic patients with ischemic stroke. METHOD Thirty-eight patients were randomized into exercise training (ET, n = 20) and usual care (UC, n = 18) groups. The ET underwent supervised exercise training (60% peak work rate) using a recumbent stepper for two to four sessions per week and 36 sessions in total. In addition, 12 healthy participants were enrolled as healthy controls. Monocyte characteristics, MPA, and plasma TrG kinetics were determined before and after intervention by flow cytometry and calibrated automated thrombogram® (CAT). RESULTS Seventeen and 15 patients completed the protocol in the ET and UC groups. Peak V̇O2 improved in ET (15.7 ± 4.8 vs 18.9 ± 5.3 mL·min-1·kg-1, +20%), so did the phase angle of the hemiplegic limbs. The counts of total MPA and MPA associated with three monocyte subtypes, alongside CD42b expression all declined in ET with subtypes 2 and 1 being the most prominent. Macrophage inflammatory protein 1β (MIP-1 β) level also declined. The TrG kinetics was attenuated after ET by delaying initiation and reducing the rising slope and peak of thrombin production. In UC, no difference was revealed in the pre-post comparison. CONCLUSIONS Stepper-based ET is feasible in nonambulatory hemiplegic patients and is effective in improving aerobic fitness. Moreover, it decreases heteroaggregation of monocytes with platelets, especially in monocyte subtypes 2 and 1. Thrombin generation was also attenuated. Hence, stepper-based ET may be incorporated in the rehabilitation of nonambulatory hemiplegic patients.
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Affiliation(s)
| | | | | | | | - Ming-Feng Liao
- Department of Neurology, Chang Gung Memorial Hospital, Linkuo, TAIWAN
| | - Chien-Ya Hsu
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Linkou, TAIWAN
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Azharuddin M, Zia NU. Correlation between sit-to-stand ability, dynamic balance, gait speed, and quality of life in stroke population: a non-randomized pilot study. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2021. [DOI: 10.1186/s43161-021-00043-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
“Sit to stand” being a prerequisite for walking, the inability of patients to perform it can result in institutionalization, impaired functioning and mobility in activities of daily living. There was a need to find out whether “sit to stand” ability correlates with gait speed, dynamic balance, and quality of life in stroke patients. It is a pilot study in which sixteen sub-acute and chronic stroke (˃ 6 months) patients aged 45 to 65 years with the ability to walk at least 10 m, Mini Mental State Examination (MMSE) score ˃ 27 were included. Patients with musculoskeletal impairments of lower extremity which would affect walking were excluded from the study. Each patient performed five times sit to stand (5TSTS) from a standard chair and time taken was recorded. Timed up and go (TUG) test and 10-m walk test (10MWT) were used to measure the dynamic balance and gait speed respectively. Stroke Adapted Sickness Impact Profile-30 (SASIP-30) scale was used to determine the quality of life of the patients.
Results
Correlation between the outcomes of the variables was analyzed using Pearson correlation co-efficient. The 5TSTS scores showed strong positive correlation to TUG (r = 0.823, P < .000) and SASIP-30 (r = 0.841, P < .000). However, moderately strong negative relationship was found between 5TSTS and gait speed (r = −0.639, P < .008).
Conclusion
The study concludes that change in the 5TSTS performance can affect motor functions like dynamic balance and gait as well as quality of life. Exercise training focusing on sit-to-stand ability may also influence activities of daily living (ADLs) after stroke.
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Kim E, Anguluan E, Kum J, Sanchez-Casanova J, Park TY, Kim JG, Kim H. Wearable Transcranial Ultrasound System for Remote Stimulation of Freely Moving Animal. IEEE Trans Biomed Eng 2021; 68:2195-2202. [PMID: 33186099 DOI: 10.1109/tbme.2020.3038018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Transcranial focused ultrasound (tFUS) has drawn considerable attention in the neuroscience field as a noninvasive approach to modulate brain circuits. However, the conventional approach requires the use of anesthetized or immobilized animal models, which places considerable restrictions on behavior and affects treatment. Thus, this work presents a wireless, wearable system to achieve ultrasound brain stimulation in freely behaving animals. METHODS The wearable tFUS system was developed based on a microcontroller and amplifier circuit. Brain activity induced by tFUS was monitored through cerebral hemodynamic changes using near-infrared spectroscopy. The system was also applied to stroke rehabilitation after temporal middle cerebral artery occlusion (tMCAO) in rats. Temperature calculations and histological results showed the safety of the application even with prolonged 40 min sonication. RESULTS The output ultrasonic wave produced from a custom PZT transducer had a central frequency of 457 kHz and peak to peak pressure of 426 kPa. The device weight was 20 g, allowing a full range of motion. The stimulation was found to induce hemodynamic changes in the sonicated area, while open-field tests showed that ultrasound applied to the ipsilateral hemisphere for 5 consecutive days after the stroke facilitated recovery. CONCLUSION The wearable tFUS system has been designed and implemented on moving rats. The results showed the ability of device to cause both short- and long lasting effects. SIGNIFICANCE The proposed device provides a more natural environment to investigate the effects of tFUS for behavioral and long-term studies.
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Huang SC, Hsu CC, Fu TC, Chen CPC, Liao MF, Hsu YH, Wang JS. Application of stepper in cardiopulmonary exercise test for patients with hemiplegia. Medicine (Baltimore) 2020; 99:e21058. [PMID: 32664120 PMCID: PMC7360193 DOI: 10.1097/md.0000000000021058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A method to perform exercise testing for patients with hemiplegia is unavailable though over half of them have cardio-pulmonary disorders. We aimed to assess the reliability and validity of using a stepper in cardiopulmonary exercise testing (CPET) in this population.14 stroke patients with hemiplegia who failed to ride the stationary bike were included. Exclusion criteria included manual muscle strength ≦1 in the lower extremity, and conventional contraindications of CPET. They underwent CPET twice by using a stepper to evaluate test-retest reliability and validity. Additionally, 10 healthy participants underwent CPET twice on the cycle ergometer and stepper respectively.In the test-retest, the ratio of two-time difference to mean was 5.0, 3, 11.3 and 12.0% on average for peak oxygen consumption, peak heart rate (HR), anaerobic threshold and minute ventilation - carbonic dioxide production slope respectively. Cronbach's alpha coefficient of peak oxygen consumption and anaerobic threshold were 0.992 and 0.919. In the stepper exercise testing of the hemiplegic participants, the ratio of peak HR to age-predicted maximal HR was 75% on average. Peak respiratory exchange ratio (mean ± standard deviation = 1.17 ± 0.08) was not different from that of healthy controls (1.21 ± 0.09). Notably, VO2 trajectory in relation to work rate is nonlinear and different in the rest-retest.This is the first research to study CPET variables in detail using stepper in patients with hemiplegia. CPET variables associated with peak are valid and reliable; nonetheless, those with sub-maximum are not. The study provides a method to do exercise testing for the patients with hemiplegia and its notice in application.
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Affiliation(s)
- Shu-Chun Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkuo
- Healthy Aging Research Center
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City
- Department of Physical Medicine and Rehabilitation, New Taipei Municipal Tucheng Hospital, Chang Gung Memorial Hospital, New Taipei, Taiwan
| | - Chih-Chin Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung
| | - Tieh-Cheng Fu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung
| | - Carl PC Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkuo
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City
| | - Ming-Feng Liao
- Department of Neurology, Chang Gung Memorial Hospital, Linkuo
| | - Yi-Hsuan Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkuo
| | - Jong-Shyan Wang
- Healthy Aging Research Center
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan
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12
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Abstract
Stroke is a leading cause of mortality and morbidity all around the world. Identification of stroke risk factors and protective lifestyles is necessary for optimizing personalized treatment and reducing mortality. Sedentary lifestyle is a well-known modifiable risk factor in primary and secondary stroke prevention. Also, in recent years, exercise has been described as a neuroprotective and neuroreparative factor. Here we summarized the existing available evidence of the relationship between physical activity and stroke.
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13
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Gaskins NJ, Bray E, Hill JE, Doherty PJ, Harrison A, Connell LA. Factors influencing implementation of aerobic exercise after stroke: a systematic review. Disabil Rehabil 2019; 43:2382-2396. [DOI: 10.1080/09638288.2019.1704075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Nicola J. Gaskins
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - Emma Bray
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - James E. Hill
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | | | | | - Louise A. Connell
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
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Bunketorp-Käll L, Pekna M, Pekny M, Blomstrand C, Nilsson M. Effects of horse-riding therapy and rhythm and music-based therapy on functional mobility in late phase after stroke. NeuroRehabilitation 2019; 45:483-492. [PMID: 31868694 PMCID: PMC7029334 DOI: 10.3233/nre-192905] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Persons with stroke commonly have residual neurological deficits that seriously hamper mobility. OBJECTIVE To investigate whether horse-riding therapy (H-RT) and rhythm and music-based therapy (R-MT) affect functional mobility in late phase after stroke. METHODS This study is part of a randomized controlled trial in which H-RT and R-MT was provided twice weekly for 12 weeks. Assessment included the timed 10-meter walk test (10 mWT), the six-minute walk test (6 MWT) and Modified Motor Assessment Scale (M-MAS). RESULTS 123 participants were assigned to H-RT (n = 41), R-MT (n = 41), or control (n = 41). Post-intervention, the H-RT group completed the 10 mWT faster at both self-selected (-2.22 seconds [95% CI, -3.55 to -0.88]; p = 0.001) and fast speed (-1.19 seconds [95% CI, -2.18 to -0.18]; p = 0.003), with fewer steps (-2.17 [95% CI, -3.30 to -1.04]; p = 0.002 and -1.40 [95% CI, -2.36 to -0.44]; p = 0.020, respectively), as compared to controls. The H-RT group also showed improvements in functional task performance as measured by M-MAS UAS (1.13 [95% CI, 0.74 to 1.52]; p = 0.001). The gains were partly maintained at 6 months among H-RT participants. The R-MT did not produce any immediate gains. However, 6 months post-intervention, the R-MT group performed better with respect to time; -0.75 seconds [95% CI, -1.36 to -0.14]; p = 0.035) and number of steps -0.76 [95% CI, -1.46 to -0.05]; p = 0.015) in the 10 mWT at self-selected speed. CONCLUSIONS The present study supports the efficacy of H-RT in producing immediate gains in gait and functional task performance in the late phase after stroke, whereas the effectiveness of R-MT is less clear.
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Affiliation(s)
- Lina Bunketorp-Käll
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Center for Advanced Reconstruction of Extremities C.A.R.E. Institute of Clinical Sciences, Sahlgrenska University Hospital/Mölndal, Sweden
| | - Marcela Pekna
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Australia
| | - Milos Pekny
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Australia
- University of Newcastle, New South Wales, Australia
| | - Christian Blomstrand
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Stroke Center West, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Michael Nilsson
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Australia
- Centre for Rehab Innovations (CRI), University of Newcastle and Hunter Medical Research Institute (HMRI) Newcastle, Australia
- LKC School of Medicine, Nanyang Technological University, Singapore
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Serra MC, Accardi CJ, Ma C, Park Y, Tran V, Jones DP, Hafer-Macko CE, Ryan AS. Metabolomics of Aerobic Exercise in Chronic Stroke Survivors: A Pilot Study. J Stroke Cerebrovasc Dis 2019; 28:104453. [PMID: 31668688 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/09/2019] [Accepted: 09/27/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Understanding the metabolic response to exercise may aid in optimizing stroke management. Therefore, the purpose of this pilot study was to evaluate plasma metabolomic profiles in chronic stroke survivors following aerobic exercise training. METHODS Participants (age: 62 ± 1 years, body mass index: 31 ± 1 kg/m2, mean ± standard error of the mean) were randomized to 6 months of treadmill exercise (N = 17) or whole-body stretching (N = 8) with preintervention and postintervention measurement of aerobic capacity (VO2peak). Linear models for microarray data expression analysis was performed to determine metabolic changes over time, and Mummichog was used for pathway enrichment analysis following analysis of plasma samples by high-performance liquid chromatography coupled to ultrahigh resolution mass spectrometry. RESULTS VO2peak change was greater following exercise than stretching (18.9% versus -.2%; P < .01). Pathway enrichment analysis of differentially expressed metabolites results showed significant enrichment in 4 pathways following treadmill exercise, 3 of which (heparan-, chondroitin-, keratan-sulfate degradation) involved connective tissue metabolism and the fourth involve lipid signaling (linoleate metabolism). More pathways were altered in pre and post comparisons of stretching, including branched-chain amino acid, tryptophan, tyrosine, and urea cycle, which could indicate loss of lean body mass. CONCLUSIONS These preliminary data show different metabolic changes due to treadmill training and stretching in chronic stroke survivors and suggest that in addition to improved aerobic capacity, weight-bearing activity, like walking, could protect against loss of lean body mass. Future studies are needed to examine the relationship between changes in metabolomic profiles to reductions in cardiometabolic risk after treadmill rehabilitation.
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Affiliation(s)
- Monica C Serra
- San Antonio GRECC, South Texas VA and the Division of Geriatrics, Gerontology & Palliative Medicine and the Sam & Ann Barshop Institute for Longevity & Aging Studies, UT Health San Antonio, San Antonio, Texas.
| | - Carolyn J Accardi
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Chunyu Ma
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Younja Park
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia; College of Pharmacy, Korea University, Sejong City, Korea
| | - ViLinh Tran
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Dean P Jones
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Charlene E Hafer-Macko
- Baltimore VA Research Service and GRECC and the Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alice S Ryan
- Baltimore VA Research Service and GRECC and the Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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MacKay-Lyons M, Billinger SA, Eng JJ, Dromerick A, Giacomantonio N, Hafer-Macko C, Macko R, Nguyen E, Prior P, Suskin N, Tang A, Thornton M, Unsworth K. Aerobic Exercise Recommendations to Optimize Best Practices in Care After Stroke: AEROBICS 2019 Update. Phys Ther 2019; 100:149-156. [PMID: 31596465 PMCID: PMC8204880 DOI: 10.1093/ptj/pzz153] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 09/18/2018] [Accepted: 06/09/2019] [Indexed: 01/18/2023]
Abstract
Most stroke survivors have very low levels of cardiovascular fitness, which limits mobility and leads to further physical deconditioning, increased sedentary behavior, and heightened risk of recurrent stroke. Although clinical guidelines recommend that aerobic exercise be a part of routine stroke rehabilitation, clinical uptake has been suboptimal. In 2013, an international group of stroke rehabilitation experts developed a user-friendly set of recommendations to guide screening and prescription-the Aerobic Exercise Recommendations to Optimize Best Practices in Care after Stroke (AEROBICS 2013). The objective of this project was to update AEROBICS 2013 using the highest quality of evidence currently available. The first step was to conduct a comprehensive review of literature from 2012 to 2018 related to aerobic exercise poststroke. A working group of the original consensus panel members drafted revisions based on synthesis. An iterative process was used to achieve agreement among all panel members. Final revisions included: (1) addition of 115 new references to replace or augment those in the original AEROBICS document, (2) rewording of the original recommendations and supporting material, and (3) addition of 2 new recommendations regarding prescription. The quality of evidence from which these recommendations were derived ranged from low to high. The AEROBICS 2019 Update should make it easier for clinicians to screen for, and prescribe, aerobic exercise in stroke rehabilitation. Clinical implementation will not only help to narrow the gap between evidence and practice but also reduce current variability and uncertainty regarding the role of aerobic exercise in recovery after stroke.
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Affiliation(s)
| | - Sandra A Billinger
- Physical Therapy and Rehab Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Dromerick
- Department of Neurology, Pasquerilla Healthcare Center, Washington, DC
| | | | - Charlene Hafer-Macko
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Richard Macko
- Department Neurology, VA Maryland Health Care System, Baltimore, Maryland
| | | | - Peter Prior
- Department of Psychology, St. Joseph's Health Care London, London, Ontario, Canada
| | - Neville Suskin
- Department of Cardiology, Western University, London, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | - Karen Unsworth
- Department of Cardiac Rehabilitation, St. Joseph's Health Care London, London, Ontario, Canada
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17
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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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [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)
- Elizabeth W Regan
- Department of Exercise Science University of South Carolina Columbia SC
| | - Reed Handlery
- Department of Exercise Science University of South Carolina Columbia SC
| | - Michael W Beets
- Department of Exercise Science University of South Carolina Columbia SC
| | - Stacy L Fritz
- Department of Exercise Science University of South Carolina Columbia SC
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18
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Munakomi S. Preventing Muscle Atrophy Following Strokes: A Reappraisal. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1088:593-601. [PMID: 30390272 DOI: 10.1007/978-981-13-1435-3_28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Muscle atrophy leading to muscle weakness accounts for major cause of disabilities among stroke survivors. It amounts to compromised gait and prevails to viscous cycle of diminished physical capacities and compromised participation in rehabilitative tasks. There is predisposition to recurrent strokes due to added risk of developing metabolic syndrome. Therefore, beyond the shadow of doubt, there is ripple effect of rehabilitation and thereby muscle protection in these subsets of patients. Herein, we highlight upon the newer insights with regard to preventing muscle atrophy following strokes.
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Affiliation(s)
- Sunil Munakomi
- Department of Neurosurgery, Nobel Teaching Hospital, Biratnagar, Nepal.
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19
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Harmsen WJ, Khajeh L, Ribbers GM, Heijenbrok-Kal MH, Sneekes E, van Kooten F, Neggers S, van den Berg-Emons RJ. People With Aneurysmal Subarachnoid Hemorrhage Have Low Physical Fitness and Can Be Predisposed to Inactive and Sedentary Lifestyles. Phys Ther 2019; 99:904-914. [PMID: 31220327 PMCID: PMC7207355 DOI: 10.1093/ptj/pzz046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/28/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Physical inactivity, sedentary lifestyles, and low functional outcome are thought to impact the level of physical fitness in patients with aneurysmal subarachnoid hemorrhage (a-SAH). However, changes in fitness over time and associated factors have not been studied in a-SAH. OBJECTIVE The objective was to evaluate the level of physical fitness in the first year after a-SAH and explore longitudinal relations with physical activity, sedentary behavior, and functional outcome. Additionally, we evaluated whether physical fitness could be predicted by disease-related characteristics (ie, severity of a-SAH, location of the aneurysm, treatment procedure, pituitary dysfunction, and complications). DESIGN This was a prospective 1-year follow-up study. METHODS Fifty-two participants performed exercise testing at 6 and 12 months after a-SAH. Cardiopulmonary exercise testing and isokinetic dynamometry were applied to determine the peak oxygen uptake $({\rm{\dot{V}}}{{\rm{o}}_{2{\rm{peak}}}})$ and the peak torque of the knee extensors (PText) and flexors (PTflex). In addition, physical activity and sedentary behavior were evaluated by accelerometer-based activity monitoring. The functional outcome was assessed by the Functional Independence Measure and Functional Assessment Measure. Disease-related characteristics were collected at hospital intake. RESULTS At both 6 and 12 months, all fitness parameters were lower compared with predicted values (ranging from 18% to 28%). Physical activity is related to both ${\rm{\dot{V}}}{{\rm{o}}_{{\rm{2peak}}}}$ and PTflex. The Functional Independence Measure and Functional Assessment Measure scores was related to PText and PTflex. Further, participants who underwent surgical clipping had lower ${\rm{\dot{V}}}{{\rm{o}}_{{\rm{2peak}}}}$ and PTflex. LIMITATIONS Longitudinal observations cannot confirm causality. CONCLUSIONS Levels of physical fitness remain low over the first year after a-SAH. Participants who were physically more active had higher levels of physical fitness, whereas participants with impaired functional outcome or who were treated with surgical clipping were at risk of low physical fitness. Exercise interventions are warranted and should focus on the promotion of physical activity and target patients with impaired functional outcome or those who have been treated with surgical clipping.
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Affiliation(s)
- Wouter J Harmsen
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands; and Department of Rehabilitation Medicine, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands,Address all correspondence to Dr Harmsen at:
| | - Ladbon Khajeh
- Department of Neurology, Erasmus MC University Medical Center
| | - Gerard M Ribbers
- Rijndam Rehabilitation Institute, and Department of Rehabilitation Medicine, Erasmus MC University Medical Center
| | - Majanka H Heijenbrok-Kal
- Rijndam Rehabilitation Institute, and Department of Rehabilitation Medicine, Erasmus MC University Medical Center
| | - Emiel Sneekes
- Rijndam Rehabilitation Institute, and Department of Rehabilitation Medicine, Erasmus MC University Medical Center
| | - Fop van Kooten
- Department of Neurology, Erasmus MC University Medical Center
| | | | - Rita J van den Berg-Emons
- Rijndam Rehabilitation Institute, and Department of Rehabilitation Medicine, Erasmus MC University Medical Center
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20
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da Silva RS, da Silva ST, de Souza JM, de Figueiredo MCC, Mendes TAS, de Sena Nunes MC, de Oliveira SKR, Cardoso DCR, da Câmara Silva RG, de Oliveira DC, Ribeiro TS. Effects of inclined treadmill training on functional and cardiovascular parameters of stroke patients: study protocol for a randomized controlled trial. Trials 2019; 20:252. [PMID: 31046812 PMCID: PMC6498604 DOI: 10.1186/s13063-019-3298-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 03/18/2019] [Indexed: 11/29/2022] Open
Abstract
Background Treadmill training has been widely used for gait recovery after stroke. Gait re-establishment is one of the main objectives of rehabilitation programs after stroke, aiming to acquire more functional patterns and increase walking speed, along with improvement in cardiovascular function. The aim of this study is to evaluate the effects of a treadmill gait training protocol on functional and cardiovascular variables in patients with chronic stroke. Methods A single-blind randomized clinical trial will be conducted. The sample will consist of 36 patients, who will be allocated in three groups: control group (n = 12), experimental group 1 (n = 12), and experimental group 2 (n = 12). The intervention will occur for 6 consecutive weeks, three times a week, 30 min each session, in all groups. The control group will perform a treadmill gait training without inclination, experimental group 1 will perform a treadmill gait training with anterior inclination of 5%, and experimental group 2 will perform a treadmill gait training with anterior inclination of 10%. All participants will be assessed for sample characterization measures, gait speed, functional capacity, systemic arterial blood pressure, heart rate, peripheral oxygen saturation, exercise capacity, neuromuscular torque, and quality of life. Evaluations of outcome measures will occur at the end of the interventions (post-training) and after 1 month and 1 year after the end of the interventions (short- and long-term follow-up). Statistical analysis will be performed descriptively and inferentially. Alpha equals 5% will be considered for inferential analysis. Mixed analysis of variance with repeated measures will be used to compare outcome measures between groups and between baseline, post-training, and follow-up. Normality test (Shapiro–Wilk) and subsequently t test (or Mann–Whitney) will be used to compare groups during the same training session. Discussion It is believed that treadmill training, especially treadmill training with anterior inclination, may result in improved exercise capacity in patients with stroke, reduced blood pressure and heart rate values, and an improvement in functional parameters with increased gait speed, functional capacity, quadriceps muscle torque, and quality of life. Trial registration Registration in Brazilian Registry of Clinical Trials (ReBEC) identifier RBR-5ffbxz, date of registration October 25 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3298-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Raiff Simplício da Silva
- Laboratory of Intervention and Movement Analysis, Department of Physical Therapy, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, 3000, Natal, Rio Grande do Norte, 59078-970, Brazil
| | - Stephano Tomaz da Silva
- Laboratory of Intervention and Movement Analysis, Department of Physical Therapy, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, 3000, Natal, Rio Grande do Norte, 59078-970, Brazil
| | - Jesimiel Missias de Souza
- Laboratory of Intervention and Movement Analysis, Department of Physical Therapy, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, 3000, Natal, Rio Grande do Norte, 59078-970, Brazil
| | - Marianna Celeste Cordeiro de Figueiredo
- Laboratory of Intervention and Movement Analysis, Department of Physical Therapy, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, 3000, Natal, Rio Grande do Norte, 59078-970, Brazil
| | - Thaís Almeida Silveira Mendes
- Laboratory of Intervention and Movement Analysis, Department of Physical Therapy, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, 3000, Natal, Rio Grande do Norte, 59078-970, Brazil
| | - Maria Clara de Sena Nunes
- Laboratory of Intervention and Movement Analysis, Department of Physical Therapy, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, 3000, Natal, Rio Grande do Norte, 59078-970, Brazil
| | - Samara Katiane Rolim de Oliveira
- Laboratory of Intervention and Movement Analysis, Department of Physical Therapy, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, 3000, Natal, Rio Grande do Norte, 59078-970, Brazil
| | - Daiane Carla Rodrigues Cardoso
- Laboratory of Intervention and Movement Analysis, Department of Physical Therapy, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, 3000, Natal, Rio Grande do Norte, 59078-970, Brazil
| | - Raiza Gabriella da Câmara Silva
- Laboratory of Intervention and Movement Analysis, Department of Physical Therapy, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, 3000, Natal, Rio Grande do Norte, 59078-970, Brazil
| | - Débora Carvalho de Oliveira
- Laboratory of Intervention and Movement Analysis, Department of Physical Therapy, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, 3000, Natal, Rio Grande do Norte, 59078-970, Brazil
| | - Tatiana Souza Ribeiro
- Laboratory of Intervention and Movement Analysis, Department of Physical Therapy, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, 3000, Natal, Rio Grande do Norte, 59078-970, Brazil.
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Tong Y, Cheng Z, Rajah GB, Duan H, Cai L, Zhang N, Du H, Geng X, Ding Y. High Intensity Physical Rehabilitation Later Than 24 h Post Stroke Is Beneficial in Patients: A Pilot Randomized Controlled Trial (RCT) Study in Mild to Moderate Ischemic Stroke. Front Neurol 2019; 10:113. [PMID: 30837938 PMCID: PMC6390474 DOI: 10.3389/fneur.2019.00113] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/28/2019] [Indexed: 12/13/2022] Open
Abstract
Objective: Very early mobilization was thought to contribute to beneficial outcomes in stroke-unit care, but the optimal intervention strategy including initiation time and intensity of mobilization are unclear. In this study, we sought to confirm the rehabilitative effects of different initiation times (24 vs. 48 h) with different mobilization intensities (routine or intensive) in ischemic stroke patients within three groups. Materials and Methods: We conducted a randomized and controlled trial with a blinded follow-up assessment. Patients with ischemic stroke, first or recurrent, admitted to stroke unit within 24 h after stroke onset were recruited. Eligible subjects were randomly assigned (1:1:1) to 3 groups: Early Routine Mobilization in which patients received < 1.5 h/d out-of-bed mobilization within 24–48 h after stroke onset, Early Intensive Mobilization in which patients initiated ≥3 h/d mobilization at 24–48 h after the stroke onset, and Very Early Intensive Mobilization in which patients received≥3 h/d mobilization within 24 h. The modified Rankin Scale score of 0–2 was used as the primary favorable outcome. Results: We analyzed 248 of the 300 patients (80 in Early Routine Mobilization, 82 in Very Early Intensive Mobilization and 86 in Early Intensive Mobilization), with 52 dropping out (20 in Early Routine Mobilization, 18 in Very Early Intensive Mobilization and 14 in Early Intensive Mobilization). Among the three groups, the Early Intensive Mobilization group had the most favorable outcomes at 3-month follow-up, followed by patients in the Early Routine Mobilization group. Patients in Very Early Intensive Mobilization received the least odds of favorable outcomes. At 3 month follow up, 53.5%, (n = 46) of patients with Early Intensive Mobilization showed a favorable outcome (modified Rankin Scale 0–2) (p = 0.041) as compared to 37.8% (n = 31) of patients in the Very Early Intensive Mobilization. Conclusions: Post-stroke rehabilitation with high intensity physical exercise at 48 h may be beneficial. Very Early Intensive Mobilization did not lead to a favorable outcome at 3 months. Clinical Trial Registration:www.chictr.org.cn, identifier ChiCTR-ICR-15005992.
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Affiliation(s)
- Yanna Tong
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Affiliated to Capital Medical University, Beijing, China.,Department of Neurology, Beijing Luhe Hospital, Affiliated to Capital Medical University, Beijing, China
| | - Zhe Cheng
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Affiliated to Capital Medical University, Beijing, China.,Department of Neurology, Beijing Luhe Hospital, Affiliated to Capital Medical University, Beijing, China
| | - Gary B Rajah
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Affiliated to Capital Medical University, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Honglian Duan
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Affiliated to Capital Medical University, Beijing, China.,Department of Neurology, Beijing Luhe Hospital, Affiliated to Capital Medical University, Beijing, China
| | - Lipeng Cai
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Affiliated to Capital Medical University, Beijing, China.,Department of Neurology, Beijing Luhe Hospital, Affiliated to Capital Medical University, Beijing, China
| | - Nan Zhang
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Affiliated to Capital Medical University, Beijing, China.,Department of Neurology, Beijing Luhe Hospital, Affiliated to Capital Medical University, Beijing, China
| | - Huishan Du
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Affiliated to Capital Medical University, Beijing, China.,Department of Neurology, Beijing Luhe Hospital, Affiliated to Capital Medical University, Beijing, China
| | - Xiaokun Geng
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Affiliated to Capital Medical University, Beijing, China.,Department of Neurology, Beijing Luhe Hospital, Affiliated to Capital Medical University, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Yuchuan Ding
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Affiliated to Capital Medical University, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
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Munford D, Gunn H. What are the perceptions and experiences of falls amongst people with stroke who live in the community? Disabil Rehabil 2018; 42:722-729. [DOI: 10.1080/09638288.2018.1510047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Danielle Munford
- School of Health Professions, University of Plymouth, Plymouth, UK
| | - Hilary Gunn
- School of Health Professions, University of Plymouth, Plymouth, UK
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23
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Chen CK, Huang MH, Liang WL, Lin RT, Juo SHH. Early functional improvement after stroke correlates with cardiovascular fitness. Kaohsiung J Med Sci 2018; 34:643-649. [PMID: 30392571 DOI: 10.1016/j.kjms.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 11/26/2022] Open
Abstract
Cardiovascular fitness exerts directly beneficial effects on functional and cognitive outcomes in patients of chronic stroke. However, the effect of early rehabilitation on cardiovascular function has not yet been thoroughly examined. We tested whether complementary rehabilitation program could influence cardiovascular fitness in an early stage of stroke patients. The associations for post-acute stroke functional recovery with cardiovascular fitness were explored. Thirty-seven patients with mean poststroke interval of 8.6 ± 3.8 days underwent inpatient rehabilitation of 22.8 ± 3.8 days. Functional outcomes of 15.3 points (17.2%) in functional independence measure improved after rehabilitation program. The therapeutic cardiovascular fitness was determined in ramp exercise test on a cycling ergometer. Peak oxygen uptake (V˙O2peak) significantly increased by 24.8% after early stroke rehabilitation. Multivariate regression analysis was performed to assess for associations of functional improvement with respect to change in V˙O2peak and extremities motor impairment. V˙O2peak gain accounted for more functional recovery than extremities motor improvement (R2 = 0.42). In conclusion, these results suggest that cardiovascular fitness appears to increase after complementary program in early stroke rehabilitation, and better cardiovascular fitness may be associated with greater functional improvement.
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Affiliation(s)
- Chun-Kai Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, Collage of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mao-Hsiung Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Lung Liang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ruey-Tay Lin
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Suh-Hang H Juo
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; Institute of New Drug Development, China Medical University, Taichung, Taiwan; Drug Development Center, China Medical University, Taichung, Taiwan; Centre for Myopia and Eye Disease, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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24
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Grau-Pellicer M, Serdà-Ferrer BC, Medina-Casanovas J, Chamarro-Lusar A. Effectiveness of a multimodal low–moderate intensity exercise rehabilitation program for stroke survivors. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.apunts.2018.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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25
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Faria GS, Polese JC, Ribeiro-Samora GA, Scianni AA, Faria CDCM, Teixeira-Salmela LF. Validity of the accelerometer and smartphone application in estimating energy expenditure in individuals with chronic stroke. Braz J Phys Ther 2018; 23:236-243. [PMID: 30143357 DOI: 10.1016/j.bjpt.2018.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To examine the concurrent validity of the GT3X® ActiGraph accelerometer and Google Fit® smartphone application in estimating energy expenditure in people who had suffered a stroke, during fast overground walking. METHODS Thirty community-dwelling stroke individuals walked on a 10-meter hallway over 5min at their fastest speeds, wearing a Cortex Metamax 3B® ergoespirometer, a GT3X® ActiGraph accelerometer, and a smartphone with the Google Fit® application. Pearson correlation coefficients were calculated to verify the associations between measures of energy expenditure, in kilocalories (kcal), estimated by both devices and those obtained with the Cortex Metamax 3B® ergoespirometer (gold-standard measure). RESULTS Fair association was found between the energy expenditure values estimated from the combined formula of the ActiGraph GT3X® and those obtained with the gold-standard measure (r=0.37; p=0.04). No significant associations were found between the energy expenditure values estimated by the Google Fit® application and those provided by the gold-standard measure. CONCLUSIONS The findings demonstrated that both the GT3X®ActiGraph accelerometer and the Google Fit® smartphone application do not provide valid measures of energy expenditure in chronic stroke individuals during fast overground walking.
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Affiliation(s)
- Giselle S Faria
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Janaine C Polese
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil; Department of Physical Therapy, Faculdade Ciências Médicas de Minas Gerais (FCMMG), Belo Horizonte, Minas Gerais, Brazil.
| | - Giane A Ribeiro-Samora
- LabCare, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Aline A Scianni
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Christina D C M Faria
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Luci F Teixeira-Salmela
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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Lloyd M, Skelton DA, Mead GE, Williams B, van Wijck F. Physical fitness interventions for nonambulatory stroke survivors: A mixed-methods systematic review and meta-analysis. Brain Behav 2018; 8:e01000. [PMID: 29920979 PMCID: PMC6043697 DOI: 10.1002/brb3.1000] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/10/2018] [Accepted: 04/15/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Physical fitness training after stroke is recommended in guidelines across the world, but evidence pertains mainly to ambulatory stroke survivors. Nonambulatory stroke survivors (FAC score ≤2) are at increased risk of recurrent stroke due to limited physical activity. This systematic review aimed to synthesize evidence regarding case fatality, effects, experiences, and feasibility of fitness training for nonambulatory stroke survivors. METHODS Eight major databases were searched for any type of study design. Two independent reviewers selected studies, extracted data, and assessed study quality, using published tools. Random-effects meta-analysis was used. Following their separate analysis, qualitative and quantitative data were synthesized using a published framework. RESULTS Of 13,614 records, 33 studies involving 910 nonambulatory participants met inclusion criteria. Most studies were of moderate quality. Interventions comprised assisted walking (25 studies), cycle ergometer training (5 studies), and other training (3 studies), mainly in acute settings. Case fatality did not differ between intervention (1.75%) and control (0.88%) groups (95% CI 0.13-3.78, p = 0.67). Compared with control interventions, assisted walking significantly improved: fat mass, peak heart rate, peak oxygen uptake and walking endurance, maximum walking speed, and mobility at intervention end, and walking endurance, balance, mobility, and independent walking at follow-up. Cycle ergometry significantly improved peak heart rate, work load, peak ventilation, peak carbon dioxide production, HDL cholesterol, fasting insulin and fasting glucose, and independence at intervention end. Effectiveness of other training could not be established. There were insufficient qualitative data to draw conclusions about participants' experiences, but those reported were positive. There were few intervention-related adverse events, and dropout rate ranged from 12 to 20%. CONCLUSIONS Findings suggest safety, effectiveness, and feasibility of adapted fitness training for screened nonambulatory stroke survivors. Further research needs to investigate the clinical and cost-effectiveness as well as experiences of fitness training-especially for chronic stroke survivors in community settings.
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Affiliation(s)
- Megan Lloyd
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - Dawn A. Skelton
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - Gillian E. Mead
- Geriatric MedicineDivision of Health SciencesCentre for Clinical Brain SciencesThe University of Edinburgh, and the Royal InfirmaryEdinburghUK
| | - Brian Williams
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
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Li Z, Zhang X, Wang K, Wen J. Effects of Early Mobilization after Acute Stroke: A Meta-Analysis of Randomized Control Trials. J Stroke Cerebrovasc Dis 2018; 27:1326-1337. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/02/2017] [Accepted: 12/17/2017] [Indexed: 02/01/2023] Open
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Pellicer MG, Lusar AC, Casanovas JM, Ferrer BCS. Effectiveness of a multimodal exercise rehabilitation program on walking capacity and functionality after a stroke. J Exerc Rehabil 2017; 13:666-675. [PMID: 29326899 PMCID: PMC5747202 DOI: 10.12965/jer.1735056.528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/05/2017] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to determine the effectiveness of a 12-week multimodal exercise rehabilitation program on walking speed, walking ability and activities of daily living (ADLs) among people who had suffered a stroke. Thirty-one stroke survivors who had completed a conventional rehabilitation program voluntarily participated in the study. Twenty-six participants completed the multimodal exercise rehabilitation program (2 days/wk, 1 hr/session). Physical outcome measures were: walking speed (10-m walking test), walking ability (6-min walking test and functional ambulation classification) and ADLs (Barthel Index). The program consisted on: aerobic exercise; task oriented exercises; balance and postural tonic activities; and stretching. Participants also followed a program of progressive ambulation at home. They were evaluated at baseline, postintervention and at the end of a 6-month follow-up period. After the intervention there were significant improvements in all outcomes measures that were maintained 6 months later. Comfortable and fast walking speed increased an average of 0.16 and 0.40 m/sec, respectively. The walking distance in the 6-min walking test increased an average of 59.8 m. At the end of the intervention, participants had achieved independent ambulation both indoors and outdoors. In ADLs, 40% were independent at baseline vs. 64% at the end of the intervention. Our study demonstrates that a multimodal exercise rehabilitation program adapted to stroke survivors has benefits on walking speed, walking ability and independence in ADLs.
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Affiliation(s)
| | - Andrés Chamarro Lusar
- Basic, Evolutionary, and Educational Psychology Department, Autonomous University of Barcelona, Barcelona,
Spain
| | - Josep Medina Casanovas
- Functional Rehabilitation Department, Private Foundation Institut Guttmann Neurorehabilitation Hospital, Badalona, Barcelona,
Spain
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29
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Morais VACD, Tourino MFDS, Almeida ACDS, Albuquerque TBD, Linhares RC, Christo PP, Martinelli PM, Scalzo PL. A single session of moderate intensity walking increases brain-derived neurotrophic factor (BDNF) in the chronic post-stroke patients. Top Stroke Rehabil 2017; 25:1-5. [DOI: 10.1080/10749357.2017.1373500] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Viviane Aparecida Carvalho de Morais
- Laboratório de Neurobiologia, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Marina Ferreira da Silva Tourino
- Laboratório de Neurobiologia, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ana Carolina de Souza Almeida
- Laboratório de Neurobiologia, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Thaís Bueno Dias Albuquerque
- Laboratório de Neurobiologia, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Roberta Castro Linhares
- Laboratório de Neurobiologia, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Paulo Pereira Christo
- Ambulatório de Neurologia, Centro de Especialidades Médicas da Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
| | - Patrícia Massara Martinelli
- Laboratório de Neurobiologia, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Paula Luciana Scalzo
- Laboratório de Neurobiologia, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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30
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Cardiorespiratory Responses to Pool Floor Walking in People Poststroke. Arch Phys Med Rehabil 2017; 99:542-547. [PMID: 28987900 DOI: 10.1016/j.apmr.2017.09.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/10/2017] [Accepted: 09/15/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare cardiorespiratory responses between pool floor walking and overground walking (OW) in people poststroke. DESIGN Cross-sectional study. SETTING University-based therapeutic exercise facility. PARTICIPANTS Participants (N=28) were comprised of 14 community-dwelling individuals poststroke (5.57±3.57y poststroke) and 14 age- and sex-matched healthy adults (mean age, 58.00±15.51y; male/female ratio, 9:5). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A telemetric metabolic system was used to collect cardiorespiratory variables, including oxygen consumption (V˙o2), energy expenditure (EE), and expired volume per unit time (V˙e), during 6-minute walking sessions in chest-depth water and on land at a matched speed, determined by average of maximum walking speed in water. RESULTS Individuals poststroke elicited no significant differences in cardiorespiratory responses between pool floor walking and OW. However, healthy controls showed significant increases in mean V˙o2 values by 94%, EE values by 109%, and V˙e values by 94% (all P<.05) during pool floor walking compared with OW. A 2×2 mixed model analysis of variance revealed a significant group × condition interaction in V˙o2, in which the control group increased V˙o2 from OW to pool floor walking, whereas the stroke group did not. CONCLUSIONS Our results indicate that people poststroke, unlike healthy adults, do not increase EE while walking in water compared with on land. Unlike stationary walking on an aquatic treadmill, forward locomotion during pool floor walking at faster speeds may have increased drag force, which requires greater EE from healthy adults. Without demanding excessive EE, walking in water may offer a naturally supportive environment for gait training in the early stages of rehabilitation.
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31
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Li F, Geng X, Khan H, Pendy JT, Peng C, Li X, Rafols JA, Ding Y. Exacerbation of Brain Injury by Post-Stroke Exercise Is Contingent Upon Exercise Initiation Timing. Front Cell Neurosci 2017; 11:311. [PMID: 29051728 PMCID: PMC5633611 DOI: 10.3389/fncel.2017.00311] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 09/19/2017] [Indexed: 12/19/2022] Open
Abstract
Accumulating evidence has demonstrated that post-stroke physical rehabilitation may reduce morbidity. The effectiveness of post-stroke exercise, however, appears to be contingent upon exercise initiation. This study assessed the hypothesis that very early exercise exacerbates brain injury, induces reactive oxygen species (ROS) generation, and promotes energy failure. A total of 230 adult male Sprague-Dawley rats were subjected to middle cerebral artery (MCA) occlusion for 2 h, and randomized into eight groups, including two sham injury control groups, three non-exercise and three exercise groups. Exercise was initiated after 6 h, 24 h and 3 days of reperfusion. Twenty-four hours after completion of exercise (and at corresponding time points in non-exercise controls), infarct volumes and apoptotic cell death were examined. Early brain oxidative metabolism was quantified by examining ROS, ATP and NADH levels 0.5 h after completion of exercise. Furthermore, protein expressions of angiogenic growth factors were measured in order to determine whether post-stroke angiogenesis played a role in rehabilitation. As expected, ischemic stroke resulted in brain infarction, apoptotic cell death and ROS generation, and diminished NADH and ATP production. Infarct volumes and apoptotic cell death were enhanced (p < 0.05) by exercise that was initiated after 6 h of reperfusion, but decreased by late exercise (24 h, 3 days). This exacerbated brain injury at 6 h was associated with increased ROS levels (p < 0.05), and decreased (p < 0.05) NADH and ATP levels. In conclusion, very early exercise aggravated brain damage, and early exercise-induced energy failure with ROS generation may underlie the exacerbation of brain injury. These results shed light on the manner in which exercise initiation timing may affect post-stroke rehabilitation.
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Affiliation(s)
- Fengwu Li
- Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China
| | - Xiaokun Geng
- Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Hajra Khan
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - John T Pendy
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Changya Peng
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Xiaorong Li
- Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China
| | - Jose A Rafols
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Yuchuan Ding
- Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
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32
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Aerobic Exercise Prescription in Stroke Rehabilitation: A Web-Based Survey of US Physical Therapists. J Neurol Phys Ther 2017; 41:119-128. [PMID: 28263254 DOI: 10.1097/npt.0000000000000177] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Best practice recommendations indicate that aerobic exercise (AEX) should be incorporated into stroke rehabilitation. However, this may be challenging in clinical settings. The purpose of this study was to assess physical therapist (PT) AEX prescription for patients with stroke, including AEX utilization, barriers to AEX prescription, dosing parameters, and safety considerations. METHODS A cross-sectional Web-based survey study was conducted. Physical therapists with valid e-mail addresses on file with the state boards of Florida, New Jersey, Ohio, Texas, and Wyoming were eligible to participate. Survey invitations were e-mailed to all licensed PT in these states. Analysis focused on respondents who were currently involved with clinical stroke rehabilitation in common practice settings. RESULTS Results from 568 respondents were analyzed. Most respondents (88%) agreed that AEX should be incorporated into stroke rehabilitation, but 84% perceived at least one barrier. Median prescribed AEX volume varied between practice settings from 20- to 30-minute AEX sessions, 3 to 5 days per week for 2 to 8 weeks. Prescribed intensity was most commonly light or moderate; intensity was determined by the general response to AEX and patient feedback. Only 2% of respondents reported that the majority of their patients with stroke had stress tests. DISCUSSION AND CONCLUSIONS Most US PTs appear to recognize the importance of AEX for persons poststroke, but clinical implementation can be challenging. Future studies and consensus are needed to clarify best practices and to develop implementation interventions to optimize AEX utilization in stroke rehabilitation.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A167).
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Abstract
BACKGROUND Circuit class therapy (CCT) offers a supervised group forum for people after stroke to practise tasks, enabling increased practice time without increasing staffing. This is an update of the original review published in 2010. OBJECTIVES To examine the effectiveness and safety of CCT on mobility in adults with stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched January 2017), CENTRAL (the Cochrane Library, Issue 12, 2016), MEDLINE (1950 to January 2017), Embase (1980 to January 2017), CINAHL (1982 to January 2017), and 14 other electronic databases (to January 2017). We also searched proceedings from relevant conferences, reference lists, and unpublished theses; contacted authors of published trials and other experts in the field; and searched relevant clinical trials and research registers. SELECTION CRITERIA Randomised controlled trials (RCTs) including people over 18 years old, diagnosed with stroke of any severity, at any stage, or in any setting, receiving CCT. DATA COLLECTION AND ANALYSIS Review authors independently selected trials for inclusion, assessed risk of bias in all included studies, and extracted data. MAIN RESULTS We included 17 RCTs involving 1297 participants. Participants were stroke survivors living in the community or receiving inpatient rehabilitation. Most could walk 10 metres without assistance. Ten studies (835 participants) measured walking capacity (measuring how far the participant could walk in six minutes) demonstrating that CCT was superior to the comparison intervention (Six-Minute Walk Test: mean difference (MD), fixed-effect, 60.86 m, 95% confidence interval (CI) 44.55 to 77.17, GRADE: moderate). Eight studies (744 participants) measured gait speed, again finding in favour of CCT compared with other interventions (MD 0.15 m/s, 95% CI 0.10 to 0.19, GRADE: moderate). Both of these effects are considered clinically meaningful. We were able to pool other measures to demonstrate the superior effects of CCT for aspects of walking and balance (Timed Up and Go: five studies, 488 participants, MD -3.62 seconds, 95% CI -6.09 to -1.16; Activities of Balance Confidence scale: two studies, 103 participants, MD 7.76, 95% CI 0.66 to 14.87). Two other pooled balance measures failed to demonstrate superior effects (Berg Blance Scale and Step Test). Independent mobility, as measured by the Stroke Impact Scale, Functional Ambulation Classification and the Rivermead Mobility Index, also improved more in CCT interventions compared with others. Length of stay showed a non-significant effect in favour of CCT (two trials, 217 participants, MD -16.35, 95% CI -37.69 to 4.99). Eight trials (815 participants) measured adverse events (falls during therapy): there was a non-significant effect of greater risk of falls in the CCT groups (RD 0.03, 95% CI -0.02 to 0.08, GRADE: very low). Time after stroke did not make a difference to the positive outcomes, nor did the quality or size of the trials. Heterogeneity was generally low; risk of bias was variable across the studies with poor reporting of study conduct in several of the trials. AUTHORS' CONCLUSIONS There is moderate evidence that CCT is effective in improving mobility for people after stroke - they may be able to walk further, faster, with more independence and confidence in their balance. The effects may be greater later after the stroke, and are of clinical significance. Further high-quality research is required, investigating quality of life, participation and cost-benefits, that compares CCT with standard care and that also investigates the influence of factors such as stroke severity and age. The potential risk of increased falls during CCT needs to be monitored.
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Affiliation(s)
- Coralie English
- University of NewcastleSchool of Health Sciences and Priority Research Centre for Stroke and Brain InjuryUniversity DrCallaghanNSWAustralia2308
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research InstituteMelbourne and NewcastleAustralia
| | - Susan L Hillier
- University of South Australia (City East)Sansom Institute for Health ResearchNorth TerraceAdelaideSAAustralia5000
| | - Elizabeth A Lynch
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research InstituteMelbourne and NewcastleAustralia
- The University of AdelaideAdelaide Nursing SchoolAdelaideSouth AustraliaAustralia
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Vanroy C, Feys H, Swinnen A, Vanlandewijck Y, Truijen S, Vissers D, Michielsen M, Wouters K, Cras P. Effectiveness of Active Cycling in Subacute Stroke Rehabilitation: A Randomized Controlled Trial. Arch Phys Med Rehabil 2017; 98:1576-1585.e5. [PMID: 28284834 DOI: 10.1016/j.apmr.2017.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/30/2017] [Accepted: 02/01/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the effects of 3 months of aerobic training (AT) followed by coaching on aerobic capacity, strength, and gait speed after subacute stroke. DESIGN Randomized controlled trial. SETTING Inpatient rehabilitation center. PARTICIPANTS Patients (N=59; mean age ± SD, 65.4±10.3y; 21 women (36%); Barthel Index ≤50 in 64% of patients) with first stroke and able to cycle at 50 revolutions/min were enrolled in the study 3 to 10 weeks after stroke onset. INTERVENTIONS Patients were randomly allocated to a 3-month active cycling group (ACG, n=33) and education, or to a control group (CG, n=26). Afterward, patients in the ACG were randomly assigned either to a coaching (n=15) or to a noncoaching group (n=16) for 9 months. MAIN OUTCOME MEASURES Aerobic capacity, isometric knee extension strength, and gait ability and speed were measured before and after intervention and during follow-up at 6 and 12 months. RESULTS A nonsignificant difference was found in workload (Wattpeak) (P=.078) between ACG and CG after 3 months. Furthermore, after 3 months of cycling and after 9 months of coaching, all groups showed significant changes over time (P≤.027) in peak oxygen consumption, Wattpeak, leg strength, and gait speed. Also, significant changes over time (P<.001) were found in the ACG and the CG in patients with walking inability at baseline. CONCLUSIONS No significant differences between training groups were found over time. Although our study did not have objective exercise data from the training device during follow-up, the 3-month active cycling (AC) program combined with education sessions seemed an applicable method in subacute stroke rehabilitation. New long-term AT interventions should focus on coaching approaches to facilitate training after a supervised AC program.
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Affiliation(s)
- Christel Vanroy
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp (Faculty of Medicine and Health Sciences), Wilrijk, Belgium; Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium.
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Anke Swinnen
- Jessa Hospital, Rehabilitation Campus Sint-Ursula, Herk-de-Stad, Belgium
| | - Yves Vanlandewijck
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Steven Truijen
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp (Faculty of Medicine and Health Sciences), Wilrijk, Belgium
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp (Faculty of Medicine and Health Sciences), Wilrijk, Belgium
| | - Marc Michielsen
- Jessa Hospital, Rehabilitation Campus Sint-Ursula, Herk-de-Stad, Belgium
| | - Kristien Wouters
- Department of Scientific Coordination and Biostatistics, University Hospital Antwerp, Edegem, Belgium
| | - Patrick Cras
- Department of Neurology, Translational Neurosciences, University of Antwerp (Faculty of Medicine and Health Sciences), Wilrijk, Belgium; Born-Bunge Institute, Edegem, Belgium; Department of Neurology, University Hospital Antwerp, Edegem, Belgium
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Linder SM, Rosenfeldt AB, Dey T, Alberts JL. Forced Aerobic Exercise Preceding Task Practice Improves Motor Recovery Poststroke. Am J Occup Ther 2017; 71:7102290020p1-7102290020p9. [PMID: 28218596 DOI: 10.5014/ajot.2017.020297] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To understand how two types of aerobic exercise affect upper-extremity motor recovery post-stroke. Our aims were to (1) evaluate the feasibility of having people who had a stroke complete an aerobic exercise intervention and (2) determine whether forced or voluntary exercise differentially facilitates upper-extremity recovery when paired with task practice. METHOD Seventeen participants with chronic stroke completed twenty-four 90-min sessions over 8 wk. Aerobic exercise was immediately followed by task practice. Participants were randomized to forced or voluntary aerobic exercise groups or to task practice only. RESULTS Improvement on the Fugl-Meyer Assessment exceeded the minimal clinically important difference: 12.3, 4.8, and 4.4 for the forced exercise, voluntary exercise, and repetitive task practice-only groups, respectively. Only the forced exercise group exhibited a statistically significant improvement. CONCLUSION People with chronic stroke can safely complete intensive aerobic exercise. Forced aerobic exercise may be optimal in facilitating motor recovery associated with task practice.
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Affiliation(s)
- Susan M Linder
- Susan M. Linder, DPT, NCS, is Project Staff, Department of Biomedical Engineering and Cleveland Clinic Concussion Center, Cleveland Clinic, Cleveland, OH;
| | - Anson B Rosenfeldt
- Anson B. Rosenfeldt, DPT, MBA, is Research Physical Therapist, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH
| | - Tanujit Dey
- Tanujit Dey, PhD, is Associate Staff, Cleveland Clinic Concussion Center and Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Jay L Alberts
- Jay L. Alberts, PhD, is Staff, Department of Biomedical Engineering, Center for Neurological Restoration, and Cleveland Clinic Concussion Center, Cleveland Clinic, Cleveland, OH
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Harmsen WJ, Ribbers GM, Slaman J, Heijenbrok-Kal MH, Khajeh L, van Kooten F, Neggers SJCMM, van den Berg-Emons RJ. The six-minute walk test predicts cardiorespiratory fitness in individuals with aneurysmal subarachnoid hemorrhage. Top Stroke Rehabil 2016; 24:250-255. [PMID: 27915583 DOI: 10.1080/10749357.2016.1260263] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Peak oxygen uptake (VO2peak) established during progressive cardiopulmonary exercise testing (CPET) is the "gold-standard" for cardiorespiratory fitness. However, CPET measurements may be limited in patients with aneurysmal subarachnoid hemorrhage (a-SAH) by disease-related complaints, such as cardiovascular health-risks or anxiety. Furthermore, CPET with gas-exchange analyses require specialized knowledge and infrastructure with limited availability in most rehabilitation facilities. OBJECTIVES To determine whether an easy-to-administer six-minute walk test (6MWT) is a valid clinical alternative to progressive CPET in order to predict VO2peak in individuals with a-SAH. METHODS Twenty-seven patients performed the 6MWT and CPET with gas-exchange analyses on a cycle ergometer. Univariate and multivariate regression models were made to investigate the predictability of VO2peak from the six-minute walk distance (6MWD). RESULTS Univariate regression showed that the 6MWD was strongly related to VO2peak (r = 0.75, p < 0.001), with an explained variance of 56% and a prediction error of 4.12 ml/kg/min, representing 18% of mean VO2peak. Adding age and sex to an extended multivariate regression model improved this relationship (r = 0.82, p < 0.001), with an explained variance of 67% and a prediction error of 3.67 ml/kg/min corresponding to 16% of mean VO2peak. CONCLUSIONS The 6MWT is an easy-to-administer submaximal exercise test that can be selected to estimate cardiorespiratory fitness at an aggregated level, in groups of patients with a-SAH, which may help to evaluate interventions in a clinical or research setting. However, the relatively large prediction error does not allow for an accurate prediction in individual patients.
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Affiliation(s)
- Wouter J Harmsen
- a Rijndam Rehabilitation Institute , Rotterdam , The Netherlands.,b Department of Rehabilitation Medicine , Erasmus University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Gerard M Ribbers
- a Rijndam Rehabilitation Institute , Rotterdam , The Netherlands.,b Department of Rehabilitation Medicine , Erasmus University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Jorrit Slaman
- b Department of Rehabilitation Medicine , Erasmus University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Majanka H Heijenbrok-Kal
- a Rijndam Rehabilitation Institute , Rotterdam , The Netherlands.,b Department of Rehabilitation Medicine , Erasmus University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Ladbon Khajeh
- c Department of Neurology , Erasmus University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Fop van Kooten
- c Department of Neurology , Erasmus University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Sebastiaan J C M M Neggers
- d Department of Endocrinology , Erasmus University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Rita J van den Berg-Emons
- a Rijndam Rehabilitation Institute , Rotterdam , The Netherlands.,b Department of Rehabilitation Medicine , Erasmus University Medical Center Rotterdam , Rotterdam , the Netherlands
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Janssen H, Dunstan DW, Bernhardt J, Walker FR, Patterson A, Callister R, Dunn A, Spratt NJ, English C. Breaking up sitting time after stroke (BUST-Stroke). Int J Stroke 2016; 12:425-429. [PMID: 27794137 DOI: 10.1177/1747493016676616] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rationale Prolonged sitting is associated with an increased risk of cardiovascular and all-cause mortality and morbidity. The metabolic and cardiovascular effects of breaking up sitting time in people with stroke are unknown. Aims and hypotheses To determine the (i) metabolic and cardiovascular effects and (ii) safety and feasibility of an experimental protocol to break up uninterrupted sitting in people with stroke. We hypothesize that activity breaks will attenuate the effects of uninterrupted sitting on glucose and insulin metabolism, blood pressure, lipid profiles, and plasma fibrinogen and that it will be both safe and feasible. Sample size estimate Based on previous estimates of population variability (SD 1% glucose and 30% insulin), 19 paired observations (i.e. participants) will achieve a power of 0.9 to detect a difference of 0.8% in glucose and 24% in insulin area under the curve (two-tailed testing, α = 0.05). Methods and design People with stroke will complete three experimental conditions one week apart in randomized order: (a) uninterrupted sitting, (b) prolonged sitting with intermittent walking, and (c) prolonged sitting with intermittent standing exercises. Serial blood samples will be collected and blood pressure measured at 30 min intervals for 8 h. Study outcomes Primary outcome will be postprandial glucose and insulin responses. Secondary outcomes will include fibrinogen concentrations, blood pressure, and adverse events and protocol feasibility. Discussion This is the first important step in determining the cardiovascular effects of breaking up sitting time after stroke. Findings will guide future studies testing behavioral strategies to reduce sitting time for the purpose of lowering recurrent stroke risk.
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Affiliation(s)
- Heidi Janssen
- 1 Hunter Stroke Service, Hunter New England Local Health District, Newcastle NSW, Australia.,2 Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, Newcastle NSW, Australia.,3 School of Health Sciences, Faculty of Health, University of Newcastle, Newcastle NSW, Australia.,4 Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle NSW, Australia
| | - David W Dunstan
- 5 Baker IDI Heart and Diabetes Institute, Melbourne VIC, Australia
| | - Julie Bernhardt
- 6 Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Heidelberg VIC, Australia.,7 University of Melbourne, Parkville VIC, Australia
| | - Frederick R Walker
- 2 Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, Newcastle NSW, Australia.,4 Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle NSW, Australia.,8 School of Biomedical Science and Pharmacy, Faculty of Health, University of Newcastle, Newcastle NSW, Australia
| | - Amanda Patterson
- 3 School of Health Sciences, Faculty of Health, University of Newcastle, Newcastle NSW, Australia
| | - Robin Callister
- 2 Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, Newcastle NSW, Australia.,4 Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle NSW, Australia.,8 School of Biomedical Science and Pharmacy, Faculty of Health, University of Newcastle, Newcastle NSW, Australia.,9 Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle NSW, Australia
| | - Ashlee Dunn
- 9 Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle NSW, Australia
| | - Neil J Spratt
- 2 Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, Newcastle NSW, Australia.,4 Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle NSW, Australia.,8 School of Biomedical Science and Pharmacy, Faculty of Health, University of Newcastle, Newcastle NSW, Australia.,10 Department of Neurology, John Hunter Hospital, Hunter New England Local Health District, Newcastle NSW, Australia
| | - Coralie English
- 2 Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, Newcastle NSW, Australia.,3 School of Health Sciences, Faculty of Health, University of Newcastle, Newcastle NSW, Australia.,4 Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle NSW, Australia
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Trinh T, Shiner CT, Thompson-Butel AG, McNulty PA. Targeted upper-limb Wii-based Movement Therapy also improves lower-limb muscle activation and functional movement in chronic stroke. Disabil Rehabil 2016; 39:1939-1949. [DOI: 10.1080/09638288.2016.1213892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Terry Trinh
- Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Christine T. Shiner
- Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Angelica G. Thompson-Butel
- Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Penelope A. McNulty
- Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia
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Sadrollahi A, Hosseinian M, Masoudi Alavi N, Khalili Z, Esalatmanesh S. Physical Activity Patterns in the Elderly Kashan Population. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e25008. [PMID: 27621923 PMCID: PMC5002999 DOI: 10.5812/ircmj.25008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/07/2015] [Accepted: 02/04/2015] [Indexed: 11/26/2022]
Abstract
Background Physical activity is an important component of health in old age that provides personal independence, physical ability, and quality of life. Objectives The current study aimed to evaluate physical activity and associated factors among the elderly population in Kashan, Iran. Patients and Methods This is a descriptive cross-sectional study. The sample was 400 elderly people (aged more than 60 years) living in Kashan, Iran in 2014. The subjects randomly selected via multi-stage cluster sampling from healthcare centers in three regions of Kashan. The sample size differed by gender and residence type. Each participant’s demographic characteristics and level of physical activity were recorded in a questionnaire, and the data were analyzed by SPSS version 16. Descriptive statistics, chi-square tests, Pearson correlations, and ordinal regression were used in the data analysis. The significance level for all the tests was P < 0.05. Results 237 (59.2%) of the subjects were female. The average age of the study population was 67.6 ± 6.8 years. Their average physical activity energy consumption was 326.21 ± 364.84 according to the metabolic equivalent of hours per week. 20 subjects (5%) reported no physical activity. 320 (80%) and 59 (14.8%) subjects had low and moderate physical activity levels, respectively. Only 1 subject (0.2%) had extreme levels of physical activity. Men (n = 43, 26.4%) were more likely to be moderately or extremely physically active than women were (n = 17, 7.2%). There was a significant relationship between physical activity and sex (P < 0.0001), marital status (P < 0.0001), educational status (P < 0.002), current occupation (P < 0.0001), and personal independence (P < 0.00001). Of course, effective predictive variations included age (P = 0.034), gender (P = 0.001), marital status (P = 0.033), independent status (P = 0), and local environment (P =0.001). Conclusions The study revealed low physical activity in the elderly population in Kashan. The pattern of physical activity in the elderly depends on their lifestyle. A promotion of active lifestyles should be a part of health care planning for the elderly.
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Affiliation(s)
- Ali Sadrollahi
- Department of Medical Surgical Nursing, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Masoumeh Hosseinian
- Department of Medical Surgical Nursing, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding Author: Masoumeh Hosseinian, Department of Medical Surgical Nursing, Kashan University of Medical Sciences, Kashan, IR Iran. Tel/Fax: +98-3615575058, E-mail: mail:
| | - Negin Masoudi Alavi
- Trauma Nursing Research Center, Department of Medical Surgical Nursing, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Zahra Khalili
- Department of Medical Surgical Nursing, Kashan University of Medical Sciences, Kashan, IR Iran
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Kremer KL, Smith AE, Sandeman L, Inglis JM, Ridding MC, Koblar SA. Transcranial Magnetic Stimulation of Human Adult Stem Cells in the Mammalian Brain. Front Neural Circuits 2016; 10:17. [PMID: 27013982 PMCID: PMC4794489 DOI: 10.3389/fncir.2016.00017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/07/2016] [Indexed: 01/09/2023] Open
Abstract
Introduction: The burden of stroke on the community is growing, and therefore, so is the need for a therapy to overcome the disability following stroke. Cellular-based therapies are being actively investigated at a pre-clinical and clinical level. Studies have reported the beneficial effects of exogenous stem cell implantation, however, these benefits are also associated with limited survival of implanted stem cells. This exploratory study investigated the use of transcranial magnetic stimulation (TMS) as a complementary therapy to increase stem cell survival following implantation of human dental pulp stem cells (DPSC) in the rodent cortex. Methods: Sprague-Dawley rats were anesthetized and injected with 6 × 105 DPSC or control media via an intracranial injection, and then received real TMS (TMS0.2 Hz) or sham TMS (TMSsham) every 2nd day beginning on day 3 post DPSC injection for 2 weeks. Brain sections were analyzed for the survival, migration and differentiation characteristics of the implanted cells. Results: In animals treated with DPSC and TMS0.2 Hz there were significantly less implanted DPSC and those that survived remained in the original cerebral hemisphere compared to animals that received TMSsham. The surviving implanted DPSC in TMS0.2 Hz were also found to express the apoptotic marker Caspase-3. Conclusions: We suggest that TMS at this intensity may cause an increase in glutamate levels, which promotes an unfavorable environment for stem cell implantation, proliferation and differentiation. It should be noted that only one paradigm of TMS was tested as this was conducted as a exploratory study, and further TMS paradigms should be investigated in the future.
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Affiliation(s)
- Karlea L Kremer
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of AdelaideAdelaide, SA, Australia; School of Medicine, The Stroke Research Programme, The University of AdelaideAdelaide, SA, Australia
| | - Ashleigh E Smith
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of AdelaideAdelaide, SA, Australia; Alliance for Research in Exercise Nutrition and Activity (ARENA), School of Health Science, Sansom Institute for Health Research, University of South AustraliaAdelaide, SA, Australia
| | - Lauren Sandeman
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of AdelaideAdelaide, SA, Australia; School of Medicine, The Stroke Research Programme, The University of AdelaideAdelaide, SA, Australia
| | - Joshua M Inglis
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of AdelaideAdelaide, SA, Australia; School of Medicine, The Stroke Research Programme, The University of AdelaideAdelaide, SA, Australia
| | - Michael C Ridding
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of Adelaide Adelaide, SA, Australia
| | - Simon A Koblar
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of AdelaideAdelaide, SA, Australia; School of Medicine, The Stroke Research Programme, The University of AdelaideAdelaide, SA, Australia
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Suhaimi R, Talha KS, Wan K, Ariffin MA. Design of movement sequences for arm rehabilitation of post-stroke. 2015 IEEE INTERNATIONAL CONFERENCE ON CONTROL SYSTEM, COMPUTING AND ENGINEERING (ICCSCE) 2015. [DOI: 10.1109/iccsce.2015.7482205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Ivey FM, Stookey AD, Hafer-Macko CE, Ryan AS, Macko RF. Higher Treadmill Training Intensity to Address Functional Aerobic Impairment after Stroke. J Stroke Cerebrovasc Dis 2015; 24:2539-46. [PMID: 26303787 DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 06/27/2015] [Accepted: 07/07/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Peak aerobic capacity (VO2 peak) is severely worsened after disabling stroke, having serious implications for function, metabolism, and ongoing cardiovascular risk. Work from our laboratory and others has previously shown that modest improvements in VO2 peak are possible in stroke participants with aerobic exercise training. The purpose of the current investigation was to test the extent to which greater enhancements in VO2 peak after stroke are possible using a treadmill protocol with far greater emphasis on intensity progression compared with a protocol without such emphasis. METHODS Using a randomized design, we compared stroke survivors engaged in higher intensity treadmill training (HI-TM, 80% heart rate reserve [HRR]) with those undergoing lower intensity treadmill training (LO-TM, 50% HRR). Measured outcomes were change in VO2 peak, 6-minute walk distance (6MWD), 30-ft walk times (30WT), and 48-hour step counts (48SC). LO-TM participants trained for a longer period of time per session in an effort to approximately match workload/caloric expenditure. Participants were randomized with stratification according to age and baseline walking capacity. RESULTS HI-TM participants (n = 18) had significantly greater gains in VO2 peak (+34%) than LO-TM participants (n = 16; +5%) across the 6-month intervention period (P = .001, group × time interaction). Conversely, there was no statistical difference between groups in the changes observed for 6MWD, 30WT, or 48SC. CONCLUSIONS HI-TM is far more effective than LO-TM for improving VO2 peak after disabling stroke. The magnitude of relative improvement for HI-TM was double compared with previous reports from our laboratory with probable clinical significance for this population.
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Affiliation(s)
- Frederick M Ivey
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Alyssa D Stookey
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland
| | - Charlene E Hafer-Macko
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alice S Ryan
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Richard F Macko
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
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Affiliation(s)
- Julie Bernhardt
- From the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia (J.B., C.E., L.J., T.B.C.); International Centre for Allied Health Evidence, University of South Australia, Australia (C.E.); Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia (L.J.)
| | - Coralie English
- From the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia (J.B., C.E., L.J., T.B.C.); International Centre for Allied Health Evidence, University of South Australia, Australia (C.E.); Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia (L.J.)
| | - Liam Johnson
- From the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia (J.B., C.E., L.J., T.B.C.); International Centre for Allied Health Evidence, University of South Australia, Australia (C.E.); Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia (L.J.)
| | - Toby B. Cumming
- From the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia (J.B., C.E., L.J., T.B.C.); International Centre for Allied Health Evidence, University of South Australia, Australia (C.E.); Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia (L.J.)
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Schuck SO, Whetstone A, Hill V, Levine P, Page SJ. Game-Based, Portable, Upper Extremity Rehabilitation in Chronic Stroke. Top Stroke Rehabil 2015; 18:720-7. [DOI: 10.1310/tsr1806-720] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Ivar Gjellesvik T, Brurok B, Hoff J, Tørhaug T, Helgerud J. Effect of High Aerobic Intensity Interval Treadmill Walking in People With Chronic Stroke: A Pilot Study With One Year Follow-Up. Top Stroke Rehabil 2014; 19:353-60. [DOI: 10.1310/tsr1904-353] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Wang Z, Wang L, Fan H, Jiang W, Wang S, Gu Z, Wang T. Adapted low intensity ergometer aerobic training for early and severely impaired stroke survivors: a pilot randomized controlled trial to explore its feasibility and efficacy. J Phys Ther Sci 2014; 26:1449-54. [PMID: 25276034 PMCID: PMC4175255 DOI: 10.1589/jpts.26.1449] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/31/2014] [Indexed: 12/21/2022] Open
Abstract
[Purpose] To evaluate the feasibility and efficacy of adapted low intensity ergometer
aerobic training for early and severely impaired stroke survivors. [Subjects] The subjects
were forty-eight early stroke survivors. [Methods] Eligible subjects were recruited and
randomly assigned to an experimental group and a control group. Both groups participated
in comprehensive rehabilitation training. Low intensity aerobic training was only
performed by the experimental group. Outcome measures were the Fugl-Meyer motor score,
Barthel index, exercise test time, peak heart rate, plasma glucose level and serum lipid
profiles. [Results] Patients in the experimental group finished 88.6% of the total aerobic
training sessions prescribed. In compliant participants (adherence≥80%), aerobic training
significantly improved the Barthel index (from 40.1±21.1 to 79.2±14.2), Fugl-Meyer motor
score (from 26.4±19.4 to 45.4±12.7), exercise test time (from 12.2±3.62 min to
13.9±3.6 min), 2-hour glucose level (from 9.22±1.16 mmol/L to 7.21±1.36 mmol/L) and
homeostasis model of assessment for insulin resistence index (from 1.72±1.01 to
1.28±0.88). [Conclusion] Preliminary findings suggest that early and severely impaired
stroke patients may benefit from low intensity ergometer aerobic training.
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Affiliation(s)
- Zun Wang
- Rehabilitation Therapy Department, The Second Medical School of Nanjing University of Traditional Chinese Medicine, China
| | - Lei Wang
- Rehabilitation Therapy Department, The Second Medical School of Nanjing University of Traditional Chinese Medicine, China
| | - Hongjuan Fan
- Rehabilitation Therapy Department, The Second Medical School of Nanjing University of Traditional Chinese Medicine, China
| | - Wenjun Jiang
- Department of Rehabilitation Medicine, Affiliated Hospital of Jiangsu University, China
| | - Sheng Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, China
| | - Zhaohua Gu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, China
| | - Tong Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, China
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Shrivastava S, Prabhu RKR, Kirubakaran R, Thomasraj J, Sundaram B. Ankle foot orthosis for walking in stroke rehabilitation. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sonali Shrivastava
- Advanced Physiotherapy Centre; House Number 188, Jawahar Nagar Durg Chhattisgarh India 491001
| | - Rama KR Prabhu
- Gulf Medical University; College of Allied Health Sciences; Ajman United Arab Emirates
| | - Richard Kirubakaran
- Christian Medical College; South Asian Cochrane Network & Center, Prof. BV Moses Center for Evidence-Informed Health Care and Health Policy; Carman Block II Floor CMC Campus, Bagayam Vellore Tamil Nadu India 632002
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Morris JH, Oliver T, Kroll T, Joice S, Williams B. From physical and functional to continuity with pre-stroke self and participation in valued activities: A qualitative exploration of stroke survivors’, carers’ and physiotherapists’ perceptions of physical activity after stroke. Disabil Rehabil 2014; 37:64-77. [DOI: 10.3109/09638288.2014.907828] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sjöholm A, Skarin M, Churilov L, Nilsson M, Bernhardt J, Lindén T. Sedentary behaviour and physical activity of people with stroke in rehabilitation hospitals. Stroke Res Treat 2014; 2014:591897. [PMID: 24772368 PMCID: PMC3977466 DOI: 10.1155/2014/591897] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 01/04/2014] [Accepted: 02/06/2014] [Indexed: 12/12/2022] Open
Abstract
Background. Sedentary behaviour is associated with health risks, independent of physical activity. This study aimed to investigate patterns of sedentary behaviour and physical activity among stroke survivors in rehabilitation hospitals. Methods. Stroke survivors admitted to four Swedish hospital-based rehabilitation units were recruited ≥7 days since stroke onset and their activity was measured using behavioural mapping. Sedentary behaviour was defined as lying down or sitting supported. Results. 104 patients were observed (53% men). Participants spent an average of 74% (standard deviation, SD 21%) of the observed day in sedentary activities. Continuous sedentary bouts of ≥1 hour represented 44% (SD 32%) of the observed day. A higher proportion (30%, SD 7%) of participants were physically active between 9:00 AM and 12:30 PM, compared to the rest of the observed day (23%, SD 6%, P < 0.0005). Patients had higher odds of being physically active in the hall (odds ratio, OR 1.7, P = 0.001) than in the therapy area. Conclusions. The time stroke survivors spend in stroke rehabilitation units may not be used in the most efficient way to promote maximal recovery. Interventions to promote reduced sedentary time could help improve outcome and these should be tested in clinical trials.
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Affiliation(s)
- Anna Sjöholm
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Monica Skarin
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Leonid Churilov
- Department of Florey, University of Melbourne, Melbourne, Australia
| | - Michael Nilsson
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Hunter Medical Research Institute, Newcastle, Australia
| | - Julie Bernhardt
- Department of Florey, University of Melbourne, Melbourne, Australia
- La Trobe University, Melbourne, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Thomas Lindén
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Florey, University of Melbourne, Melbourne, Australia
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Wang Z, Fan H, Wang L, Wang T. Effects of routine rehabilitation training on glucose tolerance among nondiabetic stroke patients: a pilot study. Intern Med 2014; 53:2051-6. [PMID: 25224186 DOI: 10.2169/internalmedicine.53.2205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Impaired glucose tolerance (IGT) and diabetic glucose tolerance (DGT) are closely associated with vascular disease mortality and morbidity. This study was designed to determine whether routine stroke rehabilitation training can be used to improve the glucose status and whether IGT and DGT persist among nondiabetic stroke patients at discharge after such training. METHODS Eighty eligible subjects were evaluated using Oral Glucose Tolerance Tests (OGTTs) at entry and discharge at the rehabilitation medical departments of two large hospitals in China. Routine rehabilitation training was provided during hospitalization. The secondary outcome measurements were BMI, Fugl-Meyer motor score, Barthel index, HbA1c, triglycerides, HDL cholesterol and LDL cholesterol. Non-acute and nondiabetic stroke patients treated at the rehabilitation department. RESULTS Fifty-four patients had IGT or DGT at entry, while 61 patients exhibited abnormal glucose tolerance at discharge, accounting for 67.7% and 76.25% of all subjects respectively. The mean 2-hour plasma glucose level was 8.98 mmol/L at entry and 9.11 mmol/L at discharge. No changes were noted in the OGTT results or secondary outcomes after training (p>0.05), with the exceptions of significant improvements in the Fugl-Meyer motor score and Barthel index (p<0.05). CONCLUSION These preliminary results suggest that IGT and DGT are present at a high frequency among nondiabetic stroke patients both before and after routine rehabilitation training. Routine stroke rehabilitation training, which greatly improves functional outcomes, may have no effect on the incidence of abnormal glucose tolerance.
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Affiliation(s)
- Zun Wang
- Rehabilitation Department, The Second Medical School of Nanjing University of Traditional Chinese Medicine, China
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