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Sandberg K, Kleist M, Wijkman M, Enthoven P. Effects of In-Bed Cycle Exercise in Patients With Acute Stroke: A Randomized Controlled Trial. Arch Rehabil Res Clin Transl 2020; 2:100085. [PMID: 33543108 PMCID: PMC7853346 DOI: 10.1016/j.arrct.2020.100085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objective To investigate the effects of in-bed cycle exercise in addition to usual care in patients with acute stroke, National Institutes of Health Stroke Scale (NIHSS) 7-42, regarding walking ability, functional outcomes, and inpatient care days. Design Randomized controlled trial. Setting Hospital care. Participants Patients (N=56) with stroke NIHSS 7-42 were recruited 24-48 hours after stroke onset from 2 stroke units in Sweden. Interventions Both groups received usual care. The intervention group also received 20 minutes bed cycling 5 days per week with a maximum of 15 sessions. Main Outcome Measures The primary outcome was median change in walking ability measured with the 6-minute walk test (6MWT). Secondary outcome measures included the median change in modified Rankin Scale (mRS), Barthel Index (BI) for activities of daily living, and inpatient care days. Measurements were performed at baseline, post intervention (3 weeks), and at 3-month follow-up. Results There was no significant difference in change of walking ability (6MWT) from baseline to follow-up between the intervention and control groups (median, 105m [interquartile range [IQR, 220m] vs 30m [IQR, 118m], respectively, P=.147, d=0.401). There were no significant differences between groups regarding mRS, BI, or inpatient care days. Patients with less serious stroke (NIHSS 7-12) seemed to benefit from the intervention. Conclusion Although this study may have been underpowered, patients with stroke NIHSS 7-42 did not benefit from in-bed cycle exercise in addition to usual care after acute stroke. A larger study is needed to confirm our results.
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Affiliation(s)
- Klas Sandberg
- Department of Rehabilitation Vrinnevi Hospital, Norrköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Marie Kleist
- Department of Rehabilitation Vrinnevi Hospital, Norrköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Magnus Wijkman
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden.,Department of Internal Medicine, Vrinnevi Hospital, Norrköping, Sweden
| | - Paul Enthoven
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
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2
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Veldema J, Jansen P. Ergometer Training in Stroke Rehabilitation: Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2020; 101:674-689. [DOI: 10.1016/j.apmr.2019.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/27/2019] [Indexed: 12/22/2022]
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Saunders DH, Sanderson M, Hayes S, Johnson L, Kramer S, Carter DD, Jarvis H, Brazzelli M, Mead GE. Physical fitness training for stroke patients. Cochrane Database Syst Rev 2020; 3:CD003316. [PMID: 32196635 PMCID: PMC7083515 DOI: 10.1002/14651858.cd003316.pub7] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Levels of physical activity and physical fitness are low after stroke. Interventions to increase physical fitness could reduce mortality and reduce disability through increased function. OBJECTIVES The primary objectives of this updated review were to determine whether fitness training after stroke reduces death, death or dependence, and disability. The secondary objectives were to determine the effects of training on adverse events, risk factors, physical fitness, mobility, physical function, health status and quality of life, mood, and cognitive function. SEARCH METHODS In July 2018 we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO, and four additional databases. We also searched ongoing trials registers and conference proceedings, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a non-exercise intervention in stroke survivors. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed quality and risk of bias, and extracted data. We analysed data using random-effects meta-analyses and assessed the quality of the evidence using the GRADE approach. Diverse outcome measures limited the intended analyses. MAIN RESULTS We included 75 studies, involving 3017 mostly ambulatory participants, which comprised cardiorespiratory (32 studies, 1631 participants), resistance (20 studies, 779 participants), and mixed training interventions (23 studies, 1207 participants). Death was not influenced by any intervention; risk differences were all 0.00 (low-certainty evidence). There were few deaths overall (19/3017 at end of intervention and 19/1469 at end of follow-up). None of the studies assessed death or dependence as a composite outcome. Disability scores were improved at end of intervention by cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% CI 0.19 to 0.84; 8 studies, 462 participants; P = 0.002; moderate-certainty evidence) and mixed training (SMD 0.23, 95% CI 0.03 to 0.42; 9 studies, 604 participants; P = 0.02; low-certainty evidence). There were too few data to assess the effects of resistance training on disability. Secondary outcomes showed multiple benefits for physical fitness (VO2 peak and strength), mobility (walking speed) and physical function (balance). These physical effects tended to be intervention-specific with the evidence mostly low or moderate certainty. Risk factor data were limited or showed no effects apart from cardiorespiratory fitness (VO2 peak), which increased after cardiorespiratory training (mean difference (MD) 3.40 mL/kg/min, 95% CI 2.98 to 3.83; 9 studies, 438 participants; moderate-certainty evidence). There was no evidence of any serious adverse events. Lack of data prevents conclusions about effects of training on mood, quality of life, and cognition. Lack of data also meant benefits at follow-up (i.e. after training had stopped) were unclear but some mobility benefits did persist. Risk of bias varied across studies but imbalanced amounts of exposure in control and intervention groups was a common issue affecting many comparisons. AUTHORS' CONCLUSIONS Few deaths overall suggest exercise is a safe intervention but means we cannot determine whether exercise reduces mortality or the chance of death or dependency. Cardiorespiratory training and, to a lesser extent mixed training, reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve fitness, balance and the speed and capacity of walking. The magnitude of VO2 peak increase after cardiorespiratory training has been suggested to reduce risk of stroke hospitalisation by ˜7%. Cognitive function is under-investigated despite being a key outcome of interest for patients. Further well-designed randomised trials are needed to determine the optimal exercise prescription, the range of benefits and any long-term benefits.
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Affiliation(s)
- David H Saunders
- University of EdinburghPhysical Activity for Health Research Centre (PAHRC)St Leonards LandHolyrood RoadEdinburghMidlothianUKEH8 8AQ
| | - Mark Sanderson
- University of the West of ScotlandInstitute of Clinical Exercise and Health ScienceRoom A071A, Almada BuildingHamiltonUKML3 0JB
| | - Sara Hayes
- University of LimerickSchool of Allied Health, Ageing Research Centre, Health Research InstituteLimerickIreland
| | - Liam Johnson
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergAustralia3084
| | - Sharon Kramer
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergAustralia3084
| | - Daniel D Carter
- University of LimerickSchool of Allied Health, Faculty of Education and Health SciencesLimerickIreland
| | - Hannah Jarvis
- Manchester Metropolitan UniversityResearch Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and EngineeringJohn Dalton BuildingChester StreetManchesterUKM1 5GD
| | - Miriam Brazzelli
- University of AberdeenHealth Services Research UnitHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
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Brouwer R, Wondergem R, Otten C, Pisters MF. Effect of aerobic training on vascular and metabolic risk factors for recurrent stroke: a meta-analysis. Disabil Rehabil 2019; 43:2084-2091. [PMID: 31794269 DOI: 10.1080/09638288.2019.1692251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM This meta-analysis aimed to determine the effect of aerobic training, compared to non-aerobic interventions, on vascular and metabolic risk factors for recurrent stroke. METHOD This study was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PRISMA). Searches were performed in PubMed, Embase, Cochrane library and Cinahl up to May 8th 2019. Randomized clinical trials evaluating the effect of solely aerobic training on vascular and metabolic risk factors for recurrent stroke were included in a meta-analysis if relevant outcomes were reported in at least two articles. RESULTS Our search resulted in a total of 7381 hits. Eleven outcomes out of nine articles were included in the meta-analysis. A significant positive effect of aerobic training was found on systolic blood pressure (-3.59 mmHg, 95% CI -6.14 to -1.05) and fasting glucose (-0.12 mmol/l, 95% CI -0.23 to -0.02). The effect on systolic blood pressure further improved when only high-quality studies were included (-4.95 mmHg, 95% CI -8.24 to -1.66). CONCLUSION Aerobic training results in a significant positive effect on systolic blood pressure and fasting glucose after stroke when compared to non-aerobic usual care or non-aerobic exercise.Implications for rehabilitationAerobic training has a positive effect on two of the most important vascular risk factors for recurrent stroke (i.e., systolic blood pressure and fasting glucose).The effect of solely aerobic training seems to be comparable to the effect of combined strength exercise and aerobic training for systolic blood pressure and fasting glucose.Since aerobic training has a significant effect on risk factors for recurrent stroke, implementation of aerobic training in daily life is important to reduce long term stroke risk.Previous research has showed that other metabolic risk factors can be altered by other interventions (e.g., strength exercise or lifestyle coaching), therefore, post-stroke prevention programs should be tailored in order to target specific risk-factors for individual patients.
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Affiliation(s)
- Rafaël Brouwer
- Royal Dutch Society for Physical Therapy (KNGF), Amersfoort, the Netherlands.,Department of Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center, Utrecht, the Netherlands
| | - Roderick Wondergem
- Department of Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center, Utrecht, the Netherlands.,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands.,Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - Carlijn Otten
- Department of Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center, Utrecht, the Netherlands
| | - Martijn F Pisters
- Department of Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center, Utrecht, the Netherlands.,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands.,Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
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5
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Alqahtani AS, Alajam R, Eickmeyer SM, Vardey R, Liu W. Feasibility and trend of pulmonary function in a pilot trial of aerobic walking exercise in non-ambulatory stroke survivors. Top Stroke Rehabil 2019; 27:190-198. [PMID: 31622173 DOI: 10.1080/10749357.2019.1673590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Lung function is compromised in stroke survivors, which may cause fatigue and exercise intolerance. Furthermore, past studies of aerobic exercise have involved only stroke survivors who could walk independently. Stroke survivors who were unable to walk were not included in the previous research-investigating changes in lung function from walking exercise interventions. In this pilot study, the feasibility and the effect of aerobic walking exercise on lung function was examined in non-ambulatory stroke survivors using a treadmill, bodyweight support system, and a gait training device.Methods: This study was a single group trial. Eight non-ambulatory stroke survivors (five males, mean age 63.3 ± 13.7 years, seven with ischemic stroke) completed a low intensity walking exercise program (30 min/session; three sessions/week for 8 weeks) and lung function test. Before and after the intervention, vital capacity (VC) and forced vital capacity (FVC) using a spirometer were measured according to the guideline from American Thoracic Society/European Respiratory Society.Results: The rates of compliance and attrition were 100% and 10%; respectively, and no adverse events were reported. There were significant differences between pre- and post-intervention assessments in FVC (p = .09), percentage of predicted VC (p = .08), and percentage of predicted FVC (p = .08).Conclusions: In non-ambulatory stroke survivors, aerobic walking exercise is feasible and safe. Also, the results are promising and suggest that aerobic walking exercise may improve lung function; more data are needed.
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Affiliation(s)
- Abdulfattah S Alqahtani
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, MO, USA.,Department of Health Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ramzi Alajam
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, MO, USA.,Department of Physical Therapy, Jazan University, Gazan, Saudi Arabia
| | - Sarah M Eickmeyer
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, MO, USA
| | - Rakesh Vardey
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, MO, USA
| | - Wen Liu
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, MO, USA
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6
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Wang C, Redgrave J, Shafizadeh M, Majid A, Kilner K, Ali AN. Aerobic exercise interventions reduce blood pressure in patients after stroke or transient ischaemic attack: a systematic review and meta-analysis. Br J Sports Med 2018; 53:1515-1525. [PMID: 29743171 DOI: 10.1136/bjsports-2017-098903] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Secondary vascular risk reduction is critical to preventing recurrent stroke. We aimed to evaluate the effect of exercise interventions on vascular risk factors and recurrent ischaemic events after stroke or transient ischaemic attack (TIA). DESIGN Intervention systematic review and meta-analysis. DATA SOURCES OVID MEDLINE, PubMed, The Cochrane Library, Web of Science, The National Institute for Health and Care Excellence, TRIP Database, CINAHL, PsycINFO, SCOPUS, UK Clinical Trials Gateway and the China National Knowledge Infrastructure were searched from 1966 to October 2017. ELIGIBILITY CRITERIA Randomised controlled trials evaluating aerobic or resistance exercise interventions on vascular risk factors and recurrent ischaemic events among patients with stroke or TIA, compared with control. RESULTS Twenty studies (n=1031) were included. Exercise interventions resulted in significant reductions in systolic blood pressure (SBP) -4.30 mm Hg (95% CI -6.77 to -1.83) and diastolic blood pressure -2.58 mm Hg (95% CI -4.7 to -0.46) compared with control. Reduction in SBP was most pronounced among studies initiating exercise within 6 months of stroke or TIA (-8.46 mm Hg, 95% CI -12.18 to -4.75 vs -2.33 mm Hg, 95% CI -3.94 to -0.72), and in those incorporating an educational component (-7.81 mm Hg, 95% CI -14.34 to -1.28 vs -2.78 mm Hg, 95% CI -4.33 to -1.23). Exercise was also associated with reductions in total cholesterol (-0.27 mmol/L, 95% CI -0.54 to 0.00), but not fasting glucose or body mass index. One trial reported reductions in secondary vascular events with exercise, but was insufficiently powered. SUMMARY Exercise interventions can result in clinically meaningful blood pressure reductions, particularly if initiated early and alongside education.
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Affiliation(s)
- Cheng Wang
- Faculty of Medicine Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Jessica Redgrave
- Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mohsen Shafizadeh
- Sheffield Hallam University, Academy of Sport and Physical Activity, Sheffield, UK
| | - Arshad Majid
- Faculty of Medicine Dentistry and Health, University of Sheffield, Sheffield, UK.,Sheffield NIHR Biomedical Research Centre, Sheffield, UK
| | - Karen Kilner
- Sheffield Hallam University, Centre for Health and Social Care Research, Sheffield, UK
| | - Ali N Ali
- Faculty of Medicine Dentistry and Health, University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Geriatrics and Stroke Medicine, Sheffield, UK
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Ribeiro TS, Chaves da Silva TC, Carlos R, de Souza E Silva EMG, Lacerda MO, Spaniol AP, Lindquist ARR. Is there influence of the load addition during treadmill training on cardiovascular parameters and gait performance in patients with stroke? A randomized clinical trial. NeuroRehabilitation 2017; 40:345-354. [PMID: 28222556 DOI: 10.3233/nre-161422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although exercises involving both lower limbs are indicated for aerobic training, stroke patients have shown expressive asymmetry between the paretic and non-paretic lower limb (NPLL). Performing activities that stimulate the paretic limb during aerobic exercise may optimize training results. OBJECTIVE To evaluate if there is influence of load addition on NPLL during treadmill training on cardiovascular parameters and gait performance of subacute stroke patients. METHODS Thirty-eight stroke subjects with gait deficits were randomized into experimental group, which underwent treadmill training with a mass attached on NPLL, and control group, which underwent only treadmill training. Interventions lasted 2 weeks (9 sessions). Main outcomes were heart rate, arterial blood pressure, gait speed and distance covered. Assessments occurred at rest, 10th and 20th minutes of the session and immediately after each session. RESULTS There was improvement in speed and walking distance in both groups. All cardiovascular parameters had showed no changes compared to 1st and 9th sessions and there were no differences between groups within each session. CONCLUSIONS Load addition on NPLL did not alter cardiovascular parameters and gait training provide better gait performance of subacute stroke patients, which indicates this therapy can be considered useful and safe for these patients.
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8
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Effects of an Individualized Aerobic Exercise Program in Individuals With a Brain Tumor Undergoing Inpatient Rehabilitation: A Feasibility Study. REHABILITATION ONCOLOGY 2017. [DOI: 10.1097/01.reo.0000000000000069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Güngen BD, Tunç A, Aras YG, Gündoğdu AA, Güngen AC, Bal S. Predictors of intensive care unit admission and mortality in patients with ischemic stroke: investigating the effects of a pulmonary rehabilitation program. BMC Neurol 2017; 17:132. [PMID: 28693521 PMCID: PMC5504678 DOI: 10.1186/s12883-017-0912-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 07/05/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the predictors of intensive care unit (ICU) admission and mortality among stroke patients and the effects of a pulmonary rehabilitation program on stroke patients. METHODS This prospective study enrolled 181 acute ischemic stroke patients aged between 40 and 90 years. Demographical characteristics, laboratory tests, diffusion-weighed magnetic resonance imaging (DWI-MRI) time, nutritional status, vascular risk factors, National Institute of Health Stroke Scale (NIHSS) scores and modified Rankin scale (MRS) scores were recorded for all patients. One-hundred patients participated in the pulmonary rehabilitation program, 81 of whom served as a control group. RESULTS Statistically, one- and three-month mortality was associated with NIHSS and MRS scores at admission and three months (p<0.001; r=0.440, r=0.432, r=0.339 and r=0.410, respectively). One and three months mortality- ICU admission had a statistically significant relationship with parenteral nutrition (p<0.001; r=0.346, r=0.300, respectively; r=0.294 and r=0.294, respectively). Similarly, there was also a statistically significant relationship between pneumonia onset and one- and three-month mortality- ICU admission (p<0.05; r=0.217, r=0.127, r=0.185 and r=0.185, respectively). A regression analysis showed that parenteral nutrition (odds ratio [OR] =13.434, 95% confidence interval [CI] =1.148-157.265, p=0.038) was a significant predictor of ICU admission. The relationship between pulmonary physiotherapy (PPT) and ICU admission- pneumonia onset at the end of three months was statistically significant (p=0.04 and p=0.043, respectively). CONCLUSION This study showed that PPT improved the prognosis of ischemic stroke patients. We believe that a pulmonary rehabilitation program, in addition to general stroke rehabilitation programs, can play a critical role in improving survival and functional outcomes. TRIAL REGISTRATION NCT03195907 . Trial registration date: 21.06.2017 'Retrospectively registered'.
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Affiliation(s)
| | - Abdulkadir Tunç
- Bezmialem Vakif Universitesi Tip Fakultesi Hastanesi, Istanbul, Turkey.
| | - Yeşim Güzey Aras
- Bezmialem Vakif Universitesi Tip Fakultesi Hastanesi, Istanbul, Turkey
| | | | - Adil Can Güngen
- Bezmialem Vakif Universitesi Tip Fakultesi Hastanesi, Istanbul, Turkey
| | - Serdar Bal
- Bezmialem Vakif Universitesi Tip Fakultesi Hastanesi, Istanbul, Turkey
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10
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Alterations in Aerobic Exercise Performance and Gait Economy Following High-Intensity Dynamic Stepping Training in Persons With Subacute Stroke. J Neurol Phys Ther 2017; 40:239-48. [PMID: 27632078 DOI: 10.1097/npt.0000000000000147] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Impairments in metabolic capacity and economy (O2cost) are hallmark characteristics of locomotor dysfunction following stroke. High-intensity (aerobic) training has been shown to improve peak oxygen consumption in this population, with fewer reports of changes in O2cost. However, particularly in persons with subacute stroke, inconsistent gains in walking function are observed with minimal associations with gains in metabolic parameters. The purpose of this study was to evaluate changes in aerobic exercise performance in participants with subacute stroke following high-intensity variable stepping training as compared with conventional therapy. METHODS A secondary analysis was performed on data from a randomized controlled trial comparing high-intensity training with conventional interventions, and from the pilot study that formed the basis for the randomized controlled trial. Participants 1 to 6 months poststroke received 40 or fewer sessions of high-intensity variable stepping training (n = 21) or conventional interventions (n = 12). Assessments were performed at baseline (BSL), posttraining, and 2- to 3-month follow-up and included changes in submaximal (Equation is included in full-text article.)O2 ((Equation is included in full-text article.)O2submax) and O2cost at fastest possible treadmill speeds and peak speeds at BSL testing. RESULTS Significant improvements were observed in (Equation is included in full-text article.)O2submax with less consistent improvements in O2cost, although individual responses varied substantially. Combined changes in both (Equation is included in full-text article.)O2submax and (Equation is included in full-text article.)O2 at matched peak BSL speeds revealed stronger correlations to improvements in walking function as compared with either measure alone. DISCUSSION AND CONCLUSIONS High-intensity stepping training may elicit significant improvements in (Equation is included in full-text article.)O2submax, whereas changes in both peak capacity and economy better reflect gains in walking function. Providing high-intensity training to improve locomotor and aerobic exercise performance may increase the efficiency of rehabilitation sessions.Video Abstract available for more insights from the authors (see Supplemental Digital Content, http://links.lww.com/JNPT/A142).
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D’Isabella NT, Shkredova DA, Richardson JA, Tang A. Effects of exercise on cardiovascular risk factors following stroke or transient ischemic attack: a systematic review and meta-analysis. Clin Rehabil 2017; 31:1561-1572. [DOI: 10.1177/0269215517709051] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
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12
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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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13
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Cardiorespiratory fitness and cognitive functioning following short-term interventions in chronic stroke survivors with cognitive impairment: a pilot study. Int J Rehabil Res 2017; 39:153-9. [PMID: 26954991 DOI: 10.1097/mrr.0000000000000161] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study, a quasi-experimental, one-group pretest-post-test design, evaluated the effects on cognitive functioning and cardiorespiratory fitness of 8-week interventions (aerobic exercise alone and aerobic exercise and cognitive training combined) in patients with chronic stroke and cognitive impairment living in the community (participants: n=14, 61.93±9.90 years old, 51.50±38.22 months after stroke, n=7 per intervention group). Cognitive functions and cardiorespiratory fitness were evaluated before and after intervention, and at a 3-month follow-up visit (episodic memory: revised-Hopkins Verbal Learning Test; working memory: Brown-Peterson paradigm; attention omission and commission errors: Continuous Performance Test; cardiorespiratory fitness: peak oxygen uptake during a symptom-limited, graded exercise test performed on a semirecumbent ergometer). Friedman's two-way analysis of variance by ranks evaluated differences in score distributions related to time (for the two groups combined). Post-hoc testing was adjusted for multiple comparisons. Compared with before the intervention, there was a significant reduction in attention errors immediately following the intervention (omission errors: 14.6±21.5 vs. 8±13.9, P=0.01; commission errors: 16.4±6.3 vs. 10.9±7.2, P=0.04), and in part at follow-up (omission errors on follow-up: 3.4±4.3, P=0.03; commission errors on follow-up: 13.2±7.6, P=0.42). These results suggest that attention may improve in chronic stroke survivors with cognitive impairment following short-term training that includes an aerobic component, without a change in cardiorespiratory fitness. Randomized-controlled studies are required to confirm these findings.
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Boyne P, Welge J, Kissela B, Dunning K. Factors Influencing the Efficacy of Aerobic Exercise for Improving Fitness and Walking Capacity After Stroke: A Meta-Analysis With Meta-Regression. Arch Phys Med Rehabil 2016; 98:581-595. [PMID: 27744025 DOI: 10.1016/j.apmr.2016.08.484] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/16/2016] [Accepted: 08/26/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the influence of dosing parameters and patient characteristics on the efficacy of aerobic exercise (AEX) poststroke. DATA SOURCES A systematic review was conducted using PubMed, MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Academic Search Complete. STUDY SELECTION Studies were selected that compared an AEX group with a nonaerobic control group among ambulatory persons with stroke. DATA EXTRACTION Extracted outcome data included peak oxygen consumption (V˙o2peak) during exercise testing, walking speed, and walking endurance (6-min walk test). Independent variables of interest were AEX mode (seated or walking), AEX intensity (moderate or vigorous), AEX volume (total hours), stroke chronicity, and baseline outcome scores. DATA SYNTHESIS Significant between-study heterogeneity was confirmed for all outcomes. Pooled AEX effect size estimates (AEX group change minus control group change) from random effects models were V˙o2peak, 2.2mL⋅kg-1⋅min-1 (95% confidence interval [CI], 1.3-3.1mL⋅kg-1⋅min-1); walking speed, .06m/s (95% CI, .01-.11m/s); and 6-minute walk test distance, 29m (95% CI, 15-42m). In meta-regression, larger V˙o2peak effect sizes were significantly associated with higher AEX intensity and higher baseline V˙o2peak. Larger effect sizes for walking speed and the 6-minute walk test were significantly associated with a walking AEX mode. In contrast, seated AEX did not have a significant effect on walking outcomes. CONCLUSIONS AEX significantly improves aerobic capacity poststroke, but may need to be task specific to affect walking speed and endurance. Higher AEX intensity is associated with better outcomes. Future randomized studies are needed to confirm these results.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio; Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
| | - Jeffrey Welge
- Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio; Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Kari Dunning
- Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio; Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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Dohle C, Tholen R, Wittenberg H, Quintern J, Saal S, Stephan KM. [Evidence-based rehabilitation of mobility after stroke]. DER NERVENARZT 2016; 87:1062-1067. [PMID: 27531212 DOI: 10.1007/s00115-016-0188-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Approximately two thirds of stroke patients initially suffer from at least impaired mobility. Various rehabilitation concepts have been proposed. OBJECTIVE Based on the current literature, which rehabilitation methods can be recommended for improvement of gait, gait velocity, gait distance and balance? METHODS A systematic literature search was carried out for randomized clinical studies and reviews with clinically relevant outcome variables. Formulation of recommendations, separated for target variables and time after stroke. RESULTS Restoration and improvement of gait function relies on a high number of repetitions of gait movements, which for more severely affected patients is preferentially machine-based. For improvement of gait velocity for less severely affected patients intensive gait training does not necessarily rely on mechanical support. Gait distance can be improved by aerobic endurance exercises with a cardiovascular effect, which have to be performed in a functional context. Improvement of balance should be achieved by intensive functional gait training. Additional stimulation techniques are only effective when included in a functionally relevant training program. DISCUSSION These guidelines not only provide recommendations for action but also provide pathophysiological insights into functional restoration of stance and gait after stroke.
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Affiliation(s)
- C Dohle
- MEDIAN Klinik Berlin-Kladow, Kladower Damm 223, 14089, Berlin, Deutschland. .,Centrum für Schlaganfallforschung, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
| | - R Tholen
- Physio Deutschland - Deutscher Verband für Physiotherapie (ZVK), Köln, Deutschland
| | - H Wittenberg
- St. Mauritius Therapieklinik, Meerbusch, Deutschland
| | - J Quintern
- Medical Park Loipl, Bischofswiesen, Deutschland
| | - S Saal
- Institut für Gesundheits- und Pflegewissenschaft, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - K M Stephan
- St. Mauritius Therapieklinik, Meerbusch, Deutschland.,SRH Gesundheitszentrum Bad Wimpfen, Bad Wimpfen, Deutschland
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Sandberg K, Kleist M, Falk L, Enthoven P. Effects of Twice-Weekly Intense Aerobic Exercise in Early Subacute Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2016; 97:1244-53. [DOI: 10.1016/j.apmr.2016.01.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 01/14/2016] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
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Katz-Leurer M, Sender I, Keren O, Dvir Z. The influence of early cycling training on balance in stroke patients at the subacute stage. Results of a preliminary trial. Clin Rehabil 2016; 20:398-405. [PMID: 16774090 DOI: 10.1191/0269215505cr960oa] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the effect of early cycling training on balance and motor abilities of stroke patients in their subacute stage. Design: Randomized clinical trial. Setting: Inpatient rehabilitation. Subjects: Twenty-four patients who had had a first stroke were randomly assigned to a cycling training group ( n = 10) or to a control ( n = 14) group. Intervention: All subjects received their usual rehabilitation programme; the cycling training group received in addition a daily session of leg cycle ergometer, lasting three weeks. Both groups were followed for six weeks. Main outcome measurements: Balance was assessed using the Postural Assessment Scale for Stroke Patients (PASS) and the standing balance test. The motor function of the lower extremity was also assessed by the Fugl-Meyer Assessment (FMA). Results: In the within-group comparison, both the exercise group and the control group had improved significantly (P B=0.01) with time with respect to PASS total (exercise group 18.79=2.8 to 31.19=2.2, control group 18.19=3.2 to 26.49=3.8) and PASS subscores, as well as the FMA score (exercise group 17.29=7.5 to 29.19=5.9, control group 16.69=6.4 to 22.19=6.8). In addition there was a significant group=time interaction effect, with exercise group patients demonstrating better performance in both the total PASS score and PASS subscores and FMA score relative to the control patients (P B=0.01). Conclusions: These preliminary findings suggest that stroke patients in the subacute stage can improve their motor and balance abilities after an early short duration of cycling training.
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Affiliation(s)
- Michal Katz-Leurer
- Sackler Faculty of Medicine, School of Health Professions, Physical Therapy Department, Tel-Aviv University, Ramat-Aviv, Israel.
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Saunders DH, Sanderson M, Hayes S, Kilrane M, Greig CA, Brazzelli M, Mead GE. Physical fitness training for stroke patients. Cochrane Database Syst Rev 2016; 3:CD003316. [PMID: 27010219 PMCID: PMC6464717 DOI: 10.1002/14651858.cd003316.pub6] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Levels of physical fitness are low after stroke. It is unknown whether improving physical fitness after stroke reduces disability. OBJECTIVES To determine whether fitness training after stroke reduces death, dependence, and disability and to assess the effects of training with regard to adverse events, risk factors, physical fitness, mobility, physical function, quality of life, mood, and cognitive function. Interventions to improve cognitive function have attracted increased attention after being identified as the highest rated research priority for life after stroke. Therefore we have added this class of outcomes to this updated review. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 1: searched February 2015), MEDLINE (1966 to February 2015), EMBASE (1980 to February 2015), CINAHL (1982 to February 2015), SPORTDiscus (1949 to February 2015), and five additional databases (February 2015). We also searched ongoing trials registers, handsearched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a non-exercise intervention in stroke survivors. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed quality and risk of bias, and extracted data. We analysed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses. MAIN RESULTS We included 58 trials, involving 2797 participants, which comprised cardiorespiratory interventions (28 trials, 1408 participants), resistance interventions (13 trials, 432 participants), and mixed training interventions (17 trials, 957 participants). Thirteen deaths occurred before the end of the intervention and a further nine before the end of follow-up. No dependence data were reported. Diverse outcome measures restricted pooling of data. Global indices of disability show moderate improvement after cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% confidence interval (CI) 0.19 to 0.84; P value = 0.002) and by a small amount after mixed training (SMD 0.26, 95% CI 0.04 to 0.49; P value = 0.02); benefits at follow-up (i.e. after training had stopped) were unclear. There were too few data to assess the effects of resistance training.Cardiorespiratory training involving walking improved maximum walking speed (mean difference (MD) 6.71 metres per minute, 95% CI 2.73 to 10.69), preferred gait speed (MD 4.28 metres per minute, 95% CI 1.71 to 6.84), and walking capacity (MD 30.29 metres in six minutes, 95% CI 16.19 to 44.39) at the end of the intervention. Mixed training, involving walking, increased preferred walking speed (MD 4.54 metres per minute, 95% CI 0.95 to 8.14), and walking capacity (MD 41.60 metres per six minutes, 95% CI 25.25 to 57.95). Balance scores improved slightly after mixed training (SMD 0.27, 95% CI 0.07 to 0.47). Some mobility benefits also persisted at the end of follow-up. The variability, quality of the included trials, and lack of data prevents conclusions about other outcomes and limits generalisability of the observed results. AUTHORS' CONCLUSIONS Cardiorespiratory training and, to a lesser extent, mixed training reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve the speed and tolerance of walking; some improvement in balance could also occur. There is insufficient evidence to support the use of resistance training. The effects of training on death and dependence after stroke are still unclear but these outcomes are rarely observed in physical fitness training trials. Cognitive function is under-investigated despite being a key outcome of interest for patients. Further well-designed randomised trials are needed to determine the optimal exercise prescription and identify long-term benefits.
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Affiliation(s)
- David H Saunders
- Institute for Sport, Physical Education and Health Sciences (SPEHS), University of EdinburghMoray House School of EducationSt Leonards LandHolyrood RoadEdinburghUKEH8 2AZ
| | - Mark Sanderson
- University of the West of ScotlandInstitute of Clinical Exercise and Health ScienceRoom A071A, Almada BuildingHamiltonUKML3 0JB
| | - Sara Hayes
- University of LimerickDepartment of Clinical TherapiesLimerickIreland
| | - Maeve Kilrane
- Royal Infirmary of EdinburghDepartment of Stroke MedicineWard 201 ‐ Stroke UnitLittle FranceEdinburghUKEH16 4SA
| | - Carolyn A Greig
- University of BirminghamSchool of Sport, Exercise and Rehabilitation Sciences, MRC‐ARUK Centre for Musculoskeletal Ageing ResearchEdgbastonBirminghamUKB15 2TT
| | - Miriam Brazzelli
- University of AberdeenHealth Services Research UnitHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
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Efficacy of Feedback-Controlled Robotics-Assisted Treadmill Exercise to Improve Cardiovascular Fitness Early After Stroke: A Randomized Controlled Pilot Trial. J Neurol Phys Ther 2016; 39:156-65. [PMID: 26050073 PMCID: PMC4484666 DOI: 10.1097/npt.0000000000000095] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Cardiovascular fitness is greatly reduced after stroke. Although individuals with mild to moderate impairments benefit from conventional cardiovascular exercise interventions, there is a lack of effective approaches for persons with severely impaired physical function. This randomized controlled pilot trial investigated efficacy and feasibility of feedback-controlled robotics-assisted treadmill exercise (FC-RATE) for cardiovascular rehabilitation in persons with severe impairments early after stroke. METHODS Twenty individuals (age 61 ± 11 years; 52 ± 31 days poststroke) with severe motor limitations (Functional Ambulation Classification 0-2) were recruited for FC-RATE or conventional robotics-assisted treadmill exercise (RATE) (4 weeks, 3 × 30-minute sessions/wk). Outcome measures focused on peak cardiopulmonary performance parameters, training intensity, and feasibility, with examiners blinded to allocation. RESULTS All 14 allocated participants (70% of recruited) completed the intervention (7/group, withdrawals unrelated to intervention), without serious adverse events occurring. Cardiovascular fitness increased significantly in both groups, with peak oxygen uptake increasing from 14.6 to 17.7 mL · kg · min (+17.8%) after 4 weeks (45.8%-55.7% of predicted maximal aerobic capacity; time effect P = 0.01; no group-time interaction). Training intensity (% heart rate reserve) was significantly higher for FC-RATE (40% ± 3%) than for conventional RATE (14% ± 2%) (P = 0.001). DISCUSSION AND CONCLUSIONS Substantive overall increases in the main cardiopulmonary performance parameters were observed, but there were no significant between-group differences when comparing FC-RATE and conventional RATE. Feedback-controlled robotics-assisted treadmill exercise significantly increased exercise intensity, but recommended intensity levels for cardiovascular training were not consistently achieved. Future research should focus on appropriate algorithms within advanced robotic systems to promote optimal cardiovascular stress.Video abstract available for more insights from the authors (Supplemental Digital Content 1, http://links.lww.com/JNPT/A107).
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Physical Exercise as a Diagnostic, Rehabilitation, and Preventive Tool: Influence on Neuroplasticity and Motor Recovery after Stroke. Neural Plast 2015; 2015:608581. [PMID: 26682073 PMCID: PMC4670869 DOI: 10.1155/2015/608581] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/03/2015] [Accepted: 06/18/2015] [Indexed: 01/19/2023] Open
Abstract
Stroke remains a leading cause of adult motor disabilities in the world and accounts for the greatest number of hospitalizations for neurological disease. Stroke treatments/therapies need to promote neuroplasticity to improve motor function. Physical exercise is considered as a major candidate for ultimately promoting neural plasticity and could be used for different purposes in human and animal experiments. First, acute exercise could be used as a diagnostic tool to understand new neural mechanisms underlying stroke physiopathology. Indeed, better knowledge of stroke mechanisms that affect movements is crucial for enhancing treatment/rehabilitation effectiveness. Secondly, it is well established that physical exercise training is advised as an effective rehabilitation tool. Indeed, it reduces inflammatory processes and apoptotic marker expression, promotes brain angiogenesis and expression of some growth factors, and improves the activation of affected muscles during exercise. Nevertheless, exercise training might also aggravate sensorimotor deficits and brain injury depending on the chosen exercise parameters. For the last few years, physical training has been combined with pharmacological treatments to accentuate and/or accelerate beneficial neural and motor effects. Finally, physical exercise might also be considered as a major nonpharmacological preventive strategy that provides neuroprotective effects reducing adverse effects of brain ischemia. Therefore, prestroke regular physical activity may also decrease the motor outcome severity of stroke.
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Billinger SA, Boyne P, Coughenour E, Dunning K, Mattlage A. Does aerobic exercise and the FITT principle fit into stroke recovery? Curr Neurol Neurosci Rep 2015; 15:519. [PMID: 25475494 DOI: 10.1007/s11910-014-0519-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Sedentary lifestyle after stroke is common which results in poor cardiovascular health. Aerobic exercise has the potential to reduce cardiovascular risk factors and improve functional capacity and quality of life in people after stroke. However, aerobic exercise is a therapeutic intervention that is underutilized by healthcare professionals after stroke. The purpose of this review paper is to provide information on exercise prescription using the FITT principle (frequency, intensity, time, type) for people after stroke and to guide healthcare professionals to incorporate aerobic exercise into the plan of care. This article discusses the current literature outlining the evidence base for incorporating aerobic exercise into stroke rehabilitation. Recently, high-intensity interval training has been used with people following stroke. Information is provided regarding the early but promising results for reaching higher target heart rates.
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Affiliation(s)
- Sandra A Billinger
- Department of Physical Therapy and Rehabilitation Science, KU Medical Center, 3901 Rainbow Blvd MS 2002, Kansas City, KS, 66160, USA,
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Gäverth J, Parker R, MacKay-Lyons M. Exercise Stress Testing After Stroke or Transient Ischemic Attack: A Scoping Review. Arch Phys Med Rehabil 2015; 96:1349-1359.e12. [DOI: 10.1016/j.apmr.2015.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 02/02/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
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Patient Characteristics That Influence Enrollment and Attendance in Aerobic Exercise Early After Stroke. Arch Phys Med Rehabil 2015; 96:823-30. [DOI: 10.1016/j.apmr.2014.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 11/25/2014] [Accepted: 12/01/2014] [Indexed: 11/21/2022]
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Cleveland S, Driver S, Swank C, Macklin S. Classifying physical activity research following stroke using the behavioral epidemiologic framework. Top Stroke Rehabil 2015; 22:289-98. [PMID: 26258454 DOI: 10.1179/1074935714z.0000000043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Stroke is a significant public health issue in the USA and a need emerges to better understand how to reduce an individual's co-morbidity risk. Physical activity is one approach to improving the health of individuals and comprehensive literature supports increased activity as a means to reduce risk of morbidity and mortality. One approach to examining whether research in a field is addressing a public health issue is through application of the behavioral epidemiological framework. OBJECTIVE To classify physical activity research for individuals following stroke into distinct phases so that efforts can be made to systematically address gaps and disseminate evidence-based practice. METHODS Specific key words were identified and then searched through EBSCO host, PubMed, and Google Scholar. Physical activity and stroke literature from 2000-2014 was categorized into one of five discrete phases. Research in Phase 1 identified associations between activity and health; Phase 2 established valid measures of activity; Phase 3 examined determinants of behavior; Phase 4 evaluated activity interventions; and Phase 5 disseminated evidence-based practice. RESULTS A comprehensive review of literature identified 202 articles with 70% categorized in Phase 1 (n = 141), 11% in Phase 2 (n = 23), 10% in Phase 3 (n = 20), 8% in Phase 4 (n = 15), and 1% in Phase 5 (n = 3). CONCLUSION Findings suggest that physical activity research for individuals following stroke is in the early stages of development with less than 10% of research evaluating or disseminating interventions.
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Khadilkar A, Phillips K, Jean N, Lamothe C, Milne S, Sarnecka J. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Post-Stroke Rehabilitation. Top Stroke Rehabil 2015; 13:1-269. [PMID: 16939981 DOI: 10.1310/3tkx-7xec-2dtg-xqkh] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this project was to create guidelines for 13 types of physical rehabilitation interventions used in the management of adult patients (>18 years of age) presenting with hemiplegia or hemiparesis following a single clinically identifiable ischemic or hemorrhagic cerebrovascular accident (CVA). METHOD Using Cochrane Collaboration methods, the Ottawa Methods Group identified and synthesized evidence from comparative controlled trials. The group then formed an expert panel, which developed a set of criteria for grading the strength of the evidence and the recommendation. Patient-important outcomes were determined through consensus, provided that these outcomes were assessed with a validated and reliable scale. RESULTS The Ottawa Panel developed 147 positive recommendations of clinical benefit concerning the use of different types of physical rehabilitation interventions involved in post-stroke rehabilitation. DISCUSSION AND CONCLUSION The Ottawa Panel recommends the use of therapeutic exercise, task-oriented training, biofeedback, gait training, balance training, constraint-induced movement therapy, treatment of shoulder subluxation, electrical stimulation, transcutaneous electrical nerve stimulation, therapeutic ultrasound, acupuncture, and intensity and organization of rehabilitation in the management of post stroke.
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Kim J, Park JH, Yim J. Effects of respiratory muscle and endurance training using an individualized training device on the pulmonary function and exercise capacity in stroke patients. Med Sci Monit 2014; 20:2543-9. [PMID: 25488849 PMCID: PMC4266259 DOI: 10.12659/msm.891112] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Because respiratory muscle function plays a strong role in exercise capacity and cardiopulmonary response to exercise, systematic training and measurement of respiratory muscle function should be considered in stroke patients. The purpose of this study was to determine whether an individualized respiratory muscle training device combined with conventional physical therapy exercise can improve the pulmonary function and exercise capacity of stroke patients. MATERIAL AND METHODS Twenty stroke patients were randomly assigned to an exercise group (n=10) or a control group (n=10). Over 4 weeks, each group participated in exercise training interventions 3 times per week. In each session, the control group received basic exercise treatments for 30 min, followed by an automated full-body workout for 20 min. The exercise group performed the same exercise regimen as the control group, as well as an additional respiratory muscle training regimen using a respiratory exercise device for 20 min. RESULTS Pulmonary function of forced vital capacity (FVC), forced expiratory volume at 1 s (FEV1), FEV1/FVC, and peak expiratory flow (PEF) and exercise capacity of a 6-min walking test and Shortness of Breath Modified Borg Dyspnea Scale (SBMBDS) scores were assessed before and after the training. A significant intergroup difference was observed in the FVC, FEV1, PEF, 6MWT, and SBMBDS scores (p<0.05). CONCLUSIONS These findings suggest that exercise of the respiratory muscles using an individualized respiratory device had a positive effect on pulmonary function and exercise capacity and may be used for breathing rehabilitation in stroke patients.
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Affiliation(s)
- JinHong Kim
- Department of Physical Therapy, Sahmyook University, Seoul, Korea
| | - Jun Hyuck Park
- Department of Physical Therapy, Sahmyook University, Seoul, Korea
| | - Jongeun Yim
- Department of Physical Therapy, Sahmyook University, Seoul, Korea
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Stoller O, de Bruin ED, Schindelholz M, Schuster-Amft C, de Bie RA, Hunt KJ. Cardiopulmonary exercise testing early after stroke using feedback-controlled robotics-assisted treadmill exercise: test-retest reliability and repeatability. J Neuroeng Rehabil 2014; 11:145. [PMID: 25306061 PMCID: PMC4271449 DOI: 10.1186/1743-0003-11-145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exercise capacity is seriously reduced after stroke. While cardiopulmonary assessment and intervention strategies have been validated for the mildly and moderately impaired populations post-stroke, there is a lack of effective concepts for stroke survivors suffering from severe motor limitations. This study investigated the test-retest reliability and repeatability of cardiopulmonary exercise testing (CPET) using feedback-controlled robotics-assisted treadmill exercise (FC-RATE) in severely motor impaired individuals early after stroke. METHODS 20 subjects (age 44-84 years, <6 month post-stroke) with severe motor limitations (Functional Ambulatory Classification 0-2) were selected for consecutive constant load testing (CLT) and incremental exercise testing (IET) within a powered exoskeleton, synchronised with a treadmill and a body weight support system. A manual human-in-the-loop feedback system was used to guide individual work rate levels. Outcome variables focussed on standard cardiopulmonary performance parameters. Relative and absolute test-retest reliability were assessed by intraclass correlation coefficients (ICC), standard error of the measurement (SEM), and minimal detectable change (MDC). Mean difference, limits of agreement, and coefficient of variation (CoV) were estimated to assess repeatability. RESULTS Peak performance parameters during IET yielded good to excellent relative reliability: absolute peak oxygen uptake (ICC =0.82), relative peak oxygen uptake (ICC =0.72), peak work rate (ICC =0.91), peak heart rate (ICC =0.80), absolute gas exchange threshold (ICC =0.91), relative gas exchange threshold (ICC =0.88), oxygen cost of work (ICC =0.87), oxygen pulse at peak oxygen uptake (ICC =0.92), ventilation rate versus carbon dioxide output slope (ICC =0.78). For these variables, SEM was 4-13%, MDC 12-36%, and CoV 0.10-0.36. CLT revealed high mean differences and insufficient test-retest reliability for all variables studied. CONCLUSIONS This study presents first evidence on reliability and repeatability for CPET in severely motor impaired individuals early after stroke using a feedback-controlled robotics-assisted treadmill. The results demonstrate good to excellent test-retest reliability and appropriate repeatability for the most important peak cardiopulmonary performance parameters. These findings have important implications for the design and implementation of cardiovascular exercise interventions in severely impaired populations. Future research needs to develop advanced control strategies to enable the true limit of functional exercise capacity to be reached and to further assess test-retest reliability and repeatability in larger samples.
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Affiliation(s)
- Oliver Stoller
- />Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- />Department of Epidemiology, Maastricht University and Caphri Research School, Maastricht, Netherlands
- />Research Department, Reha Rheinfelden,, Rheinfelden, Switzerland
| | - Eling D de Bruin
- />Department of Epidemiology, Maastricht University and Caphri Research School, Maastricht, Netherlands
- />Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- />Centre for Evidence Based Physiotherapy, Maastricht University, Maastricht, Netherlands
| | - Matthias Schindelholz
- />Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- />Research Department, Reha Rheinfelden,, Rheinfelden, Switzerland
| | - Corina Schuster-Amft
- />Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- />Research Department, Reha Rheinfelden,, Rheinfelden, Switzerland
| | - Rob A de Bie
- />Department of Epidemiology, Maastricht University and Caphri Research School, Maastricht, Netherlands
- />Centre for Evidence Based Physiotherapy, Maastricht University, Maastricht, Netherlands
| | - Kenneth J Hunt
- />Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- />Research Department, Reha Rheinfelden,, Rheinfelden, Switzerland
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Tang A, Eng JJ, Krassioukov AV, Madden KM, Mohammadi A, Tsang MYC, Tsang TSM. Exercise-induced changes in cardiovascular function after stroke: a randomized controlled trial. Int J Stroke 2014; 9:883-9. [PMID: 24148695 PMCID: PMC4486377 DOI: 10.1111/ijs.12156] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 05/22/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Cardiovascular co-morbidities are prevalent after stroke, with heart disease, hypertension and impaired glucose tolerance present in the majority of cases. Exercise has the potential to mediate cardiovascular risk factors commonly present in people with stroke. This single-blinded randomized controlled trial compared the effects of high versus low intensity exercise on fitness, cardiovascular risk factors, and cardiac function after stroke. METHODS Fifty participants (age 50-80 y, >1 y post-stroke) were randomized to a high-intensity Aerobic Exercise (AE) or low-intensity non-aerobic Balance/Flexibility (BF) program (6 months, 3 60-min sessions/week). Outcomes assessed by VO2 peak (primary outcome), arterial stiffness, ambulatory capacity, hemodynamics and cardiac function using echocardiography, and lipid, glucose and homocysteine levels. Assessors were blinded to group allocation. RESULTS Twenty-three (92%) of 25 AE group participants (withdrawals unrelated to the intervention) and all BF group participants completed the program. One BF group participant experienced 2 non-injurious falls during class. No other adverse events occurred. There were no changes in VO2 peak in either group (AE 16·9±7 to 17·4±7 ml●kg(-1) ●min(-1) vs. BF 16·9±6 to 16·6±5 ml●kg(-1) ●min(-1) , P=0·45), but AE group demonstrated greater improvement in right atrial emptying fraction (AE 30±22 to 37±22% vs. BF 35±20 to 31±20%, P=0·04). Both groups demonstrated improvements in lipid profiles, glucose and homocysteine levels, and ambulatory capacity (P<0·04). CONCLUSIONS This was the first study to examine the effects of aerobic exercise after stroke on cardiovascular hemodynamics. High-intensity exercise improved right-sided function and early myocardial relaxation. Low-intensity exercise may also benefit plasma lipid, glucose and inflammatory markers, and ambulatory capacity. This study is an important step towards understanding mechanisms by which exercise may reduce cardiovascular risk and function.
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Affiliation(s)
- Ada Tang
- Faculty of Medicine, Department of Physical Therapy, Vancouver Coastal Health, University of British Columbia, Vancouver, British Columbia, Canada
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Billinger SA, Arena R, Bernhardt J, Eng JJ, Franklin BA, Johnson CM, MacKay-Lyons M, Macko RF, Mead GE, Roth EJ, Shaughnessy M, Tang A. Physical Activity and Exercise Recommendations for Stroke Survivors. Stroke 2014; 45:2532-53. [PMID: 24846875 DOI: 10.1161/str.0000000000000022] [Citation(s) in RCA: 826] [Impact Index Per Article: 82.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Feasibility of virtual reality augmented cycling for health promotion of people poststroke. J Neurol Phys Ther 2014; 37:118-24. [PMID: 23863828 DOI: 10.1097/npt.0b013e3182a0a078] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE A virtual reality (VR) augmented cycling kit (VRACK) was developed to address motor control and fitness deficits of individuals with chronic stroke. In this article, we report on the safety, feasibility, and efficacy of using the VR augmented cycling kit to improve cardiorespiratory (CR) fitness of individuals in the chronic phase poststroke. METHODS Four individuals with chronic stroke (47-65 years old and ≥3 years poststroke), with residual lower extremity impairments (Fugl-Meyer 24-26/34), who were limited community ambulators (gait speed range 0.56-1.1 m/s) participated in this study. Safety was defined as the absence of adverse events. Feasibility was measured using attendance, total exercise time, and "involvement" measured with the presence questionnaire (PQ). Efficacy of CR fitness was evaluated using a submaximal bicycle ergometer test before and after an 8-week training program. RESULTS The intervention was safe and feasible with participants having 1 adverse event, 100% adherence, achieving between 90 and 125 minutes of cycling each week, and a mean PQ score of 39 (SD 3.3). There was a statistically significant (13%; P = 0.035) improvement in peak VO(2), with a range of 6% to 24.5%. DISCUSSION AND CONCLUSION For these individuals, poststroke, VR augmented cycling, using their heart rate to set their avatar's speed, fostered training of sufficient duration and intensity to promote CR fitness. In addition, there was a transfer of training from the bicycle to walking endurance. VR augmented cycling may be an addition to the therapist's tools for concurrent training of mobility and health promotion of individuals poststroke.
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Singh DKA, Mohd Nordin NA, Aziz NAA, Lim BK, Soh LC. Effects of substituting a portion of standard physiotherapy time with virtual reality games among community-dwelling stroke survivors. BMC Neurol 2013; 13:199. [PMID: 24330250 PMCID: PMC4029492 DOI: 10.1186/1471-2377-13-199] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 12/04/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Evidence indicates that the continuation of therapy among community-dwelling stroke survivors improves physical function. Community rehabilitation programmes often face limitations in terms of resources. It is imperative to include new motivational interventions to encourage some level of non-clinician management. The aim of this study was to determine whether there were any changes in physical function and activities of daily living when substituting a portion of the standard physiotherapy time with virtual reality games among community-dwelling stroke survivors. METHODS In this controlled trial, the experimental group received 30 minutes of virtual reality balance games in addition to 90 minutes of standard physiotherapy. The control group continued with their two hours of routine standard physiotherapy. Both groups received 12 therapy sessions: two-hour sessions twice per week for six continuous weeks. Changes in physical function, activities of daily living and balance ability were assessed using the Timed Up and Go test, 30-second Sit to Stand test, Timed Ten-Metre Walk test, Six-Minute Walk test and the Barthel Index, and static balance was assessed using a probalance board. RESULTS Twenty-eight participants completed post-intervention assessments. The results showed a significant within-subject effect on the Timed Up and Go test: F (1, 26) = 5.83, p = 0.02; and the 30-second Sit to Stand test; F (1, 26) = 13.50, p = 0.001. The between-subject effect was not significant (p > 0.05) for any of the outcome measurements. CONCLUSION Substituting a portion of the standard physiotherapy time with virtual reality games was equally effective in maintaining physical function outcomes and activities of daily living among community-dwelling stroke survivors. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register, ACTRN12613000478718.
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Affiliation(s)
- Devinder Kaur Ajit Singh
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Jalan Raja Muda Aziz, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Nor Azlin Mohd Nordin
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Jalan Raja Muda Aziz, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Noor Azah Abd Aziz
- Department of Family Medicine, Medical Faculty, University Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Beng Kooi Lim
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Jalan Raja Muda Aziz, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Li Ching Soh
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Jalan Raja Muda Aziz, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
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Abstract
BACKGROUND Levels of physical fitness are low after stroke. It is unknown whether improving physical fitness after stroke reduces disability. OBJECTIVES To determine whether fitness training after stroke reduces death, dependence, and disability. The secondary aims were to determine the effects of training on physical fitness, mobility, physical function, quality of life, mood, and incidence of adverse events. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched January 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12: searched January 2013), MEDLINE (1966 to January 2013), EMBASE (1980 to January 2013), CINAHL (1982 to January 2013), SPORTDiscus (1949 to January 2013), and five additional databases (January 2013). We also searched ongoing trials registers, handsearched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing either cardiorespiratory training or resistance training, or both, with no intervention, a non-exercise intervention, or usual care in stroke survivors. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed quality, and extracted data. We analysed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses. MAIN RESULTS We included 45 trials, involving 2188 participants, which comprised cardiorespiratory (22 trials, 995 participants), resistance (eight trials, 275 participants), and mixed training interventions (15 trials, 918 participants). Nine deaths occurred before the end of the intervention and a further seven at the end of follow-up. No dependence data were reported. Diverse outcome measures made data pooling difficult. Global indices of disability show a tendency to improve after cardiorespiratory training (standardised mean difference (SMD) 0.37, 95% confidence interval (CI) 0.10 to 0.64; P = 0.007); benefits at follow-up and after mixed training were unclear. There were insufficient data to assess the effects of resistance training.Cardiorespiratory training involving walking improved maximum walking speed (mean difference (MD) 7.37 metres per minute, 95% CI 3.70 to 11.03), preferred gait speed (MD 4.63 metres per minute, 95% CI 1.84 to 7.43), walking capacity (MD 26.99 metres per six minutes, 95% CI 9.13 to 44.84), and Berg Balance scores (MD 3.14, 95% CI 0.56 to 5.73) at the end of the intervention. Mixed training, involving walking, increased preferred walking speed (MD 4.54 metres per minute, 95% CI 0.95 to 8.14), walking capacity (MD 41.60 metres per six minutes, 95% CI 25.25 to 57.95), and also pooled balance scores but the evidence is weaker (SMD 0.26 95% CI 0.04 to, 0.49). Some mobility benefits also persisted at the end of follow-up. The variability and trial quality hampered the assessment of the reliability and generalisability of the observed results. AUTHORS' CONCLUSIONS The effects of training on death and dependence after stroke are unclear. Cardiorespiratory training reduces disability after stroke and this may be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programs to improve the speed and tolerance of walking; improvement in balance may also occur. There is insufficient evidence to support the use of resistance training. Further well-designed trials are needed to determine the optimal content of the exercise prescription and identify long-term benefits.
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Affiliation(s)
- David H Saunders
- Moray House School of Education, Institute for Sport, Physical Education and Health Sciences (SPEHS), University of Edinburgh, St Leonards Land, Holyrood Road, Edinburgh, Midlothian, UK, EH8 2AZ
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Kafri M, Myslinski MJ, Gade VK, Deutsch JE. Energy expenditure and exercise intensity of interactive video gaming in individuals poststroke. Neurorehabil Neural Repair 2013; 28:56-65. [PMID: 23897906 DOI: 10.1177/1545968313497100] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Off-the-shelf activity-promoting video games (AVGs) are proposed as a tool for promoting regular physical activity among individuals poststroke. OBJECTIVE To characterize the energy expenditure (EE), exercise intensity, and energy metabolism of individuals poststroke, while playing AVGs in different positions, from different consoles, and to compare the performance with comfortable walking and with able-bodied individuals. METHODS Eleven poststroke and 8 able-bodied participants played in standing Wii-Boxing Xbox-Boxing, Wii-Run and Penguin, and also Wii-Boxing in sitting. EE (expressed as metabolic equivalents [METs]); exercise intensity (expressed as %predicted maximal heart rate [HR]), rate of perceived exertion (RPE), and respiratory exchange ratio (RER) were used to characterize the games. RESULTS Participants' poststroke EE ranged from 1.81 ± 0.74 to 3.46 ± 1.3 METs and was lower compared with able-bodied participants for Xbox-Boxing (P = .001), Wii-Boxing in standing (P = .01), Run (P < .001), and Penguin (P = .001). Participants' poststroke exercise intensity ranged from 49.8 ± 9.3 to 64.7 ± 9.3 %predicted maximal HR and was lower compared with able-bodied participants for Xbox-Boxing (P = .007) and Run (P = .005). For participants poststroke, EE of walking at a comfortable did not differ from boxing games in standing or Run. For able-bodied participants only, the EE for Xbox-Boxing was higher than Wii-Boxing (6.5 ± 2.6 vs 4.4 ± 1.1, P = .02). EE was higher in standing versus sitting for poststroke (P = .04) and able-bodied (P = .03) participants. There were no significant group differences for RPEs. RER of playing in sitting approached anaerobic metabolism. CONCLUSIONS Playing upper extremity (ie, Boxing) or mobility (ie, Run) AVGs in standing resulted in moderate EE and intensity for participants poststroke. EE was lower for poststroke than for able-bodied participants.
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Affiliation(s)
- Michal Kafri
- 1University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
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Gordon CD, Wilks R, McCaw-Binns A. Effect of Aerobic Exercise (Walking) Training on Functional Status and Health-related Quality of Life in Chronic Stroke Survivors. Stroke 2013; 44:1179-81. [PMID: 23471273 DOI: 10.1161/strokeaha.111.000642] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carron D. Gordon
- From the Section of Physical Therapy (C.D.G.), Epidemiology Research Unit (R.W.), and Department of Community Health and Psychiatry (A.M.-B.), University of the West Indies, Mona, Jamaica, West Indies
| | - Rainford Wilks
- From the Section of Physical Therapy (C.D.G.), Epidemiology Research Unit (R.W.), and Department of Community Health and Psychiatry (A.M.-B.), University of the West Indies, Mona, Jamaica, West Indies
| | - Affette McCaw-Binns
- From the Section of Physical Therapy (C.D.G.), Epidemiology Research Unit (R.W.), and Department of Community Health and Psychiatry (A.M.-B.), University of the West Indies, Mona, Jamaica, West Indies
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Pang MY, Charlesworth SA, Lau RW, Chung RC. Using Aerobic Exercise to Improve Health Outcomes and Quality of Life in Stroke: Evidence-Based Exercise Prescription Recommendations. Cerebrovasc Dis 2013; 35:7-22. [DOI: 10.1159/000346075] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 11/23/2012] [Indexed: 11/19/2022] Open
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Stoller O, de Bruin ED, Knols RH, Hunt KJ. Effects of cardiovascular exercise early after stroke: systematic review and meta-analysis. BMC Neurol 2012; 12:45. [PMID: 22727172 PMCID: PMC3495034 DOI: 10.1186/1471-2377-12-45] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 05/17/2012] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Previous studies have shown the beneficial effects of aerobic exercise in chronic stroke. Most motor and functional recovery occurs in the first months after stroke. Improving cardiovascular capacity may have potential to precipitate recovery during early stroke rehabilitation. Currently, little is known about the effects of early cardiovascular exercise in stroke survivors. The aim of this systematic review was to evaluate the effectiveness of cardiovascular exercise early after stroke. METHODS A systematic literature search was performed. For this review, randomized and non-randomized prospective controlled cohort studies using a cardiovascular, cardiopulmonary or aerobic training intervention starting within 6 months post stroke were considered. The PEDro scale was used to detect risk of bias in individual studies. Inter-rater agreement was calculated (kappa). Meta-analysis was performed using a random-effects model. RESULTS A total of 11 trials were identified for inclusion. Inter-rater agreement was considered to be "very good" (Kappa: 0.81, Standard Error: 0.06, CI95%: 0.70-0.92), and the methodological quality was "good" (7 studies) to "fair" (4 studies). Peak oxygen uptake data were available for 155 participants. Pooled analysis yielded homogenous effects favouring the intervention group (standardised mean difference (SMD) = 0.83, CI95% = 0.50-1.16, Z = 4.93, P < 0.01). Walking endurance assessed with the 6 Minute Walk Test comprised 278 participants. Pooled analysis revealed homogenous effects favouring the cardiovascular training intervention group (SMD = 0.69, CI95% = 0.45-0.94, Z = 5.58, P < 0.01). Gait speed, measured in 243 participants, did not show significant results (SMD = 0.51, CI95% = -0.25-1.26, Z = 1.31, P = 0.19) in favour of early cardiovascular exercise. CONCLUSION This meta-analysis shows that stroke survivors may benefit from cardiovascular exercise during sub-acute stages to improve peak oxygen uptake and walking distance. Thus, cardiovascular exercise should be considered in sub-acute stroke rehabilitation. However, concepts to influence and evaluate aerobic capacity in severely affected individuals with sub-acute stroke, as well as in the very early period after stroke, are lacking.Further research is needed to develop appropriate methods for cardiovascular rehabilitation early after stroke and to evaluate long-term effects of cardiovascular exercise on aerobic capacity, physical functioning, and quality-of-life.
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Affiliation(s)
- Oliver Stoller
- Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- Department of Epidemiology, Maastricht University and Caphri Research School, Maastricht, Netherlands
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Ruud H Knols
- Physiotherapy Occupational Therapy Research, Center for Clinical Research, University Hospital Zurich, Zurich, Switzerland
| | - Kenneth J Hunt
- Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
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Chang WH, Kim MS, Huh JP, Lee PKW, Kim YH. Effects of Robot-Assisted Gait Training on Cardiopulmonary Fitness in Subacute Stroke Patients. Neurorehabil Neural Repair 2011; 26:318-24. [DOI: 10.1177/1545968311408916] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Min Su Kim
- Sungkyunkwan University, Seoul, Republic of Korea
| | | | | | - Yun-Hee Kim
- Sungkyunkwan University, Seoul, Republic of Korea
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Abstract
BACKGROUND Levels of physical fitness are low after stroke. It is unknown whether improving physical fitness after stroke reduces disability. OBJECTIVES To determine whether fitness training after stroke reduces death, dependence, and disability. The secondary aims were to determine the effects of training on physical fitness, mobility, physical function, quality of life, mood, and incidence of adverse events. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched April 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, July 2010), MEDLINE (1966 to March 2010), EMBASE (1980 to March 2010), CINAHL (1982 to March 2010), SPORTDiscus (1949 to March 2010), and five additional databases (March 2010). We also searched ongoing trials registers, handsearched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing either cardiorespiratory training or resistance training, or both, with no intervention, a non-exercise intervention, or usual care in stroke survivors. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed quality, and extracted data. We analysed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses. MAIN RESULTS We included 32 trials, involving 1414 participants, which comprised cardiorespiratory (14 trials, 651 participants), resistance (seven trials, 246 participants), and mixed training interventions (11 trials, 517 participants). Five deaths were reported at the end of the intervention and nine at the end of follow-up. No dependence data were reported. Diverse outcome measures made data pooling difficult. The majority of the estimates of effect were not significant. Cardiorespiratory training involving walking improved maximum walking speed (mean difference (MD) 8.66 metres per minute, 95% confidence interval (CI) 2.98 to 14.34), preferred gait speed (MD 4.68 metres per minute, 95% CI 1.40 to 7.96) and walking capacity (MD 47.13 metres per six minutes, 95% CI 19.39 to 74.88) at the end of the intervention. These training effects were retained at the end of follow-up. Mixed training, involving walking, increased preferred walking speed (MD 2.93 metres per minute, 95% CI 0.02 to 5.84) and walking capacity (MD 30.59 metres per six minutes, 95% CI 8.90 to 52.28) but effects were smaller and there was heterogeneity amongst the trial results. There were insufficient data to assess the effects of resistance training. The variability in the quality of included trials hampered the reliability and generalizability of the observed results. AUTHORS' CONCLUSIONS The effects of training on death, dependence, and disability after stroke are unclear. There is sufficient evidence to incorporate cardiorespiratory training involving walking within post-stroke rehabilitation programmes to improve speed, tolerance, and independence during walking. Further well-designed trials are needed to determine the optimal exercise prescription and identify long-term benefits.
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Affiliation(s)
- Miriam Brazzelli
- Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK
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Mackay-Lyons M, Thornton M, Macdonald A. Cardiovascular fitness training for a patient in the early stages of recovery post stroke. Physiother Can 2011; 63:377-82. [PMID: 22654243 PMCID: PMC3157997 DOI: 10.3138/ptc.2010-31ebp] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Marilyn Mackay-Lyons
- Marilyn MacKay-Lyons, BScPT, MSc, PhD, PT: Associate Professor, Dalhousie University, Halifax, Nova Scotia
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Calmels P, Degache F, Courbon A, Roche F, Ramas J, Fayolle-Minon I, Devillard X. The faisability and the effects of cycloergometer interval-training on aerobic capacity and walking performance after stroke. Preliminary study. Ann Phys Rehabil Med 2011; 54:3-15. [DOI: 10.1016/j.rehab.2010.09.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 09/13/2010] [Indexed: 11/25/2022]
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Letombe A, Cornille C, Delahaye H, Khaled A, Morice O, Tomaszewski A, Olivier N. Early post-stroke physical conditioning in hemiplegic patients: A preliminary study. Ann Phys Rehabil Med 2010; 53:632-42. [DOI: 10.1016/j.rehab.2010.09.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 09/13/2010] [Indexed: 11/25/2022]
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Devine JM, Zafonte RD. Physical exercise and cognitive recovery in acquired brain injury: a review of the literature. PM R 2009; 1:560-75. [PMID: 19627946 DOI: 10.1016/j.pmrj.2009.03.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 02/05/2009] [Accepted: 03/29/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Physical exercise has been shown to play an ever-broadening role in the maintenance of overall health and has been implicated in the preservation of cognitive function in both healthy elderly and demented populations. Animal and human studies of acquired brain injury (ABI) from trauma or vascular causes also suggest a possible role for physical exercise in enhancing cognitive recovery. DATA SOURCES A review of the literature was conducted to explore the current understanding of how physical exercise impacts the molecular, functional, and neuroanatomic status of both intact and brain-injured animals and humans. STUDY SELECTION Searches of the MEDLINE, CINHAL, and PsychInfo databases yielded an extensive collection of animal studies of physical exercise in ABI. Animal studies strongly tie physical exercise to the upregulation of multiple neural growth factor pathways in brain-injured animals, resulting in both hippocampal neurogenesis and functional improvements in memory. DATA EXTRACTION A search of the same databases for publications involving physical exercise in human subjects with ABI yielded 24 prospective and retrospective studies. DATA SYNTHESIS Four of these evaluated cognitive outcomes in persons with ABI who were involved in physical exercise. Three studies cited a positive association between exercise and improvements in cognitive function, whereas one observed no effect. Human exercise interventions varied greatly in duration, intensity, and level of subject supervision, and tools for assessing neurocognitive changes were inconsistent. CONCLUSIONS There is strong evidence in animal ABI models that physical exercise facilitates neurocognitive recovery. Physical exercise interventions are safe in the subacute and rehabilitative phases of recovery for humans with ABI. In light of strong evidence of positive effects in animal studies, more controlled, prospective human interventions are warranted to better explore the neurocognitive effects of physical exercise on persons with ABI.
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Affiliation(s)
- Jennifer M Devine
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
BACKGROUND Physical fitness is low after stroke. It is unknown whether improving physical fitness after stroke reduces disability. OBJECTIVES To determine whether fitness training (cardiorespiratory or strength, or both) after stroke reduces death, dependence and disability. The secondary aims were to determine the effects of fitness training on physical fitness, mobility, physical function, health status and quality of life, mood and incidence of adverse events. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (last searched March 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2007), MEDLINE (1966 to March 2007), EMBASE (1980 to March 2007), CINAHL (1982 to March 2007), and six additional databases to March 2007. We handsearched relevant journals and conference proceedings, and screened bibliographies. We searched trials registers and contacted experts in the field. SELECTION CRITERIA We included randomised controlled trials if the aim of the intervention was to improve muscle strength or cardiorespiratory fitness, or both, and if the control groups comprised either no intervention, usual care or a non-exercise intervention. DATA COLLECTION AND ANALYSIS Two review authors determined trial eligibility and quality. One review author extracted outcome data at end of intervention and follow-up scores, or as change from baseline scores. Diverse outcome measures limited the intended analysis. MAIN RESULTS We included 24 trials, involving 1147 participants, comprising cardiorespiratory (11 trials, 692 participants), strength (four trials, 158 participants) and mixed training interventions (nine trials, 360 participants). Death was infrequent at the end of the intervention (1/1147) and follow up (8/627). No dependence data were reported. Diverse disability measures made meta-analysis difficult; the majority of effect sizes were not significant. Cardiorespiratory training involving walking, improved maximum walking speed (mean difference (MD) 6.47 metres per minute, 95% confidence interval (CI) 2.37 to 10.57), walking endurance (MD 38.9 metres per six minutes, 95% CI 14.3 to 63.5), and reduced dependence during walking (Functional Ambulation Categories MD 0.72, 95% CI 0.46 to 0.98). Current data include few strength training trials, and lack non-exercise attention controls, long-term training and follow up. AUTHORS' CONCLUSIONS The effects of training on death, dependence and disability after stroke are unclear. There is sufficient evidence to incorporate cardiorespiratory training, involving walking, within post-stroke rehabilitation in order to improve speed, tolerance and independence during walking. Further trials are needed to determine the optimal exercise prescription after stroke and identify any long-term benefits.
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Affiliation(s)
- David H Saunders
- Department of Physical Education Sport and Leisure Studies, University of Edinburgh, St Leonards Land, Holyrood Road, Edinburgh, Midlothian, UK, EH8 2AZ
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Abstract
PURPOSE In North America, established long-term rehabilitation programs are commonly available for individuals following a cardiac event but are largely unavailable for stroke survivors. The purpose of this study was to determine (1) the availability of cardiac rehabilitation (CR) for individuals poststroke (survey of all programs in Ontario, Canada) and (2) the effects of CR, comparing individuals with primary and secondary diagnoses of stroke versus those with cardiac diagnoses only (retrospective review of a large outpatient North American program). METHODS An Ontario-wide survey was disseminated to CR programs to determine barriers to enrollment of stroke participants. Additionally, a retrospective analysis of data from 9,173 participants in 1 CR program in Toronto, Ontario, compared 3 subgroups (n = 19 each): (1) primary diagnosis of stroke or transient ischemic attack (TIA), (2) primary cardiac diagnosis and occurrence of stroke or TIA, and (3) cardiac diagnoses only. RESULTS Twenty-four of 40 (60%) programs surveyed included stroke participants, although the proportion was small (<5% of total enrollment). Barriers to enrollment included issues around primary diagnosis and degree of stroke-related disability. While those with a history of stroke or TIA had a lower baseline peak oxygen uptake, all 3 groups showed comparable postprogram improvements in peak oxygen uptake and anaerobic threshold (time effect, P < .001). There were no group-time interaction effects. CONCLUSIONS Despite the common cardiovascular etiology of stroke and heart disease, individuals with stroke are not routinely included in CR in Ontario. However, individuals with stroke demonstrated similar training-related improvements in exercise capacity compared with nonstroke participants.
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Fullerton A, Macdonald M, Brown A, Ho PL, Martin J, Tang A, Sibley KM, McIlroy WE, Brooks D. Survey of fitness facilities for individuals post-stroke in the Greater Toronto Area. Appl Physiol Nutr Metab 2008; 33:713-9. [PMID: 18641714 DOI: 10.1139/h08-037] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In light of the demonstrated importance of fitness programs after stroke, the current study set out to determine the availability and characteristics of fitness programs for individuals after stroke in the Greater Toronto Area (GTA). A questionnaire was distributed to 784 fitness programs in the GTA requesting information on the facility, program characteristics, and barriers to and willingness in offering specific programs for individuals post stroke. Of the 213 respondents, 146 (69%) reported that individuals with a chronic disability participated in their activities, 39 (18%) did not allow individuals with disabilities to participate, and 28 (13%) were unaware if individuals with disabilities accessed their facilities. Sixty-two facilities (29%) offered specific fitness programs for individuals with a chronic disability including 26 (12%) that offered exercise programs for people who have had a stroke. The study identified that a small percentage of fitness programs surveyed in GTA have fitness programs for individuals post-stroke. Since the occurrence of stroke is expected to increase as the population ages, the need for community fitness programs for individuals post-stroke will continue to rise. Many facilities expressed interest in offering specific fitness programs for individuals post-stroke; therefore, barriers must be addressed to facilitate the development of these programs.
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Affiliation(s)
- Amy Fullerton
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Tang A, Sibley KM, Thomas SG, Bayley MT, Richardson D, McIlroy WE, Brooks D. Effects of an Aerobic Exercise Program on Aerobic Capacity, Spatiotemporal Gait Parameters, and Functional Capacity in Subacute Stroke. Neurorehabil Neural Repair 2008; 23:398-406. [DOI: 10.1177/1545968308326426] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and objective. In spite of the challenges, engaging in exercise programs very early after stroke may positively influence aerobic capacity and stroke-related outcomes, including walking ability. The objective of this study was to evaluate the feasibility of adding aerobic cycle ergometer training to conventional rehabilitation early after stroke and to determine effects on aerobic capacity, walking ability, and health-related quality of life. Methods. A prospective matched control design was used. All participants performed a graded maximal exercise test on a semi-recumbent cycle ergometer, spatiotemporal gait assessments, 6-Minute Walk Test, and Stroke Impact Scale. The Exercise group added 30 minutes of aerobic cycle ergometry to conventional inpatient rehabilitation 3 days/week until discharge; the Control group received conventional rehabilitation only. Results. All Exercise participants (n = 23) completed the training without adverse effects. In the 18 matched pairs, both groups demonstrated improvements over time with a trend toward greater aerobic benefit in the Exercise group with 13% and 23% increases in peak VO2 and work rate respectively, compared to 8% and 16% in the Control group (group-time interaction P = .71 and .62). A similar trend toward improved 6-Minute Walk Test distance (Exercise 53% vs Controls 23%, P = .23) was observed. Conclusion. Early aerobic training can be safely implemented without deleterious effects on stroke rehabilitation. A trend toward greater improvement in aerobic capacity and walking capacity suggests that such training may have an early beneficial effect and should be considered for inclusion in rehabilitation programs.
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Affiliation(s)
- Ada Tang
- Toronto Rehabilitation Institute, Ontario, Institute of Medical Science, University of Toronto, Ontario, Department of Physical Therapy, University of Toronto, Ontario
| | - Kathryn M. Sibley
- Toronto Rehabilitation Institute, Ontario, Department of Physical Therapy, University of Toronto, Ontario, Institute of Medical Science, University of Toronto, Ontario
| | - Scott G. Thomas
- Toronto Rehabilitation Institute, Ontario, Faculty of Physical Education and Health, University of Toronto, Ontario, Institute of Medical Science, University of Toronto, Ontario
| | | | - Denyse Richardson
- Toronto Rehabilitation Institute, Ontario, Department of Physical Therapy, University of Toronto, Ontario, Institute of Medical Science, University of Toronto, Ontario
| | - William E. McIlroy
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Ontario Canada, Heart and Stroke Foundation of Ontario Centre for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Toronto Rehabilitation Institute, Ontario, Institute of Medical Science, University of Toronto, Ontario
| | - Dina Brooks
- Toronto Rehabilitation Institute, Ontario, Heart and Stroke Foundation of Ontario Centre for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Department of Physical Therapy, University of Toronto, Ontario,
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Lee MJ, Kilbreath SL, Singh MF, Zeman B, Lord SR, Raymond J, Davis GM. Comparison of Effect of Aerobic Cycle Training and Progressive Resistance Training on Walking Ability After Stroke: A Randomized Sham Exercise-Controlled Study. J Am Geriatr Soc 2008; 56:976-85. [DOI: 10.1111/j.1532-5415.2008.01707.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Patients with stroke are severely deconditioned, leading to metabolic abnormalities that significantly increase risk for myocardial infarction and recurrent stroke. This review characterizes the nature of the metabolic decline, the underlying causes, and the potential for progressive aerobic exercise to address metabolic impairment following disabling stroke. Although exercise training has previously been shown to improve peak aerobic capacity and sensorimotor function after stroke, establishing safe and effective exercise programs in this population presents unique challenges stemming from neurological deficit complexities and comorbid conditions. Thus, recommendations for application to practice are provided that include proper preexercise evaluation, guidelines for symptom-limited maximal effort exercise testing, as well as evidence-based suggestions for initiation and progression of an exercise program. Implementing regular, progressive exercise therapy is critical on the basis of the devastating impact of physical inactivity on overall metabolic heath. Prevalence of impaired or diabetic glucose metabolism may be as high as 80% in chronic stroke, predicting 2- and 3-fold increased risk for recurrent stroke, respectively. Tragically, nearly one third of patients with stroke experience recurrent stroke within 5 years, and comorbid cardiovascular conditions represent the leading cause of death in this population. Recent evidence showing the positive impact of exercise training on hyperinsulinemia and glucose tolerance in survivors of stroke is presented, given the central importance of these factors to overall cardiovascular risk. On the basis of these and other findings, structured exercise programs should be considered for all survivors of stroke.
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Katz-Leurer M, Eisenstein E, Liebermann D. Feasibility of motor capability training at home in children with acquired brain injury. Physiotherapy 2008. [DOI: 10.1016/j.physio.2007.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Janssen TW, Beltman JM, Elich P, Koppe PA, Konijnenbelt H, de Haan A, Gerrits KH. Effects of Electric Stimulation−Assisted Cycling Training in People With Chronic Stroke. Arch Phys Med Rehabil 2008; 89:463-9. [DOI: 10.1016/j.apmr.2007.09.028] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Revised: 09/03/2007] [Accepted: 09/05/2007] [Indexed: 11/25/2022]
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