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Tanaka S, Yamauchi K, Hayashi Y, Kumagae K, Goto K, Harayama E, Arakawa S. Factors influencing the reduction in quadriceps muscle thickness in the paretic limbs of patients with acute stroke. Clin Nutr ESPEN 2024; 60:173-178. [PMID: 38479907 DOI: 10.1016/j.clnesp.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/08/2023] [Accepted: 01/16/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS Muscle atrophy is an early event that occurs after stroke, but there are few reports on the changes in skeletal muscle thickness in acute stroke. This study investigated the factors contributing to reduced muscle thickness in patients with acute stroke. METHODS In total, 51 patients with stroke and the National Institute of the Health Stroke Scale (NIHSS) > 3 were included in our study. They were admitted to our hospital between July 2017 and May 2020. The quadriceps muscle thickness was measured with an ultrasound device within 2 days after admission and 14 days later. The collected data included age, sex, body mass index, stroke type, neuromuscular electrical stimulation, NIHSS, serum albumin at admission, start of enteral nutrition, Functional Oral Intake Scale (FOIS), start of mobilization and ambulation, number of physical and occupational therapy units, C-reactive protein at admission and whether surgery had been performed. These data were retrospectively retrieved from medical documents. A dietician calculated energy intake, protein intake, and energy adequacy. Multiple regression analysis was used to identify the factors associated with reduced quadriceps muscle thickness. The independent variables were NIHSS, date of start of enteral feeding, protein intake, FOIS, date of mobilization, and date of start of ambulation training. RESULTS The rate of change in quadriceps muscle thickness of the paretic limb was -15.3 % (interquartile range, -46.1-14.8 %). Multiple regression analysis showed that the factors responsible for the decrease in muscle thickness on the paretic side were FOIS (β: 0.376; 95 % Cl, 0.999 to 4.541) and the start date of ambulation (β: -0.378; 95 % Cl, -2.575 to -0.543), with a multiple correlation coefficient of 0.456. CONCLUSION The FOIS and the start date of ambulation after acute stroke were related to the rate of reduction in muscle thickness on the paretic side.
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Affiliation(s)
- Shota Tanaka
- Department of Rehabilitation, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahata Higashi Ward, Kitakyushu City, Fukuoka, Japan.
| | - Kota Yamauchi
- Department of Rehabilitation, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahata Higashi Ward, Kitakyushu City, Fukuoka, Japan.
| | - Yuri Hayashi
- Department of Rehabilitation, Kyushu University Hospital, 3-1-1, Maidashi, Higashi Ward, Fukuoka City, Fukuoka, Japan.
| | - Kenichi Kumagae
- Department of Rehabilitation, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahata Higashi Ward, Kitakyushu City, Fukuoka, Japan.
| | - Kei Goto
- Department of Rehabilitation, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahata Higashi Ward, Kitakyushu City, Fukuoka, Japan.
| | - Eisei Harayama
- Department of Rehabilitation, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahata Higashi Ward, Kitakyushu City, Fukuoka, Japan.
| | - Shuji Arakawa
- Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahata Higashi Ward, Kitakyushu City, Fukuoka, Japan.
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Ozdemir H, Sagris D, Abdul-Rahim AH, Lip GYH, Shantsila E. Management of ischaemic stroke survivors in primary care setting: the road to holistic care. Intern Emerg Med 2024; 19:609-618. [PMID: 37875703 PMCID: PMC11039521 DOI: 10.1007/s11739-023-03445-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/26/2023] [Indexed: 10/26/2023]
Abstract
The management of ischaemic stroke survivors is multidisciplinary, necessitating the collaboration of numerous medical professionals and rehabilitation specialists. However, due to the lack of comprehensive and holistic follow-up, their post-discharge management may be suboptimal. Achieving this holistic, patient-centred follow-up requires coordination and interaction of subspecialties, which general practitioners can provide as the first point of contact in healthcare systems. This approach can improve the management of stroke survivors by preventing recurrent stroke through an integrated post-stroke care, including appropriate Antithrombotic therapy, assisting them to have a Better functional and physiological status, early recognition and intervention of Comorbidities, and lifestyles. For such work to succeed, close interdisciplinary collaboration between primary care physicians and other medical specialists is required in a holistic or integrated way.
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Affiliation(s)
- Hizir Ozdemir
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Dimitrios Sagris
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Azmil Husin Abdul-Rahim
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Gregory Yoke Hong Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Eduard Shantsila
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK.
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Pogrebnoy D, Dennett AM, Simpson DB, MacDonald-Wicks L, Patterson AJ, English C. Effects of Using Websites on Physical Activity and Diet Quality for Adults Living With Chronic Health Conditions: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e49357. [PMID: 37856187 PMCID: PMC10623240 DOI: 10.2196/49357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Adults with chronic health conditions need support to manage modifiable risk factors such as physical inactivity and poor diet. Disease-specific websites with health information on physical activity and diet quality may be effective in supporting adults in managing their chronic illnesses. OBJECTIVE The primary aim of this review was to determine whether using websites with health information can lead to improvements in physical activity levels or diet quality in adults with chronic health conditions. METHODS Randomized controlled trials evaluating the effectiveness of website use on levels of physical activity or diet quality in adults with chronic health conditions were included. MEDLINE, Embase, CINAHL, and the Physiotherapy Evidence Database were searched from the earliest available record until February 2023. Data for outcomes measuring physical activity levels; diet quality; and, where reported, self-efficacy and quality of life were independently extracted by 2 reviewers. The risk of bias was assessed using the Physiotherapy Evidence Database scale, and the overall certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Where values were presented as the same unit of measure, postintervention scores were pooled for meta-analysis to yield an overall mean difference (MD). A standardized MD (SMD) was calculated for the pooled data in which different units for the same outcome were used. Individual trial data were described in cases where the data of trials could not be pooled. RESULTS A total of 29 trials (N=6418 participants) across 8 different disease groups with intervention periods ranging from 4 weeks to 12 months were included in the analysis. There was moderate-certainty evidence that using websites with health information increased levels of moderate to vigorous physical activity (MD=39 min/wk, 95% CI 18.60-58.47), quality of life (SMD=0.36, 95% CI 0.12-0.59), and self-efficacy (SMD=0.26, 95% CI 0.05-0.48) and high-certainty evidence for reduction in processed meat consumption (MD=1.1 portions/wk, 95% CI 0.70-1.58) when compared with usual care. No differences were detected in other measures of diet quality. There was no increased benefit for website users who were offered additional support. CONCLUSIONS The use of websites for risk factor management has the potential to improve physical activity levels, quality of life, and self-efficacy as well as reduce processed meat consumption for adults living with chronic health conditions when compared with usual care. However, it remains unclear whether using websites leads to meaningful and long-lasting behavior change. TRIAL REGISTRATION PROSPERO CRD42021283168; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=283168.
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Affiliation(s)
- Dina Pogrebnoy
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Department of Physiotherapy, Western Health, St Albans, Australia
| | - Amy M Dennett
- Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
- School of Allied Health, Human Services and Sport, Latrobe University, Melbourne, Australia
| | - Dawn B Simpson
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Lesley MacDonald-Wicks
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Food and Nutrition Program, Hunter Medical Institute, Newcastle, Australia
| | - Amanda J Patterson
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Food and Nutrition Program, Hunter Medical Institute, Newcastle, Australia
| | - Coralie English
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, Australia
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Effect of Pulmonary Function Training with a Respirator on Functional Recovery and Quality of Life of Patients with Stroke. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:6005914. [PMID: 36017026 PMCID: PMC9388267 DOI: 10.1155/2022/6005914] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/20/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022]
Abstract
A stroke is a sudden onset cerebral blood circulation disorder. It occurs in patients with cerebrovascular disease due to various predisposing factors causing stenosis, occlusion, or rupture of intracerebral arteries, which, in turn, causes acute cerebral blood circulation disturbance and clinically manifests as symptoms and signs of excessive or permanent cerebral dysfunction. It can cause serious harm to patients' physical and mental health. This study aimed to evaluate the effect of Breathe-Link breathing trainers on lung function and the ability to perform activities of daily living in patients with stroke. Sixty patients with stroke were randomly divided into two groups. One group was set as the control group and received routine breathing training. The experimental group received a Breathe-Link trainer based on regular training, with rehabilitation training for 12 weeks as the time node. Respiratory muscle strength, respiratory velocity, respiratory capacity, forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and rate in the first second (FEV1/FVC) were used to evaluate the respiratory function of patients, and the Barthel index was used to evaluate the ability to perform activities of daily living. Improvements in respiratory function and daily living ability were compared between the two groups. After 12 weeks of training, respiratory muscle strength, respiratory velocity, respiratory volume, FVC, FEV1, FEV1/FVC, and Barthel index of patients in the two groups improved compared with those before training (P < 0.05), and the improvement in the treatment group was better than that in the control group (P < 0.05). Breathe-Link breathing trainers can improve lung function and the ability to perform activities of daily living in patients with stroke, and its effect is acceptable. It can be recommended for clinical use.
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Comparison of the effectiveness of anti-gravity treadmill exercises and underwater walking exercises on cardiorespiratory fitness, functional capacity and balance in stroke patients. Acta Neurol Belg 2022; 123:423-432. [PMID: 35797000 DOI: 10.1007/s13760-022-02012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/16/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Aerobic exercise training after stroke has positive effects on quality of life, motor recovery, and aerobic endurance. The aim of this study was to investigate the effectiveness of anti-gravity treadmill gait training and underwater walking therapy on cardiorespiratory fitness, gait and balance in stroke survivors. METHODS The study included 39 patients with a history of stroke who were admitted to our center between July 2017 and January 2018. The patients were randomly assigned to anti-gravity treadmill training, underwater walking therapy, or a control group. The aerobic capacity of the participants was evaluated with the 6-min walk test and cycle ergometer testing before and after the treatment. Balance was examined using the Berg Balance Scale (BBS). RESULTS There was a statistically significant increase from pre- to post-treatment with regard to maximum heart rate and length of walking distance during 6-min walk test parameters in patients who underwent anti-gravity treadmill training (p < 0.05). The cycle ergometer training results showed significant improvements compared to baseline after treatment in patients who underwent anti-gravity training in terms of maximum heart rate attained during exercise stress testing, time to complete the test, rates of metabolic equivalents of task scores and peak oxygen consumption (p < 0.05). Improvements were also observed in ventricular repolarization indices including corrected QT intervals (QTc), Tp-e interval and Tp-e/QT, Tp-e/QTc ratio in the anti-gravity group (p < 0.05). BBS results showed no statistically significant difference in all groups (p > 0.05). CONCLUSION The data of this study showed that anti-gravity treadmill training has favorable effects on cardiorespiratory fitness in stroke survivors.
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Flury D, Massé F, Paraschiv-Ionescu A, Aminian K, Luft AR, Gonzenbach R. Clinical value of assessing motor performance in postacute stroke patients. J Neuroeng Rehabil 2021; 18:102. [PMID: 34167546 PMCID: PMC8223372 DOI: 10.1186/s12984-021-00898-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/14/2021] [Indexed: 01/28/2023] Open
Abstract
Background Rehabilitative treatment plans after stroke are based on clinical examinations of functional capacity and patient-reported outcomes. Objective information about daily life performance is usually not available, but it may improve therapy personalization. Objective To show that sensor-derived information about daily life performance is clinically valuable for counseling and the planning of rehabilitation programs for individual stroke patients who live at home. Performance information is clinically valuable if it can be used as a decision aid for the therapeutic management or counseling of individual patients. Methods This was an observational, cross-sectional case series including 15 ambulatory stroke patients. Motor performance in daily life was assessed with body-worn inertial sensors attached to the wrists, shanks and trunk that estimated basic physical activity and various measures of walking and arm activity in daily life. Stroke severity, motor function and activity, and degree of independence were quantified clinically by standard assessments and patient-reported outcomes. Motor performance was recorded for an average of 5.03 ± 1.1 h on the same day as the clinical assessment. The clinical value of performance information is explored in a narrative style by considering individual patient performance and capacity information. Results The patients were aged 59.9 ± 9.8 years (mean ± SD), were 6.5 ± 7.2 years post stroke, and had a National Institutes of Health Stroke Score of 4.0 ± 2.6. Capacity and performance measures showed high variability. There were substantial discrepancies between performance and capacity measures in some patients. Conclusions This case series shows that information about motor performance in daily life can be valuable for tailoring rehabilitative therapy plans and counseling according to the needs of individual stroke patients. Although the short recording time (average of 5.03 h) limited the scope of the conclusions, this study highlights the usefulness of objective measures of daily life performance for the planning of rehabilitative therapies. Further research is required to investigate whether information about performance in daily life leads to improved rehabilitative therapy results.
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Affiliation(s)
- D Flury
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - F Massé
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - A Paraschiv-Ionescu
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - K Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - A R Luft
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland.,Center for Neurology and Rehabilitation, Cereneo, Vitznau, Switzerland
| | - R Gonzenbach
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
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DiPasquale J, Trammell M, Clark K, Fowler H, Callender L, Bennett M, Swank C. Intensity of usual care physical therapy during inpatient rehabilitation for people with neurologic diagnoses. PM R 2021; 14:46-57. [PMID: 33599119 DOI: 10.1002/pmrj.12577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Early, intense rehabilitation is essential to promote recovery after stroke, spinal cord injury (SCI), and traumatic brain injury (TBI). However, intensity of usual care rehabilitation interventions during inpatient rehabilitation are poorly characterized. OBJECTIVE To describe the intensity of usual care rehabilitation interventions completed during the subacute phase of recovery from neurologic injury. DESIGN Observational. SETTING Inpatient rehabilitation facility. INTERVENTIONS Twenty-two usual care physical therapy interventions were grouped into six categories: gait (four activities), functional (two), strengthening (four), aerobic (six), balance (four), and wheelchair (two). PATIENTS Patients admitted to inpatient rehabilitation with a primary diagnosis of stroke, SCI or TBI within 6 months of injury. MAIN OUTCOME MEASURE(S) Cardiovascular intensity (physiological and perceived) was recorded during rehabilitation activity sessions. Physiological intensity was assessed by heart rate reserve (HRR) via a Polar A370 Fitness Watch and characterized as very light (<30%), light (30-39%), moderate (40-59%), vigorous (60-89%), and near maximal (≥90%). Perceived intensity was assessed using the Rating of Perceived Exertion scale. RESULTS Patients (stroke n = 16 [number of activity sessions = 388/average session duration = 15.1 min]; SCI n = 15 [299/27.3 min]; TBI n = 15 [340/13.4 min]) participated. For patients with stroke, moderate-to-vigorous HRR was attained between 42% (aerobic exercise) to 55% (wheelchair propulsion) of activity sessions. For patients with SCI, moderate-to-vigorous HRR was attained between 29% (strength training) to 46% (gait training) of activity sessions. For patients with TBI, moderate-to-vigorous HRR was attained between 29% (balance activities) to 47% (gait training) of activity sessions. Associations between HRR and rate of perceived exertion were very weak across stroke (r = 0.12), SCI (r = 0.18), and TBI (r = 0.27). CONCLUSIONS Patients with stroke, SCI, and TBI undergoing inpatient rehabilitation achieve moderate-to-vigorous intensity during some usual care activities such as gait training. Patient perception of intensity was dissimilar to physiological response.
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Affiliation(s)
- Jake DiPasquale
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - Molly Trammell
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - Kelly Clark
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - Hayden Fowler
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - Librada Callender
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - Monica Bennett
- Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Chad Swank
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
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Liu Y, Ran S, Lin Y, Zhang YX, Yang XL, Wei XT, Jiang ZX, He X, Zhang H, Feng GJ, Shen H, Tian Q, Deng HW, Zhang L, Pei YF. Four pleiotropic loci associated with fat mass and lean mass. Int J Obes (Lond) 2020; 44:2113-2123. [PMID: 32719433 PMCID: PMC7912634 DOI: 10.1038/s41366-020-0645-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/23/2020] [Accepted: 07/16/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Fat mass and lean mass are two biggest components of body mass. Both fat mass and lean mass are under strong genetic determinants and are correlated. METHODS We performed a bivariate genome-wide association meta-analysis of (lean adjusted) leg fat mass and (fat adjusted) leg lean mass in 12,517 subjects from 6 samples, and followed by in silico replication in large-scale UK biobank cohort sample (N = 370 097). RESULTS We identified four loci that were significant at the genome-wide significance (GWS, α = 5.0 × 10-8) level at the discovery meta-analysis, and successfully replicated in the replication sample: 2q36.3 (rs1024137, pdiscovery = 3.32 × 10-8, preplication = 4.07 × 10-13), 5q13.1 (rs4976033, pdiscovery = 1.93 × 10-9, preplication = 6.35 × 10-7), 12q24.31 (rs4765528, pdiscovery = 7.19 × 10-12, preplication = 1.88 × 10-11) and 18q21.32 (rs371326986, pdiscovery = 9.04 × 10-9, preplication = 2.35 × 10-95). The above four pleiotropic loci may play a pleiotropic role for fat mass and lean mass development. CONCLUSIONS Our findings further enhance the understanding of the genetic association between fat mass and lean mass and provide a new theoretical basis for their understanding.
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Affiliation(s)
- Yu Liu
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Jiangsu, PR China
- School of Medical Instruments and Food Engineering, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Shu Ran
- School of Medical Instruments and Food Engineering, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Yong Lin
- School of Medical Instruments and Food Engineering, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Yu-Xue Zhang
- School of Medical Instruments and Food Engineering, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Xiao-Lin Yang
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Jiangsu, PR China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Jiangsu, PR China
| | - Xin-Tong Wei
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Jiangsu, PR China
- Department of Epidemiology and Health Statistics, Medical College of Soochow University, Jiangsu, PR China
| | - Zi-Xuan Jiang
- School of Medical Instruments and Food Engineering, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Xiao He
- School of Medical Instruments and Food Engineering, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Hong Zhang
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Jiangsu, PR China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Jiangsu, PR China
| | - Gui-Juan Feng
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Jiangsu, PR China
- Department of Epidemiology and Health Statistics, Medical College of Soochow University, Jiangsu, PR China
| | - Hui Shen
- Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Qing Tian
- Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Hong-Wen Deng
- Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Lei Zhang
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Jiangsu, PR China.
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Jiangsu, PR China.
| | - Yu-Fang Pei
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Jiangsu, PR China.
- Department of Epidemiology and Health Statistics, Medical College of Soochow University, Jiangsu, PR China.
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Linder SM, Davidson S, Rosenfeldt A, Lee J, Koop MM, Bethoux F, Alberts JL. Forced and Voluntary Aerobic Cycling Interventions Improve Walking Capacity in Individuals With Chronic Stroke. Arch Phys Med Rehabil 2020; 102:1-8. [PMID: 32918907 DOI: 10.1016/j.apmr.2020.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/16/2020] [Accepted: 08/06/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To determine the efficacy of high-intensity cycling to improve walking capacity in individuals with chronic stroke, identify variables that predict improvement in walking capacity, and quantify the relationship between the 6-minute walk test (6MWT) and cardiopulmonary exercise (CPX) test variables. DESIGN Secondary analysis of data from 2 randomized controlled trials. SETTING Research laboratory. PARTICIPANTS Individuals with chronic stroke (N=43). INTERVENTIONS Participants were randomized to 1 of the following time-matched interventions, occurring 3 times per week for 8 weeks: (1) forced aerobic exercise and upper extremity repetitive task practice (FE+RTP [n=16]), (2) voluntary aerobic exercise and upper extremity repetitive task practice (VE+RTP [n=14]), or (3) a non-aerobic control group (n=13). MAIN OUTCOME MEASURE Change in walking capacity as measured by the 6MWT from baseline to the end of treatment (EOT). RESULTS Significant increases were observed in distance traveled during the 6MWT at the EOT compared with baseline in the FE+RTP (P<.001) and VE+RTP (P<.001) groups, but not in the control group (P=.21). Among aerobic exercise participants, a multivariate regression analysis revealed that cycling cadence, power output, and baseline 6MWT distance were significant predictors of change in walking capacity. CONCLUSIONS An 8-week aerobic cycling intervention prescribed at 60% to 80% of heart rate reserve and moderate to high cadence and resistance led to significant improvements in walking capacity in our cohort of individuals with chronic stroke. Individuals with low baseline walking capacity levels may benefit most from aerobic cycling to improve over ground locomotion. Although the 6MWT did not elicit a cardiorespiratory response comparable to the maximal exertion CPX test, the 6MWT can be considered a valid and clinically relevant submaximal test of cardiorespiratory function in individuals with chronic stroke.
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Affiliation(s)
- Susan M Linder
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH; Concussion Center, Cleveland Clinic, Cleveland, OH.
| | | | - Anson Rosenfeldt
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH
| | - John Lee
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH
| | - Mandy Miller Koop
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH; Concussion Center, Cleveland Clinic, Cleveland, OH; Center for Neurologic Restoration, Cleveland Clinic, Cleveland, OH
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Bailey RR, Serra MC, McGrath RP. Obesity and diabetes are jointly associated with functional disability in stroke survivors. Disabil Health J 2020; 13:100914. [PMID: 32139319 DOI: 10.1016/j.dhjo.2020.100914] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/06/2020] [Accepted: 02/19/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Stroke is the most common cause of complex disability. Obesity and diabetes increase risk for functional disability in the general population, but their contribution to functional disability in stroke survivors is unknown. OBJECTIVE To investigate the joint association of obesity and diabetes with functional disability in stroke survivors. METHODS Cross-sectional data from 34,376 stroke survivors from the 2015 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys were examined. Weighted and age-adjusted prevalence estimates and adjusted odds ratios (AOR, adjusted for sociodemographic characteristics) with 95% confidence intervals (CIs) were calculated to compare prevalence and odds for self-reported functional disability, stratified by obesity-diabetes status (i.e., neither condition, obesity only, diabetes only, both conditions). RESULTS Prevalence of functional disability increased across obesity-diabetes categories in the total sample: neither condition (45.4%, 95% CI: 43.4%-47.4%), obesity only (55.3%, 95% CI: 52.7%-58.0%), diabetes only (60.8%, 95% CI: 57.5%-64.1%), and both conditions (70.3%, 95% CI: 67.7%-72.9%). Compared to respondents with neither condition, those with both obesity and diabetes had 2.62 (95% CI: 2.23-3.08) higher odds for functional disability; odds were also increased for respondents with obesity only (1.52, 95% CI: 1.32-1.76) and diabetes only (1.71, CI: 1.45-2.01). CONCLUSIONS Our findings indicated a joint effect of obesity and diabetes on functional disability that exceeded either condition alone, placing stroke survivors with both health conditions at greatest risk for diminished functional capacity. Recognizing obesity and diabetes as modifiable risk factors may be useful for identifying stroke sub-populations that could benefit from lifestyle intervention.
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Affiliation(s)
- Ryan R Bailey
- Department of Occupational Science and Occupational Therapy, Saint Louis University, 3437 Caroline St, Allied Health Building Room 2020, St. Louis, MO, 63104, USA.
| | - Monica C Serra
- Department of Medicine, Division of Geriatrics, Gerontology & Palliative Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA; San Antonio Geriatric Research Education and Clinical Center, South Texas Veterans Health Care System, 7400 Merton Minter, San Antonio, TX, 78229, USA.
| | - Ryan P McGrath
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept. 2620, PO Box 6050, Fargo, ND, 58108, USA.
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11
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Serra MC, Accardi CJ, Ma C, Park Y, Tran V, Jones DP, Hafer-Macko CE, Ryan AS. Metabolomics of Aerobic Exercise in Chronic Stroke Survivors: A Pilot Study. J Stroke Cerebrovasc Dis 2019; 28:104453. [PMID: 31668688 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/09/2019] [Accepted: 09/27/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Understanding the metabolic response to exercise may aid in optimizing stroke management. Therefore, the purpose of this pilot study was to evaluate plasma metabolomic profiles in chronic stroke survivors following aerobic exercise training. METHODS Participants (age: 62 ± 1 years, body mass index: 31 ± 1 kg/m2, mean ± standard error of the mean) were randomized to 6 months of treadmill exercise (N = 17) or whole-body stretching (N = 8) with preintervention and postintervention measurement of aerobic capacity (VO2peak). Linear models for microarray data expression analysis was performed to determine metabolic changes over time, and Mummichog was used for pathway enrichment analysis following analysis of plasma samples by high-performance liquid chromatography coupled to ultrahigh resolution mass spectrometry. RESULTS VO2peak change was greater following exercise than stretching (18.9% versus -.2%; P < .01). Pathway enrichment analysis of differentially expressed metabolites results showed significant enrichment in 4 pathways following treadmill exercise, 3 of which (heparan-, chondroitin-, keratan-sulfate degradation) involved connective tissue metabolism and the fourth involve lipid signaling (linoleate metabolism). More pathways were altered in pre and post comparisons of stretching, including branched-chain amino acid, tryptophan, tyrosine, and urea cycle, which could indicate loss of lean body mass. CONCLUSIONS These preliminary data show different metabolic changes due to treadmill training and stretching in chronic stroke survivors and suggest that in addition to improved aerobic capacity, weight-bearing activity, like walking, could protect against loss of lean body mass. Future studies are needed to examine the relationship between changes in metabolomic profiles to reductions in cardiometabolic risk after treadmill rehabilitation.
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Affiliation(s)
- Monica C Serra
- San Antonio GRECC, South Texas VA and the Division of Geriatrics, Gerontology & Palliative Medicine and the Sam & Ann Barshop Institute for Longevity & Aging Studies, UT Health San Antonio, San Antonio, Texas.
| | - Carolyn J Accardi
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Chunyu Ma
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Younja Park
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia; College of Pharmacy, Korea University, Sejong City, Korea
| | - ViLinh Tran
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Dean P Jones
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Charlene E Hafer-Macko
- Baltimore VA Research Service and GRECC and the Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alice S Ryan
- Baltimore VA Research Service and GRECC and the Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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12
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MacKay-Lyons M, Billinger SA, Eng JJ, Dromerick A, Giacomantonio N, Hafer-Macko C, Macko R, Nguyen E, Prior P, Suskin N, Tang A, Thornton M, Unsworth K. Aerobic Exercise Recommendations to Optimize Best Practices in Care After Stroke: AEROBICS 2019 Update. Phys Ther 2019; 100:149-156. [PMID: 31596465 PMCID: PMC8204880 DOI: 10.1093/ptj/pzz153] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 09/18/2018] [Accepted: 06/09/2019] [Indexed: 01/18/2023]
Abstract
Most stroke survivors have very low levels of cardiovascular fitness, which limits mobility and leads to further physical deconditioning, increased sedentary behavior, and heightened risk of recurrent stroke. Although clinical guidelines recommend that aerobic exercise be a part of routine stroke rehabilitation, clinical uptake has been suboptimal. In 2013, an international group of stroke rehabilitation experts developed a user-friendly set of recommendations to guide screening and prescription-the Aerobic Exercise Recommendations to Optimize Best Practices in Care after Stroke (AEROBICS 2013). The objective of this project was to update AEROBICS 2013 using the highest quality of evidence currently available. The first step was to conduct a comprehensive review of literature from 2012 to 2018 related to aerobic exercise poststroke. A working group of the original consensus panel members drafted revisions based on synthesis. An iterative process was used to achieve agreement among all panel members. Final revisions included: (1) addition of 115 new references to replace or augment those in the original AEROBICS document, (2) rewording of the original recommendations and supporting material, and (3) addition of 2 new recommendations regarding prescription. The quality of evidence from which these recommendations were derived ranged from low to high. The AEROBICS 2019 Update should make it easier for clinicians to screen for, and prescribe, aerobic exercise in stroke rehabilitation. Clinical implementation will not only help to narrow the gap between evidence and practice but also reduce current variability and uncertainty regarding the role of aerobic exercise in recovery after stroke.
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Affiliation(s)
| | - Sandra A Billinger
- Physical Therapy and Rehab Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Dromerick
- Department of Neurology, Pasquerilla Healthcare Center, Washington, DC
| | | | - Charlene Hafer-Macko
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Richard Macko
- Department Neurology, VA Maryland Health Care System, Baltimore, Maryland
| | | | - Peter Prior
- Department of Psychology, St. Joseph's Health Care London, London, Ontario, Canada
| | - Neville Suskin
- Department of Cardiology, Western University, London, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | - Karen Unsworth
- Department of Cardiac Rehabilitation, St. Joseph's Health Care London, London, Ontario, Canada
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13
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Pogrebnoy D, Dennett A. Exercise Programs Delivered According to Guidelines Improve Mobility in People With Stroke: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2019; 101:154-165. [PMID: 31400308 DOI: 10.1016/j.apmr.2019.06.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/20/2019] [Accepted: 06/26/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine if prescribing a combined aerobic and resistance training exercise program in accordance with American Stroke Association physical activity guidelines improves mobility and physical activity levels of people after stroke. DATA SOURCES Online database search from earliest available date to August 27, 2018. STUDY SELECTION Randomized controlled trials evaluating the effectiveness of exercise programs prescribed in accordance with guidelines for improving mobility and physical activity levels in adults with subacute or chronic stroke. DATA EXTRACTION Two independent reviewers completed data extraction. Risk of bias was assessed using the Physiotherapy Evidence Database Scale, and overall quality of evidence was assessed using the Grades of Research, Assessment, Development, and Evaluation approach. DATA SYNTHESIS Data was pooled from a total of 499 participants for meta-analysis. There was high-level evidence that exercise programs adhering to guidelines improve habitual walking speed (mean difference, 0.07m/s; 95% CI, -0.01 to 0.16) and walking endurance (mean difference, 39.2m, 95% CI, 17.2-61.2). A sensitivity analysis demonstrated high-level evidence of improvements in walking endurance (mean difference, 51.1m; 95% CI, 19.96-82.24) and moderate-level evidence of improvements on the Timed Up and Go test (standardized mean difference, 0.57; 95% CI, 0.16-0.99). No differences were detected for other mobility outcome measures or physical activity levels. Adherence was high and few adverse events were reported. CONCLUSION A combined exercise program comprising aerobic and resistance training that adheres to the American Stroke Association guidelines is safe and should be prescribed in addition to usual care to improve mobility. Further research is needed to understand the relationship between exercise programs and behavior change requirements to improve long-term physical activity levels.
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Affiliation(s)
- Dina Pogrebnoy
- Community Rehabilitation Program, Eastern Health, Victoria, Australia.
| | - Amy Dennett
- Allied Health Clinical Research Office, Eastern Health, Victoria, Australia
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14
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Faria GS, Polese JC, Ribeiro-Samora GA, Scianni AA, Faria CDCM, Teixeira-Salmela LF. Validity of the accelerometer and smartphone application in estimating energy expenditure in individuals with chronic stroke. Braz J Phys Ther 2018; 23:236-243. [PMID: 30143357 DOI: 10.1016/j.bjpt.2018.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To examine the concurrent validity of the GT3X® ActiGraph accelerometer and Google Fit® smartphone application in estimating energy expenditure in people who had suffered a stroke, during fast overground walking. METHODS Thirty community-dwelling stroke individuals walked on a 10-meter hallway over 5min at their fastest speeds, wearing a Cortex Metamax 3B® ergoespirometer, a GT3X® ActiGraph accelerometer, and a smartphone with the Google Fit® application. Pearson correlation coefficients were calculated to verify the associations between measures of energy expenditure, in kilocalories (kcal), estimated by both devices and those obtained with the Cortex Metamax 3B® ergoespirometer (gold-standard measure). RESULTS Fair association was found between the energy expenditure values estimated from the combined formula of the ActiGraph GT3X® and those obtained with the gold-standard measure (r=0.37; p=0.04). No significant associations were found between the energy expenditure values estimated by the Google Fit® application and those provided by the gold-standard measure. CONCLUSIONS The findings demonstrated that both the GT3X®ActiGraph accelerometer and the Google Fit® smartphone application do not provide valid measures of energy expenditure in chronic stroke individuals during fast overground walking.
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Affiliation(s)
- Giselle S Faria
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Janaine C Polese
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil; Department of Physical Therapy, Faculdade Ciências Médicas de Minas Gerais (FCMMG), Belo Horizonte, Minas Gerais, Brazil.
| | - Giane A Ribeiro-Samora
- LabCare, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Aline A Scianni
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Christina D C M Faria
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Luci F Teixeira-Salmela
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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15
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Crozier J, Roig M, Eng JJ, MacKay-Lyons M, Fung J, Ploughman M, Bailey DM, Sweet SN, Giacomantonio N, Thiel A, Trivino M, Tang A. High-Intensity Interval Training After Stroke: An Opportunity to Promote Functional Recovery, Cardiovascular Health, and Neuroplasticity. Neurorehabil Neural Repair 2018; 32:543-556. [PMID: 29676956 DOI: 10.1177/1545968318766663] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Stroke is the leading cause of adult disability. Individuals poststroke possess less than half of the cardiorespiratory fitness (CRF) as their nonstroke counterparts, leading to inactivity, deconditioning, and an increased risk of cardiovascular events. Preserving cardiovascular health is critical to lower stroke risk; however, stroke rehabilitation typically provides limited opportunity for cardiovascular exercise. Optimal cardiovascular training parameters to maximize recovery in stroke survivors also remains unknown. While stroke rehabilitation recommendations suggest the use of moderate-intensity continuous exercise (MICE) to improve CRF, neither is it routinely implemented in clinical practice, nor is the intensity always sufficient to elicit a training effect. High-intensity interval training (HIIT) has emerged as a potentially effective alternative that encompasses brief high-intensity bursts of exercise interspersed with bouts of recovery, aiming to maximize cardiovascular exercise intensity in a time-efficient manner. HIIT may provide an alternative exercise intervention and invoke more pronounced benefits poststroke. OBJECTIVES To provide an updated review of HIIT poststroke through ( a) synthesizing current evidence; ( b) proposing preliminary considerations of HIIT parameters to optimize benefit; ( c) discussing potential mechanisms underlying changes in function, cardiovascular health, and neuroplasticity following HIIT; and ( d) discussing clinical implications and directions for future research. RESULTS Preliminary evidence from 10 studies report HIIT-associated improvements in functional, cardiovascular, and neuroplastic outcomes poststroke; however, optimal HIIT parameters remain unknown. CONCLUSION Larger randomized controlled trials are necessary to establish ( a) effectiveness, safety, and optimal training parameters within more heterogeneous poststroke populations; (b) potential mechanisms of HIIT-associated improvements; and ( c) adherence and psychosocial outcomes.
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Affiliation(s)
| | - Marc Roig
- 2 McGill University, Montreal, Quebec, Canada
| | - Janice J Eng
- 3 University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Joyce Fung
- 2 McGill University, Montreal, Quebec, Canada
| | | | | | - Shane N Sweet
- 2 McGill University, Montreal, Quebec, Canada.,7 Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | | | | | | | - Ada Tang
- 1 McMaster University, Hamilton, Ontario, Canada
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16
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Bailey RR. Lifestyle Modification for Secondary Stroke Prevention. Am J Lifestyle Med 2018; 12:140-147. [PMID: 30202386 PMCID: PMC6124986 DOI: 10.1177/1559827616633683] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 12/27/2022] Open
Abstract
Of nearly 800 000 strokes that occur annually, 23% are recurrent events. Risk for disability and mortality is higher following a recurrent stroke than following a first-time stroke, which makes secondary stroke prevention a priority. Many risk factors for stroke are modifiable and amenable to improvement through lifestyle modification. Lifestyle modification can be difficult for people with stroke, however, in part because of stroke-related physical and cognitive deficits. Despite these challenges, risk factor management through lifestyle modification is important. This article reviews the multiple cardiovascular and metabolic benefits associated with the modification of several lifestyle behaviors: diet, physical activity, smoking cessation, and alcohol consumption. Health behavior theories and existing lifestyle intervention programs are also reviewed to identify important behavioral and cognitive skills that can be used to facilitate modification of health behaviors, and practical skills and suggestions for health care providers are provided.
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Affiliation(s)
- Ryan R. Bailey
- Advanced Fellowship in Geriatrics, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
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17
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Fini NA, Bernhardt J, Holland AE. What is the relationship between physical activity and cardiovascular risk factors in stroke survivors post completion of rehabilitation? Protocol for a longitudinal study. BMJ Open 2017; 7:e019193. [PMID: 29146661 PMCID: PMC5695331 DOI: 10.1136/bmjopen-2017-019193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Physical activity (PA) can modify cardiovascular and other health risks in people with stroke, but we know little about long-term PA in this group. This study aims to describe PA levels and investigate relationships between PA, cardiovascular risk factors, mobility and participant characteristics (eg, age, mood and fatigue) in the 2 years following rehabilitation discharge after first stroke. METHODS AND ANALYSIS This is a longitudinal observational study with follow-up at 6, 12 and 24 months after rehabilitation discharge. Inclusion criteria are broad; excluding only those with previous stroke, palliative diagnosis, living more than 2 hours from the centre or admitted less than 5 days.The primary outcome of interest is duration of moderate to vigorous PA (min/day) measured by the Sensewear MF Armband (SWAB). Secondary outcomes include other PA measures measured with the SWAB; cardiovascular risk factors (eg, systolic blood pressure, fasting lipid profile and smoking status), mobility (10 m walk test), the Hospital Anxiety and Depression Scale and the Fatigue Severity Scale. All outcomes, except blood tests, are gathered at each time point.The target sample size is 77. We will explore associations between PA levels, cardiovascular risk factors, mobility and participant characteristics at baseline compared with 6, 12 and 24 months using random-effects regression modelling.The long-term PA of stroke survivors is largely unknown. We hope to identify factors that influence PA and cardiovascular risk in this population, which may help health professionals target the stroke survivors most at risk and implement appropriate treatment, preventative strategies and education. ETHICS AND DISSEMINATION Approval was granted from Alfred Hospital and La Trobe University Research Ethics Committees. The study results will be disseminated in a number of ways including journal publication and international conference presentations. TRIAL REGISTRATION NUMBER ACTRN12613000196741.
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Affiliation(s)
- Natalie A Fini
- Physiotherapy Department, Caulfield Hospital, Alfred Health, Melbourne, Australia
- Physiotherapy Department, School of Allied Health, La Trobe University, Melbourne, Australia
- Physiotherapy Department, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Australia
| | - Anne E Holland
- Physiotherapy Department, School of Allied Health, La Trobe University, Melbourne, Australia
- Physiotherapy Department, Alfred Health, Melbourne, Australia
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Borschmann KN, Ekinci EI, Iuliano S, Churilov L, Pang MYC, Bernhardt J. Reducing sedentary time and fat mass may improve glucose tolerance and insulin sensitivity in adults surviving 6 months after stroke: A phase I pilot study. Eur Stroke J 2017; 2:144-153. [PMID: 31008309 PMCID: PMC6453210 DOI: 10.1177/2396987317694469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/27/2017] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Deranged glycaemic control is common post-stroke, increasing risks of recurrent stroke and development of diabetes. The aim of the study is to examine glucose metabolism in relation to body composition, physical activity and sedentary time post-stroke. PATIENTS AND METHODS Observational study: Non-diabetic adults, unable to walk independently, were recruited within 2 weeks of first stroke. Primary outcome: 2-h glucose level (mmol/l, oral glucose tolerance test), assessed at baseline and 6 months. Homeostasis Model Assessment of Insulin Sensitivity, total body fat and lean mass (dual energy X-ray absorptiometry), sedentary time (lying or sitting), standing and walking (PAL2 accelerometer) were assessed at baseline, 1, 3 and 6 months. Generalised estimating equations were used to examine change over time and associations between outcome measures. RESULTS Thirty-six participants (69.5 years (standard deviation 11.7), 13 (36.1%) female, moderate stroke severity (National Institute of Health Stroke Scale 11.5 (interquartile range 9.75, 16)). Within 6 months, adjusting for age and National Institute of Health Stroke Scale, every month 2-h glucose reduced by 4.5% (p < 0.001), Homeostasis Model Assessment of Insulin Sensitivity improved 3% (p = 0.04) and fat mass decreased 490 g (95% confidence interval 325, 655; p = 0.01). For every extra kilogram of body fat, 2-h glucose increased by 1.02 mmol/L (95% confidence interval 1.01, 1.02; p = 0.001); Homeostasis Model Assessment of Insulin Sensitivity reduced by 0.98% (95% confidence interval 0.97, 0.99; p = 0.001). Time spent sedentary reduced from 98.5% of measurement period (interquartile range 94.3, 99.8) to 74.3% (interquartile range 65.5, 88.6), by 2.8% monthly (95% confidence interval 1.8, 3.9, p < 0.001). For every additional 5% sedentary time, 2-h glucose increased by 1.05 mmol/L (95% confidence interval 1.04, 1.07; p < 0.001). CONCLUSION Reducing sedentary time and fat mass within 6 months of stroke may improve glucose tolerance and insulin resistance.
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Affiliation(s)
- Karen N Borschmann
- School of Health Science, La Trobe
University, Australia
- Florey Institute of Neuroscience and
Mental Health, University of Melbourne, Australia
| | - Elif I Ekinci
- Department of Medicine, University of
Melbourne, Australia
- Endocrine Centre, Austin Health,
Australia
- Menzies School of Health Research,
Darwin, Australia
| | - Sandra Iuliano
- Department of Medicine, University of
Melbourne, Australia
| | - Leonid Churilov
- Florey Institute of Neuroscience and
Mental Health, University of Melbourne, Australia
| | - Marco YC Pang
- Department of Rehabilitation Sciences,
Hong Kong Polytechnic University, Hong Kong
| | - Julie Bernhardt
- School of Health Science, La Trobe
University, Australia
- Florey Institute of Neuroscience and
Mental Health, University of Melbourne, Australia
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19
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Törnbom K, Sunnerhagen KS, Danielsson A. Perceptions of physical activity and walking in an early stage after stroke or acquired brain injury. PLoS One 2017; 12:e0173463. [PMID: 28273158 PMCID: PMC5342245 DOI: 10.1371/journal.pone.0173463] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/22/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Physical activity has been established as being highly beneficial for health after stroke. There are considerable global efforts to find rehabilitation programs that encourage increased physical activity for persons with stroke. However, many persons with stroke or acquired brain injury do not reach recommended levels of physical activity and increased knowledge about why is needed. We aimed to explore views and experiences of physical activity and walking among persons with stroke or acquired brain injury. METHOD A qualitative study was conducted, among persons with stroke (n = 8) or acquired brain injury (n = 2) from a rehabilitation unit at Sahlgrenska University Hospital in Sweden. Semi-structured in-depth interviews were held about perceptions and experiences of walking and physical activity in general. Data were analyzed using qualitative content analysis, with categories that were determined inductively. RESULTS Physical activity in general and walking ability more specifically were considered very important by the participants. However, physical activity was, regardless of exercising habits pre-injury, associated with different kinds of negative feelings and experiences. Commonly reported internal barriers in the current study were; fatigue, fear of falling or getting hurt in traffic, lack of motivation and depression. Reported external barriers were mostly related to walking, for example; bad weather, uneven ground, lack of company or noisy or too busy surroundings. CONCLUSION Persons with stroke or acquired brain injury found it difficult to engage in and sustain an eligible level of physical activity. Understanding individual concerns about motivators and barriers surrounding physical activity may facilitate the work of forming tailor-made rehabilitation for these groups, so that the levels of physical activity and walking can increase.
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Affiliation(s)
- Karin Törnbom
- Research group for Rehabilitation Medicine, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Katharina S. Sunnerhagen
- Research group for Rehabilitation Medicine, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Anna Danielsson
- Research group for Rehabilitation Medicine, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden
- Unit of physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
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Jackson S, Mercer C, Singer BJ. An exploration of factors influencing physical activity levels amongst a cohort of people living in the community after stroke in the south of England. Disabil Rehabil 2016; 40:414-424. [PMID: 28029070 DOI: 10.1080/09638288.2016.1258437] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore factors influencing physical activity (PA) reported by people living in rural/semi-rural communities in the south of England post-stroke, and to understand relationships between personal, interpersonal and environmental barriers and self-reported levels of PA. METHOD A survey was mailed to patients of NHS Trusts who were identified as potential participants. Self-reported PA levels, type, and frequency of reported barriers were tabulated. Spearman's rank correlation coefficient was used to explore associations between self-reported PA level and: age, gender, level of physical function, fear of falling, beliefs regarding PA, available supports, and socioeconomic status. RESULTS Seventy-six of 322 questionnaires distributed were returned (24%). Only 55.2% of respondents reported undertaking PA of sufficient intensity to meet current guidelines. Personal barriers included fear of falling, stroke-related disability, pain, and fatigue. Interpersonal and environmental barriers included lack of social support, transport, and inclement weather. Significant relationships existed between self-reported PA and fear of falling, functional mobility, and beliefs relating to PA. CONCLUSIONS Almost half of the survey cohort reported PA levels insufficient to meet current guidelines. Similar to barriers reported in previous studies in USA and other parts of the UK, numerous interlinking and overlapping personal, interpersonal, and environmental barriers to undertaking PA were identified. Implications for Rehabilitation This study found that although more than 60% of the survey population were able to ambulate >200 m, only 55.2% reported undertaking sufficient PA to meet current guidelines, putting them at increased risk of further stroke and other co-morbidities. Participants reported a number of interlinking and overlapping personal, interpersonal, and environmental barriers to undertaking PA, which may explain this discrepancy between mobility status and self reported activity levels. Rehabilitation professionals and primary care providers are well positioned to address the barriers identified in this survey, such as providing interventions to reduce fear of falling, pain, and fatigue, providing support and education about safely increasing physical activity and addressing unhelpful beliefs about PA. Behaviour change strategies, such as increasing self-efficacy, and partnering with the person with stroke to problem solve strategies to address the barriers identified by this, and related research, are likely to be more successful in increasing PA than providing information alone.
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Affiliation(s)
- Sharon Jackson
- a School of Surgery, FMDHS , The Centre for Musculoskeletal Studies, The University of Western Australia , Perth , Australia.,b Portsmouth Hospitals NHS Foundation Trust , Portsmouth , UK
| | | | - Barbara Jennifer Singer
- a School of Surgery, FMDHS , The Centre for Musculoskeletal Studies, The University of Western Australia , Perth , Australia
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1519] [Impact Index Per Article: 189.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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Abstract
BACKGROUND Excessive sitting time is linked to cardiovascular disease morbidity. To date, no studies have accurately measured sitting time patterns in people with stroke. OBJECTIVE The purpose of this study was to investigate the amount and pattern of accumulation of sitting time, physical activity, and use of time in people with stroke compared with age-matched healthy peers. DESIGN This study used an observational design. METHODS Sitting time (total and time accumulated in prolonged, unbroken bouts of ≥30 minutes) was measured with an activity monitor. Physical activity and daily energy expenditure were measured using an accelerometer and a multisensory array armband, respectively. All monitors had a 7-day wear protocol. Participants recalled 1 day of activity (during monitor wear time) using the Multimedia Activity Recall for Children and Adults. RESULTS Sixty-three adults (40 with stroke and 23 age-matched healthy controls) participated. The participants (35% female, 65% male) had a mean age of 68.4 years (SD=10.0). Participants with stroke spent significantly more time sitting (X̅=10.9 h/d, SD=2.0) compared with controls (X̅=8.2 h/d, SD=2.0), with much of this sitting time prolonged (stroke group: X̅=7.4 h/d, SD=2.8; control group: X̅=3.7 h/d, SD=1.7). Participants with stroke accumulated most of their sitting time while watching television and in general quiet time, whereas control participants spent more time reading and on the computer. Physical activity and daily energy expenditure were lower in the stroke group compared with the control group. LIMITATIONS A sample of convenience was used to select participants for the stroke and control groups, which may reduce the generalizability of results. CONCLUSIONS Participants with stroke spent more time sitting and less time in activity than their age-matched peers. Further work is needed to determine whether reducing sitting time is feasible and leads to clinically important reductions in cardiovascular risk in this population.
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Resistance Training Improves Hyperglycemia and Dyslipidemia, Highly Prevalent Among Nonelderly, Nondiabetic, Chronically Disabled Stroke Patients. Arch Phys Med Rehabil 2015; 96:1291-6. [DOI: 10.1016/j.apmr.2015.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 03/20/2015] [Accepted: 03/23/2015] [Indexed: 11/18/2022]
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How strongly is aerobic capacity correlated with walking speed and distance after stroke? Systematic review and meta-analysis. Phys Ther 2015; 95:835-53. [PMID: 25573761 DOI: 10.2522/ptj.20140081] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 12/21/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Restoration of walking capacity, as reflected by walking speed and walking distance, is a primary goal after stroke. Peak aerobic capacity (peak oxygen consumption [V̇o₂peak]) is suggested to be correlated with walking capacity after stroke. Although the strength of this correlation is unclear, physical therapy programs often target walking capacity by means of aerobic training. PURPOSE The purpose of this systematic review was to summarize the available evidence on the correlation between V̇o₂peak and walking capacity. DATA SOURCES The databases MEDLINE, CINAHL, EMBASE, Cochrane Library, and SPORTDiscus were searched up to May 2014. STUDY SELECTION Cross-sectional studies reporting correlation coefficients between V̇o₂peak and walking capacity in stroke were included, along with longitudinal studies reporting these correlation coefficients at baseline. DATA EXTRACTION The methodological quality of the studies was assessed using a checklist of 27 items for observational research. Information on study design, stroke severity and recovery, and assessments and outcome of V̇o₂peak and walking capacity, as well as the reported correlation coefficients, were extracted. DATA SYNTHESIS Thirteen studies involving 454 participants were included. Meta-analyses showed combined correlation coefficients (rɱ) for V̇o₂peak and walking speed and for V̇o₂peak and walking distance of .42 (95% credibility interval=.31, .54) and .52 (95% credibility interval=.42, .62), respectively. LIMITATIONS The studies included in the present review had small sample sizes and low methodological quality. Clinical and methodological diversity challenged the comparability of the included studies, despite statistical homogeneity. Relevant data of 3 studies could not be retrieved. CONCLUSIONS The strength of the correlation of V̇o₂peak with walking speed was low and moderate for V̇o₂peak and walking distance, respectively, indicating that other factors, besides V̇o₂peak, determine walking capacity after stroke.
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Paul L, Brewster S, Wyke S, Gill JMR, Alexander G, Dybus A, Rafferty D. Physical activity profiles and sedentary behaviour in people following stroke: a cross-sectional study. Disabil Rehabil 2015; 38:362-7. [DOI: 10.3109/09638288.2015.1041615] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lorna Paul
- School of Medicine, University of Glasgow, Glasgow, UK,
| | | | - Sally Wyke
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK,
| | - Jason M. R. Gill
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK,
| | | | | | - Danny Rafferty
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
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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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Unaffected arm muscle hypercatabolism in dysphagic subacute stroke patients: the effects of essential amino acid supplementation. BIOMED RESEARCH INTERNATIONAL 2014; 2014:964365. [PMID: 25431770 PMCID: PMC4241696 DOI: 10.1155/2014/964365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 09/04/2014] [Accepted: 09/07/2014] [Indexed: 11/17/2022]
Abstract
Alterations in muscle protein turnover of the unaffected side of stroke patients could contribute to physical disability. We investigated whether hypercatabolic activity occurred in unaffected arm muscle and whether supplemented essential amino acids (EAAs) could limit muscle hypercatabolism (MH). Thirty-eight dysphagic subacute stroke subjects (<3 months after acute event) (29 males+9 females; 69.7±11.4 yrs) were enrolled and randomized to receive 8 g/day EAAs (n=19; EAA group) or isocaloric placebo (maltodextrin; n=19, Plac group). Before randomization, all patients had their arterial (A) and venous (V) amino acids measured and muscle (A-V) differences calculated in the unaffected arm. Eight matched and healthy subjects served as controls. When compared to healthy controls, the entire stroke population showed significant muscle release (=negative value A-V) of the amino acid phenylalanine (phenyl-) indicating a prevalence of MH. Moreover, randomized EAA and Plac groups had similar rates of MH. After 38 days from the start of the protocol, the EAA group but not the Plac group had MH converted to balanced protein turnover or anabolic activity. We concluded that muscle protein metabolism of the unaffected arm of dysphagic subacute stroke individuals could be characterized by MH which can be corrected by supplemented EAAs.
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Wang Z, Wang L, Fan H, Jiang W, Wang S, Gu Z, Wang T. Adapted low intensity ergometer aerobic training for early and severely impaired stroke survivors: a pilot randomized controlled trial to explore its feasibility and efficacy. J Phys Ther Sci 2014; 26:1449-54. [PMID: 25276034 PMCID: PMC4175255 DOI: 10.1589/jpts.26.1449] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/31/2014] [Indexed: 12/21/2022] Open
Abstract
[Purpose] To evaluate the feasibility and efficacy of adapted low intensity ergometer
aerobic training for early and severely impaired stroke survivors. [Subjects] The subjects
were forty-eight early stroke survivors. [Methods] Eligible subjects were recruited and
randomly assigned to an experimental group and a control group. Both groups participated
in comprehensive rehabilitation training. Low intensity aerobic training was only
performed by the experimental group. Outcome measures were the Fugl-Meyer motor score,
Barthel index, exercise test time, peak heart rate, plasma glucose level and serum lipid
profiles. [Results] Patients in the experimental group finished 88.6% of the total aerobic
training sessions prescribed. In compliant participants (adherence≥80%), aerobic training
significantly improved the Barthel index (from 40.1±21.1 to 79.2±14.2), Fugl-Meyer motor
score (from 26.4±19.4 to 45.4±12.7), exercise test time (from 12.2±3.62 min to
13.9±3.6 min), 2-hour glucose level (from 9.22±1.16 mmol/L to 7.21±1.36 mmol/L) and
homeostasis model of assessment for insulin resistence index (from 1.72±1.01 to
1.28±0.88). [Conclusion] Preliminary findings suggest that early and severely impaired
stroke patients may benefit from low intensity ergometer aerobic training.
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Affiliation(s)
- Zun Wang
- Rehabilitation Therapy Department, The Second Medical School of Nanjing University of Traditional Chinese Medicine, China
| | - Lei Wang
- Rehabilitation Therapy Department, The Second Medical School of Nanjing University of Traditional Chinese Medicine, China
| | - Hongjuan Fan
- Rehabilitation Therapy Department, The Second Medical School of Nanjing University of Traditional Chinese Medicine, China
| | - Wenjun Jiang
- Department of Rehabilitation Medicine, Affiliated Hospital of Jiangsu University, China
| | - Sheng Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, China
| | - Zhaohua Gu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, China
| | - Tong Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, China
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Ammann BC, Knols RH, Baschung P, de Bie RA, de Bruin ED. Application of principles of exercise training in sub-acute and chronic stroke survivors: a systematic review. BMC Neurol 2014; 14:167. [PMID: 25162455 PMCID: PMC4236657 DOI: 10.1186/s12883-014-0167-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/18/2014] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND There is increasing evidence for the beneficial effects of exercise training in stroke survivors. In order to reach the desired training effects, exercise training principles must be considered as this ensures the prescription of adequate exercises at an adequate dose. Moreover, exercise training interventions must be designed in a way that maximizes patients' adherence to the prescribed exercise regimen. The objectives of this systematic review were (1) to investigate whether training principles for physical exercise interventions are reported in RCTs for sub-acute and chronic stroke survivors, (2) to evaluate whether the RCTs reported the prescription of the FITT components of the exercise interventions as well as (3) patients' adherence to this prescription, and (4) to assess the risk of bias of the included studies. METHODS We performed a systematic review of RCTs with exercise training as the primary intervention and muscular strength and/or endurance as primary outcomes. The Cochrane library's risk of bias (ROB) tool was used to judge the methodological quality of RCTs. RESULTS Thirty-seven RCTs were included in this systematic review. Eighteen studies (48.7%) focused on aerobic, 8 (21.6%) on resistance and 11 (29.7%) on combined interventions of aerobic and resistive strength exercise. Twenty-nine studies (78.4%) included only chronic stroke survivors, 5 studies (13.5%) only sub-acute stroke survivors whilst 3 studies (8.1%) included both. In terms of principle of exercise training, 89% reported specificity, 75.7% progression, 48.7% overload, 37.8% initial values, 32.4% reversibility and 13.5% diminishing returns. One RCT described all principles of physical exercise training and 19 (51.4%) all FITT components. Patients' adherence to exercise prescription was accounted for in 3 studies (8.1%). Failure to report blinding in patients and participants and failure to report allocation concealment were the most prevalent methodological shortcomings. CONCLUSIONS Incomplete and inconsistent reporting of (1) training components, (2) underlying exercise training principles and (3) patient adherence together with (4) a broad variation in the methodological quality of the included RCTs limit both the utility and reproducibility of physical exercise programs in stroke patients.
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Affiliation(s)
| | | | | | | | - Eling D de Bruin
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, 6200 MD, the Netherlands.
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Concurrent validity of Physiological Cost Index in walking over ground and during robotic training in subacute stroke patients. BIOMED RESEARCH INTERNATIONAL 2014; 2014:384896. [PMID: 24967363 PMCID: PMC4055170 DOI: 10.1155/2014/384896] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/10/2014] [Accepted: 04/23/2014] [Indexed: 11/18/2022]
Abstract
Physiological Cost Index (PCI) has been proposed to assess gait demand. The purpose of the study was to establish whether PCI is a valid indicator in subacute stroke patients of energy cost of walking in different walking conditions, that is, over ground and on the Gait Trainer (GT) with body weight support (BWS). The study tested if correlations exist between PCI and ECW, indicating validity of the measure and, by implication, validity of PCI. Six patients (patient group (PG)) with subacute stroke and 6 healthy age- and size-matched subjects as control group (CG) performed, in a random sequence in different days, walking tests overground and on the GT with 0, 30, and 50% BWS. There was a good to excellent correlation between PCI and ECW in the observed walking conditions: in PG Pearson correlation was 0.919 (p < 0.001); in CG Pearson correlation was 0.852 (p < 0.001). In conclusion, the high significant correlations between PCI and ECW, in all the observed walking conditions, suggest that PCI is a valid outcome measure in subacute stroke patients.
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Delussu AS, Morone G, Iosa M, Bragoni M, Traballesi M, Paolucci S. Physiological responses and energy cost of walking on the Gait Trainer with and without body weight support in subacute stroke patients. J Neuroeng Rehabil 2014; 11:54. [PMID: 24720844 PMCID: PMC3991901 DOI: 10.1186/1743-0003-11-54] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 04/03/2014] [Indexed: 01/19/2023] Open
Abstract
Background Robotic-assisted walking after stroke provides intensive task-oriented training. But, despite the growing diffusion of robotic devices little information is available about cardiorespiratory and metabolic responses during electromechanically-assisted repetitive walking exercise. Aim of the study was to determine whether use of an end-effector gait training (GT) machine with body weight support (BWS) would affect physiological responses and energy cost of walking (ECW) in subacute post-stroke hemiplegic patients. Methods Participants: six patients (patient group: PG) with hemiplegia due to stroke (age: 66 ± 15y; time since stroke: 8 ± 3 weeks; four men) and 6 healthy subjects as control group (CG: age, 76 ± 7y; six men). Interventions: overground walking test (OWT) and GT-assisted walking with 0%, 30% and 50% BWS (GT-BWS0%, 30% and 50%). Main Outcome Measures: heart rate (HR), pulmonary ventilation, oxygen consumption, respiratory exchange ratio (RER) and ECW. Results Intervention conditions significantly affected parameter values in steady state (HR: p = 0.005, V’E: p = 0.001, V'O2: p < 0.001) and the interaction condition per group affected ECW (p = 0.002). For PG, the most energy (V’O2 and ECW) demanding conditions were OWT and GT-BWS0%. On the contrary, for CG the least demanding condition was OWT. On the GT, increasing BWS produced a decrease in energy and cardiac demand in both groups. Conclusions In PG, GT-BWS walking resulted in less cardiometabolic demand than overground walking. This suggests that GT-BWS walking training might be safer than overground walking training in subacute stroke patients.
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Affiliation(s)
- Anna Sofia Delussu
- Fondazione Santa Lucia, I,R,C,C,S, Via Ardeatina, 306, 00179 Rome, Italy.
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Kamm CP, Schmid JP, Müri RM, Mattle HP, Eser P, Saner H. Interdisciplinary Cardiovascular and Neurologic Outpatient Rehabilitation in Patients Surviving Transient Ischemic Attack or Stroke With Minor or No Residual Deficits. Arch Phys Med Rehabil 2014; 95:656-62. [DOI: 10.1016/j.apmr.2013.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/08/2013] [Accepted: 10/09/2013] [Indexed: 10/26/2022]
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Wang Z, Fan H, Wang L, Wang T. Effects of routine rehabilitation training on glucose tolerance among nondiabetic stroke patients: a pilot study. Intern Med 2014; 53:2051-6. [PMID: 25224186 DOI: 10.2169/internalmedicine.53.2205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Impaired glucose tolerance (IGT) and diabetic glucose tolerance (DGT) are closely associated with vascular disease mortality and morbidity. This study was designed to determine whether routine stroke rehabilitation training can be used to improve the glucose status and whether IGT and DGT persist among nondiabetic stroke patients at discharge after such training. METHODS Eighty eligible subjects were evaluated using Oral Glucose Tolerance Tests (OGTTs) at entry and discharge at the rehabilitation medical departments of two large hospitals in China. Routine rehabilitation training was provided during hospitalization. The secondary outcome measurements were BMI, Fugl-Meyer motor score, Barthel index, HbA1c, triglycerides, HDL cholesterol and LDL cholesterol. Non-acute and nondiabetic stroke patients treated at the rehabilitation department. RESULTS Fifty-four patients had IGT or DGT at entry, while 61 patients exhibited abnormal glucose tolerance at discharge, accounting for 67.7% and 76.25% of all subjects respectively. The mean 2-hour plasma glucose level was 8.98 mmol/L at entry and 9.11 mmol/L at discharge. No changes were noted in the OGTT results or secondary outcomes after training (p>0.05), with the exceptions of significant improvements in the Fugl-Meyer motor score and Barthel index (p<0.05). CONCLUSION These preliminary results suggest that IGT and DGT are present at a high frequency among nondiabetic stroke patients both before and after routine rehabilitation training. Routine stroke rehabilitation training, which greatly improves functional outcomes, may have no effect on the incidence of abnormal glucose tolerance.
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Affiliation(s)
- Zun Wang
- Rehabilitation Department, The Second Medical School of Nanjing University of Traditional Chinese Medicine, China
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Effect of low-intensity ergometer aerobic training on glucose tolerance in severely impaired nondiabetic stroke patients. J Stroke Cerebrovasc Dis 2013; 23:e187-93. [PMID: 24231135 DOI: 10.1016/j.jstrokecerebrovasdis.2013.09.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 09/24/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To investigate whether low-intensity ergometer aerobic training has beneficial effect on glucose tolerance in nondiabetic patients with severely impaired stroke. METHODS Fifty-four severely impaired stroke survivors were recruited and randomly assigned to the experimental group and control group. They have no diabetes history with fasting plasma glucose less than 7 mmol/L. Both groups participated in a 6-week rehabilitation training program with low-intensity ergometer aerobic training added only in the experimental group 3 times per week. Primary outcome variables were fasting glucose, fasting insulin, 2-hour glucose, and homeostasis model assessment-insulin resistance (HOMA-IR) in oral glucose tolerance test before and after intervention. RESULTS Before intervention, 36 of 54 (66.7%) were diagnosed with impaired glucose status or diabetic glucose tolerance totally. The average 2-hour plasma glucose level was 9.14 ± 1.39 mmol/L. After intervention, aerobic training significantly improved fasting insulin (from 8.51 ± 2.01 μU/mL to 7.11 ± 2.02 μU/mL), 2-hour glucose level (from 9.13 ± 1.14 mmol/L to 7.22 ± 1.23 mmol/L), and HOMA-IR (from 1.62 ± 1.01 to 1.29 ± .79) in the intervention group compared with the control group (P < .05). Aerobic training also significantly improved their glucose tolerance state (P < .05). CONCLUSIONS Preliminary findings suggest that abnormal glucose tolerance may be highly present among severely impaired nondiabetic stroke patients and low-intensity ergometer aerobic training may have beneficial role in improving glucose tolerance.
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Warburton DER, Gledhill N, Jamnik VK, Bredin SSD, McKenzie DC, Stone J, Charlesworth S, Shephard RJ. Evidence-based risk assessment and recommendations for physical activity clearance: Consensus Document 2011. Appl Physiol Nutr Metab 2013; 36 Suppl 1:S266-98. [PMID: 21800945 DOI: 10.1139/h11-062] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X) are internationally known preparticipation screening tools developed on the basis of expert opinion. The primary purposes of this consensus document were to seek evidence-based support for the PAR-Q and PARmed-X forms, to identify whether further revisions of these instruments are warranted, to determine how people responding positively to questions on the PAR-Q can be safely cleared without medical referral, and to develop exercise clearance procedures appropriate for various clinical conditions across the human lifespan. Seven systematic reviews were conducted, examining physical-activity-related risks and effective risk-stratification procedures for various prevalent chronic conditions. An additional systematic review assessed the risks associated with exercise testing and training of the general population. Two gap areas were identified and evaluated systematically: the role of the qualified exercise professional and the requisite core competencies required by those working with various chronic conditions; and the risks associated with physical activity during pregnancy. The risks associated with being physically inactive are markedly higher than transient risks during and following an acute bout of exercise in both asymptomatic and symptomatic populations across the lifespan. Further refinements of the PAR-Q and the PARmed-X (including online versions of the forms) are required to address the unique limitations imposed by various chronic health conditions, and to allow the inclusion of individuals across their entire lifespan. A probing decision-tree process is proposed to assist in risk stratification and to reduce barriers to physical activity. Qualified exercise professionals will play an essential role in this revised physical activity clearance process.
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Affiliation(s)
- Darren E R Warburton
- Cardiovascular Physiology and Rehabilitation Laboratory, 6108 Thunderbird Blvd, University of British Columbia, Vancouver, BC, Canada
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Zehr EP. Evidence-based risk assessment and recommendations for physical activity clearance: stroke and spinal cord injury. Appl Physiol Nutr Metab 2013; 36 Suppl 1:S214-31. [PMID: 21800943 DOI: 10.1139/h11-055] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Physical activity (PA) has potential benefits after stroke or spinal cord injury (SCI), especially in improving efficiency and functional capacity in activities of daily living. Currently, many who could benefit from PA may be routinely excluded from participation because of myths related to functional capacity and the concern for harm. The purpose of this review was to evaluate the literature for reports of adverse events during exercise after stroke or SCI, and to provide recommendations regarding exercise participation in supervised and unsupervised environments. Studies were evaluated for quality, and the summary level and quality of evidence were evaluated using the AGREE rubric, modified to address the main outcome measure of adverse events. Levels of exercise stress were evaluated for aerobic activities, using an established rubric. Included in the current analysis were 32 studies for stroke and 4 for SCI. In aggregate, this yielded a total of 730 experimental participants with stroke and 143 with SCI. It should be noted that almost all studies were not designed to examine naturally occurring adverse events from PA. Significant contraindications to unsupervised exercise include manifestation of autonomic dysreflexia in SCI and cardiovascular comorbidity after stroke. There are clear benefits of exercise training on physiological outcomes in stroke and SCI, but the relation between outcomes and safety remains unclear. However, taken on balance, the risk-to-benefit ratio favors the recommendation of exercise. This recommendation is based on studies in which participants were almost universally screened for participation in supervised environments. Thus, the grading of evidence for finding adverse events to support this conclusion is inadequate.
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Affiliation(s)
- E Paul Zehr
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, BC, Canada.
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Knops M, Werner CG, Scherbakov N, Fiebach J, Dreier JP, Meisel A, Heuschmann PU, Jungehülsing GJ, von Haehling S, Dirnagl U, Anker SD, Doehner W. Investigation of changes in body composition, metabolic profile and skeletal muscle functional capacity in ischemic stroke patients: the rationale and design of the Body Size in Stroke Study (BoSSS). J Cachexia Sarcopenia Muscle 2013; 4:199-207. [PMID: 23483531 PMCID: PMC3774919 DOI: 10.1007/s13539-013-0103-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 01/23/2013] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Stroke is steadily increasing in prevalence. Muscle tissue wasting and functional changes are frequently observed in stroke, but this has not been studied in detail yet. There is a lack of data to support guideline recommendations on how to target muscle wasting in stroke patients. We hypothesise that pathophysiological metabolic profiles and muscle functional and structural impairment are developing in stroke patients, which are associated with stroke severity and outcome after stroke. METHODS The Body Size in Stroke Study (BoSSS) is a prospective, longitudinal observation study that will explore associations between the metabolic profile, body tissue wasting and particular metabolic and functional changes in skeletal muscle tissue in stroke patients. Consecutive patients with acute stroke (n = 150) will be enrolled due to lacunar or territorial ischemic infarct in the area of the middle cerebral artery. Patients will be studied at annual intervals after 12 and 24 months. For comparison, healthy controls of similar age and patients with chronic heart failure will be used as control groups. The main objective is to study changes in body composition in stroke patients. Secondary, the study will focus on changes in insulin sensitivity of adipose tissue and skeletal muscle. Furthermore, measurements of endothelial function and peripheral blood flow will provide insight in the vascular regulation in stroke patients. CONCLUSION This study will be the largest observational study providing insights into the metabolic and functional changes of muscle tissue in patients with acute ischemic stroke. The new data will increase our understanding of the pathophysiologic tissue wasting in stroke disease and help to develop new therapeutic strategies.
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Affiliation(s)
- Michael Knops
- />Center for Stroke Research Berlin—CSB, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Claudia G. Werner
- />Center for Stroke Research Berlin—CSB, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Nadja Scherbakov
- />Center for Stroke Research Berlin—CSB, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Jochen Fiebach
- />Center for Stroke Research Berlin—CSB, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- />Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jens P. Dreier
- />Center for Stroke Research Berlin—CSB, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- />Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Meisel
- />Center for Stroke Research Berlin—CSB, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- />Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- />NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Peter U. Heuschmann
- />Center for Stroke Research Berlin—CSB, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Gerd J. Jungehülsing
- />Center for Stroke Research Berlin—CSB, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- />Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan von Haehling
- />Applied Cachexia Research, Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Dirnagl
- />Center for Stroke Research Berlin—CSB, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- />Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan D. Anker
- />Centre for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy
| | - Wolfram Doehner
- />Center for Stroke Research Berlin—CSB, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- />Applied Cachexia Research, Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Fu QH, Pei J, Jia Q, Song Y, Gu YH, You XX. [Acupuncture treatment programs for post-stroke motor rehabilitation in community hospitals: study protocol of a multicenter, randomized, controlled trial]. ZHONG XI YI JIE HE XUE BAO = JOURNAL OF CHINESE INTEGRATIVE MEDICINE 2012; 10:516-24. [PMID: 22587973 DOI: 10.3736/jcim20120506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Stroke is responsible for increasingly high rates of mortality and disability worldwide. Approximately two million people suffer from stroke for the first time in China each year. The high incidence (50%) of post-stroke disability brings a heavy burden to patients and their caregivers. Acupuncture has been widely used in the communities for post-stroke rehabilitation in China. The objective of this trial is to apply our acupuncture research achievement to treatment and evaluation of post-stroke hemiplegic patients in community. METHODS AND DESIGN A multicenter, randomized, controlled trial will be performed in Longhua Hospital and a number of community health service centers in Shanghai. A total of 124 patients (estimated sample size) with post-stroke hemiplegia will be randomly divided into an acupuncture group and a control group. The patients undergoing randomization should be stratified according to National Institutes of Health Stroke Scale score at baseline. Within the acupuncture group, different acupuncture protocols are administered to patients with flaccid paralysis or spastic paralysis based on the Ashworth Scale. Patients in the acupuncture group will also be treated with comprehensive rehabilitation therapy. The control group will be treated with comprehensive rehabilitation therapy only. The primary outcome measures are the Simplified Fugl-Meyer Motor Scale, the Modified Barthel Index, and the Burden of Stroke Scale. Secondary outcome measures are the modified Rankin Scale, the modified Ashworth Scale and the Stroke Scale of Traditional Chinese Medicine. Outcome measures will be performed after 4 and 8 weeks of treatment. The patients will be followed up after 6 months. DISCUSSION The results of this study are expected to demonstrate that our standardized acupuncture protocol for treating and evaluating post-stroke hemiplegic patients will improve motor function and lessen the burden of post-stroke patients within the communities. This will provide the evidence to support successful translation of acupuncture therapy for post-stroke hemiplegic patients in community hospital use. TRIAL REGISTRATION This trial was registered in Chinese Clinical Trial Registry with the registration number ChiCTR-TRC-11001347.
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Affiliation(s)
- Qin-hui Fu
- Department of Acupuncture and Moxibustion, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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English CK, Thoirs KA, Fisher L, McLennan H, Bernhardt J. Ultrasound is a reliable measure of muscle thickness in acute stroke patients, for some, but not all anatomical sites: a study of the intra-rater reliability of muscle thickness measures in acute stroke patients. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:368-376. [PMID: 22266233 DOI: 10.1016/j.ultrasmedbio.2011.12.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 11/23/2011] [Accepted: 12/08/2011] [Indexed: 05/31/2023]
Abstract
This prospective, blinded study investigates the test retest reliability of measures of muscle thickness made by one sonographer across two cohort groups (n = 29) of people hospitalised with acute stroke. Reliability was assessed in cohort one (n = 14) for measurements made bilaterally at the anterior and posterior upper arms, the anterior and posterior thighs (total of eight measurements) and in cohort two (n = 15), for measurements made bilaterally at the lateral forearms, the anterior abdominal wall and the anterior and lower legs (total of eight measurements). Reliability estimates varied between measurement sites; intraclass correlation coefficients (ICCs) ranged from -0.26 (lateral forearm, paretic side) to 0.95 (anterior thigh, nonparetic side), percent mean differences ranged from 0.42% (posterior upper arm, nonparetic side) to 14.68% (anterior lower limb, nonparetic side) and method error ranged from 1.08 (abdomen, nonparetic side) to 9.69 mm (posterior lower limb, nonparetic side). Only four measurement sites (anterior upper arm, posterior upper arm, abdomen and anterior thigh) were within the acceptable ranges (ICC 0.60 to 1.00, mean percent difference range 0%-5% and method error range 0-5 mm) and considered reliable to use for measures of muscle thickness in people hospitalised with acute stroke.
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Affiliation(s)
- Coralie K English
- International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, South Australia
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Globas C, Becker C, Cerny J, Lam JM, Lindemann U, Forrester LW, Macko RF, Luft AR. Chronic Stroke Survivors Benefit From High-Intensity Aerobic Treadmill Exercise. Neurorehabil Neural Repair 2011; 26:85-95. [DOI: 10.1177/1545968311418675] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and objective. Ambulatory subjects after stroke may benefit from gait-oriented cardiovascular fitness training, but trials to date have not primarily assessed older persons. Methods. Thirty-eight subjects (age >60 years) with residual hemiparetic gait were enrolled >6 months after stroke. Participants were randomized to receive 3 months (3×/week) progressive graded, high-intensity aerobic treadmill exercise (TAEX) or conventional care physiotherapy. Primary outcome measures were peak exercise capacity (Vo2peak) and sustained walking capacity in 6-minute walks (6MW). Secondary measures were gait velocity in 10-m walks, Berg Balance Scale, functional leg strength (5 chair-rise), self-rated mobility (Rivermead Mobility Index), and quality of life (SF-12). Results. Thirty-six participants completed the study (18 TAEX, 18 controls). TAEX but not conventional care improved Vo2peak (difference 6.4 mL/kg/min, P < .001) and 6MW (53 m, P < .001). Likewise, maximum walking speed (0.13 m/s, P = .01), balance ( P < .05), and the mental subscore of the SF-12 ( P < .01) improved more after TAEX. Gains in Vo2peak correlated with the degree at which training intensity could be progressed in the individual participant ( P < .01). Better walking was related to progression in treadmill velocity and training duration ( P < .001). Vo2peak and 6MW performances were still higher 1 year after the end of training when compared with the baseline, although endurance walking (6MW) at 1 year was lower than immediately after training ( P < .01). Conclusion. This trial demonstrates that TAEX effectively improves cardiovascular fitness and gait in persons with chronic stroke.
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Affiliation(s)
- Christoph Globas
- University Hospital of Zürich, Zürich, Switzerland
- Robert Bosch Krankenhaus, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
| | | | | | - Judith M. Lam
- University Hospital of Zürich, Zürich, Switzerland
- University of Tübingen, Tübingen, Germany
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Hurkmans HL, Ribbers GM, Streur-Kranenburg MF, Stam HJ, van den Berg-Emons RJ. Energy expenditure in chronic stroke patients playing Wii Sports: a pilot study. J Neuroeng Rehabil 2011; 8:38. [PMID: 21756315 PMCID: PMC3148966 DOI: 10.1186/1743-0003-8-38] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 07/14/2011] [Indexed: 11/16/2022] Open
Abstract
Background Stroke is one of the leading causes of long-term disability in modern western countries. Stroke survivors often have functional limitations which might lead to a vicious circle of reduced physical activity, deconditioning and further physical deterioration. Current evidence suggests that routine moderate- or vigorous-intensity physical activity is essential for maintenance and improvement of health among stroke survivors. Nevertheless, long-term participation in physical activities is low among people with disabilities. Active video games, such as Nintendo Wii Sports, might maintain interest and improve long-term participation in physical activities; however, the intensity of physical activity among chronic stroke patients while playing Wii Sports is unknown. We investigated the energy expenditure of chronic stroke patients while playing Wii Sports tennis and boxing. Methods Ten chronic (≥ 6 months) stroke patients comprising a convenience sample, who were able to walk independently on level ground, were recruited from a rehabilitation centre. They were instructed to play Wii Sports tennis and boxing in random order for 15 minutes each, with a 10-minute break between games. A portable gas analyzer was used to measure oxygen uptake (VO2) during sitting and during Wii Sports game play. Energy expenditure was expressed in metabolic equivalents (METs), calculated as VO2 during Wii Sports divided by VO2 during sitting. We classified physical activity as moderate (3-6 METs) or vigorous (> 6 METs) according to the American College of Sports Medicine and the American Heart Association Guidelines. Results Among the 10 chronic stroke patients, 3 were unable to play tennis because they had problems with timing of hitting the ball, and 2 were excluded from the boxing group because of a technical problem with the portable gas analyzer. The mean (± SD) energy expenditure during Wii Sports game play was 3.7 (± 0.6) METs for tennis and 4.1 (± 0.7) METs for boxing. All 8 participants who played boxing and 6 of the 7 who played tennis attained energy expenditures > 3 METs. Conclusions With the exception of one patient in the tennis group, chronic stroke patients played Wii Sports tennis and boxing at moderate-intensity, sufficient for maintaining and improving health in this population.
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Affiliation(s)
- Henri L Hurkmans
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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English C, McLennan H, Thoirs K, Coates A, Bernhardt J. Loss of Skeletal Muscle Mass after Stroke: a Systematic Review. Int J Stroke 2010; 5:395-402. [DOI: 10.1111/j.1747-4949.2010.00467.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Loss of muscle mass after stroke has implications for strength and functional ability and may also contribute to impaired glucose metabolism. Therefore, prevention of muscle loss is desirable. Before interventions to prevent loss of muscle can be designed and evaluated, the expected rate, magnitude and timing of muscle loss need to be understood. A systematic search was undertaken to identify all studies that investigated changes in skeletal muscle mass, volume or cross-sectional area in people after stroke. Studies that used either direct measures of muscle size (computer tomography, magnetic resonance imaging or ultrasound) or measures of lean tissue mass (dual X-ray absorptiometry) were included. Fourteen trials were found and the results were pooled for differences in lean tissue mass between the paretic and the nonparetic leg and arm as well as differences in the midthigh cross-sectional area. In individuals at least 6-month post-stroke, there was significantly less lean tissue mass in the paretic compared with the nonparetic lower limb (MD 342.3 g, 95% confidence interval 247.0–437.6 g) and upper limb (MD 239.9 g, 95% confidence interval 181.7–298.2 g), and significantly less midthigh muscle cross-sectional area (MD 15.4 cm2, 95% confidence interval 13.8–16.9 cm2). There were insufficient data to pool with regard to change in muscle mass over time. There is a significant difference in the regional muscle mass in the paretic vs. the nonparetic limb in individuals greater than 6-months poststroke but little is known about how early and how quickly changes in muscle mass occur.
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Affiliation(s)
| | - Holly McLennan
- International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia Adelaide, SA, Australia
| | - Kerry Thoirs
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Alison Coates
- Nutritional Physiology Research Centre, School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Julie Bernhardt
- National Stroke Research Institute (Florey Neuroscience Institute), Heidelberg Heights, Vic., Australia
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Assessment of compliance with prescribed activity by hemiplegic stroke patients after an exercise programme and physical activity education. Ann Phys Rehabil Med 2010; 53:250-7, 257-65. [DOI: 10.1016/j.rehab.2010.03.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 02/22/2010] [Indexed: 11/19/2022]
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Mossberg KA, Amonette WE, Masel BE. Endurance training and cardiorespiratory conditioning after traumatic brain injury. J Head Trauma Rehabil 2010; 25:173-83. [PMID: 20473091 PMCID: PMC2885899 DOI: 10.1097/htr.0b013e3181dc98ff] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To examine the importance of cardiorespiratory conditioning after traumatic brain injury (TBI) and provide recommendations for patients recovering from TBI. METHOD Review of literature assessing the effectiveness of endurance training programs. MAIN OUTCOMES AND RESULTS A sedentary lifestyle and lack of endurance are common characteristics of individuals with TBI who have a reduction in peak aerobic capacity of 25% to 30% compared with healthy sedentary persons. Increased physical activity and exercise training improves cardiorespiratory fitness in many populations with physical and cognitive impairments. Therefore, increasing the endurance and cardiorespiratory fitness of persons with TBI would seem to have important health implications. However, review of the TBI literature reveals that there have been few well-designed, well-controlled studies of physiologic and psychological adaptations of fitness training. Also lacking are long-term follow-up studies of persons with TBI. CONCLUSIONS Assessing endurance capacity and cardiorespiratory fitness early in the TBI rehabilitation process merits consideration as a standard of care by professional rehabilitation societies. Also, providing effective, safe, and accessible training modalities would seem to be an important consideration for persons with TBI, given the mobility impairments many possess. Long-term follow-up studies are needed to assess the effectiveness of cardiorespiratory training programs on overall morbidity and mortality.
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Affiliation(s)
- Kurt A Mossberg
- University of Texas Medical Branch, Galveston, Texas 77555, USA.
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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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Stuart M, Benvenuti F, Macko R, Taviani A, Segenni L, Mayer F, Sorkin JD, Stanhope SJ, Macellari V, Weinrich M. Community-based adaptive physical activity program for chronic stroke: feasibility, safety, and efficacy of the Empoli model. Neurorehabil Neural Repair 2009; 23:726-34. [PMID: 19318465 DOI: 10.1177/1545968309332734] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercise program for participants with hemiparetic stroke, improves function in the community. METHODS Nonrandomized controlled study in Tuscany, Italy, of participants with mild to moderate hemiparesis at least 9 months after stroke. Forty-nine participants in a geographic health authority (Empoli) were offered APA-stroke (40 completed the study). Forty-four control participants in neighboring health authorities (Florence and Pisa) received usual care (38 completed the study). The APA intervention was a community-based progressive group exercise regimen that included walking, strength, and balance training for 1 hour, thrice a week, in local gyms, supervised by gym instructors. No serious adverse clinical events occurred during the exercise intervention. Outcome measures included the following: 6-month change in gait velocity (6-Minute Timed Walk), Short Physical Performance Battery (SPPB), Berg Balance Scale, Stroke Impact Scale (SIS), Barthel Index, Hamilton Rating Scale for Depression, and Index of Caregivers Strain. RESULTS After 6 months, the intervention group improved whereas controls declined in gait velocity, balance, SPPB, and SIS social participation domains. These between-group comparisons were statistically significant at P<.00015. Individuals with depressive symptoms at baseline improved whereas controls were unchanged (P<.003). Oral glucose tolerance tests were performed on a subset of participants in the intervention group. For these individuals, insulin secretion declined 29% after 6 months (P=.01). CONCLUSION APA-stroke appears to be safe, feasible, and efficacious in a community setting.
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Affiliation(s)
- Mary Stuart
- Health Administration and Policy Program, University of Maryland, Baltimore County, Baltimore, Maryland 21250, USA.
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Optimising long-term participation in physical activities after stroke: exploring new ways of working for physiotherapists. Physiotherapy 2009; 95:228-34. [PMID: 19635344 DOI: 10.1016/j.physio.2008.11.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 09/21/2008] [Accepted: 11/26/2008] [Indexed: 11/21/2022]
Abstract
There is now good empirical evidence of physical and functional benefits for individuals with stroke from long-term engagement in a range of physical activities. However, long-term participation of stroke survivors in physical activity after rehabilitation is low, and maximum benefits are not being achieved. This article reviews relevant literature and evidence, and suggests that physiotherapists are ideally placed to support patients in long-term participation in activity as they prepare patients for the end of physical rehabilitation. However, this requires the development, testing and application of stroke-specific evidence-based behavioural and motivational interventions that are feasible in clinical practice, take account of the role of carers, and seek to address the barriers to activity faced by stroke survivors at the end of rehabilitation. It also requires physiotherapists to take a leading role in developing appropriate policies and strategies with other exercise professionals and services to address the transition from rehabilitation to an active lifestyle following stroke.
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Manns PJ, Baldwin E. Ambulatory activity of stroke survivors: measurement options for dose, intensity, and variability of activity. Stroke 2009; 40:864-7. [PMID: 19150867 DOI: 10.1161/strokeaha.108.531590] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Walking activity is an important part of exercise prescription for stroke survivors. The purpose of this study was to: (1) compare ambulatory activity parameters in subacute stroke survivors over three time periods; and (2) discuss options for measurement of ambulatory activity data with respect to absolute activity, intensity of activity, and variability and pattern of activity. METHODS Ten subacute stroke survivors participated (mean+/-SD; age: 66+/-15 years; time from stroke to discharge: 75+/-31 days). Data collection was completed across three time periods, predischarge, 2 weeks postdischarge, and 6 weeks postdischarge. The Step Activity Monitor (Cyma Corporation) was used to measure daily activity parameters. Parameters representing dose, intensity, and variability/pattern of activity were determined using MatLab. RESULTS Minutes of activity and length of activity bouts significantly increased from predischarge to 6 weeks postdischarge (P=0.030). CONCLUSIONS The measurement of a variety of ambulatory activity parameters may aid clinicians and stroke survivors to determine whether exercise recommendations are being met with daily activity.
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Affiliation(s)
- Patricia J Manns
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
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