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Linder SM, Lee J, Bethoux F, Persson D, Bischof-Bockbrader A, Davidson S, Li Y, Lapin B, Roberts J, Troha A, Maag L, Singh T, Alberts JL. An 8-week Forced-rate Aerobic Cycling Program Improves Cardiorespiratory Fitness in Persons With Chronic Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2024; 105:835-842. [PMID: 38350494 PMCID: PMC11069437 DOI: 10.1016/j.apmr.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/12/2024] [Accepted: 01/25/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To examine the cardiorespiratory effects of a forced-rate aerobic exercise (FE) intervention among individuals with chronic stroke compared with an upper extremity repetitive task practice (UE RTP) control group. DESIGN Secondary analysis of data from a randomized controlled trial. SETTING Research laboratory. PARTICIPANTS Individuals with chronic stroke (N=60). INTERVENTIONS Participants completed 24 sessions of FE followed by RTP (FE+RTP, N=30) or time matched RTP alone (N=30). The FE+RTP group was prescribed exercise at 60%-80% of heart rate reserve on a motorized stationary cycle ergometer for 45 minutes followed by 45 minutes of RTP. The control group completed 90 minutes of RTP. MAIN OUTCOME MEASURES Metabolic exercise stress tests on a cycle ergometer were conducted at baseline and post-intervention. Outcomes included peak oxygen consumption (peak V̇o2) and anaerobic threshold (AT). RESULTS Fifty participants completed the study intervention and pre/post stress tests. The FE+RTP group demonstrated significantly greater improvements in peak V̇o2 from 16.4±5.7 to 18.3±6.4 mL/min/kg compared with the RTP group (17.0±5.6 to 17.2±5.6 mL/min/kg, P=.020) and significantly greater improvements in AT from 10.3±2.8 to 11.5±3.6 mL/min/kg compared with the RTP group (10.8±3.9 to 10.4±3.2 mL/min/kg, P=.020). In analyzing predictors of post-intervention peak V̇o2, the multivariable linear regression model did not reveal a significant effect of age, sex, body mass index, or beta blocker usage. Similarly, bivariate linear regression models for the FE group only did not find any exercise variables (aerobic intensity, power, or cycling cadence) to be significant predictors of peak V̇o2. CONCLUSIONS While the aerobic exercise intervention was integrated into rehabilitation to improve UE motor recovery, it was also effective in eliciting significant and meaningful improvements in cardiorespiratory fitness. This novel rehabilitation model may be an effective approach to improve motor and cardiorespiratory function in persons recovering from stroke.
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Affiliation(s)
- Susan M Linder
- Cleveland Clinic, Department of Physical Medicine and Rehabilitation, Cleveland, OH; Cleveland Clinic, Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH.
| | - John Lee
- Cleveland Clinic, Department of Physical Medicine and Rehabilitation, Cleveland, OH
| | - Francois Bethoux
- Cleveland Clinic, Department of Physical Medicine and Rehabilitation, Cleveland, OH
| | - Daniel Persson
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | | | - Sara Davidson
- Cleveland Clinic, Concussion Center, Neurologic Institute, Cleveland, OH
| | - Yadi Li
- Cleveland Clinic, Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, OH; Cleveland Clinic, Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland, OH
| | - Brittany Lapin
- Cleveland Clinic, Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, OH; Cleveland Clinic, Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland, OH
| | - Julie Roberts
- Cleveland Clinic, Department of Cardiovascular Medicine; Heart, Vascular, and Thoracic Institute, Cleveland, OH
| | - Alexandra Troha
- Cleveland Clinic, Department of Cardiovascular Medicine; Heart, Vascular, and Thoracic Institute, Cleveland, OH
| | - Logan Maag
- Cleveland Clinic, Department of Physical Medicine and Rehabilitation, Cleveland, OH
| | - Tamanna Singh
- Cleveland Clinic, Department of Cardiovascular Medicine; Heart, Vascular, and Thoracic Institute, Cleveland, OH
| | - Jay L Alberts
- Cleveland Clinic, Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH; Cleveland Clinic, Concussion Center, Neurologic Institute, Cleveland, OH
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Rosenfeldt AB, Lopez-Lennon C, Suttman E, Jansen AE, Owen K, Dibble LE, Alberts JL. Use of a Home-Based, Commercial Exercise Platform to Remotely Monitor Aerobic Exercise Adherence and Intensity in People With Parkinson Disease. Phys Ther 2024; 104:pzad174. [PMID: 38206881 PMCID: PMC10851856 DOI: 10.1093/ptj/pzad174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 09/29/2023] [Accepted: 11/15/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Physical therapists are well-positioned to prescribe exercise outside of a clinical setting to promote positive health behaviors in people with Parkinson disease (PD). Traditionally, a barrier to precise exercise prescription has been reliance on participant self-reported exercise adherence and intensity. Home-based, commercially available exercise platforms offer an opportunity to remotely monitor exercise behavior and facilitate adherence based on objective performance metrics. The primary aim of this project was to characterize the feasibility and processes of remote aerobic exercise data monitoring from a home-based, commercially available platform in individuals participating in the 12-month Cyclical Lower Extremity Exercise for PD II (CYCLE-II) randomized clinical trial. Secondary aims focused on using exercise behavior to classify the cohort into exercise archetypes and describing a shared decision-making process to facilitate exercise adherence. METHODS Data from each exercise session were extracted, visualized, and filtered to ensure ride integrity. Weekly exercise frequency was used to determine exercise archetypes: Adherent (2-4 exercise sessions per week), Over-adherent (>4 exercise sessions per week), and Under-adherent (<2 exercise sessions per week). RESULTS A total of 123 people with PD completed 22,000+ exercise sessions. Analysis of exercise frequency indicated that 79% of participants were adherent; 8% were over-adherent; and 13% were under-adherent. Three case reports illustrate how shared decision-making with the use of exercise performance data points guided exercise prescription. CONCLUSIONS The number of exercise sessions and completeness of the data indicate that people with PD were able to utilize a commercial, home-based exercise platform to successfully engage in long-term aerobic exercise. Physical therapists can use objective data as a part of a shared decision-making process to facilitate exercise adherence. IMPACT Commercially available exercise platforms offer a unique approach for physical therapists to monitor exercise behavior outside of a clinical setting. The methods used in this project can serve as a roadmap to utilizing data from consumer-based platforms.
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Affiliation(s)
- Anson B Rosenfeldt
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Cielita Lopez-Lennon
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Erin Suttman
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - A Elizabeth Jansen
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kelsey Owen
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
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