One-legged bicycling as an assessment tool for patients with stroke

An 8-week Forced-rate Aerobic Cycling Program Improves Cardiorespiratory Fitness in Persons With Chronic Stroke: A Randomized Controlled Trial

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.

Exercise loading for cardiopulmonary assessment and evaluation of endurance in amputee football players

[Purpose] It is difficult for amputees to perform conventional cardiopulmonary exercise testing. Values were determined for two-legged, one-legged, and two-armed exercise testing in healthy adult males (Study 1), for comparison with preliminary measurements of endurance in amputee football players (Study 2). [Participants and Methods] In Study 1, cardiopulmonary exercise testing was performed in healthy adult males. Correlations between oxygen uptake in two-legged and one-legged/two-armed exercise were calculated and a comparison was made between one-legged exercise and two-armed exercise for each measured value. In Study 2, cardiopulmonary exercise testing was performed on male amputee football players using a two-arm-driven ergometer. The measured values obtained for healthy adult males and amputee football players were compared. [Results] In Study 1, peak work rate and peak heart rate values of healthy participants were significantly higher in two-armed exercise than in one-legged exercise. The correlation between peak oxygen uptake values for two-legged and one-legged exercise was decreased. In Study 2, peak work rate of two-armed exercise was significantly higher in amputee football players than in healthy participants. [Conclusion] Study 1 suggested that musculoskeletal factors might have greater significance for one-legged exercise than for two-armed exercise. Study 2 suggested that para-sports, including amputee football, may contribute to physical strength and health maintenance in lower leg amputees.

Circuit training in community-living "younger" men after stroke

OBJECTIVES

We sought to assess a training program focused on muscle strength and endurance in persons with prior stroke.

METHODS

Thirty men with a slight hemiparesis caused by a first occurrence of stroke at least 6 months earlier were included with an average age of 54 years. The following was assessed before and after an 8-week period: muscle strength, endurance, work capacity, and activity level. The training group consisted of 21 persons and 9 served as control subjects. There were no differences between the groups in the various assessments from the start. The training was set up as circuit training with 5 stations aiming to strengthen the muscles and increase endurance in the bilateral lower limbs. The session lasted for 45 minutes, 3 times per week, for 8 weeks. On eligible persons in the training group, double-sided muscle biopsies were also performed before and after.

RESULTS

There was significance in improved muscle strength and improved peak oxygen uptake for the paretic leg, which was reflected in the muscle enzymes. The nonparetic side also showed improvement, but to a lesser extent. The control group remained unchanged.

CONCLUSIONS

Stroke survivors can improve muscle strength, endurance, and work capacity in both the paretic and nonparetic leg with a circuit training program.