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Dos Reis MTF, Aguiar LT, Peniche PDC, Faria CDCDM. Are age-predicted equations valid in predicting maximum heart rate in individuals after stroke? Disabil Rehabil 2024; 46:3419-3425. [PMID: 37606274 DOI: 10.1080/09638288.2023.2247981] [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: 12/15/2022] [Accepted: 08/10/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE To investigate the validity of six age-predicted maximum heart rate (HRmax) equations after stroke. MATERIAL AND METHODS Sixty individuals (54 (12) years; 64 (69) months after stroke) were included. A Cardiopulmonary Exercise Test (CPET) performed on a treadmill obtained the HRmax. The most used age-predicted equations were investigated: (1) 220-age, proposed by Fox; (2) 206.9- (0.67 × age), proposed by Gellish; (3) 208- (0.7 × age), proposed by Tanaka; (4) 216.6- (0.84 × age), proposed by Astrand; (5) 164- (0.72 × age) and (6) 200- (0.92 × age) proposed by Brawner. RESULTS No statistically significant agreement was found between the HRmax obtained by the CPET and the one predicted by the equations 1-5 (-0.18 ≤ 95% confidence interval ≤0.79). A significant and moderate agreement was found between the HRmax obtained by the CPET and the one predicted by equation (6) (95% CI= 0.05-0.75; Intraclass Correlation Coefficient= 0.51). Bland-Altman plots showed that equations (1-4) and (6) overestimated the HRmax. Equation (6) presented the lower mean difference. CONCLUSIONS The equations developed for non-disabled individuals (1-4) are not adequate to be used in individuals after a stroke. Equation (6) (Brawner) showed the best results to be used in individuals after stroke; however, it should be used cautiously.
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Affiliation(s)
| | - Larissa Tavares Aguiar
- Department of Physical Therapy, Faculdade Ciências Médicas de Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paula da Cruz Peniche
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Silva de Sousa JC, Torriani-Pasin C, de Moraes Forjaz CL. Reproducibility (reliability and agreement) of ventilatory threshold and peak responses during cardiopulmonary exercise test in people with stroke. Top Stroke Rehabil 2024; 31:117-124. [PMID: 37210739 DOI: 10.1080/10749357.2023.2214756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND A cardiopulmonary exercise test (CPET) is used to determine the ventilatory thresholds and to directly assess cardiorespiratory capacity. However, its reproducibility should be tested in people with stroke as sequelae imposed by the stroke may induce important variations among and within each subject, affecting the reproducibility of the physiological responses to CPET. PURPOSE This cross-sectional repeated measures study design aims to determine the reproducibility of anaerobic threshold (AT), respiratory compensation point (RCP), and maximal cardiorespiratory capacity assessed during a CPET in people with stroke. METHODS Twenty-eight subjects with hemiparesis after stroke aging 60 ± 13 years were submitted to two treadmill CPETs with identical protocols. DATA ANALYSIS The reproducibility of heart rate (HR) and oxygen consumption (VO2) obtained at AT, RCP, and peak effort was evaluated by systematic error (paired t-test); reliability (ICC and 95% confidence interval); and agreement (typical error and coefficient of variation). RESULTS There were no systematic errors for HR and VO2assessed at AT, RCP, and peak effort (p > 0,05). Reliability was high for these variables during CPET (ICCs > 0.93). Agreement was good for all variables. Typical errors for HR and VO2 assessed at AT, RCP, and peak effort were, respectively, 7, 7, and 8 bpm, and 1.51, 1.44, and 1.57 ml.kg-1.min-1. Coefficients of variation assessed at AT, RCP, and peak effort were, respectively, 5.7, 5.1, and 6.0% for HR and 8.7, 7.3, and 7.5% for VO2. CONCLUSIONS HR and VO2 measured at AT, RCP, and peak effort during a treadmill CPET present good reproducibility in people with stroke, showing high reliability and good agreement.
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Affiliation(s)
- Julio Cesar Silva de Sousa
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | - Camila Torriani-Pasin
- Motor Behavior Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
- Department of Physical Therapy and Movement Sciences, The University of Texas El Paso, El Paso, TX, USA
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Serra MC, Hafer-Macko CE, Robbins R, O'Connor JC, Ryan AS. Randomization to Treadmill Training Improves Physical and Metabolic Health in Association With Declines in Oxidative Stress in Stroke. Arch Phys Med Rehabil 2022; 103:2077-2084. [PMID: 35839921 PMCID: PMC9637747 DOI: 10.1016/j.apmr.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the effect of aerobic exercise vs control (stretching/balance) on inflammatory and oxidative stress biomarkers in stroke survivors and whether these changes are associated with improvements in physical and metabolic health. DESIGN Randomized controlled trial. SETTING The general communities of Baltimore, Maryland, and Atlanta, Georgia. PARTICIPANTS Two hundred forty-six older (>50 years), chronic (>6 months) survivors of stroke (N=246) with hemiparetic gait were recruited, with 51 completing pre-intervention testing and 39 completing postintervention testing. Participants were required to have completed all conventional physical therapy and be capable of walking 3 minutes on a treadmill (N=246). INTERVENTION Participants completed 6 months of 2 times/wk stretching or balance (ST; n=19) or 3 times/wk aerobic treadmill rehabilitation (TM; n=20;). MAIN OUTCOME MEASURE(S) Peak oxygen uptake rate (V̇o2peak), 6-minute walking distance (6MWD), fasting plasma glucose, insulin, oxidative stress, and inflammatory biomarkers were assessed pre- and postintervention. Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) was calculated. RESULTS Physical function and metabolic health parameters tended to improve after TM but not ST (ST vs TM: V̇o2peak: -9% vs 24%, P<.01; 6MWD: 1% vs 15%, P=.05; insulin: -1% vs -31%, P=.05; HOMA-IR: -3% vs -29%, P=.06). Plasma concentrations of nitrotyrosine, protein carbonyls, and oxidized low-density lipoprotein (oxLDL) tended to decrease from pre-intervention concentrations in response to TM compared to ST (ST vs TM: nitrotyrosine: 2% vs -28%, P=.01; protein carbonyls: -4% vs -34%, P=.08; oxLDL: -3% vs -32%, P<.01). Changes in circulating concentrations of C-reactive protein, protein carbonyls, and oxLDL were negatively associated with changes in V̇o2peak and 6MWD (r's=-0.40 to -0.76) and positively associated with fasting plasma insulin and HOMA-IR (r's=0.52-0.81, Ps<.01). CONCLUSIONS Six months of TM tends to be associated with increased functional capacity and reduced oxidative stress in chronic stroke survivors. Our findings identify potentially modifiable systemic markers of inflammation and oxidative stress important to stroke rehabilitation and provide potential targets for novel therapeutics in future studies.
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Affiliation(s)
- Monica C Serra
- Division of Geriatrics, Gerontology & Palliative Medicine and the Sam & Ann Barshop Institute for Longevity & Aging Studies, Department of Medicine, UT Health San Antonio, San Antonio, TX; San Antonio Geriatric Research, Education, and Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX.
| | - Charlene E Hafer-Macko
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD; Department of Pharmacology, UT Health San Antonio, San Antonio, TX
| | - Ronna Robbins
- San Antonio Geriatric Research, Education, and Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX
| | - Jason C O'Connor
- Department of Pharmacology, UT Health San Antonio, San Antonio, TX
| | - Alice S Ryan
- Baltimore GRECC, VA Maryland Health Care System, Baltimore, MD; Division of Geriatrics and Palliative Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
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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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Mariman JJ, Lorca E, Biancardi C, Burgos P, Álvarez-Ruf J. Brain’s Energy After Stroke: From a Cellular Perspective Toward Behavior. Front Integr Neurosci 2022; 16:826728. [PMID: 35651830 PMCID: PMC9149581 DOI: 10.3389/fnint.2022.826728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Stroke is a neurological condition that impacts activity performance and quality of life for survivors. While neurological impairments after the event explain the performance of patients in specific activities, the origin of such impairments has traditionally been explained as a consequence of structural and functional damage to the nervous system. However, there are important mechanisms related to energy efficiency (trade-off between biological functions and energy consumption) at different levels that can be related to these impairments and restrictions: first, at the neuronal level, where the availability of energy resources is the initial cause of the event, as well as determines the possibilities of spontaneous recovery. Second, at the level of neural networks, where the “small world” operation of the network is compromised after the stroke, implicating a high energetic cost and inefficiency in the information transfer, which is related to the neurological recovery and clinical status. Finally, at the behavioral level, the performance limitations are related to the highest cost of energy or augmented energy expenditure during the tasks to maintain the stability of the segment, system, body, and finally, the behavior of the patients. In other words, the postural homeostasis. In this way, we intend to provide a synthetic vision of the energy impact of stroke, from the particularities of the operation of the nervous system, its implications, as one of the determinant factors in the possibilities of neurological, functional, and behavioral recovery of our patients.
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Affiliation(s)
- Juan José Mariman
- Laboratorio de Cognición y Comportamiento Sensoriomotor, Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Enrique Lorca
- Laboratorio de Cognición y Comportamiento Sensoriomotor, Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile
- Escuela de Enfermería, Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Carlo Biancardi
- Biomechanics Lab, Departamento de Ciencias Biológicas, CENUR Litoral Norte, Universidad de la República, Paysandú, Uruguay
| | - Pablo Burgos
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Departamento de Neurociencias, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Joel Álvarez-Ruf
- Laboratorio de Cognición y Comportamiento Sensoriomotor, Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile
- Laboratorio de Biomecánica Clínica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- *Correspondence: Joel Álvarez-Ruf,
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Boyne P, Doren S, Scholl V, Staggs E, Whitesel D, Carl D, Shatz R, Sawyer R, Awosika OO, Reisman DS, Billinger SA, Kissela B, Vannest J, Dunning K. Preliminary Outcomes of Combined Treadmill and Overground High-Intensity Interval Training in Ambulatory Chronic Stroke. Front Neurol 2022; 13:812875. [PMID: 35185766 PMCID: PMC8854218 DOI: 10.3389/fneur.2022.812875] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Locomotor high-intensity interval training (HIIT) is a promising intervention for stroke rehabilitation. However, overground translation of treadmill speed gains has been somewhat limited, some important outcomes have not been tested and baseline response predictors are poorly understood. This pilot study aimed to guide future research by assessing preliminary outcomes of combined overground and treadmill HIIT. MATERIALS AND METHODS Ten participants >6 months post-stroke were assessed before and after a 4-week no-intervention control phase and a 4-week treatment phase involving 12 sessions of overground and treadmill HIIT. RESULTS Overground and treadmill gait function both improved during the treatment phase relative to the control phase, with overground speed changes averaging 61% of treadmill speed changes (95% CI: 33-89%). Moderate or larger effect sizes were observed for measures of gait performance, balance, fitness, cognition, fatigue, perceived change and brain volume. Participants with baseline comfortable gait speed <0.4 m/s had less absolute improvement in walking capacity but similar proportional and perceived changes. CONCLUSIONS These findings reinforce the potential of locomotor HIIT research for stroke rehabilitation and provide guidance for more definitive studies. Based on the current results, future locomotor HIIT studies should consider including: (1) both overground and treadmill training; (2) measures of cognition, fatigue and brain volume, to complement typical motor and fitness assessment; and (3) baseline gait speed as a covariate.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Victoria Scholl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Emily Staggs
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Dustyn Whitesel
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Rhonna Shatz
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Russell Sawyer
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Oluwole O. Awosika
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Darcy S. Reisman
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Sandra A. Billinger
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
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Tan T, Meng Y, Li X, Bai R, Wang C, Lyu J, Yan K, Liu M, Zhang C, Wei Y. The novel effectiveness of Tai Chi on cardiopulmonary fitness among stroke patients in the recovery phase: a study protocol for a randomized controlled trial. Trials 2021; 22:614. [PMID: 34517878 PMCID: PMC8436474 DOI: 10.1186/s13063-021-05565-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke is the leading cause of death worldwide. China faces a similar risk of stroke as developed countries because of considerable changes in lifestyle, such as overeating and smoking. Tai Chi is a traditional form of mind-body exercise that has been widely practiced in China for thousands of years. However, there are few studies on the effect of Tai Chi on the cardiopulmonary function of stroke patients in the recovery phase. Therefore, it is necessary to observe the effect of Tai Chi on the cardiorespiratory fitness of patients after stroke. METHODS This is a parallel-design, two-arm, analyst assessor-blinded, randomized controlled trial. A total of 226 stroke patients in the recovery phase will be recruited and assigned randomly to a control group or Tai Chi group at a 1:1 ratio. The patients in the Tai Chi group will perform the Tai Chi exercise. The patients in the control group will perform walking exercises. Patients in both groups will receive conventional treatments and healthy education. The primary outcomes will be VO2peak and scores on the MOS item short form health survey (SF-36) scale. Secondary outcomes will include vital capacity (VC), ejection fractions (EF), and cardiac output (CO). The assessments of the tests will be performed at three time points (before exercise, at the end of exercise, and 6 weeks after exercise). Adverse events will be recorded faithfully during the study. DISCUSSION If the results are positive, this study will contribute to the establishment of further guided Tai Chi rehabilitation programs. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000034719 . Registered on 16 July 2020.
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Affiliation(s)
- Tianyang Tan
- Beijing University of Chinese Medicine, Beijing, China
| | - Yanyan Meng
- Beijing University of Chinese Medicine, Beijing, China
| | - Xinyu Li
- Beijing University of Chinese Medicine, Beijing, China
| | - Ruina Bai
- China Academy of Chinese Medicine Sciences Xiyuan Hospital, Beijing, China
| | | | - Jiaxuan Lyu
- Beijing University of Chinese Medicine, Beijing, China
| | - Kang Yan
- Beijing University of Chinese Medicine, Beijing, China
| | - Meng Liu
- Beijing University of Chinese Medicine, Beijing, China
| | | | - Yulong Wei
- Beijing University of Chinese Medicine, Beijing, China.
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Stookey AD, Macko RF, Ivey FM, Katzel LI. Evaluating Test-Retest Reliability of Fatigability in Chronic Stroke. J Stroke Cerebrovasc Dis 2021; 30:105895. [PMID: 34242857 PMCID: PMC8767492 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES The subjective nature of fatigue may contribute to inconsistencies in prevalence rates for post-stroke fatigue. More objective performance fatigue measures may offer a more reliable construct of fatigue. Our goal was to establish test-retest reliability of fatigability in stroke during 6-minute walk (6MW) testing. Relationships between post-stoke fatigability and other constructs were assessed. MATERIALS AND METHODS Twenty-three hemiparetic stroke survivors underwent two 6MW tests with portable metabolic monitoring performed at least 48 hours apart. Fatigability was defined as ratio of change in walking speed to distance covered during the 6MW. 6MW oxygen consumption (VO2), peak aerobic capacity (VO2peak), walking speed over-ground, dynamic gait index, fatigue, falls efficacy, and BMI were measured. RESULTS Fatigability was highly correlated between both 6MW trials (ICC = 0.99, p < 0.001) with no significant difference between trials (0.08, p = 0.48). The strongest correlation was between fatigability and 6MW VO2 trial 1 and 2 (r = 0.92, p < 0.001 and r = 0.95, p < 0.001, respectively). Moderate-to-strong relationships were observed between fatigability for 6MW and fastest-comfortable walking speed (r = -0.82 and -0.77), self-selected walking speed (r = -7.8 and -0.78), 6MW walking speed (r = -0.80 and 0.80, VO2peak (r = -0.47 and -0.48) (p < 0.001), and DGI (r = -0.70 and -0.68, p < 0.001). CONCLUSION This study establishes test-retest reliability for an objective measure of fatigue in stroke-related disability. The strong correlations between fatigability and other functional measures also provides insight into the contributors underlying fatigability in this population. REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01322607.
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Affiliation(s)
- Alyssa D Stookey
- Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System, Baltimore, MD, United States; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.
| | - Richard F Macko
- Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System, Baltimore, MD, United States; Department of Neurology, University of Maryland School of Medicine, Baltimore 21201, MD, United States
| | - Frederick M Ivey
- Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System, Baltimore, MD, United States
| | - Leslie I Katzel
- Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System, Baltimore, MD, United States; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
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Predictors of Adherence to Lifestyle Recommendations in Stroke Secondary Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094666. [PMID: 33925718 PMCID: PMC8124907 DOI: 10.3390/ijerph18094666] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/26/2022]
Abstract
The risk of recurrent vascular events is high following ischaemic stroke or transient ischaemic attack (TIA). Unmanaged modifiable risk factors present opportunities for enhanced secondary prevention. This cross-sectional study (n = 142 individuals post-ischaemic stroke/TIA; mean age 63 years, 70% male) describes adherence rates with risk-reducing behaviours and logistical regression models of behaviour adherence. Predictor variables used in the models com-prised age, sex, stroke/TIA status, aetiology (TOAST), modified Rankin Scale, cardiovascular fit-ness (VO2peak) measured as peak oxygen uptake during incremental exercise (L/min) and Hospital Anxiety and Depression Score (HADS). Of the study participants, 84% abstained from smoking; 54% consumed ≥ 5 portions of fruit and vegetables/day; 31% engaged in 30 min moderate-to-vigorous physical activity (MVPA) at least 3 times/week and 18% were adherent to all three behaviours. VO2peak was the only variable predictive of adherence to all three health behaviours (aOR 12.1; p = 0.01) and to MVPA participation (aOR 7.5; p = 0.01). Increased age (aOR 1.1; p = 0.03) and lower HADS scores (aOR 0.9; p = 0.02) were predictive of smoking abstinence. Men were less likely to consume fruit and vegetables (aOR 0.36; p = 0.04). Targeted secondary prevention interventions after stroke should address cardiovascular fitness training for MVPA and combined health behaviours; management of psychological distress in persistent smokers and consider environmental and social factors in dietary interventions, notably in men.
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Fahey M, Brazg G, Henderson CE, Plawecki A, Lucas E, Reisman DS, Schmit BD, Hornby TG. The Value of High Intensity Locomotor Training Applied to Patients With Acute-Onset Neurologic Injury. Arch Phys Med Rehabil 2020; 103:S178-S188. [PMID: 33383032 DOI: 10.1016/j.apmr.2020.09.399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 11/02/2022]
Abstract
Long-standing research in animal models and humans with stroke or incomplete spinal cord injury (iSCI) indicate that specific physical training variables, such as the specificity and amount of practice, may influence neurologic recovery and locomotor function. More recent data highlight the contributions of exercise intensity, as estimated indirectly by cardiovascular exertion, as potentially more important than previously considered. The effects of exercise intensity are well described in neurologically intact individuals, although confusion regarding the definitions of intensity and safety concerns have limited its implementation during physical rehabilitation of patients with neurologic injury. The purpose of this review is to delineate some of the evidence regarding the effects of exercise intensity during locomotor training in patients with stroke and iSCI. We provide specific definitions of exercise intensity used within the literature, describe methods used to ensure appropriate levels of exertion, and discuss potential adverse events and safety concerns during its application. Further details on the effects of locomotor training intensity on clinical outcomes, and on neuromuscular and cardiovascular function will be addressed as available. Existing literature across multiple studies and meta-analyses reveals that exercise training intensity is likely a major factor that can influence locomotor function after neurologic injury. To extend these findings, we describe previous attempts to implement moderate to high intensity interventions during physical rehabilitation of patients with neurologic injury, including the utility of specific strategies to facilitate implementation, and to navigate potential barriers that may arise during implementation efforts.
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Affiliation(s)
- Meghan Fahey
- Rehabilitation Institute of Chicago, Chicago, IL
| | | | - Christopher E Henderson
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN
| | | | - Emily Lucas
- Rehabilitation Hospital of Indiana, Indianapolis, IN
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI
| | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN.
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Kim JH, Han EY, Kang SY, Im SH. Paretic knee extensor strength, gait velocity, and fat mass are major determinants of peak aerobic capacity in subacute stroke: observational cohort study. Sci Rep 2020; 10:13917. [PMID: 32811893 PMCID: PMC7434872 DOI: 10.1038/s41598-020-70936-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 08/06/2020] [Indexed: 12/01/2022] Open
Abstract
The purpose of this study is to investigate major determinants of peak aerobic capacity in subacute stroke patients among body composition, balance function, walking capacity, and lower limb muscular strength. This was a retrospective observational cohort study. Eighty-three subacute stroke patients were enrolled and their medical records were retrospectively reviewed in the study (47 males; mean age: 62.95 ± 13.9 years). Gait capacity was assessed by gait velocity (10 m walk velocity:10MWV) and gait endurance (6 min walk distance:6MWD). Balance function was evaluated with Berg Balance Scale (BBS). The isometric muscular strengths of bilateral knee extensors were measured with an isokinetic dynamometer. Cardiovascular fitness was evaluated with an expired gas analyzer. In backward linear regression analyses, paretic isometric extensor strength (p < 0.001), fat mass (p = 0.005) and 10MWV (p < 0.001) are significantly correlated with peak aerobic capacity (adjusted R2 = 0.499) in all patients. Our results confirmed that paretic knee extensor strength, gait velocity, and fat mass were major determinants of peak aerobic capacity in subacute stroke. Therefore, therapeutic approaches should focus on improving gait velocity and paretic knee extensor strength in the early stages of recovery from stroke.
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Affiliation(s)
- Ji Hyun Kim
- Department of Medicine, Graduate School, Jeju National University, Jejusi, Jejudo, 63241, Republic of Korea
| | - Eun Young Han
- Department of Medicine, Graduate School, Jeju National University, Jejusi, Jejudo, 63241, Republic of Korea. .,Department of Rehabilitation Medicine, Jeju National University, College of Medicine, 15 Aran 13 gil, Jejusi, Jejudo, 63241, Republic of Korea.
| | - Sa-Yoon Kang
- Department of Neurology, Jeju National University, College of Medicine, Jejusi, Jejudo, 63241, Republic of Korea
| | - Sang Hee Im
- Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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12
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Boyne P, Scholl V, Doren S, Carl D, Billinger SA, Reisman DS, Gerson M, Kissela B, Vannest J, Dunning K. Locomotor training intensity after stroke: Effects of interval type and mode. Top Stroke Rehabil 2020; 27:483-493. [PMID: 32063178 DOI: 10.1080/10749357.2020.1728953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and Objectives: High-intensity interval training (HIIT) is a promising strategy for improving gait and fitness after stroke, but optimal parameters remain unknown. We tested the effects of short vs long interval type and over-ground vs treadmill mode on training intensity. Methods: Using a repeated measures design, 10 participants with chronic hemiparesis performed 12 HIIT sessions over 4 weeks, alternating between short and long-interval HIIT sessions. Both protocols included 10 minutes of over-ground HIIT, 20 minutes of treadmill HIIT and another 10 minutes over-ground. Short-interval HIIT involved 30 second bursts at maximum safe speed and 30-60 second rest periods. Long-interval HIIT involved 4-minute bursts at ~90% of peak heart rate (HRpeak) and 3-minute recovery periods at ~70% HRpeak. Results: Compared with long-interval HIIT, short-interval HIIT had significantly faster mean overground speeds (0.75 vs 0.67 m/s) and treadmill speeds (0.90 vs 0.51 m/s), with similar mean treadmill HR (82.9 vs 81.8%HRpeak) and session perceived exertion (16.3 vs 16.3), but lower overground HR (78.4 vs 81.1%HRpeak) and session step counts (1481 vs 1672). For short-interval HIIT, training speeds and HR were significantly higher on the treadmill vs. overground. For long-interval HIIT, the treadmill elicited HR similar to overground training at significantly slower speeds. Conclusions: Both short and long-interval HIIT elicit high intensities but emphasize different dosing parameters. From these preliminary findings and previous studies, we hypothesize that overground and treadmill short-interval HIIT could be optimal for improving gait speed and overground long-interval HIIT could be optimal for improving gait endurance.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA
| | - Victoria Scholl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA
| | - Sandra A Billinger
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center , Kansas City, KS, USA
| | - Darcy S Reisman
- Department of Physical Therapy, College of Health Sciences, University of Delaware , Newark, DE, USA
| | - Myron Gerson
- Departments of Internal Medicine and Cardiology, College of Medicine, University of Cincinnati , Cincinnati, OH, USA
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati , Cincinnati, OH, USA
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA.,Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center , Cincinnati, OH, USA
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA
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13
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Lee J, Stone AJ. Combined Aerobic and Resistance Training for Cardiorespiratory Fitness, Muscle Strength, and Walking Capacity after Stroke: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2019; 29:104498. [PMID: 31732460 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104498] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/11/2019] [Accepted: 10/23/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cardiorespiratory fitness, measured as peak oxygen consumption, is a potent predictor of stroke risk. Muscle weakness is the most prominent impairment after stroke and is directly associated with reduced walking capacity. There is a lack of recommendations for optimal combined aerobic training and resistance training for those patients. The purpose of this study was to systematically review and quantify the effects of exercise training on cardiorespiratory fitness, muscle strength, and walking capacity after stroke. METHODS Five electronic databases were searched (until May 2019) for studies that met the following criteria: (1) adult humans with a history of stroke who ambulate independently; (2) structured exercise intervention based on combined aerobic training and resistance training; and (3) measured cardiorespiratory fitness, muscle strength, and/or walking capacity. RESULTS Eighteen studies (602 participants, average age 62 years) met the inclusion criteria. Exercise training significantly improved all 3 outcomes. In subgroup analyses for cardiorespiratory fitness, longer training duration was significantly associated with larger effect size. Likewise, for muscle strength, moderate weekly frequency and lower training volume were significantly associated with larger effect size. Furthermore, in walking capacity, moderate weekly frequency and longer training duration were significantly associated with larger effect size. CONCLUSIONS These results suggest that an exercise program consisting of moderate-intensity, 3 days per week, for 20 weeks should be considered for greater effect on cardiorespiratory fitness, muscle strength, and walking capacity in stroke patients.
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Affiliation(s)
- Junghoon Lee
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas
| | - Audrey J Stone
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas.
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14
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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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15
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Bhatia R, Sharma G, Patel C, Garg A, Roy A, Bali P, Singh N, Sisodia P, Sreenivas V, Srivastava MVP, Prasad K. Coronary Artery Disease in Patients with Ischemic Stroke and TIA. J Stroke Cerebrovasc Dis 2019; 28:104400. [PMID: 31606321 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104400] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/02/2019] [Accepted: 09/07/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Ischemic stroke (IS) and coronary artery disease (CAD) share common risk factors and one may be the harbinger of the other. We aimed to study prevalence of symptomatic and asymptomatic CAD in a cohort of consecutive patients with IS and assess its relationship with intracranial and extracranial large artery cerebrovascular disease (LAD). METHODS All consecutive eligible IS and Transient Ischemic Attack (TIA) patients were recruited into the study. Both clinically suspected and asymptomatic patients (N = 259) underwent myocardial Stress-rest Gated Technetium-99m (Tc99m) MIBI Myocardial Perfusion SPECT scan performed on a dual head SPECT-CT to estimate evidence of myocardial ischemia. RESULTS Three hundred patients completed the study. Forty one patients were previously diagnosed cases of definitive CAD. Twelve patients were clinically suspected to have CAD and 247 patients were asymptomatic. Among these, 12 patients (4.81%) had a positive SPECT. The overall prevalence of CAD was 17.67% (n = 53). Presence of diabetes was an independent predictor of CAD (OR 1.98, 95% CI 1.07-3.67. P .02). No significant association was found between the presence of LAD and CAD in all subgroup comparisons. However, there was a suggestion of higher LAD among patients with known CAD compared with others. CONCLUSIONS CAD is prevalent in patients with ischemic stroke. No definitive relationship was found between CAD and intracranial or extracranial LAD. Population based stratification tools are needed to further assess the need to detect subclinical CAD in patients with stroke.
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Affiliation(s)
- Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
| | - Gautam Sharma
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Chetan Patel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Prerna Bali
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Nishita Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pranjal Sisodia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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16
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Munakomi S. Preventing Muscle Atrophy Following Strokes: A Reappraisal. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1088:593-601. [PMID: 30390272 DOI: 10.1007/978-981-13-1435-3_28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Muscle atrophy leading to muscle weakness accounts for major cause of disabilities among stroke survivors. It amounts to compromised gait and prevails to viscous cycle of diminished physical capacities and compromised participation in rehabilitative tasks. There is predisposition to recurrent strokes due to added risk of developing metabolic syndrome. Therefore, beyond the shadow of doubt, there is ripple effect of rehabilitation and thereby muscle protection in these subsets of patients. Herein, we highlight upon the newer insights with regard to preventing muscle atrophy following strokes.
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Affiliation(s)
- Sunil Munakomi
- Department of Neurosurgery, Nobel Teaching Hospital, Biratnagar, Nepal.
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17
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Outermans JC, van de Port I, Kwakkel G, Visser-Meily JM, Wittink H. The role of postural control in the association between aerobic capacity and walking capacity in chronic stroke: a cross-sectional analysis. Eur J Phys Rehabil Med 2019. [DOI: 10.23736/s1973-9087.18.04987-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Woodward JL, Connolly M, Hennessy PW, Holleran CL, Mahtani GB, Brazg G, Fahey M, Maganti K, Hornby TG. Cardiopulmonary Responses During Clinical and Laboratory Gait Assessments in People With Chronic Stroke. Phys Ther 2019; 99:86-97. [PMID: 30476281 DOI: 10.1093/ptj/pzy128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 07/16/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND The 6-Minute Walk Test (6MWT) is a common clinical assessment used to evaluate locomotor function in patients after stroke. Previous work suggests the 6MWT can estimate peak metabolic capacity (VO2peak) without cardiorespiratory assessments during graded exercise tests (GXTs), which may assist with exercise prescription. However, selected research also indicated increased heart rates (HRs) during 6MWTs beyond levels considered safe without GXTs. OBJECTIVE The goal of this study was to examine cardiorespiratory responses during 6MWTs and GXTs in individuals with chronic stroke and their associations with demographic or clinical characteristics. DESIGN The study used a cross-sectional observational design. METHODS Cardiorespiratory responses were assessed during 6MWTs at self-selected velocity (SSV) and fastest velocity (FV), and during GXTs. Secondary assessments included the lower extremity Fugl-Meyer Assessment, Functional Gait Assessment, gait speeds, and daily stepping activity. Correlation and regression analyses were used to evaluate associations between locomotor performance, cardiorespiratory responses, and clinical and demographic characteristics. RESULTS Average HRs during 6MWT-FV were 72% to 76% of the age-predicted maximum (HRmax), with 20% of participants exceeding 85% predicted HRmax. When normalized to HRs during GXTs, HRs during 6MWT-FV were 86% to 88% of observed HRmax. Primary predictors of increased HRs during 6MWTs were resting HR, body mass index, and daily stepping. Distance during 6MWT-FV was a significant predictor of VO2peak in combination with other variables. Electrocardiographic abnormalities were observed in >80% of participants at rest and 31% demonstrated distinct abnormalities during GXTs, which were not related to 6MWT or GXT performance. LIMITATIONS In addition to sample size, a primary limitation involved the ability to accurately predict or measure HRmax in patients with motor dysfunction after stroke. CONCLUSIONS Cardiac responses were higher than anticipated during 6MWTs and often exceeded recommended HR thresholds. Clinicians should closely monitor cardiorespiratory responses during 6MWTs.
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Affiliation(s)
- Jane L Woodward
- Shirley Ryan AbilityLab, Chicago, Illinois. She is a board-certified neurologic clinical specialist
| | | | - Patrick W Hennessy
- Infiniti Rehab Inc, Portland, Oregon. He is a board-certified neurologic clinical specialist
| | - Carey L Holleran
- Division of Physical Therapy, Washington University of St. Louis, St. Louis, Missouri. He is a board-certified neurologic clinical specialist
| | | | - Gabrielle Brazg
- Shirley Ryan AbilityLab. She is a board-certified neurologic clinical specialist
| | - Meghan Fahey
- Shirley Ryan AbilityLab. She is a board-certified neurologic clinical specialist
| | - Kameswari Maganti
- Department of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN 46524 (USA)
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19
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Sandroff BM, Motl RW, Bamman M, Cutter GR, Bolding M, Rinker JR, Wylie GR, Genova H, DeLuca J. Rationale and design of a single-blind, randomised controlled trial of exercise training for managing learning and memory impairment in persons with multiple sclerosis. BMJ Open 2018; 8:e023231. [PMID: 30552263 PMCID: PMC6303579 DOI: 10.1136/bmjopen-2018-023231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION This randomised controlled trial (RCT) examines treadmill walking exercise training effects on learning and memory performance, hippocampal volume, and hippocampal resting-state functional connectivity in persons with multiple sclerosis (MS) who have objective impairments in learning new information. METHODS AND ANALYSIS Forty fully ambulatory persons with MS who demonstrate objective learning and memory impairments will be randomly assigned into either the intervention or active control study conditions. The intervention condition involves supervised, progressive treadmill walking exercise training three times per week for a 3-month period. The active control condition involves supervised, progressive low-intensity resistive exercise that will be delivered at the same frequency as the intervention condition. The primary outcome will involve composite performance on neuropsychological learning and memory tests, and the secondary outcomes involve MRI measures of hippocampal volume and resting-state functional connectivity administered before and after the 3-month study period. Outcomes will be administered by treatment-blinded assessors using alternate test forms to minimise practice effects, and MRI data processing will be performed by blinded data analysts. ETHICS AND DISSEMINATION This study has been approved by a university institutional review board. The primary results will be disseminated via peer-reviewed publications and the final data will be made available to third parties in applicable data repositories. If successful, the results from this study will eventually inform subsequent RCTs for developing physical rehabilitation interventions (ie, treadmill walking exercise training) for improving learning and memory and its relationship with hippocampal outcomes in larger samples of cognitively impaired persons with MS. The results from this early-phase RCT will further lay preliminary groundwork for ultimately providing clinicians and patients with guidelines for better using chronic treadmill walking exercise for improving cognition and brain health. This approach is paramount as learning and memory impairment is common, burdensome and poorly managed in MS. TRIAL REGISTRATION NUMBER NCT03319771; Pre-results.
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Affiliation(s)
- Brian M Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marcus Bamman
- Department of Cell, Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mark Bolding
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John R Rinker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Glenn R Wylie
- Kessler Foundation, Neuropsychology and Neuroscience Research, West Orange, New Jersey, USA
| | - Helen Genova
- Kessler Foundation, Neuropsychology and Neuroscience Research, West Orange, New Jersey, USA
| | - John DeLuca
- Kessler Foundation, Neuropsychology and Neuroscience Research, West Orange, New Jersey, USA
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20
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The beneficial role of early exercise training following stroke and possible mechanisms. Life Sci 2018; 198:32-37. [DOI: 10.1016/j.lfs.2018.02.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/04/2018] [Accepted: 02/12/2018] [Indexed: 12/21/2022]
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21
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Bernardes WL, Montenegro RA, Monteiro WD, de Almeida Freire R, Massaferri R, Farinatti P. Optimizing a Treadmill Ramp Protocol to Evaluate Aerobic Capacity of Hemiparetic Poststroke Patients. J Strength Cond Res 2018; 32:876-884. [PMID: 29466277 DOI: 10.1519/jsc.0000000000002297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bernardes, WL, Montenegro, RA, Monteiro, WD, de Almeida Freire, R, Massaferri, R, and Farinatti, P. Optimizing a treadmill ramp protocol to evaluate aerobic capacity of hemiparetic poststroke patients. J Strength Cond Res 32(3): 876-884, 2018-A correct assessment of cardiopulmonary capacity is important for aerobic training within motor rehabilitation of poststroke hemiparetic patients (PSHPs). However, specific cardiopulmonary exercise testing (CPET) for these patients are scarce. We proposed adaptations in a protocol originally developed for PSHPs by Ovando et al. (CPET1). We hypothesized that our adapted protocol (CPET2) would improve the original test, by preventing early fatigue and increasing patients' peak performance. Eleven PSHPs (52 ± 14 years, 10 men) performed both protocols. CPET2 integrated changes in final speed (100-120% vs. 140% maximal speed in 10-m walking test), treadmill inclination (final inclination of 5 vs. 10%), and estimated test duration (10 vs. 8 minutes) to smooth the rate of workload increment of CPET1. Peak oxygen uptake (V[Combining Dot Above]O2peak) (20.3 ± 6.1 vs. 18.6 ± 5.0 ml·kg·min; p = 0.04), V[Combining Dot Above]O2 at gas exchange transition (V[Combining Dot Above]O2-GET) (11.5 ± 2.9 vs. 9.8 ± 2.0 ml·kg·min; p = 0.04), and time to exhaustion (10 ± 3 vs. 6 ± 2 minutes; p < 0.001) were higher in CPET2 than in CPET1. Slopes and intercepts of regressions describing relationships between V[Combining Dot Above]O2 vs. workload, heart rate vs. workload, and V[Combining Dot Above]O2 vs. heart rate were similar between CPETs. However, standard errors of estimates obtained for regressions between heart rate vs. workload (3.0 ± 1.3 vs. 3.8 ± 1.0 b·min; p = 0.004) and V[Combining Dot Above]O2 vs. heart rate (6.0 ± 2.1 vs. 4.8 ± 2.4 ml·kg·min; p = 0.05) were lower in CPET2 than in CPET1. In conclusion, the present adaptations in Ovando's CPET protocol increased exercise tolerance of PSHPs, eliciting higher V[Combining Dot Above]O2peak and V[Combining Dot Above]O2-GET, preventing earlier fatigue, and providing better physiological relationships along submaximal workloads.
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Affiliation(s)
- Wendell L Bernardes
- Graduate Program in Physical Activity Sciences, Salgado de Oliveira University, Rio de Janeiro, Brazil
| | - Rafael A Montenegro
- Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil.,Graduate Program in Clinical and Experimental Physiopathology, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Walace D Monteiro
- Graduate Program in Physical Activity Sciences, Salgado de Oliveira University, Rio de Janeiro, Brazil.,Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Raul de Almeida Freire
- Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Renato Massaferri
- Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil.,Graduate Program in Clinical and Experimental Physiopathology, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Paulo Farinatti
- Graduate Program in Physical Activity Sciences, Salgado de Oliveira University, Rio de Janeiro, Brazil.,Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
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22
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Silva de Sousa JC, Torriani-Pasin C, Tosi AB, Fecchio RY, Costa LAR, Forjaz CLDM. Aerobic Stimulus Induced by Virtual Reality Games in Stroke Survivors. Arch Phys Med Rehabil 2018; 99:927-933. [PMID: 29428343 DOI: 10.1016/j.apmr.2018.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/10/2018] [Accepted: 01/13/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate whether virtual reality games (VRGs) in stroke survivors produce significant and reproducible heart rate and oxygen consumption (V˙o2) responses during their execution, corresponding to an intensity between the anaerobic threshold (AT) and the respiratory compensation point (RCP). DESIGN Single-subject, repeated-measure design. SETTING Stroke survivors registered from a rehabilitation program. PARTICIPANTS Chronic hemiparetic stroke survivors (N=12; 10 men; mean age ± SD, 58±12y) rated at 3 or 4 in the Functional Ambulation Categories. INTERVENTIONS Participants underwent, in a random order, 2 identical sessions of VRGs (console Xbox 360 + Kinect) and 1 control session (38min watching a movie). The VRG sessions were composed of 4 sets of VRGs (3min of tennis, 1min for changing the game, and 4min of boxing) interspaced with 2 minutes of rest. MAIN OUTCOME MEASURES Heart rate and V˙o2 were measured during the experimental sessions and compared with heart rate and V˙o2 obtained at AT and RCP assessed during a maximal cardiopulmonary exercise test. RESULTS Heart rate and V˙o2 during VRGs had good reproducibility (intraclass correlation coefficients, ≥.91 and ≥.85, respectively; coefficients of variation, ≤6.7% and ≤13.7%, respectively). Heart rate during VRGs was similar to AT and significantly lower than RCP (P≤.05), while V˙o2 was significantly lower than AT and RCP (P<.05). CONCLUSIONS An acute session of VRGs composed of tennis and boxing games using the console XBox 360 + Kinect promotes reproducible responses of heart rate and V˙o2 that corresponded, respectively, to AT and below AT, characterizing a low-intensity aerobic stimulus.
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Affiliation(s)
- Julio Cesar Silva de Sousa
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | - Camila Torriani-Pasin
- Motor Behaviour Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | - Amanda Barboza Tosi
- Motor Behaviour Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | - Rafael Yokoyama Fecchio
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | - Luiz Augusto Riani Costa
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | - Cláudia Lúcia de Moraes Forjaz
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil.
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Billinger SA, Sisante JFV, Whitaker AA, Abraham MG. Time Course of Flow-Mediated Dilation and Vascular Endothelial Growth Factor following Acute Stroke. J Stroke Cerebrovasc Dis 2017; 27:957-962. [PMID: 29198900 DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 10/31/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES People after stroke demonstrate alterations in vascular endothelial function measured by flow-mediated dilation. Limited information is available in the literature on possible protective factors following stroke. The aims of the secondary analysis were (1) to characterize the time course of vascular endothelial function using flow-mediated dilation at 72 hours after stroke and 1 week later during inpatient stroke rehabilitation and (2) to determine whether flow-mediated dilation was related to vascular endothelial growth factor, brain-derived neurotrophic factor, or estimated prestroke peak oxygen uptake. METHODS Flow-mediated dilation using Doppler ultrasound was assessed in bilateral brachial arteries at the defined time points. Flow-mediated dilation and blood draws occurred on the same day between 7:30 am and 9:00 am following an overnight fast. Enzyme-linked immunosorbent assay was used to quantify plasma vascular endothelial growth factor and brain-derived neurotrophic factor values. A nonexercise estimate was used to calculate prestroke peak oxygen uptake. RESULTS We have shown that between-limb differences are evident within 72 hours after stroke and remain 1 week later during inpatient rehabilitation. Higher values for vascular endothelial growth factor were associated with increased flow-mediated dilation at both time points. Higher estimated prestroke peak oxygen uptake was related to flow-mediated dilation. Brain-derived neurotrophic factor was not related to any outcome measures. CONCLUSIONS Unique vascular adaptations start early after stroke in the stroke-affected limb and remain through inpatient stroke rehabilitation. Vascular endothelial growth factor and prestroke physical activity may have a protective role in vascular function following stroke. Future work should focus on mechanistic pathways for preservation of vascular health.
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Affiliation(s)
- Sandra A Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas.
| | - Jason-Flor V Sisante
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Alicen A Whitaker
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Michael G Abraham
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas; Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas
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Serra MC, Treuth MS, Hafer-Macko CE, Ryan AS. Increased Energy Cost of Mobility in Chronic Stroke. ACTA ACUST UNITED AC 2017; 5. [PMID: 28616366 DOI: 10.4172/2167-7182.1000356] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to compare the energy cost of completing mobility-related activities in chronic stroke to the estimated energy cost found in the compendium of physical activities, a resource that estimates and classifies energy cost of various human physical activities. Men (n=18) and women (n=10) with chronic hemiparetic gait (stroke latency: 4 ± 2 years, age: 60.4 ± 1.6 years, BMI: 31.5 ± 1.1 kg/m2) participated in the study. Portable energy cost monitoring (COSMED K4b2) was performed during five mobility activities of varying intensity to determine metabolic equivalents (METs, or oxygen consumption in multiples of resting level) for each activity. The METs achieved during the five activities were compared to the following compendium MET values for: 1) floor sweeping; 2) stepping in place; 3) over-ground walking; 4) lower speed treadmill walking (1.0 mph at 4% incline); and 5) higher speed treadmill walking (2.0 mph at 4% incline). Measurements were obtained for 10 min at rest and 5 minutes during each of the five activities. The energy cost of rest was only 85% of Compendium METS, while mobility-related activities were ~1.25-1.50 fold greater when measured in stroke vs. Compendium METS for all measures (P's<0.05), except floor sweeping, which was similar between groups. These data indicate that MET levels provided in the compendium are not applicable to chronic stroke survivors as they overestimate energy expenditure at rest and underestimate energy expenditure during physical activity, indicating poor efficiency in movement, thus elevating the oxygen cost of completing general daily activities.
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Affiliation(s)
- Monica C Serra
- Baltimore VA Research Service, USA.,Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, USA
| | | | - Charlene E Hafer-Macko
- Department of Neurology, University of Maryland School of Medicine, USA.,Baltimore Geriatric Research Education and Clinical Centers, USA
| | - Alice S Ryan
- Baltimore VA Research Service, USA.,Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, USA
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Lim HS, Yoon S. The effects of Pilates exercise on cardiopulmonary function in the chronic stroke patients: a randomized controlled trials. J Phys Ther Sci 2017; 29:959-963. [PMID: 28603381 PMCID: PMC5462708 DOI: 10.1589/jpts.29.959] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/30/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the effect of modified Pilates exercise on cardiopulmonary function in chronic stroke patients. [Subjects and Methods] Twenty participants (age, 62.7 ± 7.3 years; height, 163.3 ± 8.5 cm; weight, 68.8 ± 10.3 kg) were recruited for this study, and randomly allocated to the modified Pilates exercise group (n=10) or the control group (n=10). Graded submaximal treadmill exercise test was used to examine the status of patients' cardiopulmonary function, based on maximal oxygen intake, at the end of a patient's exercise tolerance limit. [Results] The resting heart rates, maximal oxygen intake, and maximal oxygen intake per kilogram were significantly different after 8 weeks of modified Pilates exercise. In addition, these variables were also significantly different between the Pilates and control groups after 8 weeks. [Conclusion] This study has demonstrated that 8 weeks of modified Pilates exercise program can have a positive influence on patients with chronic stroke, potentially by enhancing the cardiopulmonary function, which may have positive implications for increasing their functional ability.
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Affiliation(s)
- Hee Sung Lim
- Department of Physical Education, Korea National Sport
University, Republic of Korea
| | - Sukhoon Yoon
- Department of Community Sport, Korea National Sport
University, Republic of Korea
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26
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Ryan AS, Li G, Hafer-Macko C, Ivey FM. Resistive Training and Molecular Regulators of Vascular-Metabolic Risk in Chronic Stroke. J Stroke Cerebrovasc Dis 2016; 26:962-968. [PMID: 27955950 DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/25/2016] [Accepted: 11/02/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Peroxisome proliferator-activated receptor (PPAR)-γ coactivator (PGC-1α) gene and Sirtuin-1 (SIRT-1) respond to physiological stimuli and regulate insulin resistance. Inflammatory markers tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), and the soluble forms of intracellular adhesion molecule (sICAM-1) and vascular CAM-1 (sVCAM-1) are associated with increased risk of diabetes and coronary heart disease. Resistive training (RT) reduces hyperinsulinemia and improves insulin action in chronic stroke. Yet, the molecular mechanisms for this are unknown. This study will determine the effects of RT on skeletal muscle PGC-1α and SIRT-1 mRNA expression and inflammatory and vascular markers. METHODS Stroke survivors (50-76 years) underwent a fasting blood draw for measurement of TNF-α, IL-6, CRP, serum amyloid A, sICAM-1, sVCAM-1, and bilateral vastus lateralis biopsies before and after RT. Participants were also assessed using bilateral multislice thigh computed tomography scans from the knee to the hip, a total body scan by dual-energy X-ray absorptiometry, and 1-repetition maximum strength testing. Subjects performed 2 sets of 3 lower extremity RT exercises 3 times per week for 12 weeks. RESULTS Bilateral leg press and leg extension strength increased ~30-50% with RT (P < .001). Body weight, total body fat mass, and fat-free mass did not change. Thigh muscle area and volume increased in both legs (P < .05). Nonparetic muscle PGC-1α mRNA expression increased 14% (P < .05) after RT and SIRT-1 mRNA decreased 24% (P < .05) and 31% (P < .01) in paretic and nonparetic muscles. There were no significant changes in plasma inflammation with training. DISCUSSION RT in chronic stroke induces changes in key skeletal muscle regulators of metabolism, without effecting circulating inflammation.
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Affiliation(s)
- Alice S Ryan
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland; GRECC, MERCE, Baltimore, Maryland.
| | - Guoyan Li
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland; GRECC, MERCE, Baltimore, Maryland
| | - Charlene Hafer-Macko
- GRECC, MERCE, Baltimore, Maryland; Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Frederick M Ivey
- GRECC, MERCE, Baltimore, Maryland; Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
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27
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Sandroff BM, Balto JM, Klaren RE, Sommer SK, DeLuca J, Motl RW. Systematically developed pilot randomized controlled trial of exercise and cognition in persons with multiple sclerosis. Neurocase 2016; 22:443-450. [PMID: 27671243 DOI: 10.1080/13554794.2016.1237658] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cognitive impairment is common and debilitating among persons with multiple sclerosis (MS) and might be managed with exercise training. The present pilot study adopted a single-blind randomized controlled trial (RCT) design and is the first to examine the effect of a systematically developed, progressive treadmill walking exercise training intervention on cognition among fully ambulatory persons with MS. Ten fully ambulatory females with MS were randomly assigned into exercise training intervention or waitlist control conditions. The intervention condition involved 12 weeks of supervised, progressive chronic treadmill walking exercise training. Participants underwent measures of cognition (i.e., cognitive processing speed (CPS), executive function), walking performance, and cardiorespiratory fitness before and after the 12-week period; baseline and follow-up assessments were performed by blinded assessors. Overall, there were large intervention effects on CPS (d = 0.95), walking performance (d = 0.76), and cardiorespiratory fitness (d > 1.08). The change in cardiorespiratory fitness was significantly associated with change in CPS (r = .60), but not walking performance. This small pilot RCT provides preliminary proof-of-concept data supporting progressive treadmill walking exercise training for potentially improving CPS, walking performance, and cardiorespiratory fitness in fully ambulatory persons with MS, and that improved fitness might be a possible mechanism for improved CPS.
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Affiliation(s)
- Brian M Sandroff
- a Department of Neuropsychology and Neuroscience Research , Kessler Foundation , West Orange , NJ , USA
| | - Julia M Balto
- b Department of Kinesiology and Community Health , University of Illinois at Urbana-Champaign , Urbana , IL , USA
| | - Rachel E Klaren
- b Department of Kinesiology and Community Health , University of Illinois at Urbana-Champaign , Urbana , IL , USA
| | - Sarah K Sommer
- b Department of Kinesiology and Community Health , University of Illinois at Urbana-Champaign , Urbana , IL , USA
| | - John DeLuca
- a Department of Neuropsychology and Neuroscience Research , Kessler Foundation , West Orange , NJ , USA
| | - Robert W Motl
- b Department of Kinesiology and Community Health , University of Illinois at Urbana-Champaign , Urbana , IL , USA
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Werner C, Lindquist AR, Bardeleben A, Hesse S. The Influence of Treadmill Inclination on the Gait of Ambulatory Hemiparetic Subjects. Neurorehabil Neural Repair 2016; 21:76-80. [PMID: 17172557 DOI: 10.1177/1545968306289958] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction. This study evaluated the influence of the degree of treadmill belt inclination for training of ambulatory patients with hemiparetic stroke. Methods. Twelve patients were instructed to walk at 5 different levels of inclination (0%-8%) while harness-secured on the treadmill. The gait velocity was kept constant during all conditions. Dependent variables were heart rate, gait cycle-dependent parameters, and electromyographic activation patterns of the weight-bearing muscles. Results. Heart rate increased across all inclination levels, stride length increased and cadence decreased, whereas swing symmetry improved due to shortening of the relative swing phase of the affected side at the 6% and 8% inclination levels. No change in the activation pattern of the leg muscles was found. Conclusion. An inclination up to at least 8% can be accommodated for treadmill training by ambulatory stroke patients. For a given belt speed, heart rate increased without exceeding critical levels and patients walked with a more symmetric pattern. This protocol appeared to be safe in this selected group of subjects.
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Affiliation(s)
- C Werner
- Klinik Berlin, Department Neurological Rehabilitation, Charité - University Medicine Berlin, Germany
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29
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Use of a Nonexercise Estimate for Prestroke Peak Vo 2 During the Acute Stroke Hospital Stay. Cardiopulm Phys Ther J 2016. [DOI: 10.1097/cpt.0000000000000026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kautz SA, Duncan PW, Perera S, Neptune RR, Studenski SA. Coordination of Hemiparetic Locomotion after Stroke Rehabilitation. Neurorehabil Neural Repair 2016; 19:250-8. [PMID: 16093416 DOI: 10.1177/1545968305279279] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives. Determine whether a rehabilitation program targeting functional motor recovery of persons with poststroke hemiparesis improved motor coordination. Methods. A subgroup of 20 persons with poststroke hemiparesis (n = 11 in intervention and n =9incontrol group) was investigated from within a larger randomized controlled single-blind clinical trial of 100 patients. Motor coordination was measured using a pedaling task, and subjects in the intervention group pedaled during an intensive broad-based home exercise program that targeted flexibility, strength, balance, and endurance. Coordination variables based on paretic leg pedal forces and EMG of 4 thigh muscles were measured while pedaling pre- and postintervention. Results. Despite extensive pedaling practice, up to 30 half-hour sessions that were progressively more intense, there was no effect (P > 0.05) of the intervention on percent of total work done by the paretic leg, quantitative measures of EMG, or pedaling speed. However, walking speed was improved and pedaling and walking faster were associated after the intervention. Conclusions. There is no evidence of improved locomotor coordination postintervention. The increased walking and pedaling speed was likely achieved by a more proficient use of the same impaired pattern without EMG timing changes, likely because of increased strength and endurance postintervention. A more task-specific intervention may be required to improve coordination, consistent with principles of use-dependent plasticity.
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Affiliation(s)
- Steven A Kautz
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville FL, 32608, USA.
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31
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Touzé E, Varenne O, Calvet D, Mas JL. Coronary Risk Stratification in Patients with Ischemic Stroke or Transient Ischemic Stroke Attack. Int J Stroke 2016; 2:177-83. [DOI: 10.1111/j.1747-4949.2007.00136.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background The risk of coronary artery disease (CAD) is traditionally considered high in patients who had an ischemic stroke or a transient ischemic attack (TIA). However, few studies have specifically assessed the absolute risk of coronary events in those patients and predictors of such events are not well known. Summary of review The overall risks of myocardial infarction and nonstroke vascular death are each around 2% per year. However, those risks are only about 1% per year in patients without CAD (i.e. the only ones who are likely to benefit from specific additional strategies). The prevalence of asymptomatic CAD ranges from 15% to 60%. Although potentially higher, the risk of CAD in patients with stroke/TIA related to atherosclerosis also seems to vary widely depending on the extent of the disease. Given the relatively low CAD risk, a simple systematic reinforcement of medical treatment in all patients may be not relevant. Up to now, there have been only limited ways to stratify the CAD risk in stroke/TIA patients. High-risk patients may be identified using the traditional cardiac scoring systems, but their validity has never been specifically assessed in stroke populations. The relative influence of traditional risk factors may be altered after a first vascular event. Stroke patients could also be screened for asymptomatic CAD. However, there is no simple and valid screening test for asymptomatic CAD that could be applied to all patients. Finally, there is still uncertainty about the potential benefits of treating asymptomatic CAD. Therefore, should the identification of patients with asymptomatic CAD requiring revascularization become feasible, the relevance of this strategy would remain to be evaluated by a randomized clinical trial. Conclusion The absolute risk of CAD in stroke/TIA patients is moderately high. More research is needed to identify high risk patients who could benefit from specific strategies.
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Serra MC, Balraj E, DiSanzo BL, Ivey FM, Hafer-Macko CE, Treuth MS, Ryan AS. Validating accelerometry as a measure of physical activity and energy expenditure in chronic stroke. Top Stroke Rehabil 2016; 24:18-23. [PMID: 27322733 DOI: 10.1080/10749357.2016.1183866] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Accelerometers can objectively measure steps taken per day in individuals without gait deficits, but accelerometers also have the ability to estimate frequency, intensity, and duration of physical activity. However, thresholds to distinguish varying levels of activity intensity using the Actical brand accelerometer are standardized only for the general population and may underestimate intensity in stroke. OBJECTIVE To derive Actical activity count thresholds specific to stroke disability for use in more accurately gauging time spent at differing activity levels. METHODS Men (n = 18) and women (n = 10) with chronic hemiparetic gait (4 ± 2 years latency, 43% Caucasian, 56% African-American, ages of 47-83 years, BMI 19-48 kg/m2) participated in the study. Actical accelerometers were placed on the non-paretic hip to obtain accelerometry counts during eight activities of varying intensity: (1) watching TV; (2) seated stretching; (3) standing stretching; (4) floor sweeping; (5) stepping in place; (6) over-ground walking; (7) lower speed treadmill walking (1.0 mph at 4% incline); and (8) higher speed treadmill walking (2.0 mph at 4% incline). Simultaneous portable monitoring (Cosmed K4b2) enabled quantification of energy cost for each activity in metabolic equivalents (METs, or oxygen consumption in multiples of resting level). Measurements were obtained for 10 min of standard rest and 5 min during each of the eight activities. RESULTS Regression analysis yielded the following new stroke-specific Actical minimum thresholds: 125 counts per minute (cpm) for sedentary/light activity, 667 cpm for light/moderate activity, and 1546 cpm for moderate/vigorous activity. CONCLUSION Our revised cut points better reflect activity levels after stroke and suggest significantly lower thresholds relative to those observed for the general population of healthy individuals. We conclude that the standard, commonly applied Actical thresholds are inappropriate for this unique population.
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Affiliation(s)
- Monica C Serra
- a Research Service , Baltimore VA , Baltimore , MD , USA.,b Department of Medicine, Division of Gerontology and Geriatric Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Elizabeth Balraj
- b Department of Medicine, Division of Gerontology and Geriatric Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Beth L DiSanzo
- b Department of Medicine, Division of Gerontology and Geriatric Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Frederick M Ivey
- a Research Service , Baltimore VA , Baltimore , MD , USA.,d Department of Neurology , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Charlene E Hafer-Macko
- c GRECC , Baltimore VA , Baltimore , MD , USA.,d Department of Neurology , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Margarita S Treuth
- e Department of Kinesiology , University of Maryland Eastern Shore , Princess Anne , MD , USA
| | - Alice S Ryan
- a Research Service , Baltimore VA , Baltimore , MD , USA.,b Department of Medicine, Division of Gerontology and Geriatric Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
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Energy Expenditure and Cost During Walking After Stroke: A Systematic Review. Arch Phys Med Rehabil 2016; 97:619-632.e1. [DOI: 10.1016/j.apmr.2015.11.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/23/2015] [Accepted: 11/17/2015] [Indexed: 11/19/2022]
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Kim JS, Kang SY, Jeon HS. A comparison of the effects of visual deprivation and regular body weight support treadmill training on improving over-ground walking of stroke patients: a multiple baseline single subject design. Physiother Theory Pract 2015; 31:466-73. [PMID: 26395826 DOI: 10.3109/09593985.2015.1037875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The body-weight-support treadmill (BWST) is commonly used for gait rehabilitation, but other forms of BWST are in development, such as visual-deprivation BWST (VDBWST). In this study, we compare the effect of VDBWST training and conventional BWST training on spatiotemporal gait parameters for three individuals who had hemiparetic strokes. We used a single-subject experimental design, alternating multiple baselines across the individuals. We recruited three individuals with hemiparesis from stroke; two on the left side and one on the right. For the main outcome measures we assessed spatiotemporal gait parameters using GAITRite, including: gait velocity; cadence; step time of the affected side (STA); step time of the non-affected side (STN); step length of the affected side (SLA); step length of the non-affected side (SLN); step-time asymmetry (ST-asymmetry); and step-length asymmetry (SL-asymmetry). Gait velocity, cadence, SLA, and SLN increased from baseline after both interventions, but STA, ST-asymmetry, and SL-asymmetry decreased from the baseline after the interventions. The VDBWST was significantly more effective than the BWST for increasing gait velocity and cadence and for decreasing ST-asymmetry. VDBWST is more effective than BWST for improving gait performance during the rehabilitation for ground walking.
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Affiliation(s)
- Jeong-Soo Kim
- a Department of Physical Therapy , The Graduate School, Yonsei University , Kangwon-do , Republic of Korea .,b Department of Physical Therapy , Seoul Rehabilitation Hospital , Kangwon-do , Republic of Korea , and
| | - Sun-Young Kang
- a Department of Physical Therapy , The Graduate School, Yonsei University , Kangwon-do , Republic of Korea
| | - Hye-Seon Jeon
- a Department of Physical Therapy , The Graduate School, Yonsei University , Kangwon-do , Republic of Korea .,c Department of Physical Therapy , College of Health Science, Yonsei University , Kangwon-do , Republic of Korea
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Hyun CW, Han EY, Im SH, Choi JC, Kim BR, Yoon HM, Lee YK. Hemiparetic Knee Extensor Strength and Balance Function Are Predictors of Ambulatory Function in Subacute Stroke Patients. Ann Rehabil Med 2015; 39:577-85. [PMID: 26361594 PMCID: PMC4564705 DOI: 10.5535/arm.2015.39.4.577] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/31/2014] [Indexed: 12/04/2022] Open
Abstract
Objective To identify the potential predictors of ambulatory function in subacute stroke patients, and to determine the contributing factors according to gait severity. Methods Fifty-three subacute stroke patents were enrolled. Ambulatory function was assessed by gait speed and endurance. Balance function was evaluated by the Berg Balance Scale score (BBS) and the Timed Up and Go test (TUG). The isometric muscular strengths of bilateral knee extensors and flexors were measured using an isokinetic dynamometer. Cardiovascular fitness was evaluated using an expired gas analyzer. Participants were assigned into the household ambulator group (<0.4 m/s) or the community ambulator group (≥0.4 m/s) based on gait severity. Results In the linear regression analyses of all patients, paretic knee isometric extensor strength (p=0.007) and BBS (p<0.001) were independent predictors of gait endurance (R2=0.668). TUG (p<0.001) and BBS (p=0.037) were independent predictors of gait speed (R2=0.671). Paretic isometric extensor strength was a predictor of gait endurance (R2=0.340, p=0.008). TUG was a predictor of gait speed (R2=0.404, p<0.001) in the household ambulator group, whereas BBS was a predictive factor of gait endurance (R2=0.598, p=0.008) and speed (R2=0.713, p=0.006). TUG was a predictor of gait speed (R2=0.713, p=0.004) in the community ambulator group. Conclusion Our results reveal that balance function and knee extensor isometric strength were strong predictors of ambulatory function in subacute stroke patients. However, they work differently according to gait severity. Therefore, a comprehensive functional assessment and a different therapeutic approach should be provided depending on gait severity in subacute stroke patients.
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Affiliation(s)
- Chul Woong Hyun
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Sang Hee Im
- Department of Rehabilitation Medicine, CHA Bundang Hospital, Seongnam, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Bo Ryun Kim
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Ho Min Yoon
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Yong Ki Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
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Ivey FM, Stookey AD, Hafer-Macko CE, Ryan AS, Macko RF. Higher Treadmill Training Intensity to Address Functional Aerobic Impairment after Stroke. J Stroke Cerebrovasc Dis 2015; 24:2539-46. [PMID: 26303787 DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 06/27/2015] [Accepted: 07/07/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Peak aerobic capacity (VO2 peak) is severely worsened after disabling stroke, having serious implications for function, metabolism, and ongoing cardiovascular risk. Work from our laboratory and others has previously shown that modest improvements in VO2 peak are possible in stroke participants with aerobic exercise training. The purpose of the current investigation was to test the extent to which greater enhancements in VO2 peak after stroke are possible using a treadmill protocol with far greater emphasis on intensity progression compared with a protocol without such emphasis. METHODS Using a randomized design, we compared stroke survivors engaged in higher intensity treadmill training (HI-TM, 80% heart rate reserve [HRR]) with those undergoing lower intensity treadmill training (LO-TM, 50% HRR). Measured outcomes were change in VO2 peak, 6-minute walk distance (6MWD), 30-ft walk times (30WT), and 48-hour step counts (48SC). LO-TM participants trained for a longer period of time per session in an effort to approximately match workload/caloric expenditure. Participants were randomized with stratification according to age and baseline walking capacity. RESULTS HI-TM participants (n = 18) had significantly greater gains in VO2 peak (+34%) than LO-TM participants (n = 16; +5%) across the 6-month intervention period (P = .001, group × time interaction). Conversely, there was no statistical difference between groups in the changes observed for 6MWD, 30WT, or 48SC. CONCLUSIONS HI-TM is far more effective than LO-TM for improving VO2 peak after disabling stroke. The magnitude of relative improvement for HI-TM was double compared with previous reports from our laboratory with probable clinical significance for this population.
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Affiliation(s)
- Frederick M Ivey
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Alyssa D Stookey
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland
| | - Charlene E Hafer-Macko
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alice S Ryan
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Richard F Macko
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
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Gäverth J, Parker R, MacKay-Lyons M. Exercise Stress Testing After Stroke or Transient Ischemic Attack: A Scoping Review. Arch Phys Med Rehabil 2015; 96:1349-1359.e12. [DOI: 10.1016/j.apmr.2015.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 02/02/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
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Awad LN, Reisman DS, Wright TR, Roos MA, Binder-Macleod SA. Maximum walking speed is a key determinant of long distance walking function after stroke. Top Stroke Rehabil 2015; 21:502-9. [PMID: 25467398 DOI: 10.1310/tsr2106-502] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Walking dysfunctions persist following poststroke rehabilitation. A major limitation of current rehabilitation efforts is the inability to identify modifiable deficits that, when improved, will result in the recovery of walking function. Previous studies have relied on cross-sectional analyses to identify deficits to target during walking rehabilitation; however, these studies did not account for the influence of a key covariate - maximum walking speed. OBJECTIVE To determine the relationships between commonly studied poststroke variables and the long-distance walking function of individuals poststroke when controlling for maximum walking speed. METHODS Correlation analyses of cross-sectional data from 57 individuals more than 6 months poststroke measured the relationships between standing balance, walking balance, balance self-efficacy, lower extremity motor function, and maximum walking speed versus long-distance walking function. For a subgroup of subjects who completed training, the relationship between changes in maximum walking speed versus changes in long-distance walking function was assessed. RESULTS Each measurement of interest strongly correlated with long-distance walking function (rs from 0.448 to 0.900, all Ps ≤ .001); however, when controlling for maximum walking speed, none of the other measurements remained related to long-distance walking function. In contrast, when controlling for each of the other measurements, maximum walking speed remained highly related. Moreover, changes in maximum walking speed resulting from training were highly related to changes in long-distance walking function (r = .737, P ≤ .001). CONCLUSIONS For individuals in the chronic phase of stroke recovery, improving maximum walking speed may be necessary to improve long-distance walking function.
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Affiliation(s)
- Louis N Awad
- Department of Physical Therapy, University of Delaware, Newark, Delaware Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, Delaware Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware
| | - Tamara R Wright
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Margaret A Roos
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Stuart A Binder-Macleod
- Department of Physical Therapy, University of Delaware, Newark, Delaware Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware Delaware Clinical and Translational Research ACCEL Program, University of Delaware, Newark, Delaware
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Abstract
Stroke patients have profound cardiovascular and muscular deconditioning, with metabolic fitness levels that are about half those found in age-matched sedentary controls. Physical deconditioning, along with elevated energy demands of hemiparetic gait, define a detrimental combination termed diminished physiological fitness reserve that can greatly limit that can greatly limit performance of activities of daily living. The physiological features that underlie worsening metabolic fitness in the chronic phase of stroke include gross muscular atrophy, altered muscle molecular phenotype, increased intramuscular area fat, elevated tissue inflammatory markers, and diminished peripheral blood flow dynamics. Epidemiological evidence further suggests that the reduced cardiovascular fitness and secondary biological changes in muscle may propagate components of the metabolic syndrome, conferring added morbidity and mortality risk. This article reviews some of the consequences of poor fitness in chronic stroke and the potential biological underpinnings that support a rationale for more aggressive approaches to exercise therapy in this population.
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Affiliation(s)
- F M Ivey
- Department of Medicine, Division of Gerontology, University of Maryland School of Medicine and Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA
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Macko RF, Ivey FM, Forrester LW. Task-Oriented Aerobic Exercise in Chronic Hemiparetic Stroke: Training Protocols and Treatment Effects. Top Stroke Rehabil 2015; 12:45-57. [PMID: 15736000 DOI: 10.1310/pjqn-kan9-ttvy-hyqh] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Stroke is the leading cause of disability in older Americans. Each year 750,000 Americans suffer a stroke, two thirds of whom are left with neurological deficits that persistently impair function. Principal among them is hemiparetic gait that limits mobility and increases fall risk, promoting a sedentary lifestyle. These events propagate disability by physical deconditioning and "learned non-use," with further functional declines accelerated by the sarcopenia and fitness decrements of advancing age. Conventional rehabilitation care typically provides little or no structured therapeutic exercise beyond the subacute stroke recovery period, based on natural history studies showing little or no further functional motor recovery beyond 6 months after stroke. Emerging evidence suggests that new models of task-oriented exercise have the potential to improve motor function even years after stroke. This article presents treadmill as a task-oriented training paradigm to optimize locomotor relearning while eliciting cardiovascular conditioning in chronic stroke patients. Protocols for exercise testing and longitudinal aerobic training progression are presented that provide fundamental formulas that safely approach the complex task of customizing aerobic training to gait deficit severity in the high CVD risk stroke population. The beneficial effects of 6 months task-oriented treadmill exercise on cardiovascular-metabolic fitness, energy cost of hemiparetic gait, ADL mobility task performance, and leg strength are discussed with respect to the central and peripheral neuromuscular adaptations targeted by the training. Collectively, these findings constitute one initial experience in a much broader neuroscience and exercise rehabilitation development of task-oriented training paradigms that offer a multisystems approach to improving both neurological and cardiovascular health outcomes in the chronic stroke population.
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Affiliation(s)
- R F Macko
- Department of Neurology, Division of Gerontology, Baltimore Veterans Affairs Medical Center and University of Maryland School of Medicine, Baltimore, MD, USA
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Ganley KJ, Herman RM, Willis WT. Muscle Metabolism During Overground Walking in Persons with Poststroke Hemiparesis. Top Stroke Rehabil 2015; 15:218-26. [DOI: 10.1310/tsr1503-218] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Impact of serum nutritional status on physical function in african american and caucasian stroke survivors. Stroke Res Treat 2014; 2014:174308. [PMID: 25530905 PMCID: PMC4229960 DOI: 10.1155/2014/174308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/07/2014] [Indexed: 11/29/2022] Open
Abstract
Background. The purpose of this study is to compare serum nutritional profiles in chronic stroke survivors to a representative sample of US Adults (NHANESIII) and determine whether these serum markers differed by race and impact physical function in stroke. Methods. Fasting serum samples were collected for analysis of lipids, uric acid, and albumin in 145 African American (AA) and 111 Caucasian (C) stroke survivors (age: 60 ± 1 years [mean ± SEM]). A six-minute walk was performed in a subset of stroke survivors (N = 134). Results. Triglycerides were higher and HDL-cholesterol and albumin lower in C than AA women stroke survivors (Ps < 0.05). Uric acid was lower in C than AA stroke survivors (P < 0.05). Compared to NHANESIII, HDL-cholesterol, albumin, and hemoglobin generally were lower (Ps < 0.05) and lipids were more favorable in stroke (Ps < 0.01). Uric acid was related to six-minute walk performance among a subset of stroke survivors (P < 0.05). Conclusion. In stroke, racial differences exist with regard to serum nutritional risk, but these differences are similar to that observed in the general population. Regardless of race, nutritional risk appears elevated above that of the general population with regard to many of the serum markers. As a modifiable biomarker, uric acid should be monitored closely as it may provide insight into the functional risk of stroke survivors.
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Stoller O, de Bruin ED, Schindelholz M, Schuster-Amft C, de Bie RA, Hunt KJ. Cardiopulmonary exercise testing early after stroke using feedback-controlled robotics-assisted treadmill exercise: test-retest reliability and repeatability. J Neuroeng Rehabil 2014; 11:145. [PMID: 25306061 PMCID: PMC4271449 DOI: 10.1186/1743-0003-11-145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exercise capacity is seriously reduced after stroke. While cardiopulmonary assessment and intervention strategies have been validated for the mildly and moderately impaired populations post-stroke, there is a lack of effective concepts for stroke survivors suffering from severe motor limitations. This study investigated the test-retest reliability and repeatability of cardiopulmonary exercise testing (CPET) using feedback-controlled robotics-assisted treadmill exercise (FC-RATE) in severely motor impaired individuals early after stroke. METHODS 20 subjects (age 44-84 years, <6 month post-stroke) with severe motor limitations (Functional Ambulatory Classification 0-2) were selected for consecutive constant load testing (CLT) and incremental exercise testing (IET) within a powered exoskeleton, synchronised with a treadmill and a body weight support system. A manual human-in-the-loop feedback system was used to guide individual work rate levels. Outcome variables focussed on standard cardiopulmonary performance parameters. Relative and absolute test-retest reliability were assessed by intraclass correlation coefficients (ICC), standard error of the measurement (SEM), and minimal detectable change (MDC). Mean difference, limits of agreement, and coefficient of variation (CoV) were estimated to assess repeatability. RESULTS Peak performance parameters during IET yielded good to excellent relative reliability: absolute peak oxygen uptake (ICC =0.82), relative peak oxygen uptake (ICC =0.72), peak work rate (ICC =0.91), peak heart rate (ICC =0.80), absolute gas exchange threshold (ICC =0.91), relative gas exchange threshold (ICC =0.88), oxygen cost of work (ICC =0.87), oxygen pulse at peak oxygen uptake (ICC =0.92), ventilation rate versus carbon dioxide output slope (ICC =0.78). For these variables, SEM was 4-13%, MDC 12-36%, and CoV 0.10-0.36. CLT revealed high mean differences and insufficient test-retest reliability for all variables studied. CONCLUSIONS This study presents first evidence on reliability and repeatability for CPET in severely motor impaired individuals early after stroke using a feedback-controlled robotics-assisted treadmill. The results demonstrate good to excellent test-retest reliability and appropriate repeatability for the most important peak cardiopulmonary performance parameters. These findings have important implications for the design and implementation of cardiovascular exercise interventions in severely impaired populations. Future research needs to develop advanced control strategies to enable the true limit of functional exercise capacity to be reached and to further assess test-retest reliability and repeatability in larger samples.
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Affiliation(s)
- Oliver Stoller
- />Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- />Department of Epidemiology, Maastricht University and Caphri Research School, Maastricht, Netherlands
- />Research Department, Reha Rheinfelden,, Rheinfelden, Switzerland
| | - Eling D de Bruin
- />Department of Epidemiology, Maastricht University and Caphri Research School, Maastricht, Netherlands
- />Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- />Centre for Evidence Based Physiotherapy, Maastricht University, Maastricht, Netherlands
| | - Matthias Schindelholz
- />Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- />Research Department, Reha Rheinfelden,, Rheinfelden, Switzerland
| | - Corina Schuster-Amft
- />Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- />Research Department, Reha Rheinfelden,, Rheinfelden, Switzerland
| | - Rob A de Bie
- />Department of Epidemiology, Maastricht University and Caphri Research School, Maastricht, Netherlands
- />Centre for Evidence Based Physiotherapy, Maastricht University, Maastricht, Netherlands
| | - Kenneth J Hunt
- />Department of Engineering and Information Technology, Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- />Research Department, Reha Rheinfelden,, Rheinfelden, Switzerland
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Hyun CW, Kim BR, Han EY, Kim SM. Use of an Ankle-Foot Orthosis Improves Aerobic Capacity in Subacute Hemiparetic Stroke Patients. PM R 2014; 7:264-9. [DOI: 10.1016/j.pmrj.2014.08.944] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/06/2014] [Accepted: 08/10/2014] [Indexed: 12/28/2022]
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Tang A, Eng JJ, Tsang TSM, Krassioukov AV. Cognition and motor impairment correlates with exercise test performance after stroke. Med Sci Sports Exerc 2013; 45:622-7. [PMID: 23135375 DOI: 10.1249/mss.0b013e31827a0169] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Exercise not only benefits physical and cardiovascular function in older adults with multiple chronic conditions but may also improve cognitive function. Peak HR, a physiological indicator for maximal effort, is the most common and practical means of establishing and monitoring exercise intensity. In particular, in the absence of graded maximal exercise test (GXT) results, age-predicted maximal HR values are typically used. Using individuals with stroke as a model for examining older adults with coexisting cardiovascular and neuromotor conditions, the purpose of this article was to examine the determinants associated with achieving age-predicted maximal HR on a GXT, with respect to neurological, cognitive, and lower limb function. METHODS Forty-seven participants with stroke (age, 67 ± 7 yr; 4 ± 3 yr poststroke (mean ± SD)) performed GXT. The peak values for gas exchange, HR, and RPE were noted. Logistic regression analysis was performed to examine determinants (neurological impairment, leg motor impairment, Montreal Cognitive Assessment score, and walking ability) associated with the ability to achieve age-predicted maximal HR on the GXT. RESULTS V˙O2peak was 16.5 ± 6 mL·kg·min. Fourteen (30%) participants achieved ≥100% of age-predicted maximal HR. Logistic regression modeling revealed that the ability to achieve this threshold was associated with less leg motor impairment (P = 0.02; odds ratio, 2.3) and higher cognitive scores (P = 0.048; odds ratio, 1.3). CONCLUSIONS These results suggest that noncardiopulmonary factors such as leg motor impairment and cognitive function are important contributors to achieving maximal effort during exercise tests. This study has important implications for poststroke exercise prescription, whereby training intensities that are based on peak HR from GXT may be underestimated among individuals with cognitive and physical impairments.
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Affiliation(s)
- Ada Tang
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
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Ryan AS, Dobrovolny CL, Silver KH, Smith GV, Macko RF. Cardiovascular fitness after stroke: Role of muscle mass and gait deficit severity. J Stroke Cerebrovasc Dis 2013; 9:185-91. [PMID: 24192026 DOI: 10.1053/jscd.2000.7237] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/1999] [Accepted: 02/24/2000] [Indexed: 11/11/2022] Open
Abstract
Functional disability after hemiparetic stroke may be compounded by physical deconditioning and muscular wasting, factors related to disuse and advancing age. However, the role of body composition, severity, and chronicity of gait deficits as determinants of exercise fitness after stroke is unknown. The purpose of this study was to determine whether oxygen consumption during peak exercise (VO2 peak) is associated with body composition, the severity, or duration of gait deficits in chronic (>6 months) hemiparetic stroke patients. Twenty-six patients (22 men, 4 women), aged 66 ± 9 years (mean ± standard deviation [SD]), completed a progressive graded treadmill test until fatigue to measure VO2 peak (1.3 ± 0.4 L/minute). Timed 30-foot walks were used to determine self-selected floor walking velocity (0.63 ± 0.31 m/s), an index of gait deficit severity. Percent body fat (30.4% ± 10.6%), total lean mass (52.0 ± 9.3 kg), lean mass of the paretic and nonaffected legs (17.2 ± 3.7 kg), and lean mass of the paretic and nonaffected thighs (13.2 ± 2.7 kg) were determined by dual-energy x-ray absorptiometry. Total lean mass (r = 0.60), lean mass of both legs (r = 0.58), paretic leg lean mass (r = 0.55), lean mass of both thighs (r = 0.64), and self-selected floor walking velocity (r = 0.53, all P < .01) correlated with VO2 peak. In contrast, percent body fat and latency since index stroke were unrelated to VO2 peak. In a stepwise regression analysis, lean mass of both thighs (r = 0.64, P < .001) and self-selected walking velocity (cumulative r = 0.78, P < .001) were independent predictors of VO2 peak and explained 61% of the variance. These results suggest that hemiparetic stroke patients are profoundly deconditioned, regardless of the latency since stroke, and that lower lean thigh mass and greater gait deficit severity predict even poorer peak exercise capacity.
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Affiliation(s)
- A S Ryan
- Division of Gerontology, Department of Medicine, and the Departments of Neurology and Physical Therapy, University of Maryland School of Medicine, Baltimore, MD; and the Geriatric Research, Education and Clinical Center (GRECC), Baltimore VA Medical Center, Baltimore, MD
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Lee SY, Kang SY, Im SH, Kim BR, Kim SM, Yoon HM, Han EY. The effects of assisted ergometer training with a functional electrical stimulation on exercise capacity and functional ability in subacute stroke patients. Ann Rehabil Med 2013; 37:619-27. [PMID: 24231752 PMCID: PMC3825937 DOI: 10.5535/arm.2013.37.5.619] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 08/16/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine if assistive ergometer training can improve the functional ability and aerobic capacity of subacute stroke patients and if functional electrical stimulation (FES) of the paretic leg during ergometer cycling has additional effects. METHODS Sixteen subacute stroke patents were randomly assigned to the FES group (n=8) or the control group (n=8). All patients underwent assistive ergometer training for 30 minutes (five times per week for 4 weeks). The electrical stimulation group received FES of the paretic lower limb muscles during assistive ergometer training. The six-minute walk test (6MWT), Berg Balance Scale (BBS), and the Korean version of Modified Barthel Index (K-MBI) were evaluated at the beginning and end of treatment. Peak oxygen consumption (Vo2peak), metabolic equivalent (MET), resting and maximal heart rate, resting and maximal blood pressure, maximal rate pressure product, submaximal rate pressure product, submaximal rate of perceived exertion, exercise duration, respiratory exchange ratio, and estimated anaerobic threshold (AT) were determined with the exercise tolerance test before and after treatment. RESULTS At 4 weeks after treatment, the FES assistive ergometer training group showed significant improvements in 6MWT (p=0.01), BBS (p=0.01), K-MBI (p=0.01), Vo2peak (p=0.02), MET (p=0.02), and estimated AT (p=0.02). The control group showed improvements in only BBS (p=0.01) and K-MBI (p=0.02). However, there was no significant difference in exercise capacity and functional ability between the two groups. CONCLUSION This study demonstrated that ergometer training for 4 weeks improved the functional ability of subacute stroke patients. In addition, aerobic capacity was improved after assisted ergometer training with a FES only.
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Affiliation(s)
- So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
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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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Jung T, Ozaki Y, Lai B, Vrongistinos K. Comparison of Energy Expenditure Between Aquatic and Overground Treadmill Walking in People Post-Stroke. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2013; 19:55-64. [DOI: 10.1002/pri.1564] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 06/09/2013] [Accepted: 07/29/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Taeyou Jung
- Kinesiology; California State University Northridge; Northridge, CA USA
| | - Yoshi Ozaki
- Kinesiology; California State University Northridge; Northridge, CA USA
| | - Byron Lai
- Kinesiology; California State University Northridge; Northridge, CA USA
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Kim BR, Han EY, Joo SJ, Kim SY, Yoon HM. Cardiovascular fitness as a predictor of functional recovery in subacute stroke patients. Disabil Rehabil 2013; 36:227-31. [PMID: 23594057 DOI: 10.3109/09638288.2013.787123] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the correlation between baseline cardiovascular fitness and functional status, and whether baseline cardiovascular fitness is of predictive value in terms of functional recovery after rehabilitation in subacute stroke patients. METHOD This study was a descriptive, observational cohort study. Fifty-five subacute stroke patients (37 males and 18 females; average age, 62.2 years) were enrolled for this study, and all subjects underwent symptom-limited low-velocity graded treadmill testing. Baseline assessments included cardiovascular fitness, 6-min walk test (6MWT), Korean-Modified Barthel Index (K-MBI) and Motricity Index (MI). Four weeks after rehabilitation, K-MBI was measured repeatedly. RESULTS Mean peak oxygen consumption (Vo2 peak) was 19.7 ± 6.7 mL/kg/min. Baseline K-MBI correlated significantly with Vo2 peak, peak heart rate (HR), 6MWT and MI, and in regression analysis, Vo2 peak and MI were significant independent predictors of baseline K-MBI. Follow-up K-MBI correlated significantly with Vo2 peak, peak HR, peak rate pressure product, 6MWT, baseline K-MBI and MI, and in linear regression analysis, Vo2 peak and baseline K-MBI were significant independent predictors of follow-up K-MBI. CONCLUSION These results indicate that baseline cardiovascular fitness correlates significantly with the baseline functional status, in addition to being an important prognostic factor regarding the functional recovery of subacute stroke patients.
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