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Liu YT, Liu XX, Liu YQ, Zhang L, Zhang LJ, Wang JH, Shi Y, Xie QF. Effects of respiratory muscle training on post-stroke rehabilitation: A systematic review and meta-analysis. World J Clin Cases 2024; 12:4289-4300. [PMID: 39015926 PMCID: PMC11235562 DOI: 10.12998/wjcc.v12.i20.4289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Stroke often results in significant respiratory dysfunction in patients. Respiratory muscle training (RMT) has been proposed as a rehabilitative intervention to address these challenges, but its effectiveness compared to routine training remains debated. This systematic review and meta-analysis aim to evaluate the effects of RMT on exercise tolerance, muscle strength, and pulmonary function in post-stroke patients. AIM To systematically assess the efficacy of RMT in improving exercise tolerance, respiratory muscle strength, and pulmonary function in patients recovering from a stroke, and to evaluate whether RMT offers a significant advantage over routine training modalities in enhancing these critical health outcomes in the post-stroke population. METHODS Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a comprehensive search across PubMed, Embase, Web of Science, and the Cochrane Library was conducted on October 19, 2023, without temporal restrictions. Studies were selected based on the predefined inclusion and exclusion criteria focusing on various forms of RMT, control groups, and outcome measures [including forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), maximal voluntary ventilation (MVV), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and 6-min walking test (6MWT)]. Only randomized controlled trials (RCTs) were included. Data extraction and quality assessment were conducted independently by two reviewers using the Cochrane Collaboration's risk of bias tool. Statistical analyses, including those using the fixed-effect and random-effects models, sensitivity analysis, and publication bias assessment, were performed using Review Manager software. RESULTS A total of 15 RCTs were included. Results indicated significant improvements in MIP (12.51 cmH2O increase), MEP (6.24 cmH2O increase), and various pulmonary function parameters (including FEV1, FVC, MVV, and PEF). A substantial increase in 6MWT distance (22.26 meters) was also noted. However, the heterogeneity among studies was variable, and no significant publication bias was detected. CONCLUSION RMT significantly enhances walking ability, respiratory muscle strength (MIP and MEP), and key pulmonary function parameters (FEV1, FVC, MVV, and PEF) in post-stroke patients. These findings support the incorporation of RMT into post-stroke rehabilitative protocols.
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Affiliation(s)
- Yong-Tao Liu
- Department of Rehabilitation, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Xiao-Xin Liu
- Ophthalmologist Clinic, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Yi-Qing Liu
- Department of Cardiology, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Lei Zhang
- Department of Ultrasound, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Lin-Jing Zhang
- Department of Rehabilitation, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Jian-Hua Wang
- Department of Rehabilitation, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Yan Shi
- Department of Rehabilitation, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Qing-Fan Xie
- Department of Rehabilitation, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
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Do J, Lim WT, Kim DY, Ko EJ, Ko MH, Kim GW, Kim JH, Kim S, Kim H. Effects of high-intensity interval robot-assisted gait training on cardiopulmonary function and walking ability in chronic stroke survivors: A multicenter single-blind randomized controlled trial. J Back Musculoskelet Rehabil 2024; 37:1309-1319. [PMID: 38788059 DOI: 10.3233/bmr-230385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
BACKGROUND Chronic stroke can impair cardiopulmonary function, mobility, and daily activities. This study assessed the impact of robot-assisted gait training (RAGT) on such impairments. OBJECTIVE To investigate the effects of robot-assisted gait training on cardiopulmonary function, walking ability, lower extremity function and strength, activities of daily living (ADLs), and blood test results among individuals with chronic stroke. METHODS A multicenter, prospective, single-blinded, randomized controlled trial with 22 chronic stroke participants compared RAGT against a control exercise regimen. RAGT involved three days weekly sessions of high-intensity interval training for 8 weeks (24 sessions) with a Morning Walk® device. The control group also performed home exercises. (24 sessions) Measures included VO2max, Functional Ambulatory Category, 2-minute walk test, 10-meter walk test, Motricity Index-Lower, Korean version of the Fugl-Meyer Assessment Scale, Modified Barthel Index, Berg Balance Scale, muscle strength, InBody body composition, and blood tests (cholesterol, lipid, glucose). RESULTS RAGT significantly improved VO2max, gait, balance, and lower limb strength compared with controls, with significant improvements in 2-minute walk test, 10-meter walk test, Motricity Index-Lower, and Fugl-Meyer Assessment outcomes. No changes were seen in muscle mass or blood markers. CONCLUSION RAGT enhances cardiopulmonary function and ambulatory capacity in chronic stroke patients, underscoring its potential in stroke rehabilitation.
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Affiliation(s)
- Junghwa Do
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo-Taek Lim
- Department of Physical Therapy, College of Health and Welfare, Woosong University, Daejeon, Korea
| | - Dae Yul Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine of Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
| | - Geon Woo Kim
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hye Kim
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - SooBin Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwal Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Barnett HM, Davis AP, Khot SP. Stroke and breathing. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:201-222. [PMID: 36031305 DOI: 10.1016/b978-0-323-91532-8.00016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Stroke remains a leading cause of neurologic disability with wide ranging effects, including a variety of respiratory abnormalities. Stroke may influence the central control of the respiratory drive and breathing pattern, airway protection and maintenance, and the respiratory mechanics of inspiration and expiration. In the acute phase of stroke, the central control of breathing is affected by changes in consciousness, cerebral edema, and direct damage to brainstem respiratory centers, resulting in abnormalities in respiratory pattern and loss of airway protection. Common acute complications related to respiratory dysfunction include dysphagia, aspiration, and pneumonia. Respiratory control centers are located in the brainstem, and brainstem stroke causes specific patterns of respiratory dysfunction. Depending on the exact location and extent of stroke, respiratory failure may occur. While major respiratory abnormalities often improve over time, sleep-disordered breathing remains common in the subacute and chronic phases and worsens outcomes. Respiratory mechanics are impaired in hemiplegic or hemiparetic stroke, contributing to worse cardiopulmonary health in stroke survivors. Interventions to address the respiratory complications are under researched, and further investigation in this area is critical to improving outcomes among stroke survivors.
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Affiliation(s)
- Heather M Barnett
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Arielle P Davis
- Department of Neurology, University of Washington, Seattle, WA, United States
| | - Sandeep P Khot
- Department of Neurology, University of Washington, Seattle, WA, United States.
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Fujita D, Kubo Y. The reliability of VO 2 kinetics during a 6-minute walking test is influenced by walk speed. J Phys Ther Sci 2021; 33:876-879. [PMID: 34873366 PMCID: PMC8636911 DOI: 10.1589/jpts.33.876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/08/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to investigate the reliability of time constant measurements
of oxygen intake at fast and comfortable speeds during a 6-min waling test. [Participants
and Methods] The study included 10 healthy young males who walked at 4.5 km/h and 6.0 km/h
twice for 6 min each in speed treadmill. Breath-by-breath gas exchange data were
continuously measured and used to calculate the time constant of oxygen uptake. The
reproducibility and variability of the variables were verified using the limit of
agreement, inter-class correlation coefficient, coefficient of variation, and standard
error of measurement. [Results] The limit of agreement was −8.5 to 2.3 s and −3.9 to 2.1 s
for speeds 4.5 km/h and 6.0 km/h, respectively. The inter-class correlation coefficient,
coefficient of variation, and standard error of measurement of the time constant for both
speeds were 0.52 and 0.83, 11.2% and 6.4%, and 5.3 s and 1.8 s, respectively. [Conclusion]
The results of this study suggested that the cardiopulmonary response, in terms of oxygen
uptake, was more consistent during fast walking than during comfortable walking in a 6-min
walking test with constant speed.
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Affiliation(s)
- Daisuke Fujita
- Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare: 3-6-40 Momochihama, Sawara-ku, Fukuoka city, Fukuoka 814-0001, Japan
| | - Yuusuke Kubo
- Department of Rehabilitation, Kobori Orthopaedic Clinic, Japan
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Oyake K, Baba Y, Suda Y, Murayama J, Mochida A, Ito Y, Abe H, Kondo K, Otaka Y, Momose K. A Single Bout of Constant-Load Exercise Test for Estimating the Time Constant of Oxygen Uptake Kinetics in Individuals With Stroke. Ann Rehabil Med 2021; 45:304-313. [PMID: 34496473 PMCID: PMC8435463 DOI: 10.5535/arm.21087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022] Open
Abstract
Objective To examine the relationship between the time constant of oxygen uptake kinetics during the onset of exercise (τVO2) estimated from a single exercise bout and that obtained from three averaged exercise bouts in individuals with stroke. Methods Twenty participants with stroke performed three bouts of a constant-load pedaling exercise at approximately 80% of the workload corresponding to the ventilatory threshold to estimate τVO2. The VO2 data from the first trial of three bouts were used to estimate τVO2 for a single bout. Additionally, data collected from three bouts were ensemble-averaged to obtain τVO2 for three averaged bouts as the criterion. Results There was a very high correlation between τVO2 for a single bout (34.8±14.0 seconds) and τVO2 for three averaged bouts (38.5±13.4 seconds) (r=0.926, p<0.001). However, τVO2 for a single bout was smaller than that for three averaged bouts (p=0.006). Conclusion τVO2 for a single bout could reflect the relative difference in τVO2 for three averaged bouts among individuals with stroke. However, it should be noted that τVO2 for a single bout may be underestimated compared to τVO2 for three averaged bouts.
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Affiliation(s)
- Kazuaki Oyake
- Department of Physical Therapy, School of Health Sciences, Shinshu University, Nagano, Japan.,Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Yasuto Baba
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Yuki Suda
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Jun Murayama
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Ayumi Mochida
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Yuki Ito
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Honoka Abe
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan.,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan
| | - Kimito Momose
- Department of Physical Therapy, School of Health Sciences, Shinshu University, Nagano, Japan
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Cardiorespiratory responses to exercise related to post-stroke fatigue severity. Sci Rep 2021; 11:12780. [PMID: 34140566 PMCID: PMC8211681 DOI: 10.1038/s41598-021-92127-w] [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: 11/19/2020] [Accepted: 06/07/2021] [Indexed: 11/08/2022] Open
Abstract
Physical deconditioning after stroke may induce post-stroke fatigue. However, research on this association is limited. Our primary objective was to investigate the associations of post-stroke fatigue severity with oxygen uptake ([Formula: see text]O2) at peak exercise and the time constant of [Formula: see text]O2 kinetics (τ[Formula: see text]O2) at exercise onset. The secondary objective was to examine the associations between fatigue and cardiorespiratory variables potentially affecting [Formula: see text]O2 during exercise. Twenty-three inpatients from a subacute rehabilitation ward were enrolled in this study. The median (interquartile range) Fatigue Severity Scale (FSS) score, as a measure of fatigue, was 32 (range 27-42) points. The FSS score was not associated with [Formula: see text]O2 at peak exercise during a symptom-limited graded exercise test (rho = - 0.264; p = 0.224), whereas it was significantly associated with τ[Formula: see text]O2 during a submaximal constant-load exercise test (rho = 0.530; p = 0.009). A higher FSS score also significantly correlated with a longer time constant of cardiac output (CO) kinetics (rho = 0.476; p = 0.022). Our findings suggest that severe post-stroke fatigue is associated with delayed increases in [Formula: see text]O2 and CO at the onset of exercise. Our findings can contribute to the development of an appropriate rehabilitation programme for individuals with post-stroke fatigue.
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Cardiorespiratory mechanisms underlying the impaired oxygen uptake kinetics at exercise onset after stroke. Ann Phys Rehabil Med 2021; 64:101465. [PMID: 33285294 DOI: 10.1016/j.rehab.2020.101465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 04/04/2020] [Accepted: 04/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Oxygen uptake (V˙O2) kinetics at the onset of exercise is slower in patients with stroke than in healthy adults. However, little is known about the cardiorespiratory mechanisms underlying the impaired V˙O2 kinetics. OBJECTIVES This study aimed to investigate the relative effect of impaired oxygen delivery and utilisation on V˙O2 kinetics at the onset of submaximal exercise in patients with stroke by comparing the time constants of cardiac output (τCO) and V˙O2 (τV˙O2). In addition, we aimed to examine the association between the kinetics of cardiorespiratory variables and functional outcomes. METHODS We included 21 patients with stroke (15 males, mean [SD] age 58.7 [9.5] years, mean days post-stroke 67.9 [30.9]). A submaximal constant-load exercise test was performed to measure τV˙O2, τCO, and the time constant of arterialvenous oxygen difference (τAVO2diff). The ratio of τCO to τV˙O2 was calculated to assess the matching of oxygen delivery and consumption. Fugl-Meyer lower-extremity motor scores, comfortable gait speeds, and Functional Independence Measure motor scores were used as functional variables. RESULTS Mean (SD) τAVO2diff was markedly shorter than τV˙O2 and τCO (26.1 [7.1] vs. 38.7 [10.2] and 46.6 [23.2 s], P<0.05), with no significant difference between τV˙O2 and τCO (P=0.444). The greater ratio of τCO to τV˙O2 was related to poorer motor function (rho=-0.484, P=0.026) and slower comfortable gait speed (r=-0.482, P=0.027). CONCLUSIONS An increase in CO was slower than that in AVO2diff in patients with stroke. Therefore, V˙O2 kinetics in patients with stroke appears to be affected by a delayed increase in CO rather than AVO2diff. Furthermore, these patients with motor and gait impairments may have a poor matching of oxygen delivery and consumption during exercise onset.
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Ribeiro JAM, Oliveira AGDS, Thommazo-Luporini LD, Monteiro CI, Ocamoto GN, Catai AM, Borghi-Silva A, Phillips SA, Russo TL. Underlying mechanisms of oxygen uptake kinetics in chronic post-stroke individuals: A correlational, cross-sectional pilot study. PLoS One 2020; 15:e0241872. [PMID: 33166347 PMCID: PMC7652273 DOI: 10.1371/journal.pone.0241872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022] Open
Abstract
Post-stroke individuals presented deleterious changes in skeletal muscle and in the cardiovascular system, which are related to reduced oxygen uptake ([Formula: see text]) and take longer to produce energy from oxygen-dependent sources at the onset of exercise (mean response time, MTRON) and during post-exercise recovery (MRTOFF). However, to the best of our knowledge, no previous study has investigated the potential mechanisms related to [Formula: see text] kinetics response (MRTON and MRTOFF) in post-stroke populations. The main objective of this study was to determine whether the MTRON and MRTOFF are related to: 1) body composition; 2) arterial compliance; 3) endothelial function; and 4) hematological and inflammatory profiles in chronic post-stroke individuals. Data on oxygen uptake ([Formula: see text]) were collected using a portable metabolic system (Oxycon Mobile®) during the six-minute walk test (6MWT). The time to achieve 63% of [Formula: see text] during a steady state (MTRON) and recovery (MRTOFF) were analyzed by the monoexponential model and corrected by a work rate (wMRTON and wMRTOFF) during 6MWT. Correlation analyses were made using Spearman's rank correlation coefficient (rs) and the bias-corrected and accelerated bootstrap method was used to estimate the 95% confidence intervals. Twenty-four post-stroke participants who were physically inactive took part in the study. The wMRTOFF was correlated with the following: skeletal muscle mass (rs = -0.46), skeletal muscle mass index (rs = -0.45), augmentation index (rs = 0.44), augmentation index normalized to a heart rate of 75 bpm (rs = 0.64), reflection magnitude (rs = 0.43), erythrocyte (rs = -0.61), hemoglobin (rs = -0.54), hematocrit (rs = -0.52) and high-sensitivity C-reactive protein (rs = 0.58), all p < 0.05. A greater amount of oxygen uptake during post-walking recovery is partially related to lower skeletal muscle mass, greater arterial stiffness, reduced number of erythrocytes and higher systemic inflammation in post-stroke individuals.
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Affiliation(s)
| | | | | | | | | | - Aparecida Maria Catai
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Audrey Borghi-Silva
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Shane A. Phillips
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Thiago Luiz Russo
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
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Effectiveness of Respiratory Muscle Training for Pulmonary Function and Walking Ability in Patients with Stroke: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155356. [PMID: 32722338 PMCID: PMC7432552 DOI: 10.3390/ijerph17155356] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 01/01/2023]
Abstract
Background: Neurological dysfunction due to stroke affects not only the extremities and trunk muscles but also the respiratory muscles. Aim: to synthesise the evidence available about the effectiveness of respiratory muscle training (RMT) to improve respiratory function parameters and functional capacity in poststroke patients. Methods: a systematic electronic search was performed in the MEDLINE, EMBASE, SPORTDiscus, PEDro and Web of Science databases, from inception to May 2020. Study selection and data extraction: randomised controlled trials (RCTs) that examined the effects of RMT versus non-RMT or sham RMT in poststroke patients. We extracted data about respiratory function, respiratory muscle strength and functional capacity (walking ability, dyspnea, balance, activities of daily life), characteristics of studies and features of RMT interventions (a type of RMT exercise, frequency, intensity and duration). Two reviewers performed study selection and data extraction independently. Results: nineteen RCTs met the study criteria. RMT improved the first second forced expiratory volume (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP) and walking ability (6 min walking test), but not Barthel index, Berg balance scale, and dyspnea. Conclusions: RMT interventions are effective to improve respiratory function and walking ability in poststroke patients.
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de Souza RJP, Brandão DC, Martins JV, Fernandes J, Dornelas de Andrade A. Addition of proprioceptive neuromuscular facilitation to cardiorespiratory training in patients poststroke: study protocol for a randomized controlled trial. Trials 2020; 21:184. [PMID: 32059691 PMCID: PMC7023709 DOI: 10.1186/s13063-019-3923-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 11/21/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Individuals affected by stroke present with changes in cardiovascular and respiratory functions. Cardiorespiratory training (CRT) is one of the classic intervention guidelines for cardiorespiratory fitness. CRT in association with the proprioceptive neuromuscular facilitation (PNF) technique for respiratory muscles could improve the quality of life, cardiorespiratory function and gait parameters of patients after stroke. OBJECTIVE To assess the effects of respiratory and trunk patterns of CRT associated with PNF on the quality of life, gait, oxygen consumption, respiratory muscle strength and thoracic volumes. METHODS/DESIGN A blind, randomized clinical trial with allocation confidentiality will be performed. Forty patients will be randomized into four groups: CRT-lower limb (LL) plus PNF; CRT-LL and respiration; CRT-upper limb (UL) plus PNF; or CRT-UL and respiration. Individuals will be evaluated at three different times (pretreatment, after 20 days of treatment and 1 month after the end of treatment). The treatment protocol consists of respiratory exercises, 30 min of CRT (cycle ergometer) and then repetition of the respiratory exercises, performed three times a week over a period of 20 days. Primary outcome measures are quality of life, gait, balance, peak oxygen uptake and rib cage compartment volumes. As secondary outcomes, respiratory function and maximal inspiratory and expiratory pressures will be measured. DISCUSSION The association of PNF with CRT may be a viable and accessible alternative to increase cardiorespiratory function in patients with stroke. TRIAL REGISTRATION ClinicalTrials.gov, NCT03171012. Registered on 6 June 2017.
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Affiliation(s)
| | | | - José Vicente Martins
- Departamento de Fisioterapia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Juliana Fernandes
- Departamento de Fisioterapia, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
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Affiliation(s)
- Qiwei Fan
- From the Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China (Q.F., J.J.)
| | - Jie Jia
- From the Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China (Q.F., J.J.)
- School of Life and Environmental Sciences, University of Sydney, Australia (J.J.)
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Oyake K, Baba Y, Ito N, Suda Y, Murayama J, Mochida A, Kondo K, Otaka Y, Momose K. Cardiorespiratory factors related to the increase in oxygen consumption during exercise in individuals with stroke. PLoS One 2019; 14:e0217453. [PMID: 31596863 PMCID: PMC6785174 DOI: 10.1371/journal.pone.0217453] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 09/24/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Understanding the cardiorespiratory factors related to the increase in oxygen consumption ([Formula: see text]) during exercise is essential for improving cardiorespiratory fitness in individuals with stroke. However, cardiorespiratory factors related to the increase in [Formula: see text] during exercise in these individuals have not been examined using multivariate analysis. This study aimed to identify cardiorespiratory factors related to the increase in [Formula: see text] during a graded exercise in terms of respiratory function, cardiac function, and the ability of skeletal muscles to extract oxygen. METHODS Eighteen individuals with stroke (aged 60.1 ± 9.4 years, 67.1 ± 30.8 days poststroke) underwent a graded exercise test for the assessment of cardiorespiratory response to exercise. The increases in [Formula: see text] from rest to first threshold and that from rest to peak exercise were measured as a dependent variable. The increases in respiratory rate, tidal volume, minute ventilation, heart rate, stroke volume, cardiac output, and arterial-venous oxygen difference from rest to first threshold and those from rest to peak exercise were measured as the independent variables. RESULTS From rest to first threshold, the increases in arterial-venous oxygen difference (β = 0.711) and cardiac output (β = 0.572) were significant independent variables for the increase in [Formula: see text] (adjusted R2 = 0.877 p < 0.001). Similarly, from rest to peak exercise, the increases in arterial-venous oxygen difference (β = 0.665) and cardiac output (β = 0.636) were significant factors related to the increase in [Formula: see text] (adjusted R2 = 0.923, p < 0.001). CONCLUSION Our results suggest that the ability of skeletal muscle to extract oxygen is a major cardiorespiratory factor related to the increase in [Formula: see text] during exercise testing in individuals with stroke. For improved cardiorespiratory fitness in individuals with stroke, the amount of functional muscle mass during exercise may need to be increased.
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Affiliation(s)
- Kazuaki Oyake
- Department of Physical Therapy, School of Health Sciences, Shinshu University, Matsumoto, Nagano, Japan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | - Yasuto Baba
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | - Nao Ito
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | - Yuki Suda
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | - Jun Murayama
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | - Ayumi Mochida
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Kimito Momose
- Department of Physical Therapy, School of Health Sciences, Shinshu University, Matsumoto, Nagano, Japan
- * E-mail:
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Slupska L, Halski T, Żytkiewicz M, Ptaszkowski K, Dymarek R, Taradaj J, Paprocka-Borowicz M. Proprioceptive Neuromuscular Facilitation for Accessory Respiratory Muscles Training in Patients After Ischemic Stroke. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1160:81-91. [PMID: 30680643 DOI: 10.1007/5584_2018_325] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
This study focused on how pulmonary function is affected by proprioceptive neuromuscular facilitation (PNF) of accessory respiratory muscles in the chronic post-stroke phase. The study involved patients who had had ischemic stroke 6 months or more before the PNF treatment investigated. The objective was to define the effect of PNF on bioelectrical resting and maximum activity of the accessory muscles. Patients were randomly assigned to PNF treatment and just positioning treatment as a reference for comparison; 30 patients each. Electromyography of accessory muscles was investigated before and after physiotherapeutic treatments. We found that there was a greater reduction in EMG activity in all muscles investigated after PNF compared to positioning treatment alone. A reduction of muscle activity due to PNF concerned both affected and unaffected body side, but it was greater on the affected side. We conclude that a reduction of the accessory respiratory muscle activity due to PNF treatment could be of benefit in chronic stoke patients in that it would help normalize breathing pattern and thereby prevent the development of hypoxia.
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Affiliation(s)
- Lucyna Slupska
- Department of Physiotherapy, Opole Medical School, Opole, Poland
| | - Tomasz Halski
- Department of Physiotherapy, Opole Medical School, Opole, Poland
| | | | - Kuba Ptaszkowski
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland.
| | - Robert Dymarek
- Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Jakub Taradaj
- Department of Physiotherapy Basics, Academy of Physical Education, Katowice, Poland.,College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Malgorzata Paprocka-Borowicz
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
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van Hooff M, Schep G, Meijer E, Bender M, Savelberg H. Near-Infrared Spectroscopy Is Promising to Detect Iliac Artery Flow Limitations in Athletes: A Pilot Study. JOURNAL OF SPORTS MEDICINE (HINDAWI PUBLISHING CORPORATION) 2018; 2018:8965858. [PMID: 30671480 PMCID: PMC6317127 DOI: 10.1155/2018/8965858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/05/2018] [Accepted: 11/13/2018] [Indexed: 06/09/2023]
Abstract
Endurance cyclists have a substantial risk to develop flow limitations in the iliac arteries during their career. These flow limitations are due to extreme hemodynamic stress which may result in functional arterial kinking and/or intravascular lesions. Early diagnosis may improve outcome and could prevent the necessity for surgical vascular repair. However, current diagnostic techniques have unsatisfactory sensitivity and cannot be applied during exercise. Near-infrared spectroscopy (NIRS) has shown great diagnostic potential in peripheral vascular disease and might bring a solution since it measures tissue oxygenation in real time during and after exercise. This report describes the first experiences of the application of NIRS in the vastus lateralis muscle during and after maximal graded cycling exercise in ten healthy participants and in three patients with flow limitations due to (1) subtle functional kinking, (2) an intravascular lesion, and (3) severe functional kinking. The results are put into perspective based on an empirically fitted model. Delayed recovery, showing clearly different types of patterns of tissue reoxygenation after exercise, was found in the affected athletes compared with the healthy participants. In the patients that had kinking of the arteries, tissue reoxygenation was clearly more delayed if NIRS was measured in provocative position with flexed hip. In this pilot experiment, clearly distinctive reoxygenation patterns are observed during recovery consistent with severity of flow limitation, indicating that NIRS is a promising diagnostic tool to detect and grade arterial flow limitations in athletes. Our findings may guide research and optimization of NIRS for future clinical application.
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Affiliation(s)
- Martijn van Hooff
- Department of Sports and Exercise, Máxima Medical Centre, De Run 4600, 5500 MB Veldhoven, Noord-Brabant, Netherlands
- Department of Human Movement Science, Faculty of Health Science, Maastricht University Maastricht, Postbus/P.O. Box 616, 6200 MD, Maastricht, Limburg, Netherlands
| | - Goof Schep
- Department of Sports and Exercise, Máxima Medical Centre, De Run 4600, 5500 MB Veldhoven, Noord-Brabant, Netherlands
| | - Eduard Meijer
- Department of Clinical Physics, Máxima Medical Centre, De Run 4600, 5500 MB Veldhoven, Noord-Brabant, Netherlands
| | - Mart Bender
- Surgery Department, Máxima Medical Centre, De Run 4600, 5500 MB Veldhoven, Noord-Brabant, Netherlands
| | - Hans Savelberg
- Department of Human Movement Science, Faculty of Health Science, Maastricht University Maastricht, Postbus/P.O. Box 616, 6200 MD, Maastricht, Limburg, Netherlands
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McCoy J, Bates M, Eggett C, Siervo M, Cassidy S, Newman J, Moore SA, Gorman G, Trenell MI, Velicki L, Seferovic PM, Cleland JGF, MacGowan GA, Turnbull DM, Jakovljevic DG. Pathophysiology of exercise intolerance in chronic diseases: the role of diminished cardiac performance in mitochondrial and heart failure patients. Open Heart 2017; 4:e000632. [PMID: 28878952 PMCID: PMC5574430 DOI: 10.1136/openhrt-2017-000632] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/22/2017] [Accepted: 06/20/2017] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Exercise intolerance is a clinical hallmark of chronic conditions. The present study determined pathophysiological mechanisms of exercise intolerance in cardiovascular, neuromuscular, and metabolic disorders. METHODS In a prospective cross-sectional observational study 152 patients (heart failure reduced ejection fraction, n=32; stroke, n=34; mitochondrial disease, n=28; type two diabetes, n=28; and healthy controls, n=30) performed cardiopulmonary exercise testing with metabolic and haemodynamic measurements. Peak exercise O2 consumption and cardiac power output were measures of exercise tolerance and cardiac performance. RESULTS Exercise tolerance was significantly diminished in patients compared with controls (ie, by 45% stroke, 39% mitochondria disease, and 33% diabetes and heart failure, p<0.05). Cardiac performance was only significantly reduced in heart failure (due to reduced heart rate, stroke volume, and blood pressure) and mitochondrial patients (due reduced stroke volume) compared with controls (ie, by 53% and 26%, p<0.05). Ability of skeletal muscles to extract oxygen (ie, arterial-venous O2 difference) was diminished in mitochondrial, stroke, and diabetes patients (by 24%, 22%, and 18%, p<0.05), but increased by 21% in heart failure (p<0.05) compared with controls. Cardiac output explained 65% and 51% of the variance in peak O2 consumption (p<0.01) in heart failure and mitochondrial patients, whereas arterial-venous O2 difference explained 69% (p<0.01) of variance in peak O2 consumption in diabetes, and 65% and 48% in stroke and mitochondrial patients (p<0.01). CONCLUSIONS Different mechanisms explain exercise intolerance in patients with heart failure, mitochondrial dysfunction, stroke and diabetes. Their better understanding may improve management of patients, their stress tolerance and quality of life.
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Affiliation(s)
- Jodi McCoy
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew Bates
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
- Department of Cardiothoracic, The James Cook University Hospital, Middleborough, UK
| | - Christopher Eggett
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Mario Siervo
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Sophie Cassidy
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Jane Newman
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah A Moore
- Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - Grainne Gorman
- Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
- Wellcome Trust Centre for Mitochondrial Research, Newcastle University, Newcastle uponTyne, UK
| | - Michael I Trenell
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
- Research Councils UK Centre for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Lazar Velicki
- Department of Cardiovascular Surgery and Faculty of Medicine, Institute of Cardiovascular Diseases Sremska Kamenica, Novi Sad, Serbia
| | - Petar M Seferovic
- Department of Cardiology, Clinical Centre Serbia, University of Belgrade, Serbia, UK
| | - John G F Cleland
- Department of Cardiology, Imperial College Royal Brompton and Harefield Trust London, London, UK
| | - Guy A MacGowan
- Department of Cardiology, Freeman Hospital and Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Doug M Turnbull
- Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
- Wellcome Trust Centre for Mitochondrial Research, Newcastle University, Newcastle uponTyne, UK
| | - Djordje G Jakovljevic
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
- Clinical Research Facility, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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16
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Han EY, Kim BR, Joo SJ, Lee CS, Kang SY, Kim SY, Choi JH, Hyun CW. Arterial Stiffness in Subacute Stroke: Changing Pattern and Relationship with Functional Recovery. J Stroke Cerebrovasc Dis 2016; 26:922-929. [PMID: 28007328 DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/05/2016] [Accepted: 10/31/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND To examine changing patterns in arterial stiffness and functional outcome in patients with subacute stroke, and to determine which parameter shows a strong correlation with the reversal of arterial stiffness, during a 3-month period of comprehensive rehabilitation therapy. METHODS This descriptive, observational cohort study enrolled 60 patients (43 male and 17 female; average age, 62.7 years), and all received conventional rehabilitation therapy, during a 3-month period. Brachial-ankle pulse wave velocity (baPWV) was measured as an index of arterial stiffness. Functional assessments included the 6-minute walk test (6MWT), Fugl-Meyer Assessment of hemiparetic upper and lower limbs, the functional ambulatory category, the Berg balance scale, the Korean Mini-Mental Status Examination, and the Korean-Modified Barthel Index. All measurements were conducted at baseline and 1 and 3 months after stroke onset. RESULTS Rehabilitation therapy resulted in a statistically significant improvement in baPWV since 3 months post stroke. Another functional outcome measure showed statistically significant improvements since 1 month after rehabilitation. Multivariable linear regression analysis revealed that a change in baPWV was significantly correlated with changes in the 6MWT. CONCLUSIONS Three months of comprehensive rehabilitation therapy led to statistically significant improvements in arterial stiffness and functional outcomes during the subacute phase of stroke. Thus, the comprehensive rehabilitation focused on improving gait endurance would be warranted in subacute stroke patients.
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Affiliation(s)
- Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea
| | - Bo Ryun Kim
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea.
| | - Seung-Jae Joo
- Division of Cardiology, Department of Internal Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea
| | - Chang Sub Lee
- Department of Neurosurgery, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea
| | - Sa-Yoon Kang
- Department of Neurology, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea
| | - Song-Yi Kim
- Division of Cardiology, Department of Internal Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea
| | - Joon Hyouk Choi
- Division of Cardiology, Department of Internal Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea
| | - Chul Woong Hyun
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea
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Dunn A, Marsden DL, Van Vliet P, Spratt NJ, Callister R. Independently ambulant, community-dwelling stroke survivors have reduced cardiorespiratory fitness, mobility and knee strength compared to an age- and gender-matched cohort. Top Stroke Rehabil 2016; 24:163-169. [PMID: 27670905 DOI: 10.1080/10749357.2016.1236482] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Most exercise interventions for stroke survivors are designed for those who have substantial motor and functional disabilities. There remains a group of well-recovered stroke survivors who have yet to be investigated in terms of their physical capacity and fitness levels. OBJECTIVE To assess and compare the physical capacities of independently ambulant, community-dwelling stroke survivors to age- and gender-matched comparison participants. METHODS Data were obtained from 17 stroke survivors participating in the How FITSS? Trial, all with functional ambulatory category of ≥4 and a self-selected walking speed ≥0.8 m s-1. An additional 17 healthy control participants were recruited. Cardiorespiratory fitness (CRF) was measured using oxygen consumption (VO2peak), and additional measures of walking speed (m s-1), leg strength and body composition were also assessed. Differences between groups were assessed by matched pairs t-tests. Effect sizes were calculated using Cohen's d. RESULTS There were no significant differences in age, BMI, muscle mass or body fat between groups (p > 0.05). Peak VO2 was lower in the stroke group for the shuttle walk test (p = 0.037) and progressive cycle test (p = 0.019), as were all CRF test performance measures (p < 0.05). Stroke survivors walked significantly (p < 0.001) slower at both self-selected and fast speeds. Effect sizes of group differences for all leg strength variables were medium to large, with peak torque lower in the stroke group for all trials. CONCLUSIONS Despite being independently ambulant and community dwelling, the CRF, walking speed and leg strength of this group were reduced compared to non-stroke comparison participants. These patients may benefit from undertaking targeted exercise programmes.
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Affiliation(s)
- Ashlee Dunn
- a Priority Research Centre for Physical Activity and Nutrition , University of Newcastle , Callaghan , New South Wales, Australia.,b Hunter Medical Research Institute , New Lambton Heights , New South Wales, Australia
| | - Dianne L Marsden
- a Priority Research Centre for Physical Activity and Nutrition , University of Newcastle , Callaghan , New South Wales, Australia.,b Hunter Medical Research Institute , New Lambton Heights , New South Wales, Australia.,c Hunter New England Local Health District , New Lambton Heights , New South Wales, Australia
| | - Paulette Van Vliet
- a Priority Research Centre for Physical Activity and Nutrition , University of Newcastle , Callaghan , New South Wales, Australia.,b Hunter Medical Research Institute , New Lambton Heights , New South Wales, Australia
| | - Neil J Spratt
- a Priority Research Centre for Physical Activity and Nutrition , University of Newcastle , Callaghan , New South Wales, Australia.,b Hunter Medical Research Institute , New Lambton Heights , New South Wales, Australia.,c Hunter New England Local Health District , New Lambton Heights , New South Wales, Australia
| | - Robin Callister
- a Priority Research Centre for Physical Activity and Nutrition , University of Newcastle , Callaghan , New South Wales, Australia.,b Hunter Medical Research Institute , New Lambton Heights , New South Wales, Australia
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Boyne P, Reisman D, Brian M, Barney B, Franke A, Carl D, Khoury J, Dunning K. Ventilatory threshold may be a more specific measure of aerobic capacity than peak oxygen consumption rate in persons with stroke. Top Stroke Rehabil 2016; 24:149-157. [PMID: 27454553 DOI: 10.1080/10749357.2016.1209831] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND After stroke, aerobic deconditioning can have a profound impact on daily activities. This is usually measured by the peak oxygen consumption rate achieved during exercise testing (VO2-peak). However, VO2-peak may be distorted by motor function. The oxygen uptake efficiency slope (OUES) and VO2 at the ventilatory threshold (VO2-VT) could more specifically assess aerobic capacity after stroke, but this has not been tested. OBJECTIVES To assess the differential influence of motor function on three measures of aerobic capacity (VO2-peak, OUES, and VO2-VT) and to evaluate the inter-rater reliability of VO2-VT determination post-stroke. METHODS Among 59 persons with chronic stroke, cross-sectional correlations with motor function (comfortable gait speed [CGS] and lower extremity Fugl-Meyer [LEFM]) were compared between the different aerobic capacity measures, after adjustment for covariates, in order to isolate any distorting effect of motor function. Reliability of VO2-VT determination between three raters was assessed with intra-class correlation (ICC). RESULTS CGS was moderately correlated with VO2-peak (r = 0.52, p < 0.0001) and weakly correlated with OUES (r = 0.41, p = 0.002) and VO2-VT (r = 0.37, p = 0.01). LEFM was weakly correlated with VO2-peak (r = 0.26, p = 0.055) and very weakly correlated with OUES (r = 0.19, p = 0.17) and VO2-VT (r = 0.14, p = 0.31). Compared to VO2-peak, VO2-VT was significantly less correlated with CGS (r difference = -0.16, p = 0.02). Inter-rater reliability of VO2-VT determination was high (ICC: 0.93, 95% CI: 0.89-0.96). CONCLUSIONS Motor dysfunction appears to artificially lower measured aerobic capacity. VO2-VT seemed to be less distorted than VO2-peak and had good inter-rater reliability, so it may provide more specific assessment of aerobic capacity post-stroke.
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Affiliation(s)
- Pierce Boyne
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA.,b Department of Environmental Health , College of Medicine, University of Cincinnati , Cincinnati , OH , USA
| | - Darcy Reisman
- c Department of Physical Therapy , College of Health Sciences, University of Delaware , Newark , DE , USA
| | - Michael Brian
- c Department of Physical Therapy , College of Health Sciences, University of Delaware , Newark , DE , USA
| | - Brian Barney
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA
| | - Ava Franke
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA
| | - Daniel Carl
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA
| | - Jane Khoury
- b Department of Environmental Health , College of Medicine, University of Cincinnati , Cincinnati , OH , USA.,d Division of Biostatistics and Epidemiology , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
| | - Kari Dunning
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA.,b Department of Environmental Health , College of Medicine, University of Cincinnati , Cincinnati , OH , USA
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Decreased tidal volume may limit cardiopulmonary performance during exercise in subacute stroke. J Cardiopulm Rehabil Prev 2016; 35:334-41. [PMID: 26034936 DOI: 10.1097/hcr.0000000000000119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE The aim of this retrospective study was to determine whether pulmonary function was reduced at submaximal and peak exercise in subacute stroke (SG) when compared with sedentary adults (CON). METHODS Ten individuals with subacute stroke and 10 sedentary, age- and gender-matched adults performed cardiopulmonary exercise testing (CPET), using a recumbent stepper. We used independent t tests to determine between-group differences at peak effort. We used repeated-measures analysis of variance with Test Minute (minutes 1-6) as the within-subject factor and Group (SG, CON) as the between-subject factor to assess cardiopulmonary submaximal performance. RESULTS The SG had significantly lower values (P < .05) for oxygen uptake, minute ventilation ((Equation is included in full-text article.)E), and tidal volume (VT) than CON at peak effort of the CPET. During CPET submaximal effort, we report a significant main effect for Test Minute and Group for VT and respiratory rate but no main effect of Group for (Equation is included in full-text article.)E. To maintain adequate (Equation is included in full-text article.)E during submaximal effort and decreased VT, higher respiratory rate was observed. CONCLUSIONS These results suggest that diminished VT in subacute stroke patients may limit performance during submaximal and peak effort of CPET. Rehabilitation professionals should consider methods for improving pulmonary function during stroke rehabilitation.
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Gomes-Neto M, Saquetto MB, Silva CM, Carvalho VO, Ribeiro N, Conceição CS. Effects of Respiratory Muscle Training on Respiratory Function, Respiratory Muscle Strength, and Exercise Tolerance in Patients Poststroke: A Systematic Review With Meta-Analysis. Arch Phys Med Rehabil 2016; 97:1994-2001. [PMID: 27216224 DOI: 10.1016/j.apmr.2016.04.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the effects of respiratory muscle training on respiratory function, respiratory muscle strength, and exercise tolerance in patients poststroke. DATA SOURCES We searched MEDLINE, Cochrane Library, Embase, SciELO, Physiotherapy Evidence Database (PEDro), and CINAHL (from the earliest date available to November 2015) for trials. STUDY SELECTION Randomized controlled trials (RCTs) that examined the effects of respiratory muscle training versus nonrespiratory muscle training in patients poststroke. Two reviewers selected studies independently. DATA EXTRACTION Extracted data from the published RCTs. Study quality was evaluated using the PEDro Scale. Weighted mean differences (WMDs), standard mean differences (SMDs), and 95% confidence intervals (CIs) were calculated. DATA SYNTHESIS Eight studies met the study criteria. Respiratory muscle training improved maximal inspiratory pressure WMDs (7.5; 95% CI, 2.7-12.4), forced vital capacity SMDs (2.0; 95% CI, 0.6-3.4), forced expiratory volume at 1 second SMDs (1.2; 95% CI, 0.6-1.9), and exercise tolerance SMDs (0.7; 95% CI, 0.2-1.2). No serious adverse events were reported. CONCLUSIONS Respiratory muscle training should be considered an effective method of improving respiratory function, inspiratory muscle strength, and exercise tolerance in patients poststroke. Further research is needed to determine optimum dosages and duration of effect.
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Affiliation(s)
- Mansueto Gomes-Neto
- Department of Physical Therapy, Federal University of Bahia, Salvador, Bahia, Brazil; Postgraduate Program in Medicine and Health - UFBA, Salvador, Bahia, Brazil; The GREAT Group (Study Group on Physical Activity), Aracaju, Sergipe, Brazil.
| | - Micheli Bernardone Saquetto
- Department of Physical Therapy, Federal University of Bahia, Salvador, Bahia, Brazil; Postgraduate Program in Medicine and Health - UFBA, Salvador, Bahia, Brazil
| | | | - Vitor Oliveira Carvalho
- The GREAT Group (Study Group on Physical Activity), Aracaju, Sergipe, Brazil; Department of Physical Therapy, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Nildo Ribeiro
- Department of Physical Therapy, Federal University of Bahia, Salvador, Bahia, Brazil
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Moore SA, Jakovljevic DG, Ford GA, Rochester L, Trenell MI. Exercise Induces Peripheral Muscle But Not Cardiac Adaptations After Stroke: A Randomized Controlled Pilot Trial. Arch Phys Med Rehabil 2016; 97:596-603. [PMID: 26763949 PMCID: PMC5813708 DOI: 10.1016/j.apmr.2015.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 12/22/2022]
Abstract
Objective To explore the physiological factors affecting exercise-induced changes in peak oxygen consumption and function poststroke. Design Single-center, single-blind, randomized controlled pilot trial. Setting Community stroke services. Participants Adults (N=40; age>50y; independent with/without stick) with stroke (diagnosed >6mo previously) were recruited from 117 eligible participants. Twenty participants were randomized to the intervention group and 20 to the control group. No dropouts or adverse events were reported. Interventions Intervention group: 19-week (3times/wk) progressive mixed (aerobic/strength/balance/flexibility) community group exercise program. Control group: Matched duration home stretching program. Main Outcome Measures (1) Pre- and postintervention: maximal cardiopulmonary exercise testing with noninvasive (bioreactance) cardiac output measurements; and (2) functional outcome measures: 6-minute walk test; timed Up and Go test, and Berg Balance Scale. Results Exercise improved peak oxygen consumption (18±5 to 21±5mL/(kg⋅min); P<.01) and peak arterial-venous oxygen difference (9.2±2.7 to 11.4±2.9mL of O2/100mL of blood; P<.01), but did not alter cardiac output (17.2±4 to 17.7±4.2L/min; P=.44) or cardiac power output (4.8±1.3 to 5.0±1.35W; P=.45). A significant relation existed between change in peak oxygen consumption and change in peak arterial-venous oxygen difference (r=.507; P<.05), but not with cardiac output. Change in peak oxygen consumption did not strongly correlate with change in function. Conclusions Exercise induced peripheral muscle, but not cardiac output, adaptations after stroke. Implications for stroke clinical care should be explored further in a broader cohort.
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Affiliation(s)
- Sarah A Moore
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Djordje G Jakovljevic
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Research Councils UK, Newcastle Centre for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Gary A Ford
- University of Oxford, Oxford, United Kingdom
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael I Trenell
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Research Councils UK, Newcastle Centre for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
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Boyne P, Buhr S, Rockwell B, Khoury J, Carl D, Gerson M, Kissela B, Dunning K. Predicting Heart Rate at the Ventilatory Threshold for Aerobic Exercise Prescription in Persons With Chronic Stroke. J Neurol Phys Ther 2015; 39:233-40. [PMID: 26371532 DOI: 10.1097/npt.0000000000000102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Treadmill aerobic exercise improves gait, aerobic capacity, and cardiovascular health after stroke, but a lack of specificity in current guidelines could lead to underdosing or overdosing of aerobic intensity. The ventilatory threshold (VT) has been recommended as an optimal, specific starting point for continuous aerobic exercise. However, VT measurement is not available in clinical stroke settings. Therefore, the purpose of this study was to identify an accurate method to predict heart rate at the VT (HRVT) for use as a surrogate for VT. METHODS A cross-sectional design was employed. Using symptom-limited graded exercise test (GXT) data from 17 subjects more than 6 months poststroke, prediction methods for HRVT were derived by traditional target HR calculations (percentage of HRpeak achieved during GXT, percentage of peak HR reserve [HRRpeak], percentage of age-predicted maximal HR, and percentage of age-predicted maximal HR reserve) and by regression analysis. The validity of the prediction methods was then tested among 8 additional subjects. RESULTS All prediction methods were validated by the second sample, so data were pooled to calculate refined prediction equations. HRVT was accurately predicted by 80% HRpeak (R, 0.62; standard deviation of error [SDerror], 7 bpm), 62% HRRpeak (R, 0.66; SDerror, 7 bpm), and regression models that included HRpeak (R, 0.62-0.75; SDerror, 5-6 bpm). DISCUSSION AND CONCLUSIONS Derived regression equations, 80% HRpeak and 62% HRRpeak, provide a specific target intensity for initial aerobic exercise prescription that should minimize underdosing and overdosing for persons with chronic stroke. The specificity of these methods may lead to more efficient and effective treatment for poststroke deconditioning.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A114).
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation Sciences (P.B., S.B., B.R., D.C., K.D.), Department of Environmental Health (P.B., J.K., K.D.), Departments of Internal Medicine and Cardiology (M.G.), and Department of Neurology and Rehabilitation Medicine (B.K.), University of Cincinnati, Cincinnati, Ohio; and Division of Biostatistics and Epidemiology (J.K.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Saengsuwan J, Huber C, Schreiber J, Schuster-Amft C, Nef T, Hunt KJ. Feasibility of cardiopulmonary exercise testing and training using a robotics-assisted tilt table in dependent-ambulatory stroke patients. J Neuroeng Rehabil 2015; 12:88. [PMID: 26410821 PMCID: PMC4583724 DOI: 10.1186/s12984-015-0078-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 09/17/2015] [Indexed: 11/16/2022] Open
Abstract
Background We evaluated the feasibility of an augmented robotics-assisted tilt table (RATT) for incremental cardiopulmonary exercise testing (CPET) and exercise training in dependent-ambulatory stroke patients. Methods Stroke patients (Functional Ambulation Category ≤ 3) underwent familiarization, an incremental exercise test (IET) and a constant load test (CLT) on separate days. A RATT equipped with force sensors in the thigh cuffs, a work rate estimation algorithm and real-time visual feedback to guide the exercise work rate was used. Feasibility assessment considered technical feasibility, patient tolerability, and cardiopulmonary responsiveness. Results Eight patients (4 female) aged 58.3 ± 9.2 years (mean ± SD) were recruited and all completed the study. For IETs, peak oxygen uptake (V'O2peak), peak heart rate (HRpeak) and peak work rate (WRpeak) were 11.9 ± 4.0 ml/kg/min (45 % of predicted V'O2max), 117 ± 32 beats/min (72 % of predicted HRmax) and 22.5 ± 13.0 W, respectively. Peak ratings of perceived exertion (RPE) were on the range "hard" to "very hard". All 8 patients reached their limit of functional capacity in terms of either their cardiopulmonary or neuromuscular performance. A ventilatory threshold (VT) was identified in 7 patients and a respiratory compensation point (RCP) in 6 patients: mean V'O2 at VT and RCP was 8.9 and 10.7 ml/kg/min, respectively, which represent 75 % (VT) and 85 % (RCP) of mean V'O2peak. Incremental CPET provided sufficient information to satisfy the responsiveness criteria and identification of key outcomes in all 8 patients. For CLTs, mean steady-state V'O2 was 6.9 ml/kg/min (49 % of V'O2 reserve), mean HR was 90 beats/min (56 % of HRmax), RPEs were > 2, and all patients maintained the active work rate for 10 min: these values meet recommended intensity levels for bouts of training. Conclusions The augmented RATT is deemed feasible for incremental cardiopulmonary exercise testing and exercise training in dependent-ambulatory stroke patients: the approach was found to be technically implementable, acceptable to the patients, and it showed substantial cardiopulmonary responsiveness. This work has clinical implications for patients with severe disability who otherwise are not able to be tested.
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Affiliation(s)
- Jittima Saengsuwan
- Institute for Rehabilitation and Performance Technology, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, Burgdorf, Switzerland. .,ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Research Group, University of Bern, Bern, Switzerland. .,Research Department, Reha Rheinfelden, Rheinfelden, Switzerland. .,Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Celine Huber
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.
| | | | - Corina Schuster-Amft
- Institute for Rehabilitation and Performance Technology, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, Burgdorf, Switzerland. .,Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.
| | - Tobias Nef
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Research Group, University of Bern, Bern, Switzerland.
| | - Kenneth J Hunt
- Institute for Rehabilitation and Performance Technology, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, Burgdorf, Switzerland. .,Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.
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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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Cardiovascular Stress Induced by Whole-Body Vibration Exercise in Individuals With Chronic Stroke. Phys Ther 2015; 95:966-77. [PMID: 25592188 DOI: 10.2522/ptj.20140295] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 01/05/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although whole-body vibration (WBV) has sparked tremendous research interest in neurorehabilitation, the cardiovascular responses to WBV in people with stroke remain unknown. OBJECTIVE The aim of this study was to determine the acute effects of different WBV protocols on oxygen consumption (V̇o2), heart rate (HR), rate of perceived exertion (RPE), blood pressure (BP), and rate-pressure product (RPP) during the performance of 6 different exercises among people with chronic stroke (time since onset ≥6 months). DESIGN A repeated-measures design was used. METHODS Each of the 48 participants experienced all 3 WBV protocols in separate sessions: (1) no WBV, (2) low-intensity WBV (peak acceleration=0.96 unit of gravity of Earth [g]), and (3) high-intensity WBV (1.61g). The order in which they encountered the WBV protocols was randomized, as was the order of exercises performed during each session. Oxygen consumption, HR, and RPE were measured throughout the study. Blood pressure and RPP were measured before and after each session. RESULTS Low-intensity and high-intensity WBV induced significantly higher V̇o2 by an average of 0.69 and 0.79 mL/kg/min, respectively, compared with the control condition. These protocols also increased HR by an average of 4 bpm. The 2 WBV protocols induced higher RPE than the control condition during static standing exercise only. Although the diastolic and systolic BP and RPP were increased at the end of each exercise session, the addition of WBV had no significant effect on these variables. LIMITATIONS The results are generalizable only to ambulatory and community-dwelling people with chronic stroke. CONCLUSIONS Addition of high- and low-intensity WBV significantly increased the V̇o2 and HR, but the increase was modest. Thus, WBV should not pose any substantial cardiovascular hazard in people with chronic stroke.
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Tomczak CR, Haykowsky MJ. Letter by Tomczak and Haykowsky Regarding Article, “Discrepancy Between Cardiac and Physical Functional Reserves in Stroke”. Stroke 2012; 43:e91; author reply e92. [DOI: 10.1161/strokeaha.112.660787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Corey R. Tomczak
- Department of Speech Pathology and Audiology
University of Alberta
Edmonton, Alberta, Canada (Tomczak)
| | - Mark J. Haykowsky
- Faculty of Rehabilitation Medicine
University of Alberta
Edmonton, Alberta, Canada (Haykowsky)
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Jakovljevic DG, Moore SA, Trenell MI. Response to Letter Regarding Article, “Discrepancy Between Cardiac and Physical Functional Reserves in Stroke”. Stroke 2012. [DOI: 10.1161/strokeaha.112.662486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Djordje G. Jakovljevic
- Institute for Ageing and Health and
Institute for Cellular Medicine
Newcastle University
Newcastle upon Tyne, UK (Jakovljevic, Moore, Trenell)
| | - Sarah A. Moore
- Institute for Ageing and Health and
Institute for Cellular Medicine
Newcastle University
Newcastle upon Tyne, UK (Jakovljevic, Moore, Trenell)
| | - Michael I. Trenell
- Institute for Ageing and Health and
Institute for Cellular Medicine
Newcastle University
Newcastle upon Tyne, UK (Jakovljevic, Moore, Trenell)
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Abstract
Cardiorespiratory fitness programs are increasingly used in stroke rehabilitation. Maximal oxygen uptake is the gold standard measurement of cardiorespiratory fitness; however, no recent publications have collated evidence about maximal oxygen uptake levels following stroke. We therefore performed a systematic review of maximal oxygen uptake in stroke survivors, aiming to observe changes in levels over time, and associations with severity of stroke. We searched Medline and Embase until April 2011, and included cross-sectional studies, longitudinal studies, and baseline data from intervention trials. Studies had to recruit at least 10 stroke survivors, and report direct measurement of maximal/peak oxygen uptake. We then compared maximal oxygen uptake with published data from age and gender-matched controls. The search identified 3357 articles. Seventy-two full texts were retrieved, of which 41 met the inclusion criteria. Time since stroke ranged from 10 days to over seven-years. Peak oxygen uptake ranged from 8 to 22 ml/kg/min, which was 26–87% of that of healthy age- and gender-matched individuals. Stroke severity was mild in most studies. Three studies reported longitudinal changes; there was no clear evidence of change in peak oxygen uptake over time. Most studies recruited participants with mild stroke, and it is possible that cardiorespiratory fitness is even more impaired after severe stroke. Maximal oxygen uptake might have been overestimated, as less healthy and older stroke survivors may not tolerate maximal exercise testing. More studies are needed describing mechanisms of impaired cardiorespiratory fitness and longitudinal changes over time to inform the optimal ‘prescription’ of cardiorespiratory fitness programs for stroke survivors.
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Affiliation(s)
- Alexandra C. Smith
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - David H. Saunders
- Institute for Sport, Physical Education & Health Sciences (SPEHS), University of Edinburgh, Edinburgh, UK
| | - Gillian Mead
- Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
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Jakovljevic DG, Moore SA, Tan LB, Rochester L, Ford GA, Trenell MI. Discrepancy Between Cardiac and Physical Functional Reserves in Stroke. Stroke 2012; 43:1422-5. [DOI: 10.1161/strokeaha.111.649434] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Djordje G. Jakovljevic
- From the Institute for Ageing and Health (D.G.J., S.A.M., M.I.T.) and the Institute for Cellular Medicine (D.G.J., S.A.M., L.R., G.A.F., M.I.T.), Newcastle University, Newcastle upon Tyne, UK; and the Cardiology Department (L.-B.T.), Leeds General Infirmary, Leeds, UK
| | - Sarah A. Moore
- From the Institute for Ageing and Health (D.G.J., S.A.M., M.I.T.) and the Institute for Cellular Medicine (D.G.J., S.A.M., L.R., G.A.F., M.I.T.), Newcastle University, Newcastle upon Tyne, UK; and the Cardiology Department (L.-B.T.), Leeds General Infirmary, Leeds, UK
| | - Lip-Bun Tan
- From the Institute for Ageing and Health (D.G.J., S.A.M., M.I.T.) and the Institute for Cellular Medicine (D.G.J., S.A.M., L.R., G.A.F., M.I.T.), Newcastle University, Newcastle upon Tyne, UK; and the Cardiology Department (L.-B.T.), Leeds General Infirmary, Leeds, UK
| | - Lynn Rochester
- From the Institute for Ageing and Health (D.G.J., S.A.M., M.I.T.) and the Institute for Cellular Medicine (D.G.J., S.A.M., L.R., G.A.F., M.I.T.), Newcastle University, Newcastle upon Tyne, UK; and the Cardiology Department (L.-B.T.), Leeds General Infirmary, Leeds, UK
| | - Gary A. Ford
- From the Institute for Ageing and Health (D.G.J., S.A.M., M.I.T.) and the Institute for Cellular Medicine (D.G.J., S.A.M., L.R., G.A.F., M.I.T.), Newcastle University, Newcastle upon Tyne, UK; and the Cardiology Department (L.-B.T.), Leeds General Infirmary, Leeds, UK
| | - Michael I. Trenell
- From the Institute for Ageing and Health (D.G.J., S.A.M., M.I.T.) and the Institute for Cellular Medicine (D.G.J., S.A.M., L.R., G.A.F., M.I.T.), Newcastle University, Newcastle upon Tyne, UK; and the Cardiology Department (L.-B.T.), Leeds General Infirmary, Leeds, UK
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Chang WH, Kim MS, Huh JP, Lee PKW, Kim YH. Effects of Robot-Assisted Gait Training on Cardiopulmonary Fitness in Subacute Stroke Patients. Neurorehabil Neural Repair 2011; 26:318-24. [DOI: 10.1177/1545968311408916] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Min Su Kim
- Sungkyunkwan University, Seoul, Republic of Korea
| | | | | | - Yun-Hee Kim
- Sungkyunkwan University, Seoul, Republic of Korea
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Cardiopulmonary response to exercise testing in people with chronic stroke: a retrospective study. Stroke Res Treat 2011; 2012:987637. [PMID: 21961083 PMCID: PMC3180817 DOI: 10.1155/2012/987637] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/07/2011] [Accepted: 07/14/2011] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose. This study investigated the cardiopulmonary response and safety of exercise testing at peak effort in people during the chronic stage of stroke recovery. Methods. This retrospective study examined data from 62 individuals with chronic stroke (males: 32; mean (SD); age: (12.0) yr) participating in an exercise test. Results. Both males and females had low cardiorespiratory fitness levels. No significant differences were found between gender for peak HR (P = 0.27), or VO(2) peak (P = 0.29). Males demonstrated higher values for minute ventilation, tidal volume, and respiratory exchange ratio. No major adverse events were observed in the exercise tests conducted. Discussion and Conclusion. There are differences between gender that may play a role in exercise testing performance and should be considered when developing exercise programs. The low VO(2) peak of this cohort of chronic stroke survivors suggests the need for participation in exercise interventions.
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Reduced cardiorespiratory fitness after stroke: biological consequences and exercise-induced adaptations. Stroke Res Treat 2011; 2012:959120. [PMID: 21876848 PMCID: PMC3159380 DOI: 10.1155/2012/959120] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Accepted: 06/27/2011] [Indexed: 01/08/2023] Open
Abstract
Evidence from several studies consistently shows decline in cardiorespiratory (CR) fitness and physical function after disabling stroke. The broader implications of such a decline to general health may be partially understood through negative poststroke physiologic adaptations such as unilateral muscle fiber type shifts, impaired hemodynamic function, and decrements in systemic metabolic status. These physiologic changes also interrelate with reductions in activities of daily living (ADLs), community ambulation, and exercise tolerance, causing a perpetual cycle of worsening disability and deteriorating health. Fortunately, initial evidence suggests that stroke participants retain the capacity to adapt physiologically to an exercise training stimulus. However, despite this evidence, exercise as a therapeutic intervention continues to be clinically underutilized in the general stroke population. Far more research is needed to fully comprehend the consequences of and remedies for CR fitness impairments after stroke. The purpose of this brief review is to describe some of what is currently known about the physiological consequences of CR fitness decline after stroke. Additionally, there is an overview of the evidence supporting exercise interventions for improving CR fitness, and associated aspects of general health in this population.
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Manns PJ, Tomczak CR, Jelani A, Cress ME, Haennel R. Use of the Continuous Scale Physical Functional Performance Test in Stroke Survivors. Arch Phys Med Rehabil 2009; 90:488-93. [DOI: 10.1016/j.apmr.2008.08.219] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 07/06/2008] [Accepted: 08/06/2008] [Indexed: 11/26/2022]
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