Cardiovascular fitness as a predictor of functional recovery in subacute stroke patients

Association Between Early Mobilization and Functional Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Multicenter Retrospective Propensity Score-Matched Study

BACKGROUND

Early mobilization has been shown to promote functional recovery and prevent complications in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, the efficacy of early mobilization in patients with aSAH remains unclear. This study aimed to investigate the association between early mobilization and functional outcomes in patients with aSAH.

METHODS

This multicenter retrospective study was conducted in Japan and included patients with aSAH who received physical therapy with or without occupational therapy from April 2014 to March 2019. The primary outcome was the modified Rankin Scale (mRS) score, with a favorable functional outcome defined as an mRS score of 0-2 and an unfavorable outcome with an mRS score of 3-5. Patients initiating walking training within 14 days of aSAH onset were classified into the early mobilization group, whereas those initiating training after 14 days were classified into the delayed mobilization group. Propensity score matching analysis was performed to assess the association between early mobilization and favorable outcomes.

RESULTS

A total of 718 patients were screened, and 450 eligible patients were identified. Before matching, 229 patients (50.9%) were in the early mobilization group and 221 (49.1%) were in the delayed mobilization group. After matching, each group consisted of 122 patients, and the early mobilization group exhibited a higher proportion of favorable outcomes than did the delayed mobilization group (81.1% vs. 52.5%, risk difference 28.7%, 95% confidence interval 17.4-39.9, p < 0.001).

CONCLUSIONS

This multicenter retrospective study suggests that initiating walking training within 14 days of aSAH onset is associated with favorable outcomes.

Stroke volume and cardiac output during 6 minute-walk tests are strong predictors of maximal oxygen uptake in people after stroke

Background and objectives

The 6-minute walk test (6MWT) is a field test commonly used to predict peak oxygen consumption (VO2peak) in people after stroke. Inclusion of cardiodynamic variables measured by impedance cardiography (ICG) during a 6MWT has been shown to improve prediction of VO2peak in healthy adults but these data have not been considered in people after stroke. This study investigates whether the prediction of VO2peak can be improved by the inclusion of cardiovascular indices derived by impedance cardiography (ICG) during the 6MWT in people after stroke.

Methods

This was a cross-sectional study. Patients diagnosed with stroke underwent in random order, a maximal cardiopulmonary exercise test (CPET) and 6MWT in separate dates. Heart rate (HR), stroke volume (SV) and cardiac output (CO) were measured by ICG during all tests. Oxygen consumption was recorded by a metabolic cart during the CPET. Recorded data were subjected to multiple regression analyses to generate VO2peak prediction equations.

Results

Fifty-nine patients, mean age 50.0±11.7 years were included in the analysis. The mean distance covered in the 6MWT (6MWD) was 294±13 m, VO2peak was 19.2±3.2 ml/min/kg. Mean peak HR, SV and CO recorded during 6MWT were 109±6 bpm, 86.3±8.8 ml, 9.4±1.2 L/min and during CPET were 135±14 bpm, 86.6±9 ml, 11.7±2 L/min respectively. The prediction equation with inclusion of cardiodynamic variables: 16.855 + (-0.060 x age) + (0.196 x BMI) + (0.01 x 6MWD) + (-0.416 x SV6MWT) + (3.587 x CO 6MWT) has a higher squared multiple correlation (R2) and a lower standard error of estimate (SEE) and SEE% compared to the equation using 6MWD as the only predictor.

Conclusion

Inclusion of SV and CO measured during the 6MWT in stroke patients further improved the VO2peak prediction power compared to using 6MWD as a lone predictor.

Exploring Alternative Measurements of Cardiorespiratory Fitness in Patients With Mild Ischemic Stroke at Acute Phase

Background

While emerging studies have suggested an association of cardiorespiratory fitness (CRF) with stroke risk and overall health outcomes, little is known regarding the optimum methods of CRF measurement in patients with mild acute ischemic stroke.

Objective

The aim of this study was to explore the association between the 6-min walk distance (6MWD) and other measurements related to CRF in patients with mild ischemic stroke at the acute stage.

Methods

A total of 30 patients with stroke and 71 healthy subjects matched for age and grip strength (GS) were prospectively recruited. All patients were within 14 days after stroke onset and presented mild motor impairment (with a full score of Fugl-Meyer Motor Assessment). Demographic data of both groups and clinical information of the stroke group were documented, and the CRF comparison between the two groups was conducted. Each participant underwent a one-time assessment of 6MWD and a series of measurements related to CRF, including GS, 10-m walk test (10mWT), five-times sit-to-stand time (FTSST), functional reaching test (FRT), Berg Balance Scale (BBS), and waistline. Pearson's product-moment correlation coefficient test and multiple linear regression were performed to explore the indicators of CRF.

Results

Significant moderate correlations (0.3 < r <0.6) were found between 6MWD and GS of left hand (GS-left) (r = 0.573, p = 0.001), GS of right hand (GS-right) (r = 0.524, p = 0.003), FTSST (r = −0.551, p = 0.002), 10mWT (r = 0.554, p = 0.001), and FRT (r = 0.449, p = 0.021) in the patient group. While 6MWD displayed significant moderate correlations with waistline (r = 0.364, p = 0.002), 10mWT (r = 0.512, p < 0.001), FTSST (r = −0.573, p < 0.001), and FRT (r = 0.550, p < 0.001) in the healthy group. All these dependent variables were entered into a stepwise multiple linear regression analysis to evaluate their values in estimating CRF as measured by 6MWD in each group. Analyses suggested that GS-left (p = 0.002) and FTSST (p = 0.003) were the indicators of CRF in the patient group with stroke and explained 51.4% of the variance of 6MWD (R² = 0.514); FTSST (p < 0.001), 10mWT (p < 0.001), and FRT (p = 0.021) were the indicators of CRF in the healthy group and explained 58.9% of variance of 6MWD (R² = 0.589).

Conclusions

Our data confirmed that CRF is impaired in patients with mild ischemic stroke at the acute phase. Moreover, GS-left may be an optional indicator of CRF in patients with mild acute ischemic stroke, but not in healthy people.

Clinical Trial Registration

www.chictr.org.cn, identifier: ChiCTR2000031379.

Advancing motor rehabilitation for adults with chronic neurological conditions through increased involvement of kinesiologists: a perspective review

Many people with neurological conditions experience challenges with movement. Although rehabilitation is often provided acutely and sub-acutely following the onset of a condition, motor deficits commonly persist in the long-term and are exacerbated by disuse and inactivity. Notably, motor rehabilitation approaches that incorporate exercise and physical activity can support gains in motor function even in the chronic stages of many neurological conditions. However, delivering motor rehabilitation on a long-term basis to people with chronic neurological conditions is a challenge within health care systems, and the onus is often placed on patients to find and pay for services. While neurological motor rehabilitation is largely the domain of physical and occupational therapists, kinesiologists may be able to complement existing care and support delivery of long-term neurological motor rehabilitation, specifically through provision of supported exercise and physical activity programs. In this perspective style review article, we discuss potential contributions of kinesiologists to advancing the field through exercise programming, focusing on community-based interventions that increase physical activity levels. We conclude with recommendations on how kinesiologists' role might be further optimized towards improving long-term outcomes for people with chronic neurological conditions, considering issues related to professional regulation and models of care.

Paretic knee extensor strength, gait velocity, and fat mass are major determinants of peak aerobic capacity in subacute stroke: observational cohort study

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.

Cardiorespiratory factors related to the increase in oxygen consumption during exercise in individuals with stroke

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.

Exergame-Driven High-Intensity Interval Training in Untrained Community Dwelling Older Adults: A Formative One Group Quasi- Experimental Feasibility Trial

Purpose

To investigate the feasibility of an exergame-driven high-intensity interval training (HIIT) and its effects on cardiovascular fitness in untrained community dwelling older adults.

Methods

Twelve older participants [10 women, age 72.3 (SD: 4.44) years] performed a high-intensity interval exergame intervention three times a week for 4 weeks. Data was acquired during two baseline and one final measurement. Feasibility outcomes included attrition, adherence, acceptability [Technology Acceptance Model Questionnaire (TAM)], usability [System Usability Scale (SUS)], and enjoyment of exergaming. Furthermore, participants' physical activity levels pre and post intervention were compared to physical activity levels for similar types of training. The secondary outcome was exercise capacity [heart rate at rest (HRrest), heart rate variability (HRV), maximum heart rate (HRmax), and maximum workload (W, in watt)] evaluated through maximal exercise testing.

Results

Eleven participants completed the study (8% attrition), without any adverse events. Adherence to the HIIT intervention was 91% and participants showed high acceptance of the intervention with TAM scores between 5.8 and 6.7 points. User satisfaction was rated as excellent (SUS total score: 93.5 of 100) and the overall enjoyment of exergaming scored 4.5 of 5 possible points. Total exercise time ranged from 19 to 35 min with a mean of 30.8 (SD: 3.6) min. Actual high-intensity exercise time showed consistency with the target exercise time in 98% percent of trainings. Eighty-six percent of high-intensity intervals met the targeted intensity range (>70-90% of HRmax). Thirty-six percent of the recovery periods were completed with a heart rate above the target range of 50-70% of HRmax. Maximum workload (W) during the incremental exercise test post-training increased significantly compared to the baseline measurements one and two (p = 0.032, effect size r = 0.77 and p = 0.012, r = 0.87).

Conclusion

High-intensity interval training through exergaming is feasible, safe, and shows high usability and acceptance in community dwelling older people. Exergame-driven HIIT had a significant effect on maximum power output on an incremental exercise test. A more extensive exergame intervention period, higher work to recovery ratios as well as a higher-intensity activity should be considered in future projects.

Making More of IT: Enabling Intensive Motor Cognitive Rehabilitation Exercises in Geriatrics Using Information Technology Solutions

Although the health benefits of physical activity and exercise for older people are well established, a largely sedentary lifestyle still prevails in ageing western societies. Finding new ways to make exercise more accessible and acceptable for older adults must be developed to fully unleash its potential in preventing and weakening age-related physical and cognitive decline. Existing barriers to implement effective exercise-based treatment plans include motivational reservations on both the clinician's and patient's side, but also physical limitations caused by disease or deconditioning. Particularly in the more senior population, debilitating conditions do not allow adherence to currently recommended exercise regimes. A major rethinking of age- and user-adapted exercise is overdue. The high intensities required for physical and mental adaptations must be modifiable and personalized according to the functional status of each patient. Emerging information and communication technologies (ICT) have brought forward a plethora of attractive solutions for smart and adapted exercise, but there remains a vast gap between technological advancement and clinical relevance. Where in the beginning ICT for active ageing mainly focussed on aspects of usability and user experience, the current status of IT as applied in ageing populations noticeably shifted toward new services, applications, and devices that can be offered with the aim to prevent, compensate, care, and/or enhance daily life functioning of senior citizens. In this perspective paper, we aim to summarize the current state of the art in ICT-based interventions aimed at improved motor-cognitive control and make suggestions about how these could be combined with high-intensive interval exercise regimes to make rehabilitation for the impaired older adults more effective, and more fun.

Safety and Feasibility of the 6-Minute Walk Test in Patients with Acute Stroke

BACKGROUND

Our objective was to investigate the safety and feasibility of the 6-minute walk test in patients with acute stroke.

MATERIALS AND METHODS

Consecutive patients with acute stroke, admitted to the Itami Kosei Neurosurgical Hospital from September 2016 to April 2017 were enrolled. Walking capacity was assessed by a physical therapist using the 6-minute walk test in 94 patients with acute stroke within 14 days of hospital admission. The primary outcomes were safety (i.e., the prevalence of new adverse events during and after the test) and feasibility (i.e., test completion rate) of the 6-minute walk test.

RESULTS

The 6-minute walk test was performed for a mean duration of 5.1 days (standard deviation, 2.6 days) after hospital admission. Seventy patients (74.5%) could walk without standby assistance or a walking aid, and 24 patients (25.5%) could walk without standby assistance but with a walking aid. The average distance walked by patients during the 6-minute walk test was 331 m (standard deviation, 107.2 m). Adverse events following the 6-minute walk test occurred in 6 patients (6.4%) and included stroke progression, stroke recurrence, seizures, and neurological deterioration. Heart rate increase (>120 beats/min) occurred in 3 patients (3.2%) during the test. Lastly, 6 patients (6.4%) were unable to complete the 6-minute walk test.

CONCLUSIONS

Although performance in the 6-minute walk test was decreased in patients with acute stroke, the test itself appears to be safe and feasible in this patient population.

Unilateral Arm Crank Exercise Test for Assessing Cardiorespiratory Fitness in Individuals with Hemiparetic Stroke

Cardiorespiratory fitness assessment with leg cycle exercise testing may be influenced by motor impairments in the paretic lower extremity. Hence, this study examined the usefulness of a unilateral arm crank exercise test to assess cardiorespiratory fitness in individuals with stroke, including sixteen individuals with hemiparetic stroke (mean ± SD age, 56.4 ± 7.5 years) and 12 age- and sex-matched healthy controls. Participants performed the unilateral arm crank and leg cycle exercise tests to measure oxygen consumption ([Formula: see text]O2) and heart rate at peak exercise. The [Formula: see text]O2 at peak exercise during the unilateral arm crank exercise test was significantly lower in the stroke group than in the control group (p < 0.001). In the stroke group, the heart rate at peak exercise during the unilateral arm crank exercise test did not significantly correlate with the Brunnstrom recovery stages of the lower extremity (p = 0.137), whereas there was a significant correlation during the leg cycle exercise test (rho = 0.775, p < 0.001). The unilateral arm crank exercise test can detect the deterioration of cardiorespiratory fitness independently of lower extremity motor impairment severity in individuals with hemiparetic stroke. This study is registered with UMIN000014733.

Cardiorespiratory Fitness after Transient Ischemic Attack and Minor Ischemic Stroke: Baseline Data of the MoveIT Study

BACKGROUND

Cardiorespiratory fitness (CRF) is reduced in patients with stroke. It is unclear whether it is also reduced in patients with a transient ischemic attack (TIA) or minor stroke. We investigated the CRF in patients with a recent TIA or minor stroke and explored which determinants are associated with a lower fitness.

METHODS

In 113 patients with a recent TIA or minor ischemic stroke (64 (SD = 10) years of age; 49 (IQR 27-86) days post TIA or stroke), the peak oxygen consumption (VO2peak) was determined in a symptom-limited ramp exercise test. Physical activity level, vascular risk factors, history of vascular or pulmonary disease, and stroke characteristics were recorded at inclusion and related to the VO2peak.

RESULTS

Mean VO2peak was 22 mL/kg/min (SD = 6), which is the fifth percentile of age- and sex-related normative values. Increasing age and female sex were associated with a lower VO2peak (B (95% CI): per 10 years -2.57 mL/kg/min (-3.75; -1.40) and female sex -5.84 mL/kg/min (-8.06; -3.62)). Age- and sex-adjusted linear regression analyses showed that a history of cardiovascular disease and pulmonary disease was associated with a lower VO2peak. In addition, a lower level of physical activity, hypertension, smoking, and overweight were associated with a lower VO2peak. History of stroke and stroke characteristics were not related to VO2peak.

CONCLUSION

The majority of patients with a recent TIA or minor ischemic stroke have a poor CRF. Our findings suggest that premorbid cardiovascular and pulmonary disease and vascular risk factors, but not TIA- or stroke-related factors, contribute to a reduced CRF.

Robot-assisted gait training improves brachial-ankle pulse wave velocity and peak aerobic capacity in subacute stroke patients with totally dependent ambulation: Randomized controlled trial

OBJECTIVE

Brachial-ankle pulse wave velocity (baPWV) evaluates arterial stiffness and also predicts early outcome in stroke patients. The objectives of this study were to investigate arterial stiffness of subacute nonfunctional ambulatory stroke patients and to compare the effects of robot-assisted gait therapy (RAGT) combined with rehabilitation therapy (RT) on arterial stiffness and functional recovery with those of RT alone.

METHOD

The RAGT group (N = 30) received 30 minutes of robot-assisted gait therapy and 30 minutes of conventional RT, and the control group (N = 26) received 60 minutes of RT, 5 times a week for 4 weeks. baPWV was measured and calculated using an automated device. The patients also performed a symptom-limited graded exercise stress test using a bicycle ergometer, and parameters of cardiopulmonary fitness were recorded. Clinical outcome measures were categorized into 4 categories: activities of daily living, balance, ambulatory function, and paretic leg motor function and were evaluated before and after the 4-week intervention.

RESULTS

Both groups exhibited significant functional recovery in all clinical outcome measures after the 4-week intervention. However, peak aerobic capacity, peak heart rate, exercise tolerance test duration, and baPWV improved only in the RAGT group, and the improvements in baPWV and peak aerobic capacity were more noticeable in the RAGT group than in the control group.

CONCLUSION

Robot-assisted gait therapy combined with conventional rehabilitation therapy represents an effective method for reversing arterial stiffness and improving peak aerobic capacity in subacute stroke patients with totally dependent ambulation. However, further large-scale studies with longer term follow-up periods are warranted to measure the effects of RAGT on secondary prevention after stroke.

Predictors of functional level and quality of life at 6 months after a first-ever stroke: the KOSCO study

Predicting functional outcome and quality of life (QOL) is critical to the treatment of patients with stroke. The purpose of this study was to analyze the factors influencing functional status and QOL of stroke patients 6 months after a first-ever stroke. This study was an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation Study, designed to include 10 years of follow-up for first-ever stroke patients. This study analyzed data from 2857 patients who completed face-to-face assessments with the functional independence measurement (FIM) and Euro Quality of Life-5D (EQ-5D) at 6 months after stroke onset. A multivariate regression analysis was used to analyze factors that potentially influenced FIM and EQ-5D results at 6 months after stroke. Of the patients in this study, 80.1 % suffered from ischemic stroke and 19.9 % experienced hemorrhagic stroke. The independent predictors of functional independency measured by FIM at 6 months after stroke were age, initial stroke severity, duration of hospitalization, and functional level at discharge in terms of motor, ambulation, and language. For QOL measured by EQ-5D at 6 months after stroke, age, duration of hospitalization, and motor function at discharge were significant predictors. In conclusion, proper treatment to achieve maximal functional gain at discharge may be an important factor in improving functional independency and QOL in chronic stage stroke survivors. These results provide useful information for establishing comprehensive and systematic care for stroke patients.

Hemiparetic Knee Extensor Strength and Balance Function Are Predictors of Ambulatory Function in Subacute Stroke Patients

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.

Protocol variations and six-minute walk test performance in stroke survivors: a systematic review with meta-analysis

Objective. To investigate the use of the six-minute walk test (6MWT) for stroke survivors, including adherence to 6MWT protocol guidelines and distances achieved. Methods. A systematic search was conducted from inception to March 2014. Included studies reported a baseline (intervention studies) or first instance (observational studies) measure for the 6MWT performed by stroke survivors regardless of time after stroke.  Results. Of 127 studies (participants n = 6,012) that met the inclusion criteria, 64 were also suitable for meta-analysis. Only 25 studies made reference to the American Thoracic Society (ATS) standards for the 6MWT, and 28 reported using the protocol standard 30 m walkway. Thirty-nine studies modified the protocol walkway, while 60 studies did not specify the walkway used. On average, stroke survivors walked 284 ± 107 m during the 6MWT, which is substantially less than healthy age-matched individuals. The meta-analysis identified that changes to the ATS protocol walkway are associated with reductions in walking distances achieved. Conclusion. The 6MWT is now widely used in stroke studies. The distances achieved by stroke patients indicate substantially compromised walking ability. Variations to the standard 30 m walkway for the 6MWT are common and caution should be used when comparing the values achieved from studies using different walkway lengths.

The functional exercise capacity and its correlates in obese treatment-seeking people with binge eating disorder: an exploratory study

PURPOSE

The primary aim was to compare the functional exercise capacity between obese treatment-seeking people with and without binge eating disorder (BED) and non-obese controls. The secondary aim was to identify clinical variables including eating and physical activity behaviour, physical complaints, psychopathology and physical self-perception variables in obese people with BED that could explain the variability in functional exercise capacity.

METHODS

Forty people with BED were compared with 20 age-, gender- and body mass index (BMI)-matched obese persons without BED and 40 age and gender matched non-obese volunteers. A 6-minute walk test (6MWT), the Baecke physical activity questionnaire, the Symptom Checklist-90, the Physical Self-Perception Profile and the Eating Disorder Inventory were administered. Physical complaints before and after the 6MWT were also documented.

RESULTS

The distance achieved on the 6MWT was significantly lower in obese participants with BED (512.1 ± 75.8 m versus 682.7 ± 98.4, p < 0.05) compared to non-obese controls. No significant differences were found between obese participants with and without BED. Participants with BED reported significantly (p < 0.05) more musculoskeletal pain and fatigue after the walk test than obese and non-obese controls. A forward stepwise regression analysis demonstrated that sports participation and perceived physical strength explained 41.7% of the variance on the 6MWT in obese participants with BED.

CONCLUSION

Physical activity participation, physical self-perception and perceived physical discomfort during walking should be considered when developing rehabilitation programs for obese people with BED.

IMPLICATIONS FOR REHABILITATION

Rehabilitation programmes in people with binge eating disorder should incorporate a functional exercise capacity assessment. Clinicians involved in the rehabilitation of people with binge eating disorder should consider depression and lower self-esteem as potential barriers. Clinicians should take into account the frequently observed physical discomfort when developing rehabilitation programmes for people with binge eating disorder.