Cardiovascular response during submaximal underwater treadmill exercise in stroke patients

Changes in Keyboard Typing Accuracy and Spatial Perception after Cardiovascular Fitness Exercise

Background

This study aimed to identify the association between cardiopulmonary exercise and neurological activation by measuring dictation accuracy and the extent of spatial perception.

Methods

First of all, the body composition of subjects was analyzed to verify their physical abnormality. The subjects were given treadmill exercise using modified Bruce protocol. Before and after the treadmill exercise, a spatial perception test and dictation task with auditory and visual stimulation were carried out to identify the changes in neurological activation.

Results

The scores of spatial perception after treadmill exercise were higher than those before treadmill exercise (p < 0.05). In addition, the speed of the post-treadmill dictation task with visual stimulation was significantly increased compared to that of the pre-treadmill dictation task (p < 0.05). However, the accuracy of the post-treadmill dictation task with visual stimulation was significantly decreased compared to that of the pre-treadmill dictation task (p < 0.05).

Conclusion

In this study, it was shown that spatial perception and speed of visual dictation were increased after treadmill exercise. These results suggest that cardiovascular fitness exercise increases spatial perception and typing speed by facilitating neurological activation.

Effects of Aquatic Exercise in Post-exercise Hypotension: A Systematic Review and Meta-Analysis

Background

Post-exercise hypotension (PEH) can be an important non-pharmacological strategy in the treatment of arterial hypertension. Both aerobic and resistance exercises produce PEH, but it is not clear if the exercise environment can lead to a higher PEH.

Objective

This meta-analysis investigated whether a session of aquatic exercise (AE) induces PEH in comparison with control conditions such as land exercise (LE) or rest in hypertensive subjects.

Methods

The present systematic review and meta-analysis was conducted using the following electronic databases: PubMed, Google Scholar, and EMBASE. Ambulatory blood pressure measurements made in randomized clinical trials were pooled to compare PEH induced by AE with LE and rest conditions in hypertensive subjects.

Results

Data from four trials were included, which comprised 127 participants (94 women and 33 men). A 24-h analysis did not detect significant differences between AE and LE or rest for either systolic blood pressure (SBP) or diastolic blood pressure (DBP). Monitoring during the night showed that AE induced significant PEH in comparison with LE for SBP [−8.6 (−15.0 to −1.5) mmHg (p = 0.01)]. For DBP, the AE had pronounced PEH during the night in comparison with LE [−3.7 (−4.7 to −2.8) mmHg, p = 0.000] and rest [−1.7 (−1.9 to −0.8) mmHg, p = 0.000]. There were no differences in daytime values.

Conclusion

AE showed a higher PEH effect than LE sessions and rest conditions. PEH was observed in both SBP and DBP during the night. The number of studies was low, but all studies included in this meta-analysis used 24-h monitoring. The understanding of clinical relevance of AE, inducing a higher PEH, depends on a standardization of exercise protocols plus a rigorous monitoring of blood pressure.

Systematic Review Registration

PROSPERO registration: CRD42021271928.

The effect of aquatic physical therapy in patients with stroke: A systematic review and meta-analysis

Objective: The purpose of this study was to evaluate the literature reports of qualitative and quantitative results of physical therapy treatments in the alternative aquatic setting for individuals affected by strokes. Method: PRISMA guidelines were used to carry out the systematic review and meta-analysis. Three bibliographic databases were searched: MEDLINE, PEDro, and the Cochrane Library. Papers included in the study were required to: (a) have a randomized controlled trial (RCT) design of research; and (b) be published in English; (c) be published during the last 10 years (2008-2018). Only randomized controlled trials were employed in the study. The quality of the clinical trials to be included was evaluated according to the Jadad scale. The internal validity was assessed according to the PEDro scale. Results: Eleven RCTs were initially identified in the systematic review. Eight of these were involved in the meta-analysis comparing outcomes and follow-up. Eight studies received a Jadad score of three, indicating a high level of quality. The remaining three studies achieved a lower score which indicated lower qualitative level. Nearly all of the results of the quantitative analysis were statistically significant (P < 0,05) and most of them favored of the experimental group subject to aquatic treatment. Conclusion: Aquatic physical therapy may be a valid means for the rehabilitation of people affected by stroke. The integration of this methodological approach with conventional physical therapy should be considered. However, more studies; a larger number of participants; and varying lengths of follow-up times are necessary.

Acute Effects of Water-Based Concurrent Training Intrasession Exercise Sequences on Energy Expenditure in Young Women

BACKGROUND

To compare the acute effects of water-based aerobic-resistance and resistance-aerobic concurrent training (CT) sessions on energy expenditure (EE) during and postexercise in young women.

METHODS

Nine active women (24 [3] y; 60 [5] kg) completed 4 sessions: (1) familiarization, (2) aquatic maximal test to determine the heart rate corresponding to the anaerobic threshold, (3) CT protocol with aerobic-resistance sequence, and (4) CT protocol with resistance-aerobic sequence. Both protocols started and ended with the participants in the supine position for 30 minutes to perform resting and postexercise oxygen consumption measurements. The water-based resistance protocol comprised 4 sets of 15 seconds at maximal velocity, and the water-based aerobic protocol was performed at a continuous intensity (heart rate corresponding to the anaerobic threshold). EE measurements were calculated based on oxygen consumption and the corresponding caloric equivalent. Paired t test was used to compare the EE values between the water-based CT intrasession exercise sequences (α = .05).

RESULTS

There was no difference between the water-based aerobic-resistance and resistance-aerobic in total EE (330.78 vs 329.56 kcal; P = .96), EE per minute (7.35 vs 7.32 kcal·min-1; P = .96), and postexercise EE (63.65 vs 59.92 kcal; P = .50).

CONCLUSIONS

The intrasession exercise sequence during water-based CT had no influence on the EE in young women.

The effects of Ai Chi for balance in individuals with chronic stroke: a randomized controlled trial

This study investigated the effectiveness of Ai Chi compared to conventional water-based exercise on balance performance in individuals with chronic stroke. A total of 20 individuals with chronic stroke were randomly allocated to receive either Ai Chi or conventional water-based exercise for 60 min/time, 3 times/week, and a total of 6 weeks. Balance performance assessed by limit of stability (LOS) test and Berg balance scale (BBS). Fugl-Meyer assessment (FMA) and gait performance were documented for lower extremity movement control and walking ability, respectively. Excursion and movement velocity in LOS test was significantly increased in anteroposterior axis after receiving Ai Chi (p = 0.005 for excursion, p = 0.013 for velocity) but not conventional water-based exercise. In particular, the improvement of endpoint excursion in the Ai Chi group has significant inter-group difference (p = 0.001). Both groups showed significant improvement in BBS and FMA yet the Ai Chi group demonstrated significantly better results than control group (p = 0.025). Ai Chi is feasible for balance training in stroke, and is able to improve weight shifting in anteroposterior axis, functional balance, and lower extremity control as compared to conventional water-based exercise.

Cardiorespiratory Responses to Pool Floor Walking in People Poststroke

OBJECTIVE

To compare cardiorespiratory responses between pool floor walking and overground walking (OW) in people poststroke.

DESIGN

Cross-sectional study.

SETTING

University-based therapeutic exercise facility.

PARTICIPANTS

Participants (N=28) were comprised of 14 community-dwelling individuals poststroke (5.57±3.57y poststroke) and 14 age- and sex-matched healthy adults (mean age, 58.00±15.51y; male/female ratio, 9:5).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

A telemetric metabolic system was used to collect cardiorespiratory variables, including oxygen consumption (V˙o₂), energy expenditure (EE), and expired volume per unit time (V˙e), during 6-minute walking sessions in chest-depth water and on land at a matched speed, determined by average of maximum walking speed in water.

RESULTS

Individuals poststroke elicited no significant differences in cardiorespiratory responses between pool floor walking and OW. However, healthy controls showed significant increases in mean V˙o₂ values by 94%, EE values by 109%, and V˙e values by 94% (all P<.05) during pool floor walking compared with OW. A 2×2 mixed model analysis of variance revealed a significant group × condition interaction in V˙o₂, in which the control group increased V˙o₂ from OW to pool floor walking, whereas the stroke group did not.

CONCLUSIONS

Our results indicate that people poststroke, unlike healthy adults, do not increase EE while walking in water compared with on land. Unlike stationary walking on an aquatic treadmill, forward locomotion during pool floor walking at faster speeds may have increased drag force, which requires greater EE from healthy adults. Without demanding excessive EE, walking in water may offer a naturally supportive environment for gait training in the early stages of rehabilitation.

Efficacy of Aquatic Treadmill Training on Gait Symmetry and Balance in Subacute Stroke Patients

Objective

To determine the efficacy of aquatic treadmill training (ATT) as a new modality for stroke rehabilitation, by assessing changes in gait symmetry, balance function, and subjective balance confidence for the paretic and non-paretic leg in stroke patients.

Methods

Twenty-one subacute stroke patients participated in 15 intervention sessions of aquatic treadmill training. The Comfortable 10-Meter Walk Test (CWT), spatiotemporal gait parameters, Berg Balance Scale (BBS), and Activities-specific Balance Confidence scale (ABC) were assessed pre- and post-interventions.

Results

From pre- to post-intervention, statistically significant improvements were observed in the CWT (0.471±0.21 to 0.558±0.23, p<0.001), BBS (39.66±8.63 to 43.80±5.21, p<0.001), and ABC (38.39±13.46 to 46.93±12.32, p<0.001). The step-length symmetry (1.017±0.25 to 0.990±0.19, p=0.720) and overall temporal symmetry (1.404±0.36 to 1.314±0.34, p=0.218) showed improvement without statistical significance.

Conclusion

ATT improves the functional aspects of gait, including CWT, BBS and ABC, and spatiotemporal gait symmetry, though without statistical significance. Further studies are required to examine and compare the potential benefits of ATT as a new modality for stroke therapy, with other modalities.

Poststroke alterations in heart rate variability during orthostatic challenge

Older adults following recovery from ischemic stroke have a higher incidence of orthostatic hypotension, syncope, and fall risk, which may be related to impaired autonomic responses limiting the ability to maintain cerebral blood flow. Thus, we investigated cerebrovascular and cardiovascular regulation in 23 adults ≥55 years of age, 10 diagnosed with ischemic stroke, and 13 age-matched healthy controls when sitting at rest and upon standing to compare differences of autonomic variables at ∼7 months (218 ± 41 days) poststroke.Arterial blood pressure via finger plethysmography, muscle-pump baroreflex via electromyography, heart rate variability via 3-lead ECG, and cerebral blood flow velocity via transcranial Doppler were analyzed while sitting for 5 minutes and then during quiet standing for 5 minutes.From the seated to standing position, the stroke group had significantly greater decline in the low frequency component of heart rate variability (164 [79] vs 25 [162] ms; P = 0.043). All other cardiovascular parameters and assessments of autonomic function were not significantly different between the two groups.Our findings support the hypothesis of continued autonomic dysfunction after recovery from ischemic stroke, with potential attenuation of the cardiovascular response to standing. However, further investigation is required to determine the mechanisms underlying the increased risk of orthostatic hypotension, syncope, and falls poststroke.

Cardiovascular Stress Induced by Whole-Body Vibration Exercise in Individuals With Chronic Stroke

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.