Background and Purpose Cardiovascular health is often impaired after stroke. Reduced exercise capacity (VO2 peak) and changes in the vascular system in the stroke-affected limb may impact physical performance such as walking. There is little information regarding the role of prescribed moderate-high intensity exercise in subacute stroke. The purpose of this study was to examine whether an 8-week aerobic exercise intervention would improve cardiovascular health and physical performance. Methods Ten subjects were enrolled in the study and 9 completed the intervention. Participants were 61.2 ± 4.7 years old, 66.7 ± 41.5 days post-stroke and had minor motor performance deficits (Fugl-Meyer score, 100.3 ± 29.3). Outcome measures were taken at baseline, post-intervention and one-month follow-up. Brachial artery vasomotor reactivity (flow mediated dilation; FMD) of both arms assessed vascular health and a peak exercise test assessed exercise capacity. The six-minute walk (6-MWT) test was used to assess physical performance. Participants exercised on a recumbent stepper three times per week for eight weeks in a prescribed heart rate (HR) intensity. Results At baseline, we report between-limb differences in brachial artery FMD and low VO2 peak values. After the intervention, significant improvements were reported in FMD in both arms, resting systolic blood pressure (SBP) and the 6MWT. Although we also observed improvements in resting diastolic BP, HR and VO2 peak values, after the exercise intervention, these were not statistically significant Discussion and Conclusion Aerobic exercise in subacute stroke was beneficial for improving cardiovascular health, reducing cardiac risk and improving physical performance (6MWT).

Sedentary lifestyle after stroke is common which results in poor cardiovascular health. Aerobic exercise has the potential to reduce cardiovascular risk factors and improve functional capacity and quality of life in people after stroke. However, aerobic exercise is a therapeutic intervention that is underutilized by healthcare professionals after stroke. The purpose of this review paper is to provide information on exercise prescription using the FITT principle (frequency, intensity, time, type) for people after stroke and to guide healthcare professionals to incorporate aerobic exercise into the plan of care. This article discusses the current literature outlining the evidence base for incorporating aerobic exercise into stroke rehabilitation. Recently, high-intensity interval training has been used with people following stroke. Information is provided regarding the early but promising results for reaching higher target heart rates.

Background and Purpose Observational studies demonstrate low levels of physical activity during in-patient stroke rehabilitation. There is no objective measure of sedentary time on the acute stroke unit and whether sedentary time is related to functional outcomes. The purpose of this study was to characterize sedentary time after acute stroke and determine whether there is a relationship to functional performance at discharge. Methods Thirty-two individuals (18 males; 56.5 ± 12.7 years) with acute stroke were enrolled within 48 hours of hospital admission. An accelerometer was placed on the stroke-affected ankle to measure 24-hour activity and was worn for 4 days or until discharge from the hospital. Performance of activities of daily living, walking endurance, and functional mobility was assessed using the Physical Performance Test (PPT), Six-Minute Walk Test (6MWT), and Timed-Up and Go (TUG), respectively. Results Mean percent time spent sedentary was 93.9 ± 4.1% and percent time in light activity was 5.1 ± 2.4%. When controlling for baseline performance, the mean time spent sedentary per day was significantly related to PPT performance at discharge (r = −0.37; p = 0.05), but not the 6MWT or TUG. Discussion and Conclusions Patients with acute stroke were sedentary most of their hospital stay. To minimize the potential negative effects of inactivity, our data suggest that there should be an emphasis towards increasing physical activity during the hospital stay. Video Abstract available for more insights from the authors (See Video, Supplemental Digital Content 1).

Reduced cardiovascular fitness poststroke may negatively impact recovery. There is little information regarding exercise testing performance and cardiorespiratory response to an aerobic exercise intervention in subacute stroke. The purpose of this study was to examine cardiorespiratory response in subacute stroke after an 8-week aerobic exercise intervention using a total body recumbent stepper (TBRS). Methods: Nine individuals with mean age 61.2 (SD 4.7) years and mean 66.7 (SD 41.5) days post-stroke completed the exercise intervention. Participants had a mean Fugl-Meyer score of 100.3 (SD 29.3). Outcome measures were obtained at baseline and postintervention. A peak exercise test using a TBRS assessed oxygen consumption, heart rate, and minute ventilation. Participants completed an 8-week exercise intervention on a recumbent stepper 3 times per week at a prescribed heart rate intensity. Results: Submaximal VO 2 was significantly lower from baseline to postintervention with a main effect of Study Visit (F 1,8 = 8.5, p = 0.02). Heart rate was not significantly different pre-to postintervention. Minute ventilation exhibited no main effect of Study Visit or Test Minute. Conclusion: Moderate-high intensity aerobic exercise in subacute stroke appears to be beneficial for improving cardiovascular outcomes during submaximal performance of an exercise test.

PurposeThe purpose of the present study was to determine the reliability of the exercise response (predicted peak VO2) using the total body recumbent stepper (TBRS) submaximal exercise test in: 1) healthy adults 20–70 years of age and 2) adults participating in inpatient stroke rehabilitation. We hypothesized that the predicted peak VO2 (Visit 1) would have an excellent relationship (r > 0.80) to predicted peak VO2 (Visit 2). We also wanted to test whether the exercise response at Visit 1 and Visit 2 would be significantly different.MethodsHealthy adults were recruited from the Kansas City metro area. Stroke participants were recruited during their inpatient rehabilitation stay. Eligible participants completed 2 TBRS submaximal exercise tests between 24 hours and 5 days at similar times of day.ResultsA total of 70 participants completed the study. Healthy adults (n = 50) were 36 M, 38.1 ± 10.1 years and stroke participants (n = 20) were 15 M, 62.5 ± 11.8 years of age. The exercise response was reliable for healthy adults (r = 0.980, p<0.01) and stroke participants (r = 0.987, p<0.01) between Visit 1 and Visit 2. Repeated Measures ANOVA showed a significant difference in predicted values between the two visits for healthy adults (47.2 ± 8.4 vs 47.7 ± 8.5 mL∙kg-1∙min-1; p = 0.04) but not for stroke participants (25.0 ± 9.9 vs 25.3 ± 11.4 mL∙kg-1∙min-1; p = 0.65).ConclusionThese results suggest that the exercise response is reliable using the TBRS submaximal exercise test in this cohort of healthy adults and stroke participants.

Purpose/Aim Data from chronic stroke studies have reported reduced blood flow and vascular endothelial function in the stroke affected limb. It is unclear whether these differences are present early after stroke. First, we investigated whether vascular endothelial function in the stroke affected limb would be different from healthy adults. Second, we examined whether between-limb differences in vascular endothelial function existed in the stroke affected arm compared to the non-affected arm. Last, we tested whether reduced vascular endothelial function was related to pro-inflammatory markers that are present early after stroke. Materials and Methods Vascular endothelial function was assessed by flow-mediated dilation (FMD) in the brachial artery within 72 hours post-stroke. All participants withheld medications from midnight until after the procedure. Ultrasound scans and blood draws for pro-inflammatory markers occurred on the same day between 7:30 am and 9:00 am. Results People with acute stroke had significantly lower FMD (4.2% ± 4.6) than control participants (8.5% ± 5.2, p = 0.037). Stroke participants had between limb differences in FMD (4.2% ± 4.6 stroke affected vs 5.3% ± 4.4 non-affected, p = 0.02) whereas the control participants did not. Of the pro-inflammatory markers only vascular cell adhesion molecule-1(VCAM-1) had a significant relationship to FMD (stroke affected limb, r = −0.62, p = 0.03; non-affected limb, −0.75, p = 0.005), but not tumor necrosis factor alpha nor interleukin-6. Conclusions Vascular endothelial function is reduced starting in the early stage of stroke recovery. People with higher levels of VCAM-1 had a lower FMD response.

Background High insulin-like growth factor-1 (IGF-1), measured once during acute-stroke, is associated with greater survival rates and lower stroke severity. However, information is lacking regarding how IGF-1 availability, determined by IGF-1’s ratio to insulin-like growth factor binding protein-3 (IGFBP-3), relates to recovery and how the response of IGF-1 during the first week of stroke relates to outcomes. The purpose of this study was to determine: 1) the relationship between percent-change in IGF-1 and IGF-1 ratio during the first week of stroke and stroke outcomes; and 2) the difference in percent-change in IGF-1 and IGF-1 ratio in individuals who discharged home and individuals who discharged to inpatient facilities. Methods IGF-1 and IGFBP-3 were quantified from blood sampled twice (<72 hours of admission; 1-week post-stroke) in fifteen individuals with acute-stroke. Length of stay, modified Rankin Scale at one-month, and discharge destination were obtained from electronic medical records. Results Percent-change in IGF-1 ratio was related to length of stay (r=.54; p=.04). Modified Rankin Scale (n=10) was related to percent-change in IGF-1 (r=.90; p<.001) and IGF-1 ratio (r=.75 p=.01). Those who went home (n=7) had decreases in IGF-1 (−24±25%) and IGF-1 ratio (−36±50%), while those who went to inpatient facilities (n=8) had increases in IGF-1 (37±46%) and IGF-1 ratio (30±40%). These differences were significant (IGF-1: p=.008; IGF-1 ratio p=.01). Conclusion Our findings suggest that a decrease in IGF-1 and IGF-1 ratio during the first week of stroke is associated with favorable outcomes: shorter length of stay, greater independence at one-month on the modified Rankin Scale, and discharging home.

Remote limb ischemic conditioning (RLIC) is a clinically feasible method in which brief, sublethal bouts of ischemia protects remote organs or tissues from subsequent ischemic injury. A single session of RLIC can improve exercise performance and increase muscle activation. The purpose of this study, therefore, was to assess the effects of a brief, two-week protocol of repeated RLIC combined with strength training on strength gain and neural adaptation in healthy young adults. Participants age 18-40 years were randomized to receive either RLIC plus strength training (n = 15) or sham conditioning plus strength training (n = 15). Participants received RLIC or sham conditioning over 8 visits using a blood pressure cuff on the dominant arm with 5 cycles of 5 minutes each alternating inflation and deflation. Visits 3-8 paired conditioning with wrist extensors strength training on the non-dominant (non-conditioned) arm using standard guidelines. Changes in one repetition maximum (1 RM) and electromyography (EMG) amplitude were compared between groups. Both groups were trained at a similar workload. While both groups gained strength over time (P = 0.001), the RLIC group had greater strength gains (9.38 ± 1.01 lbs) than the sham group (6.3 ± 1.08 lbs, P = 0.035). There was not a significant group x time interaction in EMG amplitude (P = 0.231). The RLIC group had larger percent changes in 1 RM (43.8% vs. 26.1%, P = 0.003) and EMG amplitudes (31.0% vs. 8.6%, P = 0.023) compared to sham conditioning. RLIC holds promise for enhancing muscle strength in healthy young and older adults, as well as clinical populations that could benefit from strength training.