Feasibility and adherence to moderate intensity cardiovascular fitness training following stroke: a pilot randomized controlled trial

Abstract

Background Stroke is a leading cause of disability worldwide and the cardiovascular fitness levels of stroke survivors are diminished to an extent that impairs functioning and activities of daily living performance. While cardiovascular training seems an empirically appropriate intervention, the optimal dosage and intensity of cardiovascular training in stroke survivors remains unclear. The aim was to determine the safety and feasibility of moderate-intensity cardiovascular training following stroke, including measurement of adherence to training. Methods A pilot, prospective, patient- and assessor-blinded randomised controlled trial conducted in a tertiary, metropolitan hospital-based community rehabilitation centre. Eligibility criteria included ambulant (> 100 m), 6 weeks-12 months post stroke. Moderate-intensity fitness training or control (low-intensity) exercise was offered biweekly for 12 weeks. Outcome measures included adverse events, peak oxygen uptake (VO2), functional exercise capacity (6-Minute Walk Test, 10-m Walk Test) and health-related quality of life (Short Form-36) and mood (Patient Health Questionnaire, PHQ9). Results Feasibility: Seventy-one (50%) of 141 screened participants were eligible (29% did not agree to participate). Twenty participants (10 intervention, 10 control) were recruited. The median (%; IQR) supervised sessions was 19.5 (81%; 12, 20); and 20 (83%; 19, 22) in the intervention and control groups, respectively. Progression of duration and intensity was limited; mean of 10 sessions to achieve target duration (30 min). There were no adverse events. Baseline peak oxygen uptake (VO2) levels were low (15.94 ml/kg/min). Significant improvements in VO2 peak in both groups were observed (p < 0.05). Although there were no significant between-group differences, this feasibility trial was not powered to detect change. Conclusions Moderate-intensity fitness training was safe but achievement of target duration and intensity was challenging for stroke survivors. A definitive adequately-powered randomised trial is required. Alternative fitness training protocols may need to be explored. Trial registration The trial protocol was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN 12613000822785) on 25/07/2013.

Program of Rehabilitative Exercise and Education to Avert Vascular Events After Non-Disabling Stroke or Transient Ischemic Attack (PREVENT Trial): A Randomized Controlled Trial

“…In a recent community-based exercise trial of ambulatory people post-stroke, participants struggled to achieve and sustain the prescribed dose of exercise. 53 Issues underlying this problem were not explored by the investigators but previously reported personal barriers to exercise post-stroke, including lack of motivation to exercise, health concerns (e.g., fatigue and depression), and motor impairments, may have been contributing factors. 54 The importance of exercise dose to exercise-related outcomes is well documented in older adults 55 (e.g., a robust dose–response relationship is often observed between intensity of aerobic exercise and HDL-C levels 56 ).…”

A Multicenter Randomized Comparison of High-Intensity Interval Training and Moderate-Intensity Exercise to Recover Walking Post-Stroke: Results of the HIT-Stroke Trial

“…In total, participants attended 1,675 (85%) of 1,980 planned treatment sessions and 197 (90%) of 220 planned testing sessions. 67 [62,72] 52 [47,57] 15 [8,22] 0.0002 Block 2 (sessions [13][14][15][16][17][18][19][20][21][22][23][24] 77 [72,82] 59 [54,64] 18 [11,26] <0.0001 Block 3 (sessions [25][26][27][28][29][30][31][32][33][34][35][36] 82 [77,87] 65 [59,70] 17 [10,25] <0.0001…”

“…[6][7][8] Studies also suggest that a more vigorous training intensity (>60% HRR vs 40-60% HRR) could augment outcomes, 9 but that a vigorous intensity can be difficult to achieve and sustain for many persons with stroke. [34][35][36] Thus, high-intensity interval training (HIT) has emerged as a promising strategy for post-stroke locomotor exercise. 37,38 This method involves bursts of fast walking alternated with recovery periods, and is designed to enable higher sustained intensities 39 at lower perceived exertion than high-intensity continuous exercise.…”

Effectiveness of hospital-based low intensity and inspected aerobic training on functionality and cardiorespiratory fitness in unconditioned stroke patients: Importance of submaximal aerobic fitness markers

“…While many studies have found that moderate (40%-59% HRR) and high intensity (60%-84% HRR) aerobic exercise significantly improve exercise capacity, the low intensity (<40% HRR) is prescribed for most people with stroke. [ 12 ] The moderate- intensity fitness training safe but achievement of target duration and intensity was challenging for chronic stroke patients. [ 12 ]…”

“…[ 12 ] The moderate- intensity fitness training safe but achievement of target duration and intensity was challenging for chronic stroke patients. [ 12 ]…”