Aerobic Exercise Prescription in Stroke Rehabilitation: A Web-Based Survey of US Physical Therapists

Abstract

Background and Purpose Best practice recommendations indicate aerobic exercise (AEX) should be incorporated into stroke rehabilitation. However, this may be challenging in clinical settings. The purpose of this study was to assess physical therapist (PT) AEX prescription for patients with stroke, including AEX utilization, barriers to AEX prescription, dosing parameters and safety considerations. Methods A cross-sectional web-based survey study was conducted. PTs with valid email addresses on file with the state boards of Florida, New Jersey, Ohio, Texas and Wyoming were eligible to participate. Survey invitations were emailed to all licensed PT in these states. Analysis focused on respondents who were currently involved with clinical stroke rehabilitation in common practice settings. Results Results from 568 respondents were analyzed. Most respondents (88%) agreed that AEX should be incorporated into stroke rehabilitation, but 84% perceived at least one barrier. Median prescribed AEX volume varied between practice settings from 20 to 30 minute AEX sessions, 3 to 5 days per week for 2 to 8 weeks. Prescribed intensity was most commonly light or moderate; intensity was determined by the general response to AEX and patient feedback. Only 2% of respondents reported that the majority of their patients with stroke had stress tests. Discussion and Conclusions Most United States PTs appear to recognize the importance of AEX for persons post stroke, but clinical implementation can be challenging. Future studies and consensus are needed to clarify best practices and to develop implementation interventions to optimize AEX utilization in stroke rehabilitation.

Aerobic exercise in adult neuromuscular rehabilitation: A survey of healthcare professionals

“…It is therefore important to note that our respondents used several different methods to determine target intensity. This same pattern was seen among physical therapists in stroke rehabilitation (18,19), and, in line with the large support need with respect to dosing of exercise, it probably reflects the difficulties that healthcare professionals experience related to exercise intensity prescription in NMD. Together with the reported frequent use of unreliable methods to determine individual target intensity in NMD, such as those based on the (age-)predicted maximal heart rate (33,34), this emphasizes the need for the development and more consistent use of methods to determine the intensity and other FITT factors for AE in NMD.…”

“…Substantial underuse was also reported in previous studies by both practitioners (27) and patients (28), even though this concerned general physical therapy treatment in NMD. A study in stroke rehabilitation showed that, despite clear recommendations for moderate-to-vigorous intensity AE, physical therapists commonly prescribed light intensities (19). The authors relate this to safety concerns, which, supported by the perceived barriers in the current study, may also be the case in NMD.…”

“…In designing the questionnaire, we made use of 2 previous surveys on the application of AE in neurological rehabilitation (e.g. stroke, cerebral palsy, spinal cord injury) in Canada (18) and the USA (19) and of a qualitative study on the experiences of patients and physical therapists with AE in post-polio syndrome (16).…”

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“…2,5,6 Again, in stroke rehabilitation, exercise is applied to patients on a Web basis to relieve spasticity and increase function. 1,7 In addition, today there are various web-based approaches developed for a range of chronic health problems, including cardio-vascular disease, chronic obstructive pulmonary disease, cancer, and psychiatric disorders. To date, Web-based rehabilitation practices have been disclosed to be both feasible and acceptable for piloted individuals, other participants and physiotherapists.…”

Delivering Intensive Rehabilitation in Stroke: Factors Influencing Implementation

“…This was echoed in an observational study of therapy sessions which found patients spent a negligible amount of time (2.8+/-0.9 min) in an aerobic training zone 16 . Despite the recognition by physical therapists that aerobic exercise and hence higher intensity rehabilitation is important, clinical implementation remains challenging 17 . A small number of --5 studies have explored this evidence-practice gap by exploring reasons for not implementing intensive exercise 17,18 .…”