Barriers and Facilitators to Aerobic Exercise Implementation in Stroke Rehabilitation: A Scoping Review

Moncion, Kevin; Biasin, Louis; Jagroop, David; Bayley, Mariana; Danells, Cynthia; Mansfield, Avril; Salbach, Nancy M.; Inness, Elizabeth L.; Tang, Ada

doi:10.1097/npt.0000000000000318

Cited by 34 publications

(33 citation statements)

References 30 publications

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“…The use of exercise testing for clinical assessment and exercise prescription is limited in stroke rehabilitation settings 45 , 46 , thus limiting the clinical applicability of our findings. A lack of exercise equipment, time, space, and support staff have also been reported as barriers to exercise testing 45 . Moreover, cardiac, cognitive, functional, and physical impairments in individuals with stroke may make it difficult to perform exercise testing safely 45 .…”

Section: Discussionmentioning

confidence: 95%

“…A lack of exercise equipment, time, space, and support staff have also been reported as barriers to exercise testing 45 . Moreover, cardiac, cognitive, functional, and physical impairments in individuals with stroke may make it difficult to perform exercise testing safely 45 . More specific clinical guidelines for post-stroke exercise testing, educational training associated with exercise testing, and greater collaboration between stroke and cardiac rehabilitation teams could help to implement exercise testing more effectively in stroke rehabilitation settings 45 , 46 .…”

Section: Discussionmentioning

confidence: 99%

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Cardiorespiratory responses to exercise related to post-stroke fatigue severity

Oyake

Baba

Suda

et al. 2021

Sci Rep

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Physical deconditioning after stroke may induce post-stroke fatigue. However, research on this association is limited. Our primary objective was to investigate the associations of post-stroke fatigue severity with oxygen uptake ($$\dot{\mathrm{V}}$$ V ˙ O2) at peak exercise and the time constant of $$\dot{\mathrm{V}}$$ V ˙ O2 kinetics (τ$$\dot{\mathrm{V}}$$ V ˙ O2) at exercise onset. The secondary objective was to examine the associations between fatigue and cardiorespiratory variables potentially affecting $$\dot{\mathrm{V}}$$ V ˙ O2 during exercise. Twenty-three inpatients from a subacute rehabilitation ward were enrolled in this study. The median (interquartile range) Fatigue Severity Scale (FSS) score, as a measure of fatigue, was 32 (range 27–42) points. The FSS score was not associated with $$\dot{\mathrm{V}}$$ V ˙ O2 at peak exercise during a symptom-limited graded exercise test (rho = − 0.264; p = 0.224), whereas it was significantly associated with τ$$\dot{\mathrm{V}}$$ V ˙ O2 during a submaximal constant-load exercise test (rho = 0.530; p = 0.009). A higher FSS score also significantly correlated with a longer time constant of cardiac output (CO) kinetics (rho = 0.476; p = 0.022). Our findings suggest that severe post-stroke fatigue is associated with delayed increases in $$\dot{\mathrm{V}}$$ V ˙ O2 and CO at the onset of exercise. Our findings can contribute to the development of an appropriate rehabilitation programme for individuals with post-stroke fatigue.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Cardiorespiratory responses to exercise related to post-stroke fatigue severity

Oyake

Baba

Suda

et al. 2021

Sci Rep

View full text Add to dashboard Cite

show abstract

“…The use of exercise testing for the clinical assessment and exercise prescription is limited in stroke rehabilitation settings [47,48], limiting the clinical applicability of our findings. A lack of exercise equipment, time, space, and support staff have also been reported as a barrier to exercise testing [47]. In addition, the cardiac, cognitive, functional, and physical impairments in individuals with stroke may make it difficult to perform exercise testing safely [47].…”

Section: Discussionmentioning

confidence: 96%

“…A lack of exercise equipment, time, space, and support staff have also been reported as a barrier to exercise testing [47]. In addition, the cardiac, cognitive, functional, and physical impairments in individuals with stroke may make it difficult to perform exercise testing safely [47]. More specific clinical guidelines for post-stroke exercise testing, educational training associated with exercise testing, and greater collaboration between stroke and cardiac rehabilitation teams can help implement exercise testing in stroke rehabilitation settings [47,48].…”

Section: Discussionmentioning

confidence: 99%

Ability of The Cardiorespiratory System to Adapt to Exercise is Impaired in Individuals With Severe Post-Stroke Fatigue

Oyake

Baba

Suda

et al. 2020

Preprint

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Physical deconditioning after stroke may induce post-stroke fatigue. However, research on this association is limited. Our primary objective was to investigate the associations of post-stroke fatigue with oxygen uptake (⩒O2) at peak exercise and the time constant of ⩒O2 kinetics (τ⩒O2) at the onset of exercise. The secondary objective was to examine the associations between fatigue and cardiorespiratory variables potentially affecting ⩒O2 during exercise. Twenty-three inpatients from a subacute rehabilitation ward were enrolled in this study. The median (interquartile range) Fatigue Severity Scale (FSS) score as a measure of fatigue was 32 (27, 42) points. The FSS score was not associated with ⩒O2 at peak exercise during a symptom-limited graded exercise test (rho = −0.264; p = 0.224), while it was significantly associated with τ⩒O2 during a submaximal constant-load exercise test (rho = 0.530; p = 0.009). A higher FSS score was also significantly correlated with a longer time constant of cardiac output kinetics (rho = 0.476, p = 0.022). These results suggest that the ability of the cardiorespiratory system to adapt to exercise is impaired in individuals with severe post-stroke fatigue. Our findings can contribute to the development of an appropriate rehabilitation program for such individuals.

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“…Furthermore, stroke survivors are not meeting physical activity targets once discharged into the community [ 13 , 14 ]. The limited treatment time available to each patient, and a lack of access to the specialized equipment needed to adapt traditional ergometer-type aerobic exercise for stroke survivors with hemiparesis, are among the barriers to incorporating aerobic exercise during formalized rehabilitation [ 15 ]. Similarly, stroke related impairments limit access to existing exercise programs available at the community level [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Task-Oriented Circuit Training as an Alternative to Ergometer-Type Aerobic Exercise Training after Stroke

Kelly

Chaves

Curtis

et al. 2021

JCM

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Moderate-intensity aerobic exercise training is an important treatment strategy to enhance functional recovery and decrease cardiometabolic risk factors after stroke. However, stroke related impairments limit access to ergometer-type exercise. The aims of the current study were (1) to evaluate whether our task-oriented circuit training protocol (intermittent functional training; IFT) could be used to sustain moderate-intensity aerobic workloads over a 10-week intervention period, and (2) to investigate its preliminary effects on cardiorespiratory fitness and metabolic profiles compared to constant-load ergometer-type exercise (CET). Forty chronic hemiparetic stroke survivors were randomized to receive 30 sessions of IFT or CET over ten weeks. Similar proportions of participants were randomized to IFT (7/19) and CET (9/18) sustained workloads associated with moderate-intensity aerobic exercise over the study period (p = 0.515). However, CET was associated with more substantial changes in maximal oxygen uptake (MD = 2.79 mL min−1 kg−1 CI: 0.84 to 4.74) compared to IFT (MD = 0.62 mL min−1 kg−1 CI: −0.38 to 1.62). Pre to post changes in C-reactive protein (−0.9 mg/L; p =0.017), short-term glycemia (+14.7 mol/L; p = 0.026), and resting whole-body carbohydrate oxidation (+24.2 mg min−1; p = 0.046) were observed when considering both groups together. Accordingly, IFT can replicate the aerobic intensities sustained during traditional ergometer-type exercise training. More work is needed to evaluate the dose–response effects of such task-oriented circuit training protocols on secondary prevention targets across the continuum of stroke recovery.

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Barriers and Facilitators to Aerobic Exercise Implementation in Stroke Rehabilitation: A Scoping Review

Abstract: Provide a structured summary that includes (as applicable): background, objectives, eligibility criteria, sources of evidence, charting methods, results, and conclusions that relate to the review questions and objectives.

Cited by 34 publications

References 30 publications

Cardiorespiratory responses to exercise related to post-stroke fatigue severity

Cardiorespiratory responses to exercise related to post-stroke fatigue severity

Ability of The Cardiorespiratory System to Adapt to Exercise is Impaired in Individuals With Severe Post-Stroke Fatigue

Task-Oriented Circuit Training as an Alternative to Ergometer-Type Aerobic Exercise Training after Stroke

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