Feasibility and effects of adapted cardiac rehabilitation after stroke: a prospective trial

Abstract

BackgroundDespite the cardiovascular etiology of stroke, exercise and risk factor modification programs akin to cardiac rehabilitation (CR) are not available. This study aimed to establish the feasibility of adapting a CR model for individuals with mild to moderate stroke disability. A secondary objective was to determine the program's effects on aerobic and walking capacity, and stroke risk factors.MethodsA repeated measures design was used with a 3-month baseline period and 6-month adapted CR intervention (n = 43, mean ± SD age 65 ± 12 years, 30 ± 28 months post stroke). Feasibility was determined by the number of participants who completed the study, occurrence of adverse events and frequency, duration and intensity of exercise performed. To determine effectiveness of the program, outcomes measured included aerobic capacity (VO2peak, ventilatory threshold), 6-Minute Walk Test (6MWT) distance, and risk factors. Descriptive statistics characterized the classes attended and number and intensity of exercise sessions. Paired t-tests, one-factor repeated measures analyses of variance contrasts and chi-square analyses were used to compare changes over time.ResultsTwo participants withdrew during the baseline period. Of the remaining 41 participants who commenced the program, 38 (93%) completed all aspects. No serious adverse effects occurred. Post-intervention, VO2peak improved relative to the stable baseline period (P = 0.046) and the increase in ventilatory threshold approached significance (P = 0.062).ConclusionsCR is feasible after stroke and may be adapted to accommodate for those with a range of post-stroke disability. It is effective in increasing aerobic capacity. CR may be an untapped opportunity for stroke survivors to access programs of exercise and risk factor modification to lower future event risk.Trial registrationClinicalTrials.gov registration number: NCT01067495

Physical Activity and Exercise Recommendations for Stroke Survivors

“…206 The application of cardiac rehabilitation models to stroke has been the focus of recent work. Studies have established the feasibility and effectiveness of adapting exercise-based cardiac rehabilitation interventions for individuals with mild to moderate disability from stroke, 172,207 and comprehensive models that integrate exercise, lifestyle modification, and medications have been shown to be beneficial for individuals after TIA or stroke with little to no residual deficits. 68,208 Larger clinical trials are currently under way to examine whether similar models of care involving exercise and risk factor modification can be adapted and implemented among individuals with TIA or a broader range of clinical presentation after stroke.…”

Physiotherapy Needs Assessment of People with Stroke Following Discharge from Hospital, Stratified by Acute Functional Independence Measure Score

“…29 It is also clear from the evidence that this impairment is amenable to physiotherapy treatment. 30 In addition to referral to traditional outpatient physiotherapy programmes, in-patient therapists may recommend participation in cardiac-rehabilitation-style programmes 31 or referral to community-based exercise programmes. 32 …”

Elements of patient–health-care provider communication related to cardiovascular rehabilitation referral

“…Participation in CR programs have been shown to reduce mortality by about 25%-30% and to have favorable effects on re-hospitalization and functional capacity (Grace et al, 2008). Emerging evidence supports the feasibility, safety and benefits of CR for transient ischemic attack/mild non-disabling stroke patients as well (Lennon et al, 2008;Prior et al, 2011;Tang et al, 2010).…”