Step Number and Aerobic Minute Exercise Prescription and Progression in Stroke: A Roadmap

Abstract

Background While higher therapeutic intensity improves motor recovery after stroke, translating findings from successful studies is challenging without clear exercise intensity targets. We show in the DOSE trial 1 more than double the steps and aerobic minutes within a session can be achieved compared with usual care and translates to improved long-term walking outcomes. Objective We modeled data from this successful higher intensity multi-site RCT to develop targets for prescribing and progressing exercise for varying levels of walking impairment after stroke. Methods In twenty-five individuals in inpatient rehabilitation, twenty sessions were monitored for a total of 500 one-hour physical therapy sessions. For the 500 sessions, step number and aerobic minute progression were modeled using linear mixed effects regression. Using formulas from the linear mixed effects regression, targets were calculated. Results The model for step number included session number and baseline walking speed, and for aerobic minutes, session number and age. For steps, there was an increase of 73 steps per session. With baseline walking speed, for every 0.1 m/s increase, a corresponding increase of 302 steps was predicted. For aerobic minutes, there was an increase of .56 minutes of aerobic activity (ie, 34 seconds) per session. For every year increase in age, a decrease of .39 minutes (ie, 23 seconds) was predicted. Conclusions Using data associated with better walking outcomes, we provide step number and aerobic minute targets that future studies can cross-validate. As walking speed and age are collected at admission, these models allow for uptake of routine measurement of therapeutic intensity. Registration: www.clinicaltrials.gov ; NCT01915368.

Präzisionsrehabilitation im Neuroreha-Alltag

“…Je nach Fitnesszustand der Patienten soll anschließend mit leichter (<40% HRR) oder moderater Intensität (40–60% HRR) gestartet und das Training über die kommenden Wochen graduell intensiviert werden. Das kontinuierliche Monitoring soll es in Zukunft erlauben, dass die Ausdauer patientenspezifisch optimiert wird und durch die zugeschnittene Trainingsintensität bessere Langzeitergebnisse erzielt werden können 18 . In Kombination mit weiteren Daten, wie z.…”

Blood pressure trajectory of inpatient stroke rehabilitation patients from the Determining Optimal Post-Stroke Exercise (DOSE) trial over the first 12 months post-stroke

“…However, the effect of these high repetition gait training interventions at aerobic intensities on BP remain unclear. The Determining Optimal Post-Stroke Exercise (DOSE) randomized controlled trial showed evidence of greater improvements in walking recovery among those receiving high repetition gait training at aerobic intensities (i.e., progression to at least 2,000 steps and at least 30 min of 40–60% HRR per session) during inpatient rehabilitation, compared with usual care ( 20 , 23 ). In this secondary analysis, we aimed to determine the effect of high repetition gait training at aerobic intensities on the BP trajectory over the first 12 months post-stroke in participants from the DOSE trial.…”