Most stroke survivors have very low levels of cardiovascular fitness, which limits mobility and leads to further physical deconditioning, increased sedentary behavior, and heightened risk of recurrent stroke. Although clinical guidelines recommend that aerobic exercise be a part of routine stroke rehabilitation, clinical uptake has been suboptimal. In 2013, an international group of stroke rehabilitation experts developed a user-friendly set of recommendations to guide screening and prescription - the Aerobic Exercise Recommendations to Optimize Best Practices in Care after Stroke (AEROBICS 2013). The objective of this project was to update AEROBICS 2013 using the highest quality of evidence currently available. The first step was to conduct a comprehensive review of literature from 2012-2018 related to aerobic exercise poststroke. A working group of the original consensus panel members drafted revisions based on synthesis. An iterative process was used to achieve agreement among all panel members. Final revisions included: (1) addition of 115 new references to replace or augment those in the original AEROBICS document, (2) rewording of the original recommendations and supporting material, and (3) addition of 2 new recommendations regarding prescription. The quality of evidence from which these recommendations were derived ranged from low to high. AEROBICS 2019 Update should make it easier for clinicians to screen for, and prescribe, aerobic exercise in stroke rehabilitation. Clinical implementation will not only help to narrow the gap between evidence and practice but also reduce current variability and uncertainty regarding the role of aerobic exercise in recovery after stroke.

Discussion | Our study findings suggest that the superior efficacy of PDL treatment of PWSs located proximally on the limb might be associated with the more superficial distribution of blood vessels as a result of the thinner epidermis and stratum corneum in this aspect of the limb. These results are consistent with earlier studies 4 suggesting that it is easier to coagulate more superficially distributed vessels. A correlation between laser therapy outcome and the rate of light penetration into the skin was reported. 1 Theoretically, the thicker epidermis and stratum corneum may cause higher scattering and absorption of laser light, resulting in lower efficacy in PWSs located distally on the limb. Thus, therapeutic outcome may be improved by the use of skin thickness-reducing techniques, such as ablative laser treatment, 5 or longerwavelength laser (eg, 755 nm or 1064 nm) when treating PWSs located distally on the limb, even though such approaches may increase the risk of scarring. 6 A limitation of our study is its small sample size.In conclusion, histological assessment of PWSs and their association with the efficacy of PDL treatment between lesions located proximally vs distally on the limb suggests that the differences in blood vessel depth and thickness of the epidermis and stratum corneum might be associated with the variation in therapeutic outcomes in the same patient.

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