Aerobic Exercise Recommendations to Optimize Best Practices in Care After Stroke: AEROBICS 2019 Update

MacKay‐Lyons, Marilyn; Billinger, Sandra A.; Eng, Janice J.; Dromerick, Alex W.; Giacomantonio, Nicholas; Hafer‐Macko, Charlene E.; Macko, Richard F.; Nguyen, Emily; Prior, Peter; Suskin, Neville; Tang, Ada; Thornton, Marianne; Unsworth, K.

doi:10.1093/ptj/pzz153

Cited by 132 publications

(154 citation statements)

References 40 publications

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“…Thirdly, uncertainty on how to progress patients with ongoing cardiovascular risk and comorbid conditions has been identified as a barrier to reaching target HR training zones (Biasin et al, 2014 ). This is further complicated by recommendations to perform maximal exercise testing with electrocardiography monitoring (MacKay-Lyons et al, 2012 ), which is not routinely available in rehabilitation units. Progression within the IFT protocol could be achieved by increasing the complexity of a given functional task (e.g., practice on unstable surface) rather than increasing the target HR.…”

Section: Discussionmentioning

confidence: 99%

“…The body weight supported treadmill GXT protocol was based on the AEROBICS guidelines (MacKay-Lyons et al, 2012 ), which involved: 2 min stages beginning with walking at self-selected speed and 0% treadmill grade for 2 min, followed by a 2.5% increase in grade every 2 min until an incline of 10% was reached and, thereafter, a 0.05 m s −1 increase in speed every 2 min, until test termination. A <10% bodyweight support was used during the GXT to prevent falls.…”

Section: Methodsmentioning

confidence: 99%

“…Attainment of the minimum threshold to be considered moderate intensity exercise (American College of Sports Medicine, 2010 ; MacKay-Lyons et al, 2012 ) was determined after completion of the IFT protocol. The following equations were used to determine if the minimum threshold criteria (MTC) were exceeded based on 40% of

O 2 reserve (

O 2 R), HR reserve (HRR), and HRR calculated from age predicted maximal HR (HRR pred ):…”

Section: Methodsmentioning

confidence: 99%

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Intensifying Functional Task Practice to Meet Aerobic Training Guidelines in Stroke Survivors

et al. 2017

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Objective: To determine whether stroke survivors could maintain workloads during functional task practice that can reach moderate levels of cardiometabolic stress (i.e., ≥40% oxygen uptake reserve (trueV˙O2R) for ≥20 min) without the use of ergometer-based exercise.Design: Cross-sectional study using convenience sampling.Setting: Research laboratory in a tertiary rehabilitation hospital.Participants: Chronic hemiparetic stroke survivors (>6-months) who could provide consent and walk with or without assistance.Intervention: A single bout of intermittent functional training (IFT). The IFT protocol lasted 30 min and involved performing impairment specific multi-joint task-oriented movements structured into circuits lasting ~3 min and allowing 30–45 s recovery between circuits. The aim was to achieve an average heart rate (HR) 30-50 beats above resting without using traditional ergometer-based aerobic exercise.Outcome measures: Attainment of indicators for moderate intensity aerobic exercise. Oxygen uptake (trueV˙O2), carbon dioxide production (trueV˙CO2), and HR were recorded throughout the 30 min IFT protocol. Values were reported as percentage of trueV˙O2R, HR reserve (HRR) and HRR calculated from predicted maximum HR (HRRpred), which were determined from a prior maximal graded exercise test.Results: Ten (3-female) chronic (38 ± 33 months) stroke survivors (70% ischemic) with significant residual impairments (NIHSS: 3 ± 2) and a high prevalence of comorbid conditions (80% ≥ 1) participated. IFT significantly increased all measures of exercise intensity compared to resting levels: trueV˙O2 (Δ 820 ± 290 ml min−1, p < 0.001), HR (Δ 42 ± 14 bpm, p < 0.001), and energy expenditure (EE; Δ 4.0 ± 1.4 kcal min−1, p < 0.001). Also, mean values for percentage of trueV˙O2R (62 ± 19), HRR (55 ± 14), and HRRpred (52 ± 18) were significantly higher than the minimum threshold (40%) indicating achievement of moderate intensity aerobic exercise (p = 0.004, 0.016, and 0.043, respectively).Conclusion: Sufficient workloads to achieve moderate levels of cardiometabolic stress can be maintained in chronic stroke survivors using impairment-focused functional movements that are not dependent on ergometers or other specialized equipment.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

O 2 reserve (

O 2 R), HR reserve (HRR), and HRR calculated from age predicted maximal HR (HRR pred ):…”

Section: Methodsmentioning

confidence: 99%

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Intensifying Functional Task Practice to Meet Aerobic Training Guidelines in Stroke Survivors

et al. 2017

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“…What is known already is that fitness training facilitates secondary prevention of cardiovascular morbidity (Garber et al., ), reduces disability, and improves walking (Saunders et al., ), quality of life (Carin‐Levy, Kendall, Young, & Mead, ), psychosocial functioning (Carin‐Levy et al., ), and adaptation to life after stroke (Reed, Harrington, Duggan, & Wood, ). This evidence underpins guidelines for community‐based exercise after stroke services in the UK (Best et al., ; Poltawski et al., ) and clinical guidelines across the world (Billinger et al., ; MacKay‐Lyons et al., ; Royal College of Physicians Intercollegiate Stroke Working Party, ; Scottish Intercollegiate Guidelines Network, , ; Stroke Foundation, ). These guidelines mainly pertain to ambulatory stroke survivors, however.…”

Section: Introductionmentioning

confidence: 95%

Physical fitness interventions for nonambulatory stroke survivors: A mixed‐methods systematic review and meta‐analysis

et al. 2018

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IntroductionPhysical fitness training after stroke is recommended in guidelines across the world, but evidence pertains mainly to ambulatory stroke survivors. Nonambulatory stroke survivors (FAC score ≤2) are at increased risk of recurrent stroke due to limited physical activity. This systematic review aimed to synthesize evidence regarding case fatality, effects, experiences, and feasibility of fitness training for nonambulatory stroke survivors.MethodsEight major databases were searched for any type of study design. Two independent reviewers selected studies, extracted data, and assessed study quality, using published tools. Random‐effects meta‐analysis was used. Following their separate analysis, qualitative and quantitative data were synthesized using a published framework.ResultsOf 13,614 records, 33 studies involving 910 nonambulatory participants met inclusion criteria. Most studies were of moderate quality. Interventions comprised assisted walking (25 studies), cycle ergometer training (5 studies), and other training (3 studies), mainly in acute settings. Case fatality did not differ between intervention (1.75%) and control (0.88%) groups (95% CI 0.13–3.78, p = 0.67). Compared with control interventions, assisted walking significantly improved: fat mass, peak heart rate, peak oxygen uptake and walking endurance, maximum walking speed, and mobility at intervention end, and walking endurance, balance, mobility, and independent walking at follow‐up. Cycle ergometry significantly improved peak heart rate, work load, peak ventilation, peak carbon dioxide production, HDL cholesterol, fasting insulin and fasting glucose, and independence at intervention end. Effectiveness of other training could not be established. There were insufficient qualitative data to draw conclusions about participants' experiences, but those reported were positive. There were few intervention‐related adverse events, and dropout rate ranged from 12 to 20%.ConclusionsFindings suggest safety, effectiveness, and feasibility of adapted fitness training for screened nonambulatory stroke survivors. Further research needs to investigate the clinical and cost‐effectiveness as well as experiences of fitness training—especially for chronic stroke survivors in community settings.

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“…There is some evidence available regarding the effectiveness of solely aerobic training as secondary prevention. Aerobic training can be any physical training that depends primarily on the aerobic energy-generating process, on the condition that it is of sufficient intensity to maintain or improve physical fitness [16]. Aerobic training is usually performed at target heartrates between 50-85% of heart rate reserve for at least 20 min per session [17,18].…”

Section: Introductionmentioning

confidence: 99%

Effect of aerobic training on vascular and metabolic risk factors for recurrent stroke: a meta-analysis

Brouwer

Wondergem

Otten

et al. 2019

Disability and Rehabilitation

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Aim: This meta-analysis aimed to determine the effect of aerobic training, compared to non-aerobic interventions, on vascular and metabolic risk factors for recurrent stroke. Method: This study was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PRISMA). Searches were performed in PubMed, Embase, Cochrane library and Cinahl up to May 8 th 2019. Randomized clinical trials evaluating the effect of solely aerobic training on vascular and metabolic risk factors for recurrent stroke were included in a meta-analysis if relevant outcomes were reported in at least two articles. Results: Our search resulted in a total of 7381 hits. Eleven outcomes out of nine articles were included in the meta-analysis. A significant positive effect of aerobic training was found on systolic blood pressure (À3.59 mmHg, 95% CI À6.14 to À1.05) and fasting glucose (À0.12 mmol/l, 95% CI À0.23 to À0.02). The effect on systolic blood pressure further improved when only high-quality studies were included (À4.95 mmHg, 95% CI À8.24 to À1.66). Conclusion: Aerobic training results in a significant positive effect on systolic blood pressure and fasting glucose after stroke when compared to non-aerobic usual care or non-aerobic exercise. ä IMPLICATIONS FOR REHABILITATION Aerobic training has a positive effect on two of the most important vascular risk factors for recurrent stroke (i.e., systolic blood pressure and fasting glucose). The effect of solely aerobic training seems to be comparable to the effect of combined strength exercise and aerobic training for systolic blood pressure and fasting glucose. Since aerobic training has a significant effect on risk factors for recurrent stroke, implementation of aerobic training in daily life is important to reduce long term stroke risk. Previous research has showed that other metabolic risk factors can be altered by other interventions (e.g., strength exercise or lifestyle coaching), therefore, post-stroke prevention programs should be tailored in order to target specific risk-factors for individual patients.

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Aerobic Exercise Recommendations to Optimize Best Practices in Care After Stroke: AEROBICS 2019 Update

Cited by 132 publications

References 40 publications

Intensifying Functional Task Practice to Meet Aerobic Training Guidelines in Stroke Survivors

Intensifying Functional Task Practice to Meet Aerobic Training Guidelines in Stroke Survivors

Physical fitness interventions for nonambulatory stroke survivors: A mixed‐methods systematic review and meta‐analysis

Effect of aerobic training on vascular and metabolic risk factors for recurrent stroke: a meta-analysis

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