Cardiorespiratory Stress is not Achieved During Routine Physiotherapy in Chronic Stroke

Polese, Janaíne Cunha

doi:10.4172/2329-9096.1000211

Cited by 3 publications

(4 citation statements)

References 29 publications

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“…Most RTP in this study was performed at <40% HRR, which is in alignment with previous studies reporting low aerobic response during physical or occupational therapy ( Barrett et al., 2018 ; MacKay-Lyons & Makrides, 2002a ; Polese et al., 2014 ). Although time spent in an aerobic zone was not associated with improvement in UE impairment or aerobic capacity, in this observational study, the goal of RTP was to provide appropriate motor challenge for functional recovery.…”

Section: Discussionsupporting

confidence: 89%

“…Given that physical and occupational therapy are foundational in stroke rehabilitation, an opportunity exists for these professions to encourage safe and appropriate levels of physical activity in all phases of recovery. Traditional stroke rehabilitation interventions generally are low intensity with only a few minutes spent within in an aerobic zone in typical inpatient and outpatient sessions ( Barrett et al., 2018 ; Kuys et al., 2006 ; MacKay-Lyons & Makrides, 2002a ; Polese et al., 2014 ). However, researchers from these studies estimated aerobic intensity using age-predicted maximum heart rate.…”

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confidence: 99%

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Characterizing Heart Rate Response During Upper Extremity Repetitive Task Practice in Chronic Stroke

Davidson,

Bischof-Bockbrader,

Zimmerman

et al. 2024

The American Journal of Occupational Therapy

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Importance: Although the cardiopulmonary benefits of aerobic exercise poststroke are well-established, typical stroke rehabilitation does not elicit an aerobic response. Objective: To characterize heart rate response during upper extremity repetitive task practice (RTP) and determine factors that predict a higher aerobic intensity during RTP. Design: Secondary analysis of a subset of data from a randomized clinical trial. Setting: Research laboratory in a large academic medical center. Participants: Patients with chronic stroke (N = 19). Intervention: Participants received 90 min of RTP for 24 sessions across 8 wk. Outcomes and Measures: Aerobic intensity as measured by heart rate reserve (HRR) during RTP. Results: A total of 2,968 tasks were included in the analysis. Of the tasks performed, approximately 79.5% elicited a very light aerobic response (<30% HRR), 10.2% elicited a light aerobic response (30%–39% HRR), and 10.3% elicited a moderate to vigorous intensity aerobic response (≥40% HRR). Of the tasks that elicited a moderate to vigorous intensity aerobic response, 54.1% were performed in standing, 79.7% were gross motor in nature, and 27.9% had targets at or above shoulder height. Standing position, targets at or above shoulder height, and gross motor tasks predicted higher HRR (all ps < .001). Conclusions and Relevance: To maximize aerobic intensity during poststroke RTP, therapists should include gross motor tasks trained in standing with targets at or above shoulder height. Plain-Language Summary: The study characterizes heart rate response in stroke rehabilitation and identifies factors that predict a higher aerobic intensity during upper extremity repetitive task practice. Certain task characteristics were more likely to produce an aerobic response, including gross motor, targets at or above the shoulder, and a standing position. Occupational therapists should include gross motor tasks trained in standing with targets at or above shoulder height to maximize aerobic intensity during poststroke repetitive task practice. Monitoring heart rate may improve awareness of aerobic response to training.

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Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

Characterizing Heart Rate Response During Upper Extremity Repetitive Task Practice in Chronic Stroke

Davidson,

Bischof-Bockbrader,

Zimmerman

et al. 2024

The American Journal of Occupational Therapy

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“…Also, direct effects of the stroke itself (eg, hemiparesis), and the hospital environment have an impact on physical activity and fitness. Several studies have shown that inpatients spend little time exercising at the required intensity to elicit cardiovascular benefits . Low CRF levels of people with stroke or TIA limit their ability to engage in rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

“…Despite the known benefits of CRF training, the level of practice intensity during routine physiotherapy sessions in inpatient and outpatient stroke rehabilitation have been shown to be too low to induce a CRF training effect. Our limited knowledge about the safety of exercise training programs for, and the aerobic capacity of, stroke survivors, especially early after stroke onset, may be contributing to this insufficient intensity of therapy.…”

Section: Introductionmentioning

confidence: 99%

Safety of Performing a Graded Exercise Test Early after Stroke and Transient Ischemic Attack

Johnson

Kramer

Catanzariti

et al. 2019

PM&R

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Background: Low cardiorespiratory fitness (CRF) is a predictor of stroke risk and poor outcome poststroke. Fitness levels are rarely assessed in the acute phase and it is unclear if it is safe for stroke survivors and people with transient ischemic attack (TIA) to perform a graded exercise test to assess fitness. Objective: To determine if people within 14 days post stroke can safely perform a graded exercise test. Design: Observational study. Setting: Research institute. Participants: People with stroke or TIA admitted to an acute stroke unit. Intervention: Not applicable. Main Outcome Measures: Safety of performing a graded exercise test early post stroke. Safety outcomes were (1) occurrence of an adverse event or (2) <85% blood oxygen saturation (SpO 2 ). Participants performed a graded exercise test on a recumbent stepper at a research institute <2 weeks postevent. CRF was determined by measuring peak volume of oxygen uptake (VO 2peak ) using a metabolic cart. Results: Twenty-nine participants were enrolled in the study (median age 69 years; interquartile range 58-75). Sixteen were diagnosed with TIA and 13 with a mild stroke. Twenty-eight participants completed the test; one participant was unable to perform the test due to back pain. The test was terminated due to standardized stopping criteria in 26 cases (5 = volitional fatigue, 6 = unable to keep required cadence, 15 = reaching 85% HR max ), one due to safety (ie, SpO 2 < 85%), and one was inadvertently terminated before stopping criteria were reached. Average CRF determined by the exercise test was low; mean VO 2peak of 16.2 AE 4.5 mL/kg/min for men (n = 20) and 12.4 AE 3.6 mL/kg/min for women (n = 8). Conclusions: Determining exercise capacity early post stroke and TIA using a graded exercise test appears to be safe in patients with mild deficits. This information should be useful to plan tailored exercise programs. Further research should focus on determining safety of exercise testing in more severely affected stroke survivors.

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Recommended moderate to vigorous physical activity levels for people in the chronic phase of stroke can be achieved in outpatient physiotherapy: a multicentre observational study

Goncalves,

Le Bourvellec,

Duclos

et al. 2024

Topics in Stroke Rehabilitation

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Cardiorespiratory Stress is not Achieved During Routine Physiotherapy in Chronic Stroke

Abstract: Background: Cardiorespiratory deconditioning is a well-established sequel of stroke and this may interfere with integration into community. In the chronic phase, when motor recovery has plateaued, rehabilitation should include cardiorespiratory training.

Cited by 3 publications

References 29 publications

Characterizing Heart Rate Response During Upper Extremity Repetitive Task Practice in Chronic Stroke

Characterizing Heart Rate Response During Upper Extremity Repetitive Task Practice in Chronic Stroke

Safety of Performing a Graded Exercise Test Early after Stroke and Transient Ischemic Attack

Recommended moderate to vigorous physical activity levels for people in the chronic phase of stroke can be achieved in outpatient physiotherapy: a multicentre observational study

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