Cardiovascular Responses Associated with Daily Walking in Subacute Stroke

Abstract

Despite the importance of regaining independent ambulation after stroke, the amount of daily walking completed during in-patient rehabilitation is low. The purpose of this study is to determine if (1) walking-related heart rate responses reached the minimum intensity necessary for therapeutic aerobic exercise (40%–60% heart rate reserve) or (2) heart rate responses during bouts of walking revealed excessive workload that may limit walking (>80% heart rate reserve). Eight individuals with subacute stroke attending in-patient rehabilitation were recruited. Participants wore heart rate monitors and accelerometers during a typical rehabilitation day. Walking-related changes in heart rate and walking bout duration were determined. Patients did not meet the minimum cumulative requirements of walking intensity (>40% heart rate reserve) and duration (>10 minutes continuously) necessary for cardiorespiratory benefit. Only one patient exceeded 80% heart rate reserve. The absence of significant increases in heart rate associated with walking reveals that patients chose to walk at speeds well below a level that has meaningful cardiorespiratory health benefits. Additionally, cardiorespiratory workload is unlikely to limit participation in walking. Measurement of heart rate and walking during in-patient rehabilitation may be a useful approach to encourage patients to increase the overall physical activity and to help facilitate recovery.

Cardiorespiratory Stress is not Achieved During Routine Physiotherapy in Chronic Stroke

“…Similar duration and intensity of routine physiotherapy were found by previous studies [3][4][5]. For example, maximum average HRR achieved in the present study (32%) was similar to 35% reported by Kuys et al [4] for stepping.…”

“…There are now four international studies [3][4][5], including the present one (Canada, Australia, Brazil) that informed us that physiotherapists do not do it. Why?…”

“…Then, the resting heart rate was recorded for each participant after five minutes of sitting. Heart rate was continuously measured and manually recorded after the end of each performed activity [5]. If the activity continued for longer than 10 minutes, additional heart rate measures were recorded at 10-minute intervals.…”

“…Furthermore, it appears both feasible and safe [2] and, can therefore, be confidently included in physiotherapy rehabilitation for stroke survivors. Despite this, previous studies have demonstrated that the extent of cardiorespiratory stress induced by routine inpatient physiotherapy rehabilitation is low [3][4][5]. As people with chronic stroke are able to achieve minimum recommended exercise levels [6], it would seem reasonable to expect that cardiorespiratory fitness training would be a focus of physiotherapy rehabilitation in the chronic phase following stroke.…”

“…In Canada, patients spent three (SD 1) minutes within the targeted heart rate zones per physiotherapy session, i.e., above 40% of the heart rate reserve (HRR) [3]. More recently, Prajapati et al [5] found that things had not changed in 10 years; i.e., patients did not meet the minimum cumulative requirements of walking intensity (>40% HRR) and duration (>10 minutes) continuously. In Australia, patients spent only 22 minutes in standing and walking activities at 24% of their HRR per physiotherapy session [4].…”