Physical fitness training for stroke patients

Saunders, David H.; Greig, Carolyn; Mead, Gillian; Young, Archie

doi:10.1002/14651858.cd003316.pub3

Cited by 114 publications

(134 citation statements)

References 188 publications

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“…Pre-program fitness levels were below the metabolic energy requirements needed to perform many ADL's [30], but did exceed the 15 ml·kg -1 ·min -1 threshold [31] by program completion. The mean change in VO 2 peak was lower than overall average change of 3.5 ml·kg -1 ·min -1 reported in a recent Cochrane review that combined the results of randomized controlled exercise trials for individuals with stroke [32]. The magnitude of change was, however, comparable to other non-CR exercise interventions that may have used study methodologies other than randomized controlled trials that relied on multiple weekly on-site exercise sessions [13,33-35].…”

Section: Discussionmentioning

confidence: 79%

Feasibility and effects of adapted cardiac rehabilitation after stroke: a prospective trial

Tang

Marzolini

et al. 2010

BMC Neurol

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BackgroundDespite the cardiovascular etiology of stroke, exercise and risk factor modification programs akin to cardiac rehabilitation (CR) are not available. This study aimed to establish the feasibility of adapting a CR model for individuals with mild to moderate stroke disability. A secondary objective was to determine the program's effects on aerobic and walking capacity, and stroke risk factors.MethodsA repeated measures design was used with a 3-month baseline period and 6-month adapted CR intervention (n = 43, mean ± SD age 65 ± 12 years, 30 ± 28 months post stroke). Feasibility was determined by the number of participants who completed the study, occurrence of adverse events and frequency, duration and intensity of exercise performed. To determine effectiveness of the program, outcomes measured included aerobic capacity (VO2peak, ventilatory threshold), 6-Minute Walk Test (6MWT) distance, and risk factors. Descriptive statistics characterized the classes attended and number and intensity of exercise sessions. Paired t-tests, one-factor repeated measures analyses of variance contrasts and chi-square analyses were used to compare changes over time.ResultsTwo participants withdrew during the baseline period. Of the remaining 41 participants who commenced the program, 38 (93%) completed all aspects. No serious adverse effects occurred. Post-intervention, VO2peak improved relative to the stable baseline period (P = 0.046) and the increase in ventilatory threshold approached significance (P = 0.062).ConclusionsCR is feasible after stroke and may be adapted to accommodate for those with a range of post-stroke disability. It is effective in increasing aerobic capacity. CR may be an untapped opportunity for stroke survivors to access programs of exercise and risk factor modification to lower future event risk.Trial registrationClinicalTrials.gov registration number: NCT01067495

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Section: Discussionmentioning

confidence: 79%

Feasibility and effects of adapted cardiac rehabilitation after stroke: a prospective trial

Tang

Marzolini

et al. 2010

BMC Neurol

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“…Previous well-controlled studies in stroke patients investigating effects of strength training on locomotion and postural balance performance have reported little or no effects (Saunders et al 2009). However, these studies did not employ a training strategy optimized for developing explosive strength.…”

Section: Discussionmentioning

confidence: 99%

Neuromuscular performance of paretic versus non-paretic plantar flexors after stroke

et al. 2011

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The objective of this study was to compare the neuromuscular function of the paretic and non-paretic plantar flexors (i.e. soleus, gastrocnemius medialis, lateralis) in chronic stroke patients. It was hypothesized that the contractile rate of force development (RFD) and neural activation, assessed by electromyogram (EMG) and V-waves normalized to the M-wave, and voluntary activation (twitch interpolation) would be reduced during plantar flexor maximum voluntary isometric contraction and that the evoked muscle twitch properties would be reduced in the paretic limb. Ten chronic stroke survivors completed the study. The main findings were that the paretic side showed deteriorated function compared to the non-paretic leg in terms of (1) RFD in all analyzed time windows from force onset to 250 ms, although relative RFD (i.e. normalized to maximum voluntary force) was similar; (2) fast neural activation (for most analyzed time windows), assessed by EMG activity in time windows from EMG onset to 250 ms; (3) V-wave responses (except for gastrocnemius medialis); (4) voluntary activation; (5) the evoked peak twitch force, although there was no evidence of intrinsic muscle slowing; (6) EMG activity obtained at maximal voluntary force. In conclusion, this study demonstrates considerable neuromuscular asymmetry of the plantar flexors in chronic stroke survivors. Effective rehabilitation regimes should be investigated.

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“…Most patients exercised more than 2 but less than 7 h per week. The effects of training as they pertain to secondary stroke prevention, death, dependence and disability after stroke remain unclear [116]. Although secondary prevention programs for stroke patients exist, they are not as well studied or widely available as secondary prevention programs for cardiac patients [117].…”

Section: Physical Exercise In Primary Prevention Of Cvdmentioning

confidence: 99%

Train the Vessel, Gain the Brain: Physical Activity and Vessel Function and the Impact on Stroke Prevention and Outcome in Cerebrovascular Disease

Schmidt¹,

Endres²,

Dimeo

et al. 2013

Cerebrovasc Dis

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The burden of cerebrovascular disease (CVD) is huge and therapeutic options are limited. Physical activity is effective in preventing coronary heart and peripheral artery disease both experimentally and clinically. It is likely that the protective effects of exercise can be extended to both CVD and cognitive impairment. The pleiotropic protective and preventive mechanisms induced by physical activity include increased perfusion as well as mechanisms of collateral recruitment and neovascularization mediated by arterio- and angiogenesis. Physical activity increases the bioavailability of nitric oxide, bone marrow-derived CD34+ cells and growth factors, all of which promote neovascularization. Additionally, shear stress is discussed as a potential mechanism for vessel growth. Moreover, physical activity plays a role in endothelial function and cerebral autoregulation in small- and large-artery CVD. The vascular niche hypothesis highlights the complex interactions of neuro- and angiogenesis for regenerative and repair mechanisms in the human brain. Experimental and clinical studies demonstrate the positive impact of prior physical activity on stroke lesion size and on outcome after stroke. Clinical trials are necessary to further address the impact of physical activity on primary and secondary stroke prevention, outcome and cognitive function.

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Physical fitness training for stroke patients

Cited by 114 publications

References 188 publications

Feasibility and effects of adapted cardiac rehabilitation after stroke: a prospective trial

Feasibility and effects of adapted cardiac rehabilitation after stroke: a prospective trial

Neuromuscular performance of paretic versus non-paretic plantar flexors after stroke

Train the Vessel, Gain the Brain: Physical Activity and Vessel Function and the Impact on Stroke Prevention and Outcome in Cerebrovascular Disease

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