Outcomes in people after stroke attending an adapted cardiac rehabilitation exercise program: does time from stroke make a difference?
BACKGROUND
Individuals referred to cardiac rehabilitation programs (CRPs) after stroke have demonstrated postprogram improvements in cardiovascular fitness (VO2peak). However, the effect of CRPs on other physiological/quality-of-life outcomes and effect of time from stroke on these results has not been investigated. The objectives of the present study are (1) to evaluate the effects of a CRP in participants with motor impairment after stroke and (2) to explore the effects of elapsed time from stroke on physiological/quality-of-life outcomes.


METHODS
The CRP included 24 weeks of resistance and aerobic training. Primary outcomes in 120 participants, 25.4±42.3 (mean±standard deviation) months after stroke, included 6-minute walk distance (6MWD), VO2peak, timed repeated sit-to-stand performance, and affected-side isometric knee extensor strength (IKES). Secondary measures included gait characteristics (cadence, step lengths, and symmetry), walking speed, balance (Berg Balance Scale), affected-side range of motion (ROM), elbow flexor and grip strength, anaerobic threshold, and perceptions of participation/social reintegration.


RESULTS
After adjusting for multiple comparisons, participants demonstrated significant improvements (all P<.001) in 6MWD (283.2±126.6 to 320.7±141.8 m), sit-to-stand performance (16.3±9.5 to 13.3±7.1 seconds), affected-side IKES (25.9±10.1 to 30.2±11 kg as a percentage of body mass), and VO2peak (15.2±4.5 to 17.2±4.9 mL·kg·min(-1)). Participants also demonstrated post-CRP improvements in secondary outcomes: anaerobic threshold, balance, affected-side hip/shoulder ROM, grip and isometric elbow flexor strength, participation, walking speed, cadence (all P<.001), and bilateral step lengths (P<.04). In a linear regression model, there was a negative association between the change in 6MWD and time from stroke (β=-42.1; P=.002) independent of baseline factors.


CONCLUSIONS
A CRP yields improvements over multiple domains of recovery; however, those who start earlier demonstrate greater improvement in functional ambulation independent of baseline factors. These data support the use of adapted CRPs as a standard of care practice after conventional stroke rehabilitation.
Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario. Electronic address: Susan.marzolini@uhn.ca.
Susan
S
Marzolini
Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, Ontario; School of Rehabilitation Science, McMaster University, Hamilton, Ontario.
Ada
A
Tang
Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, Ontario; Department of Kinesiology, University of Waterloo, Waterloo, Ontario.
William
W
McIlroy
Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, Ontario.
Paul I
PI
Oh
Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, Ontario; Department of Physical Therapy, University of Toronto, Toronto, Ontario.
Dina
D
Brooks
D000368:Aged; D002545:Brain Ischemia / Q000534:rehabilitation*; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
Rehabilitation; stroke care; stroke delivery; stroke recovery