title: Investigating measures of intensity during a structured upper limb exercise program in stroke rehabilitation: an exploratory study.
abstract: OBJECTIVE
  To use 3 measures of intensity—time, observed repetitions, and wrist accelerometer activity counts—to describe the intensity of exercise carried out when completing a structured upper limb exercise program, and to explore whether a relationship exists between wrist accelerometer activity counts and observed repetitions.
  
  
  METHODS
  Observational study design.
  
  
  METHODS
  Rehabilitation center research laboratory.
  
  
  METHODS
  Community-dwelling stroke survivors (N=13) with upper limb hemiparesis.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Time engaged in exercise, total repetitions, and accelerometer activity counts for the affected upper limb.
  
  
  RESULTS
  Mean session time ± SD was 48.5±7.8 minutes. Participants were observed to be engaged in exercises for 63.8%±7.5% of the total session time. The median number of observed repetitions per session was 340 (interquartile range [IQR], 199-407), of which 251 (IQR, 80-309) were purposeful repetitions. Wrist accelerometers showed the stroke survivors' upper limbs to be moving for 75.7%±15.9% of the total session time. Purposeful repetitions and activity counts were found to be significantly correlated (ρ=.627, P<.05).
  
  
  CONCLUSIONS
  Stroke survivors were not actively engaged in exercises for approximately one third of each exercise session. Overall session time may not be the most accurate measure of intensity. Counting repetitions was feasible when using a structured exercise program and provides a clinically meaningful way of monitoring intensity and progression. Wrist accelerometers provided an objective measure for how much the arm moves, which correlated with purposeful repetitions. Further research using repetitions and accelerometers as measures of intensity is warranted.
authors.affiliation: Clinical Practice Research Unit, School of Health, University of Central Lancashire, Preston, United Kingdom. Electronic address: laconnell@uclan.ac.uk.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Connell
authors.affiliation: Clinical Practice Research Unit, School of Health, University of Central Lancashire, Preston, United Kingdom.
authors.forename: Naoimh E
authors.initials: NE
authors.lastname: McMahon
authors.affiliation: Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Simpson
authors.affiliation: Clinical Practice Research Unit, School of Health, University of Central Lancashire, Preston, United Kingdom.
authors.forename: Caroline L
authors.initials: CL
authors.lastname: Watkins
authors.affiliation: Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Janice J
authors.initials: JJ
authors.lastname: Eng
mesh_terms: D061725:Accelerometry; D000368:Aged; D000369:Aged, 80 and over; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation*; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D013997:Time Factors; D034941:Upper Extremity / Q000503:physiopathology
keywords: Exercise; Rehabilitation; Stroke; Time; Upper extremity