title: Cardiovascular fitness is improved post-stroke with upper-limb Wii-based Movement Therapy but not dose-matched constraint therapy.
abstract: Post-stroke cardiovascular fitness is typically half that of healthy age-matched people. Cardiovascular deconditioning is a risk factor for recurrent stroke that may be overlooked during routine rehabilitation. This study investigated the cardiovascular responses of two upper limb rehabilitation protocols.
  
  
  
  Forty-six stroke patients completed a dose-matched program of Wii-based Movement Therapy (WMT) or modified Constraint-induced Movement Therapy (mCIMT). Heart rate and stepping were recorded during early (day 2)- and late (day 12-14)-therapy. Pre- and post-therapy motor assessments included the Wolf Motor Function Test and 6-min walk.
  
  
  
  Upper limb motor function improved for both groups after therapy (WMT p = 0.003, mCIMT p = 0.04). Relative peak heart rate increased from early- to late-therapy WMT by 33% (p < 0.001) and heart rate recovery (HRR) time was 40% faster (p = 0.04). Peak heart rate was higher and HRR faster during mCIMT than WMT, but neither measure changed during mCIMT. Stepping increased by 88% during Wii-tennis (p < 0.001) and 21% during Wii-boxing (p = 0.045) while mCIMT activities were predominantly sedentary. Six-min walk distances increased by 8% (p = 0.001) and 4% (p = 0.02) for WMT and mCIMT, respectively.
  
  
  
  Cardiovascular benefits were evident after WMT as both a cardiovascular challenge and improved cardiovascular fitness. The peak heart rate gradient across WMT activities suggests this therapy can be further individualized to address cardiovascular needs. The mCIMT data suggest a cardiovascular stress response.
  
  
  
  This is the first study to demonstrate a cardiovascular benefit during specifically targeted upper limb rehabilitation. Thus, WMT not only improves upper limb motor function but also improves cardiovascular fitness.
authors.affiliation: a Neuroscience Research Australia , Sydney , Australia.|b School of Medical Sciences, Faculty of Medicine , University of New South Wales , Sydney , Australia.
authors.forename: Terry
authors.initials: T
authors.lastname: Trinh
authors.affiliation: a Neuroscience Research Australia , Sydney , Australia.|b School of Medical Sciences, Faculty of Medicine , University of New South Wales , Sydney , Australia.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Scheuer
authors.affiliation: a Neuroscience Research Australia , Sydney , Australia.|b School of Medical Sciences, Faculty of Medicine , University of New South Wales , Sydney , Australia.
authors.forename: Angelica G
authors.initials: AG
authors.lastname: Thompson-Butel
authors.affiliation: a Neuroscience Research Australia , Sydney , Australia.|b School of Medical Sciences, Faculty of Medicine , University of New South Wales , Sydney , Australia.
authors.forename: Christine T
authors.initials: CT
authors.lastname: Shiner
authors.affiliation: a Neuroscience Research Australia , Sydney , Australia.|b School of Medical Sciences, Faculty of Medicine , University of New South Wales , Sydney , Australia.
authors.forename: Penelope A
authors.initials: PA
authors.lastname: McNulty
mesh_terms: D000328:Adult; D000368:Aged; D000072599:Cardiorespiratory Fitness / Q000502:physiology*; D003198:Computer Simulation; D026241:Exercise Movement Techniques / Q000295:instrumentation / Q000379:methods*; D005081:Exercise Therapy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D020521:Stroke / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000295:instrumentation / Q000379:methods*; D034941:Upper Extremity / Q000503:physiopathology*
keywords: Aerobic exercise; Cardiac stress response; Heart rate; Heart rate recovery; Rehabilitation; Stroke; Upper extremity