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Aerobic exercise programs improve endurance, walking after stroke
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Stroke survivors improved their aerobic capacity and walking ability after completing group-based aerobic exercise programs that are similar in design and duration to cardiac rehabilitation programs in the U.S.
According to a study published in the Journal of the American Heart Association, group intervention that focused on aerobic activity resulted in a 0.38 (95% CI, 0.27– 0.49) improvement in aerobic capacity. While this exhibited a small positive effect, researchers indicated that group-based aerobic exercise may be an alternative to one-on-one cardiac rehabilitation, regardless of time since stroke, age, sex and initial aerobic capacity. In this study, patients with fewer mobile impairments and higher initial aerobic capacity demonstrated the greatest improvement.
Researchers conducted a systematic review and meta-analysis of 19 studies that included 23 group interventions for survivors of stroke that featured a primary aerobic component. Nearly 500 adults aged 54 to 71 years completed exercise programs similar in nature to cardiac rehabilitation, according to a press release. Participants attended two to three sessions per week for about 3 months. Walking was the most common type of activity, followed by stationary cycling and mixed-mode aerobic exercise, according to the release.
“The study provides a basis for further evaluation of cardiac rehabilitation programs for stroke survivors,” Elizabeth Regan, PT, DPT, board certified clinical specialist in orthopedic physical therapy at the University of South Carolina, told Cardiology Today. “Aerobic activity, including walking, treadmill walking, stationary bicycling, seated stepping or a combination of activities, increases stroke survivor’s endurance over a 12- to 16-week period.”
Researchers analyzed the 23 group interventions, which featured a primary aerobic component with dosage from 18 to 36 visits over 8 to 18 weeks, similar to the cardiac rehabilitation requirements in the U.S.
Measures of aerobic capacity included 6-minute walk test, maximal oxygen consumption (VO2) peak and walking speed. Summary effect sizes and outcomes were calculated for preintervention to postintervention as well as preintervention to follow-up.
Researchers found that the preintervention to postintervention analysis of aerobic capacity improved by 0.38 and the I2 static, used to calculate variance between the 19 studies, showing little variance in effect size between them.
The findings for summary effect size from preintervention to follow-up resulted in a statistically insignificant 0.22 (95% CI, 0.07 to 0.50) improvement and were deemed inconclusive.
When the researchers examined outcomes by activity type, mixed aerobic activity provided the best result, followed by walking. Cycling or recumbent stepping were the least effective. Overall, the researchers observed significant improvements in aerobic endurance and walking ability.
“[The] study findings confirm that stroke survivors, regardless of time since stroke, can continue to make improvements in endurance that can impact their daily lives.
“While further research will confirm the feasibility of integrating stroke survivors, hospitals that have existing cardiac rehabilitation programs with excess capacity could add stroke survivors into their phase 3 programs. Minimal additional resources would be required and include staff training on stroke impairments and, if needed, a referral from physical therapist to provide modifications for mobility impairments,” Regan said. – by Scott Buzby
For more information:
Elizabeth Regan, PT, DPT , can be reached at 921 Assembly St., Columbia, SC 29208; email: eregan@email.sc.edu.
Disclosures: Regan reports no relevant financial disclosures. The other authors report no relevant financial disclosures.
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