Guided short-interval high-intensity exercise could improve outcomes after stroke
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Key takeaways:
- Short-interval high-intensity exercise improved peak VO2 more vs. moderate-intensity training after stroke.
- A high-intensity exercise intervention may improve future stroke outcomes in high-functioning patients.
Short-interval high-intensity exercise after stroke improved oxygen consumption and may reduce risk for future strokes and hospitalizations, according to a study published in Stroke.
“This is the first randomized trial to examine a time-efficient, high-intensity interval training program to incorporate a phased and progressive approach,” Ada Tang, PhD, a physiotherapist, professor and assistant dean of rehabilitation science at McMaster University in Hamilton, Ontario, Canada, said in a press release. “We also used an adaptive recumbent stepper, which we believe allowed more people to participate in high-intensity interval training, even those who cannot walk fast enough or long enough on a treadmill.”
Exercise after stroke
To compare the effects of short-interval high-intensity training and moderate-intensity continuous training on outcomes after stroke, the researchers randomly assigned 82 patients from multiple sites to either of the two interventions (mean age, 65 years; 39% women). Participants underwent randomization on average 1.8 years after stroke.
The interventions were conducted three times per week for 12 weeks, with an additional 8 weeks of follow-up.
Exercise training for all was conducted on adaptive recumbent steppers (NuStep T4r, NuStep LLC).
The short-interval high-intensity intervention involved 10 1-minute exercise intervals, separated by nine 1-minute low-intensity intervals. The intervention targeted a heart rate reserve of 80% and increased by 10% every 4 weeks up to 100%, whereas the low-intensity intervals targeted a 30% heart rate reserve.
The moderate-intensity intervention involved a traditional protocol for continuous training for stroke rehabilitation, with a targeted heart rate reserve of 40% for 20 minutes, which increased by 10% and 5 minutes every 4 weeks up to a heart rate reserve of 60% for 30 minutes.
Outcomes of interest included peak VO2, CV risk factors — carotid-femoral pulse wave velocity, BP and waist-hip ratio — 6-minute walk test and 10 m gait speed.
Improved oxygen consumption after stroke
Participants attended 82% of the exercise training sessions, and no adverse events occurred during the study period.
The researchers reported a significant interaction was found for the outcome of peak VO2 at 12 weeks, with the high-intensity interval-training group experiencing greater gains in oxygen consumption (average change, 3.52 mL/kg per minute; 95% CI, 2.47-4.57; P < .001) compared with the moderate-intensity group (average change, 1.71 mL/kg per minute; 95% CI, 0.55-2.86; P = .001; mean between-group difference, 1.81; P = .0004).
Eight weeks after the conclusion of the exercise interventions, researchers reported no significant difference in peak VO2 between the two groups (mean difference, 1.08; 95% CI, 0.26 to 2.42; P = .11).
Moreover, there were no significant differences between the interventions in CV risk factors, 6-minute walk test and 10 m gait speed at any time point, according to the study.
The researchers concluded that the observed improvements in peak VO2 with short-interval high-intensity exercise in this population is within ranges associated with reduced risk for incident stroke and stroke hospitalization.
“This study shows that people with stroke can also benefit from high-intensity interval training,” Kevin Moncion, PhD, a physiotherapist who led this study as part of his doctoral studies at McMaster University, said in the release. “With the right support and guidance, stroke survivors can safely and effectively engage in high-intensity interval training, significantly improving their overall health and recovery.”
The researchers noted that a limitation to the wider applicability of these results is that participants in the present study were high functioning after their respective strokes, and studies in cohorts with more severe physical impairment are needed.
Reference:
- Short, intense bursts of exercise more effective after stroke than steady, moderate exercise. https://newsroom.heart.org/news/short-intense-bursts-of-exercise-more-effective-after-stroke-than-steady-moderate-exercise. Published Aug 8, 2024. Accessed Aug. 8, 2024.
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