Abstract
Background: Cardiorespiratory deconditioning is a well-established sequel of stroke and this may interfere with integration into community. In the chronic phase, when motor recovery has plateaued, rehabilitation should include cardiorespiratory training. Objective: To determine whether physiotherapy rehabilitation in the chronic phase of stroke provides enough stress in terms of duration (>10 min) and intensity (>40% of heart rate reserve - HRR) to induce cardiorespiratory benefits. Methods: Two physiotherapy sessions, at least one week apart, of 20 chronic stroke patients (mean time since the onset of the stroke of 26 months, mean age of 58 years, 45% male) were observed, in terms of duration (time) and intensity (40 %HRR). The activities were categorized as upper limb tasks, standing, stepping, basic walking, and advanced walking. Average duration and intensity for each participant across the two sessions were determined. Results: Lower limb activities, such as standing and walking were undertaken for 25 (SD 5) minutes; comprising 57% of the total session. The remainder of the session was taken up with upper limb activities (27%) or inactivity (16%). None of the activities reached the target intensity, with the highest average intensity being achieved during advanced walking (mean 32% HRR, SD 2). Conclusions: Routine physiotherapy did not provide sufficient duration or intensity to induce cardiorespiratory stress in this group of chronic stroke patients. The evidence practice gap needs to be closed for cardiorespiratory fitness to be trained.
Highlights
Significant cardiorespiratory deconditioning is a well-established sequel of stroke and contributes to disability [1]
The latest update of the Cochrane systematic review on physical fitness showed that cardiorespiratory training during both the acute/subacute and chronic phases improves walking performance [2]
As people with chronic stroke are able to achieve minimum recommended exercise levels [6], it would seem reasonable to expect that cardiorespiratory fitness training would be a focus of physiotherapy rehabilitation in the chronic phase following stroke
Summary
Significant cardiorespiratory deconditioning is a well-established sequel of stroke and contributes to disability [1]. The latest update of the Cochrane systematic review on physical fitness showed that cardiorespiratory training during both the acute/subacute and chronic phases improves walking performance [2]. It appears both feasible and safe [2] and, can be confidently included in physiotherapy rehabilitation for stroke survivors. In Canada, patients spent three (SD 1) minutes within the targeted heart rate zones per physiotherapy session, i.e., above 40% of the heart rate reserve (HRR) [3]. In Australia, patients spent only 22 minutes in standing and walking activities at 24% of their HRR per physiotherapy session [4]. In the chronic phase, when motor recovery has plateaued, rehabilitation should include cardiorespiratory training
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