Abstract
BackgroundAfter experiencing a stroke, most individuals also suffer from cardiac disease, are immobile and thus have low endurance for exercise. Aerobic capacity is seriously reduced in these individuals and does not reach reasonable levels after conventional rehabilitation programmes. Cardiovascular exercise is beneficial for improvement of aerobic capacity in mild to moderate stroke. However, less is known about its impact on aerobic capacity, motor recovery, and quality-of-life in severely impaired individuals. The aim of this pilot study is to explore the clinical efficacy and feasibility of cardiovascular exercise with regard to aerobic capacity, motor recovery, and quality-of-life using feedback-controlled robotics-assisted treadmill exercise in non-ambulatory individuals soon after experiencing a stroke.Methods/DesignThis will be a single-centred single blind, randomised control trial with a pre-post intervention design. Subjects will be recruited early after their first stroke (≤20 weeks) at a neurological rehabilitation clinic and will be randomly allocated to an inpatient cardiovascular exercise programme that uses feedback-controlled robotics-assisted treadmill exercise (experimental) or to conventional robotics-assisted treadmill exercise (control). Intervention duration depends on the duration of each subject’s inpatient rehabilitation period. Aerobic capacity, as the primary outcome measure, will be assessed using feedback-controlled robotics-assisted treadmill-based cardiopulmonary exercise testing. Secondary outcome measures will include gait speed, walking endurance, standing function, and quality-of-life. Outcome assessment will be conducted at baseline, after each 4-week intervention period, and before clinical discharge. Ethical approval has been obtained.DiscussionWhether cardiovascular exercise in non-ambulatory individuals early after stroke has an impact on aerobic capacity, motor recovery, and quality-of-life is not yet known. Feedback-controlled robotics-assisted treadmill exercise is a relatively recent intervention method and might be used to train and evaluate aerobic capacity in this population. The present pilot trial is expected to provide new insights into the implementation of early cardiovascular exercise for individuals with severe motor impairment. The findings of this study may guide future research to explore the effects of early cardiovascular activation after severe neurological events.Trial registrationThis trial is registered with the Clinical Trials.gov Registry (NCT01679600).
Highlights
After experiencing a stroke, most individuals suffer from cardiac disease, are immobile and have low endurance for exercise
Whether cardiovascular exercise in non-ambulatory individuals early after stroke has an impact on aerobic capacity, motor recovery, and quality-of-life is not yet known
It has been estimated that stroke will occur in 35% of the population over the age of 65, a group that will increase in proportion due to demographic shifts in most populations [4]
Summary
Most individuals suffer from cardiac disease, are immobile and have low endurance for exercise. It has been estimated that stroke will occur in 35% of the population over the age of 65, a group that will increase in proportion due to demographic shifts in most populations [4] This leads to an increased need for effective rehabilitation programmes to enhance recovery, improve functional status and quality-of-life, while considering the future challenges in worldwide health care economics [5]. These values are 25 to 45% lower than VO2peak in age-matched healthy subjects [15,16] This early and persistent decline in aerobic capacity can delay or inhibit participation in a therapeutic exercise programme, cause difficulties in the rehabilitation process and long-term post-stroke course of care, and limits an individual’s independent performance of functional activities [7,17]
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