EP 3. Impact of energy expenditure and cognitive function on long- term outcome after stroke

Abstract

Introduction Stroke leads to lesion-induced deficits like hemiparesis and aphasia. Furthermore patients suffer from low aerobic endurance and high energy expenditure of walking as well as from cognitive decline. Motor and Activity of daily living (ADL) rehabilitation might be negatively impacted by these factors. Here, our aim was to evaluate how (a) energy expenditure of walking and (b) cognitive function in the subacute phase after stroke correlate to long-term outcomes (gait speed, activities of daily life). Method The presented data was drawn from the ongoing multi-center RCT PHYS-Stroke (NCT01953549) as shown in Fig. 1 . Cost of walking was determined during the Six-Minute Walk Test while wearing a mobile spirometry, overall cognitive function was determined via the Montreal Cognitive Assessment (MoCA). Main outcome of the RCT were gait speed (GS) and Barthel Index (BI) at 3 months post stroke. Correlation was calculated between Baseline Values of energy expenditure and MoCA as independent variables and gait speed and Barthel Index as dependent variables using Spearman’s Rho. The Main hypothesis was tested with a linear Model using log-transformation and age and VO2Peak as control variables. Results Overall, patients improved in gait speed (.18 m/sec; CI .07–.37), BI (30 points; CI 20–35) and in 6 min Walk-Distance (38 m; CI 5–84). Lower values of energy expenditure at baseline were associated with both higher gait speed and higher Barthel Index score as seen in Fig. 2 . After fitting a Linear Model results remained significant in gait speed (Est -.68, SE .11, p Discussion Within this preliminary analysis we aimed to evaluate how (a) energy expenditure of walking and (b) cognitive function in the subacute phase after stroke correlate to long-term outcomes. We found that high energy expenditure during walking seems to be negatively associated to gait speed and Barthel Index over time. Taken together, stroke survivors with high energy expenditure seem to be less likely to regain independent ambulation. Our ongoing interventional trial will demonstrate if aerobic training in the subacute phase will beneficially influence energy expenditure and subsequently BI and gait speed. Further analysis will provide information if aerobic training will influence cognition directly after the intervention and in the long-run.