Total Body Recumbent Stepper Research Articles

Tai Chi as a complementary exercise for pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomised controlled trial

ObjectivesWith the characteristics of mindfulness and breathing techniques, Tai Chi has been recommended with therapeutic values in chronic obstructive pulmonary disease (COPD). However, its strengths as a complementary exercise for conventional pulmonary rehabilitation (PR) remain unclear. Design and settingThis single-blinded randomised controlled trial recruited patients with mild to severe stable COPD. Eligible participants were randomly assigned to the group with usual care (control), total body recumbent stepper (TBRS) exercise, Tai Chi (TC), or combined TBRS exercise and Tai Chi (TBRS-TC). Patients received a two-month hospital-based supervised exercise, followed by a ten-month community- or home-based rehabilitation program. ResultsA total of 120 participants were recruited, and 102 were included in the per-protocol analysis. The mean changes in St George’s Respiratory Questionnaire (SGRQ) total score from baseline to the post-hospital exercise in the control group, TBRS group, TC group, and TBRS-TC group was 2.62 (95 % CI −8.99 to 8.99), −9.28 (95 % CI −13.96 to −4.60), −10.19 (95 % CI −13.72 to −6.67), and −16.75 (95 % CI −20.25 to −13.24), respectively, with a statistically significant difference between groups in favor of the TBRS-TC exercise (P < 0.001). The remarkable effect of TBRS-TC exercise in improving the quality of life maintained until the end of the community- or home-based rehabilitation training (P < 0.001). Besides, a statistically better effect with the TBRS-TC exercise was also observed in the outcomes regarding exercise capacity, pulmonary function, symptom burden, and systemic inflammation after the whole process of 12-month integrative PR exercise programme. ConclusionsBased on the results, a novel integrated exercise modality combining Tai Chi and conventional pulmonary rehabilitation was developed. It might contribute to more positive effects in patients with stable COPD. RegistrationThe study was registered with the Chinese Clinical Trial Registry (ChiCTR-IOR-15006874) prior to commencing recruitment.

Effect of modified Total Body Recumbent Stepper training on exercise capacity and thioredoxin in COPD: a randomized clinical trial

Exercise intolerance is one of the major symptoms of chronic obstructive pulmonary disease (COPD). Exercise training can benefit COPD patients, but the underlying mechanism remains unclear. The modified Total Body Recumbent Stepper (TBRS, Nustep-T4) can benefit patients with stroke, spinal cord injury and amyotrophic lateral sclerosis. Nevertheless, the effect of TBRS training alone on pulmonary rehabilitation (PR) in COPD patients remains largely unknown. We aimed to explore the effect of TBRS training on exercise capacity and the thioredoxin system (TRXS) in COPD patients to provide a novel rehabilitation modality and new theoretical basis for PR of COPD patients. Ninety stable COPD patients were randomly divided into a control group (NC group) and a TBRS training group (TBRS group), with 45 cases in each group. Subjects in the TBRS training group were scheduled to undergo TBRS endurance training triweekly for 12 weeks under the guidance of a rehabilitation therapist. We assessed the primary outcome: exercise capacity (6-min walking distance, 6MWD); and secondary outcomes: perception of dyspnoea (mMRC, Borg), the COPD assessment test (CAT), the BODE index, pulmonary function, the number of acute exacerbations of COPD and oxidative stress (TRXS) at one-year follow-up. Compared with before the intervention and the control group, after the intervention, the TBRS training group, exhibited an increase in the 6MWD (from 366.92 ± 85.81 to 484.10 ± 71.90, 484.10 ± 71.90 vs 370.63 ± 79.87, P < 0.01), while the scores on the BORG, mMRC, BODE index, CAT, and the number of acute exacerbations of COPD were reduced, and the protein and mRNA expression levels of TRXS was significantly increased (P < 0.01). However, no differences were found in PF parameters in the comparison with before the intervention or between groups. TBRS training can effectively increase exercise capacity, while there are indications that it can alleviate COPD-related dyspnoea and reduce the number of acute exacerbations of COPD. Interestingly, long-term regular TBRS training may reduce oxidative stress associated with COPD to increase exercise capacity.

Recumbent stepping aerobic exercise in amyotrophic lateral sclerosis: a pilot study

Aerobic exercise can promote neuroplastic responses in the healthy and injured brain. Although the role of exercise in amyotrophic lateral sclerosis (ALS) is debated, new evidence suggests that exercise may reduce disease progression. While common exercise modalities such as the treadmill and cycle ergometer have been explored in ALS, the safety and feasibility of a total body recumbent stepper have not been investigated. Additionally, the functional and neurophysiological effects of recumbent stepping in ALS are still unknown. Here, we investigated the safety and feasibility of a 4-week recumbent stepping program to slow disease progression in ALS and possibly facilitate neuroplasticity. Nine individuals with ALS performed moderate intensity recumbent stepping for four weeks. Outcomes included participation satisfaction questionnaire, ALS Functional Rating Scale Revised (ALSFRS-R), clinical tests of walking and endurance, fatigue severity scale, Beck depression inventory, SF-12, and transcranial magnetic stimulation-induced motor evoked potentials (MEPs). All measurements were collected at baseline, post-intervention, and at the 1-month follow-up. Eight participants completed the study without any adverse events. The ALSFRS-R scores were similar at the end of the study and at follow-up. No significant differences were noted for any of the clinical outcomes. MEPs were present only in two participants and changes in corticomotor excitability after exercise were minimal. Results from this preliminary study support the safety and feasibility of 12 sessions of total body recumbent stepping in individuals with ALS.

Environmental temperature and exercise modality independently impact central and muscle fatigue among people with multiple sclerosis.

BackgroundHeat sensitivity and fatigue limit the ability of multiple sclerosis patients to participate in exercise.ObjectiveThe purpose of this study was to determine the optimal aerobic exercise parameters (environmental temperature and exercise modality) to limit exercise-induced central and muscle fatigue among people with multiple sclerosis.MethodsFourteen people with multiple sclerosis with varying levels of disability completed four randomized exercise sessions at 65% of the maximal volume of oxygen: body-weight supported treadmill cool (16°C), body-weight supported treadmill room (21°C), total-body recumbent stepper cool and total-body recumbent stepper room. Maximum voluntary contraction, electromyography, and evoked contractile properties were collected from the more affected plantar flexors along with subjective levels of fatigue, body temperature and perceived level of exertion.ResultsExercise in cooler room temperature increased maximum voluntary contraction force (p = 0.010) and stabilized body temperature (p = 0.011) compared to standard room temperature. People with multiple sclerosis experienced greater peak twitch torque (p = 0.047), shorter time to peak twitch (p = 0.035) and a longer half relaxation time (p = 0.046) after total-body recumbent stepper suggestive of less muscle fatigue.ConclusionCooling the exercise environment limits the negative effects of central fatigue during aerobic exercise and using total-body recumbent stepper (work distributed among four limbs) rather than body-weight supported treadmill lessens muscular fatigue. Therapists can titrate these two variables to help people with multiple sclerosis achieve sufficient exercise workloads.

Exercise Training in Progressive Multiple Sclerosis: A Comparison of Recumbent Stepping and Body Weight-Supported Treadmill Training.

Background: There is evidence of the benefits of exercise training in multiple sclerosis (MS); however, few studies have been conducted in individuals with progressive MS and severe mobility impairment. A potential exercise rehabilitation approach is total-body recumbent stepper training (TBRST). We evaluated the safety and participant-reported experience of TBRST in people with progressive MS and compared the efficacy of TBRST with that of body weight-supported treadmill training (BWSTT) on outcomes of function, fatigue, and health-related quality of life (HRQOL). Methods: Twelve participants with progressive MS (Expanded Disability Status Scale scores, 6.0-8.0) were randomized to receive TBRST or BWSTT. Participants completed three weekly sessions (30 minutes) of exercise training for 12 weeks. Primary outcomes included safety assessed as adverse events and patient-reported exercise experience assessed as postexercise response and evaluation of exercise equipment. Secondary outcomes included the Multiple Sclerosis Functional Composite, the Modified Fatigue Impact Scale, and the Multiple Sclerosis Quality of Life-54 questionnaire scores. Assessments were conducted at baseline and after 12 weeks. Results: Safety was confirmed in both exercise groups. Participants reported enjoying both exercise modalities; however, TBRST was reviewed more favorably. Both interventions reduced fatigue and improved HRQOL (P ≤ .05); there were no changes in function. Conclusions: Both TBRST and BWSTT seem to be safe, well tolerated, and enjoyable for participants with progressive MS with severe disability. Both interventions may also be efficacious for reducing fatigue and improving HRQOL. TBRST should be further explored as an exercise rehabilitation tool for patients with progressive MS.

Study design for a randomised controlled trial to explore the modality and mechanism of Tai Chi in the pulmonary rehabilitation of chronic obstructive pulmonary disease

IntroductionAlthough pulmonary rehabilitation (PR) is associated with significant clinical benefits in chronic obstructive pulmonary disease (COPD) and has been recommended by guidelines, PR with conventional exercise training has not been...

Development of protocols to estimate maximal oxygen consumption and body composition in individuals with spinal cord injury (884.27)

Cardiovascular complications and obesity are common secondary complications after spinal cord injury (SCI). The measurement of VO2max during graded exercise test is the gold standard to evaluate cardiovascular fitness. Due to the complexity and cost of VO2max measurements, regression equations to estimateVO2max from submaximal tests based on heart rate have been developed. Due to sympathetic impairments secondary to SCI heart rate may not be an accurate tool to use to predict VO2 max in SCI. The aim of this study was to validate a submaximal test based on Ratings of Perceived Exertion (RPE) to predict VO2max for people with SCI. A second aim of this study was to validate current skinfold equations to estimate percentage of body fat (%fat) in this population. Methods: 10 able‐bodied and 12 SCI individuals participated in this study. The standardized test protocols for VO2 max were performed on a total body recumbent stepper (NuStep T4 ergometer). Analysis of the expired gases occurred every 10 seconds. Heart rate was recorded using a Polar heart rate monitor and 3‐lead ECG. RPE was recorded using the Borg 6‐20 scale. Estimation of %fat by skinfold measurements in supine position were compared with values obtained by DXA scans. Results: There was a strong positive correlation between predicted and observed VO2max in able‐bodied subjects using RPE (ρ = 0.86; p蠄0.05) and RPE + watts (ρ = 0.88; p蠄0.05). SCI subjects were able to perform both, the maximal and submaximal protocols, with a cadence of 80 steps per minute. Current validated skinfolds equations underestimate %fat in SCI individuals. Conclusions: The results of this study show promise for the development of submaximal RPE‐based protocols for the prediction of VO2max in this population. Future directions include the examination of protocols ending at RPE 13 and RPE 15 as well as to develop prediction equations for a larger group of individuals with varying levels and severity of SCI. New prediction equations to estimate %fat for SCI need to be developed.

Cross-Validation of the Recumbent Stepper Submaximal Exercise Test to Predict Peak Oxygen Uptake in Older Adults

Submaximal exercise testing can have a greater application in clinical settings because peak exercise testing is generally not available. In previous work, a prediction equation was developed to estimate peak oxygen consumption (Vo2) using a total body recumbent stepper (TBRS) and the Young Men's Christian Association (YMCA) protocol in adults who were healthy. The purpose of the present study was to cross-validate the TBRS peak Vo2 prediction equation in older adults. A cross-sectional study was conducted. Thirty participants (22 female, 8 male; mean age=66.8 years, SD=5.52; mean weight=68.51 kg, SD=13.39) who previously completed a peak exercise test and met the inclusion criteria were invited to participate in the cross-validation study. Within 5 days of the peak Vo2 test, participants completed the TBRS submaximal exercise test. The TBRS submaximal exercise test equation was used to estimate peak Vo2. The variables in the equation included age, weight, sex, watts (at the end of the submaximal exercise test), and heart rate (at the end of the submaximal exercise test). A strong correlation was found between the predicted peak Vo2 and the measured peak Vo2. The difference between the values was 0.9 mL·kg(-1)·min(-1), which was not statistically different. The standard error of the estimate was 4.2 mL·kg(-1)·min(-1). The sample included individuals who volunteered to perform a peak exercise test, which may have biased the results toward those willing to exercise to fatigue. The data suggest the TBRS submaximal exercise test and prediction equation can be used to predict peak Vo2 in older adults. This finding is important for health care professionals wanting to provide information to their patients or clients regarding their fitness level.

Submaximal and Peak Cardiorespiratory Response After Moderate-High Intensity Exercise Training in Subacute Stroke

Reduced cardiovascular fitness post-stroke may negatively impact recovery. There is little information regarding exercise testing performance and cardiorespiratory response to an aerobic exercise intervention in subacute stroke. The purpose of this study was to examine cardiorespiratory response in subacute stroke after an 8-week aerobic exercise intervention using a total body recumbent stepper (TBRS). Nine individuals with mean age 61.2 (SD 4.7) years and mean 66.7 (SD 41.5) days post-stroke completed the exercise intervention. Participants had a mean Fugl-Meyer score of 100.3 (SD 29.3). Outcome measures were obtained at baseline and postintervention. A peak exercise test using a TBRS assessed oxygen consumption, heart rate, and minute ventilation. Participants completed an 8-week exercise intervention on a recumbent stepper 3 times per week at a prescribed heart rate intensity. Submaximal VO2 was significantly lower from baseline to postintervention with a main effect of Study Visit (F1,8 = 8.5, p = 0.02). Heart rate was not significantly different pre- to postintervention. Minute ventilation exhibited no main effect of Study Visit or Test Minute. Moderate-high intensity aerobic exercise in subacute stroke appears to be beneficial for improving cardiovascular outcomes during submaximal performance of an exercise test.

Adapted exercise interventions for persons with progressive multiple sclerosis

Multiple sclerosis (MS) is an immune-mediated neurodegenerative disease that results in a myriad of physical and mental symptoms. Current disease-modifying therapies do not prevent long-term disability accumulation and are particularly ineffective for patients with a progressive disease onset. Exercise may represent an alternative strategy for managing symptoms and disability accumulation, particularly in progressive MS. Whereas the benefits of exercise have been established primarily in ambulatory MS patients with a relapsing disease course, few studies have investigated the benefits of exercise for patients with progressive MS with greater impairment. Therefore, the purpose of this dissertation was to determine the short-term, long-term, and maintenance effects of adapted exercise interventions for patients with progressive MS of high disability, which was addressed by conducting 2 adapted exercise interventions. The first intervention examined the effects of 24 weeks of body-weight-supported treadmill training (BWSTT) on outcomes of physical and mental functioning, fatigue, quality of life (QoL), and brain health. Outcomes were evaluated at baseline, 12 weeks, and 24 weeks following the intervention, and again 12 weeks postintervention. The second intervention evaluated and compared the effects of 12 weeks of total-body recumbent stepper training (TBRST) with BWSTT on outcomes of safety, physical and mental functioning, fatigue, QoL, and equipment preference. Safety of BWSTT and TBRST was established. Significant improvements in fatigue and QoL were observed with both training modalities; however, neither significantly improved physical function. There was some evidence to suggest that long-term BWSTT may improve cognitive performance and brain health, and that TBRST was the preferred exercise modality. Furthermore, most beneficial effects of long-term BWSTT tended not to be maintained when exercise was discontinued. This dissertation established evidence for the potential benefits of BWSTT and TBRST in patients with progressive MS with high disability. BWSTT and TBRST may represent viable alternative strategies for disease management.

Abstract WP316: Submaximal Exercise Test to Predict VO2 Peak in Subacute Stroke

Purpose: Submaximal exercise testing can be an attractive alternative to peak testing especially in clinical environments where a metabolic cart and adequately trained medical staff may not be readily available. We examined the relationship between peak oxygen consumption (VO2 peak) and a predicted VO2 peak value obtained from a submaximal exercise test that we developed for a total body recumbent stepper (TBRS). We hypothesized that in people with subacute stroke, the actual VO2 peak and predicted VO2 peak would have a moderate (r &gt; 0.75) relationship. Methods: Ten individuals in the subacute stage of stroke recovery (68.6+40.1 days post-stroke) and 61.2+ 5.0 years of age participated in the study. Exercise testing using a metabolic cart and the TBRS for the exercise modality was performed on the first day to obtain VO2 peak. We used the Young Men’s Christian Association (YMCA) protocol for the TBRS. The step rate was maintained between 95-100 steps per minute (spm). Participants started the test at 30 watts and resistance was increased every 3 minutes according to the protocol until volitional fatigue, or 85% of age-predicted HR max was achieved. HR was recorded ten seconds prior to the end of the second and third minute of each stage. If the two HR measures were within 5 bpm of each other, participants progressed to the next stage. However, if the difference was greater than 5 bpm, an additional minute was performed to ensure a steady-state. The participants completed the submaximal exercise test within one to two days after the peak exercise test. The workload in watts and HR at the end of the submaximal exercise test along with age, sex and weight (kg) were used in the equation to predict VO2 peak. Results: We found that predicted VO2 peak generated from the submaximal exercise test equation had a strong correlation to the actual VO2 peak (r = 0.80, p = 0.006). Mean peakVO2 (ml*kg-1*min-1) from the exercise test was 22.9 + 7.3 ml*kg-1*min-1 and the predicted mean value was 17.6 + 6.1 ml*kg-1*min-1. Paired t-test revealed a statistically significant difference between these two values (p = 0.005). Conclusion: This preliminary data demonstrates the TBRS submaximal exercise test shows promise for assessing VO2 peak in sub-acute stroke.

Recumbent Stepper Submaximal Exercise Test to Predict Peak Oxygen Uptake

The purpose of this study was to examine the ability of the YMCA submaximal exercise test protocol using a total body recumbent stepper to predict V˙O(2peak). Of 112 individuals initially screened, 110 individuals with low to moderate cardiovascular disease risk met the inclusion criteria for participation in the study. The maximal exercise test used a motorized treadmill and the Bruce or modified Bruce protocol. Oxygen uptake was measured and analyzed through collection of expired gases using a metabolic measurement system. The submaximal exercise test was performed at least 24 h later but no more than 5 d after maximal exercise testing. Participants were instructed to keep a pace of 100 steps per minute and the resistance increase every 3 min according to the protocol until fatigue, or until 85% of HR max was achieved. A cross-validation study was also performed to determine the accuracy of the prediction equation. Using a stepwise regression, we report that V˙O(2peak) can be predicted using a five-element model including age, weight, sex, wattsend_submax, and HRend_submax (F5,69 = 70.31, P < 0.001). We report a strong correlation between the predicted V˙O(2peak) to the actual V˙O(2peak). These data suggest the YMCA submaximal exercise test can be used with the total body recumbent stepper to predict V˙O(2peak) in healthy adults.

Abstract 3433: The Effects of an 8-week Aerobic Exercise Intervention on Cardiovascular Function and Physical Performance in Sub-Acute Stroke - A Preliminary Study

Purpose/Hypothesis: Impaired vascular function and decline in cardiorespiratory (CR) fitness can result in considerable limitations in physical function in people post-stroke. These cardiovascular changes may result from reductions in oxidative capacity, blood flow, and altered muscle fiber type expression in the hemiparetic limb. CR fitness is significantly lower in people with stroke and limits walking speed, endurance and performance of daily activities. Aerobic exercise training is an excellent intervention to improve cardiovascular outcomes in people with stroke. The purpose of this preliminary study was to examine the effects of an 8-week total body recumbent stepper(TBRS) aerobic exercise intervention on vascular function using flow-mediated dilation(FMD), CR fitness, and the 6-minute walk test(6-MWT) during sub-acute stroke. Subjects: We have enrolled 8 participants and 5 have completed the exercise intervention. These 5 individuals (male, n = 3) were 63.0±6.3 years of age; 65.0±45.2 days post-stroke (range: 10-123) and had a total Fugl-Meyer score of 107±22.6. Methods: The exercise intervention consisted of aerobic exercise using the TBRS 3 times/week for 8 weeks. Using the results from the exercise test, target HR range was calculated at 50-59% of HR reserve for the first 4 weeks and then increased to 60-69% of HR reserve for the final 4 weeks. Brachial artery diameter and reactive hyperemia using FMD were assessed in bilateral upper extremities. The vessel was scanned using Doppler ultrasound with a 7.5 Mhz linear array transducer. A pneumatic cuff was placed around the forearm and inflated to suprastolic pressure for 5 minutes. After cuff deflation, images were recorded to the computer for off-line analysis using an automated edge-detection and wall-tracking software. CR fitness was assessed using a metabolic cart during an incremental peak exercise test. To assess physical performance, participants completed a 6-MWT. All outcome measures were assessed at baseline and post-intervention. Results: Preliminary results demonstrated improvements in vascular function, CR fitness and the 6-MWT. Although brachial artery diameter was smaller in the stroke-affected side (3.63±0.52 vs 4.04±0.66), both sides increased in diameter (stroke affected: 3.68±0.44; non-affected: 4.37±0.55) and FMD increased by 7.2% (stroke affected) and 8.6% in non-affected side after the intervention. CR fitness increased by 10%(baseline:15.6±2.8 to 17.2±4.6 ml*kg -1 *min -1 ). The 6-MWT increased from 281±144.1 to 314.3±160.4 (12%) meters. Conclusion: Aerobic exercise in sub-acute stroke appears to be beneficial for improving cardiovascular function and physical performance. Aerobic exercise interventions should be considered an integral component of stroke rehabilitation.

Modified Total-Body Recumbent Stepper Exercise Test for Assessing Peak Oxygen Consumption in People With Chronic Stroke

Assessment of peak oxygen consumption (Vo(2)peak) using traditional modes of testing such as treadmill or cycle ergometer can be difficult in individuals with stroke due to balance deficits, gait impairments, or decreased coordination. The purpose of this study was to quantitatively assess the validity and feasibility of a modified exercise test using a total-body recumbent stepper (mTBRS-XT) in individuals after stroke. A within-subject design, with a sample of convenience, was used. Eleven participants (7 male, 4 female) with a mean of 40.1 months (SD=32.7) after stroke, a mean age of 60.9 years (SD=12.0), and mild to severe lower-extremity Fugl-Myer test scores (range=13-34) completed the study. Participants performed 2 maximal-effort graded exercise tests on separate days using the mTBRS-XT and a cycle ergometer exercise protocol to assess cardiorespiratory fitness. Measurements of Vo(2)peak and peak heart rate (peak HR) were obtained during both tests. A strong relationship existed between the mTBRS-XT and the cycle ergometer exercise test for Vo(2)peak and peak HR (r=.91 and .89, respectively). Mean Vo(2)peak was significantly higher for the mTBRS-XT (16.6 mL x kg(-1) x min(-1)[SD=4.5]) compared with the cycle ergometer exercise protocol (15.4 mL x kg(-1) x min(-1) [SD=4.5]). All participants performed the mTBRS-XT. One individual with severe stroke was unable to pedal the cycle ergometer. No significant adverse events occurred. The mTBRS-XT may be a safe, feasible, and valid exercise test to obtain measurements of Vo(2)peak in people with stroke. Health care professionals may use the mTBRS-XT to prescribe aerobic exercise based on Vo(2)peak values for individuals with mild to severe deficits after stroke.

Validity of a Total Body Recumbent Stepper Exercise Test to Assess Cardiorespiratory Fitness

Maximum oxygen consumption ([latin capital V with dot above]o2max) is the primary measure for cardiorespiratory fitness, and the [latin capital V with dot above]o2max value achieved on the treadmill using the Bruce protocol is considered the gold standard. A novel exercise test using a total body recumbent stepper (TBRS) would be an alternative for measuring [latin capital V with dot above]o2max in healthy individuals. Furthermore, the TBRS exercise test (TBRS-XT) may be beneficial for individuals such as those with stroke, who cannot tolerate a treadmill or cycle ergometer test due to hemiparesis, increased tone in the extremities, or balance deficits. The purpose of the study was to assess the validity and reliability of the TBRS-XT in determining [latin capital V with dot above]o2max in healthy adults. Twenty-two healthy adults (9 women, 13 men; 26.9 +/- 6.1 years of age) participated in 2 maximum exercise tests in random order. One exercise test was performed on the treadmill using the Bruce protocol and the other exercise test was the TBRS-XT. Statistical analysis of the data was conducted using simple linear regression where the response variable was the [latin capital V with dot above]o2max from the Bruce protocol and the predictor variable was the [latin capital V with dot above]o2max from the TBRS-XT. A 95% prediction interval was used to assess the strength of the prediction of [latin capital V with dot above]o2 from the Bruce protocol with R2 = 0.851. Preliminary data suggest that the TBRS-XT may be a valid test to predict [latin capital V with dot above]o2max when treadmill testing is not feasible. This would allow clinicians an alternative method for exercise testing and prescription to promote healthy lifestyle interventions for a variety of patient populations.

USE OF A RECUMBENT STEPPER TO OBTAIN PEAK OXYGEN CONSUMPTION IN PEOPLE WITH STROKE.

Purpose/Hypothesis: People with stroke have decreased cardiorespiratory fitness. Aerobic exercise improves functional mobility, increases participation in leisure activities, and decreases risk factors associated with heart disease and stroke. Assessment of peak oxygen consumption (VO2 peak) using traditional modes of testing such as treadmill or cycle ergometer may prove to be difficult in a variety of populations but more specifically individuals with stroke. Balance deficits, gait impairments, and decreased coordination may limit exercise test performance on traditional modes (ie treadmill, cycle ergometer), which may be less accurate for exercise prescription. In our previous work, 22 healthy adults were recruited to participate in a study comparing the total body recumbent stepper exercise test (TBRS-XT) to the Bruce protocol using a treadmill. The results of that study indicated a strong correlation between the TBRS-XT and Bruce protocol exercise tests. Based on those results in a healthy population, the purpose of this study was to determine if the TBRS-XT is a feasible exercise test protocol to obtain VO2 peak (ml*kg-1*min-1) for individuals with chronic stroke. Subjects: Seven adults (4 males, 3 females; 63.0 ± 11.0 years) with mild to severe stroke (Fugl-Meyer (FM) scores ranged 13–34 for lower extremity) participated in the study. Subjects were an average of 51±38 months post-stroke. Materials/Methods: Subjects participated in two exercise tests on separate days in alternating order to obtain VO2 peak using open circuit spirometry. One exercise test was performed using the TBRS-XT while a cycle ergometer was used for the other exercise test. Data was analyzed using Pearson correlation coefficient and paired t-tests with alpha set at 0.05. Results: No significant differences were observed between the TBRS-XT and cycle ergometer for VO2 peak (15.2 ± 5.9 vs 15.3 ± 4.9 ml * kg-1 * min-1), peak heart rate (138.3 ± 23.8 vs 141.2 ± 19.8 beats *min-1), respiratory exchange ratio (1.1 ± 0.1 vs 1.1 ± 0.1), and exercise time (11.9 ± 2.5 vs 11.9 ± 5.2 minutes). A moderate correlation (0.78) was observed between FM scores and VO2 peak values from the TBRS-XT. One subject (FM score = 18) was unable to perform the cycle ergometer exercise test but was able to complete the TBRS-XT to volitional fatigue. No adverse events were reported during the exercise tests. Conclusions: Data suggest that the TBRS-XT may be a safe, feasible and valid exercise test to obtain VO2 peak in people with stroke. Clinical Relevance: Use of the TBRS-XT allows clinicians to accurately prescribe aerobic exercise based on VO2 peak values for individuals post-stroke with mild to severe deficits as defined by FM scores.

Poster 39: Total body reciprocal training improves hand function in chronic stroke survivors

Objective: To examine changes in hand function of chronic stroke survivors participating in exercise using a total body recumbent stepper (TBRS). Design: Case series. Setting: University medical school. Participants: 11 participants (8 men; age, 61.3±11.0y) >6 months poststroke with mild to moderate hemiparesis (6 with right side involvement). Intervention: An 8-week exercise program using TBRS 3 times a week for 30 minutes per session. Main Outcome Measures: Functional Rating Score (FRS) from the Wolf Motor Function Test and bilateral grip strength measured by dynamometry. Results: Statistical analyses were conducted using a repeated-measures 2×2×4 factorial analysis of variance for factors of gender and the more affected side along with time. Results indicated a significant interaction of the intervention with left grip strength. Left grip strength increased from 13.44±8.92lb to 16.72±7.23lb after intervention. Values were significant at P<.05. The average for right grip strength did not demonstrate significance after intervention. FRS improved, but not significantly. Conclusion: Improvements in function and strength are possible for chronic stroke survivors participating in exercise involving a TBRS.

Effects of Recumbent Stepper Exercise on Blood Pressure, Strength and Mobility in Residents of Assisted Living Communities: A Pilot Study

Objective: To examine the effects of a total body recumbent stepper exercise program on blood pressure, strength and walking speed in elderly, assisted-living residents.Design: A non-experimental (longitudinal) pre-post-test descriptive design was used to determine changes in physical performance measures after 13 weeks of recumbent stepper exercising.Setting: Morningside Assisted-Living Communities in Middle Tennessee.Participants: Thirty-nine volunteer, assisted-living residents with mean age of 85.5 ± 6.6 years, height of 1.6 ± .1 m, and weight of 63.6 ± 9.6 kg.Interventions: Recumbent Stepper exercise program. The residents were classified into two groups based on the total time of exercise logged over the test period. One group exercised less than an average of nine minutes per week while the other group averaged nine or more minutes of exercise per week.Main Outcomes Measures: The residents were tested on physical characteristics, sitting and standing blood pressure, mobility (15.2 meter timed walk), and six strength measurements on a hydraulic exercise machine.Results: Statistically significant differences pre- and post-intervention were found on several measures of blood pressure, strength, and mobility. While residents exercising less than nine minutes per week tended to remain stable or show changes in adverse directions on these measures (e.g., decreased Shoulder Press strength, p < .05), residents exercising at least nine minutes per week demonstrated positive improvements (e.g., Knee Flexion and Back Pulldown, p < .01), as well as increased mobility (p < .01). Statistically significant decreases were also found for measures of sitting and standing blood pressure (p < .05).Conclusions: The results of this study revealed that assisted-living residents who exercised on a recumbent stepper as little as nine minutes per week decreased blood pressure, and increased strength and walking speed. This effect holds true even in the oldest-old individuals.

INCREASES IN CARDIOVASCULAR AND MUSCULAR FITNESS IN RESPONSE TO TOTAL BODY RECUMBENT STEPPING

680 We examined the efficacy of a total body recumbent stepper (TBRS) in developing both cardiovascular and muscular fitness. Twenty-six sedentary adults (48.4±6.4 yrs) were randomized into a non-exercising control group (CON, n=9) or an exercise group (EX, n=17) that trained 3 d/wk for 12 wks using the TBRS. Training intensity & duration progressed weekly from 50% HRRmax for 20 min to 75% HRRmax for 40 min. Max exercise responses were measured during graded incremental tests on a treadmill (TM) and the TBRS to examine specificity of training mode. Muscular strength was measured via a 1 RM test for the leg press (LP), chest press (CP), and seated row (SR). Muscular endurance (END) was evaluated for LP, CP, & SR as the # of reps to failure using 60% of baseline 1 RM. Body comp was assessed using the sum of 7 skinfold technique. After 12 wks of training, significant increases (p<0.05) in relative VO2 max and exercise time were observed in the EX on both the TM (9.3% & 4.8%, respectively) & TBRS (18.2% & 70.5%, respectively). EX significantly increased (p<0.01) 1 RM & END for LP (10.8% & 55.7%, respectively), CP (2.9% & 30.1%, respectively), & SR. (5.2% & 38.8%, respectively). Further, EX significantly decreased % body fat & fat mass and significantly increased lean body mass (p<0.01), whereas the CON did not change for any measure (p>0.05). These data indicate that simultaneous upper and lower body training on the TBRS improves markers of both cardiovascular and muscular fitness and that the adaptations in VO2 max were specific to the training modality. The 18% improvement in VO2 max on the TBRS is comparable to improvements resulting from other modalities using similar training intensity and duration. Supported by NuStep, Inc.

MUSCLE ACTIVATION PATTERNS DURING TOTAL-BODY STEADY-STATE EXECISE

870 Physiological responses to exercise vary with mode and intensity. The standard treadmill and cycle ergometers have allowed researchers to study these responses during walking, running, and cycling. However, newly designed ergometers that combine both upper and lower extremity exercise creates yet another mode of exercise. This new mode of exercise potentially increases the muscle mass used to perform the activity and, therefore, may alter the physiological responses. The purpose of this study was to examine the concentric activation patterns of brachioradialis (BR), triceps (TR), posterior (PD) and anterior deltoid, pectoralis major, latissimus dorsi, vastus lateralis, and rectus femoris muscles located on the right side of the body during steady-state exercise on a total-body recumbent stepper (RS) using surface electromyographic technique. Twelve healthy college students (8M, 4F) exercised at 46% VO2 peak until an equivalent of 300 kcal was expended. Oxygen consumption, heart rate, ratings of perceived exertion, and integrated EMG were monitored continuously, and an average IEMG values were analyzed at the fifth and final minute of exercise. An ANOVA with repeated measures (p<0.05) revealed a significant decrease in force exerted by upper body muscular activity, with significant decreases observed in the BR, TR, and PD muscles. These findings suggest that when exercising on the total-body RS, the degree of muscle activation shifts among various muscles in order to maintain steady-state.