DALLAS, January 27, 2021 – Stroke survivors who completed a cardiac rehabilitation program focused on aerobic exercise, currently not prescribed for stroke survivors, significantly improved their ability to transition from a seated to a standing position, and the distance they could walk during a minute walk test, according to new research published today in American Heart Association Journal, an open access newspaper from the American Heart Association.
Cardiac rehabilitation is a structured exercise program prevalent in the United States for people with cardiovascular disease that has been shown to increase cardiovascular endurance and improve quality of life. Despite many similar cardiovascular risk factors, stroke is not among the diagnoses covered for cardiac rehabilitation. Physical inactivity is common among stroke survivors, with more than 75% of all American patients surviving a stroke not receiving the amount of exercise recommended by the guidelines (150 minutes of moderate intensity or 75 minutes of vigorous physical activity per week). Currently, exercise-based cardiac rehabilitation programs are not the standard of care offered to stroke survivors in the U.S.
“Through this study, we hope to improve controllable risk factors for stroke survivors and potentially prevent future stroke and cardiac events,” said the study’s lead author, Elizabeth W. Regan, DPT, Ph.D., professor clinical assistant in exercise science in the physiotherapy program at the University of South Carolina in Columbia, South Carolina. “Increased physical activity is an important way to prevent stroke and we wanted to see if the rehabilitation that patients receive after surviving a heart attack could have similar positive results for patients who survive a stroke.”
The researchers launched a pilot study at a North Carolina medical center to investigate the benefits of a cardiac rehabilitation program for stroke survivors. In total, 24 participants, aged between 33 and 81 years, who had a stroke from three months to 10 years earlier, were enrolled in a cardiac rehabilitation program including aerobic exercise sessions of 30 to 51 minutes three times a week, during three months.
At the beginning of the program, participants were assessed for physical function (cardiovascular endurance, functional strength and walking speed) and other health measures, such as a mental health questionnaire and a balance test. In a post-program evaluation, participants repeated these evaluations. In a six-month follow-up visit, they completed the same tests one last time and answered lifestyle and exercise questionnaires. In the initial post-program evaluation, the researchers found that, compared to the beginning of the study:
Participants noted an improvement in the distance they could walk during a six-minute walk test. On average, each participant improved their distance by 203 feet.
Participants improved their ability to move quickly from a sitting to a standing position in the sit and stand test five times. The improvements in this test correspond to increased leg strength and may correspond to a lower risk of falling for people after a stroke.
Study participants improved the level of metabolic equivalent of the task (MET), or the maximum level of the amount of energy generated by the average person to perform a specific task, by about 3.6. For example, a metabolic task equivalent is defined as the energy needed to watch TV and seven are needed to run.
In the six-month follow-up visit, participants maintained these gains and 83.3% of participants reported that they were still exercising at least once a week.
“Our most important goal as healthcare professionals is to help stroke survivors reduce as many risk factors as possible to prevent future stroke or cardiovascular disease. Based on these preliminary findings, we hope that the cardiac rehabilitation prescription will be considered for everyone patients after a stroke, as it is for patients after a heart attack, “said Regan. “We need to value exercise as a medicine. Exercise is health and is important for each individual, regardless of physical limitations or age. Hopefully, increasing physical activity can be one of the first steps to improving overall health after a stroke. “
This study included a small sample of patients and was a pilot study at a single center in a multicenter health care system; therefore, further studies are needed to confirm these preliminary results.
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Co-authors are Reed Handlery, Ph.D., DPT; Jill C. Stewart, Ph.D., PT; Joseph L. Pearson, Dr.PH; Sara Wilcox, Ph.D .; and Stacy Fritz, Ph.D., PT The author’s disclosures are listed in the manuscript.
This study was funded by the University of South Carolina, the American Heart Association, the American Physical Therapy Association, the Foundation for Physical Therapy Research and the Arnold Fellowship.
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