ABSTRACT
Background. The COVID-19 pandemic attributable to the severe acute respiratory syndrome virus (SARS-CoV-2) has had a significant and continuing impact across all areas of healthcare including stroke. Individuals post-stroke are at high risk for infection, disease severity, and mortality after COVID-19 infection. Exercise stroke rehabilitation programs remain critical for individuals recovering from stroke to mitigate risk factors and morbidity associated with the potential long-term consequences of COVID-19. There is currently no exercise rehabilitation guidance for people post-stroke with a history of COVID-19 infection. Purpose. To (1) review the multi-system pathophysiology of COVID-19 related to stroke and exercise; (2) discuss the multi-system benefits of exercise for individuals post-stroke with suspected or confirmed COVID-19 infection; and (3) provide clinical considerations related to COVID-19 for exercise during stroke rehabilitation. This article is intended for healthcare professionals involved in the implementation of exercise rehabilitation for individuals post-stroke who have suspected or confirmed COVID-19 infection and non-infected individuals who want to receive safe exercise rehabilitation. Results. Our clinical considerations integrate pre-COVID-19 stroke (n = 2) and COVID-19 exercise guidelines for non-stroke populations (athletic [n = 6], pulmonary [n = 1], cardiac [n = 2]), COVID-19 pathophysiology literature, considerations of stroke rehabilitation practices, and exercise physiology principles. A clinical decision-making tool for COVID-19 screening and eligibility for stroke exercise rehabilitation is provided, along with key subjective and physiological measures to guide exercise prescription. Conclusion. We propose that this framework promotes safe exercise programming within stroke rehabilitation for COVID-19 and future infectious disease outbreaks.
Subject(s)
COVID-19/rehabilitation , Exercise Therapy/methods , Stroke Rehabilitation/methods , Stroke/therapy , COVID-19/complications , COVID-19/physiopathology , Clinical Decision-Making , Delivery of Health Care , Humans , SARS-CoV-2 , Stroke/complications , Stroke/physiopathologyABSTRACT
Objective(s) 1) To discuss the implications of COVID-19 for exercise in the setting of stroke rehabilitation and 2) to guide and inform the clinical implementation of evidence-based aerobic exercise in stroke rehabilitation. Data Sources A literature search was conducted using 4 databases: MEDLINE, EMBASE, PsycINFO, and AMED Allied and Complementary Medicine, from inception to January 27th, 2021. Study Selection We utilized keywords related to COVID-19, exercise, rehabilitation, and included published athletic return to play after COVID-19 infection and clinical practice guidelines on exercise-based recommendations for COVID-19. Out of 391 published articles, none were related to exercise recommendations and stroke rehabilitation in the context of the COVID-19 pandemic. Data Extraction In the absence of stroke-specific guidance, we drew upon pre-COVID clinical practice aerobic exercise guidelines for stroke (n=2) and COVID-19 exercise recommendations for other populations (e.g., athletic [n=6], pulmonary [n=1] and cardiac rehabilitation [n=2]). Data Synthesis Clinical considerations were developed for hospital and out-patient settings to outline safety considerations to reduce the risk of viral transmission and implementation strategies for pre-participation screening, prescription, and progression of aerobic exercise for symptomatic and asymptomatic cases of COVID-19. Based on limited evidence, we suggest that cardiopulmonary exercise stress testing with electrocardiography be conducted following COVID-19 infection and identify subjective and physiological measures to guide decision making regarding the suitability and prescription of aerobic exercise. Finally, we recommend that clinicians and researchers stay abreast with the literature to implement evidence-based practice relating to stroke, aerobic exercise, and COVID-19. Conclusions Using a patient and clinician approach, we have developed COVID-19 specific guidance as a framework for restoring aerobic exercise implementation in stroke rehabilitation settings. Author(s) Disclosures No conflicts of interest.