Effectiveness of hospital-based low intensity and inspected aerobic training on functionality and cardiorespiratory fitness in unconditioned stroke patients: Importance of submaximal aerobic fitness markers.

INTRODUCTION: The purpose of our study was to evaluate the effectiveness of low-to moderate intensity aerobic training on cardiorespiratory functions in chronic unconditioned stroke patients. The oxygen uptake efficiency slope (OUES) and the ventilatory threshold (VO2-VT) could represent the aerobic capacity in submaximal test. Our study examined the application of the submaximal parameters for evaluating aerobic capacity of chronic stroke patients. MATERIALS AND METHODS: In our assessor-blinded controlled pilot study 37 patients were randomized into 2 groups named: intervention group (IG, n: 21) and control group (CG, n:16), respectively. Cardiorespiratory functions were evaluated by ergospirometer before and after the 4-week (20 days) program. Both groups participated in daily occupational therapy (30 minutes) and conventional, customized physiotherapy CG (60 minutes), IG (30 minutes). Only IG performed aerobic training by bicycles (30 minutes) aiming to reach low-to moderate training intensity. Outcome measures included peak oxygen uptake (VO2 peak), OUES, VO2-VT, functional exercise capacity 6-Minute Walking Test (6MWT) and Functional Independence Measure. RESULTS: Thirty-five subjects completed the study. The VO2 peak uptake was very low in both groups (IG: 11.9 mL/kg/min, CG: 12.45 mL/kg/min) and did not improve after the program, but submaximal parameters such as VO2-VT (P < .01) and OUES (P < .001) have shown significant improvement, but only in IG regardless of insufficient impact on VO2 peak. Each participant in both groups was unable to permanently reach the moderate intensity zone. Functional Independence Measure changed for the better in both groups, but 6MWT only in the IG. DISCUSSION AND CONCLUSIONS: Four-week exercise training even at low intensity by lower limb cycle ergometer may provide benefit on aerobic and functional capacity without improvement of VO2 peak on unconditioned chronic stroke patients.

Feasibility of six-point Goal Attainment Scale among subacute and chronic stroke patients.

Feasibility of six-point Goal Attainment Scale among stroke patients were examined. Thirty-five subacute and chronic stroke patients with upper limb function problems were included (December 2015-March 2017). Sixty-minute conventional therapy and 30-minute occupational therapy was provided on every consecutive weekday, for 4 weeks. Beside Functional Independence Measure, Action Reach Arm test, Fugl-Meyer upper extremity assessment motor function subtest and six-point Goal Attainment Scale were collected. The content of the previous tests was linked with International Classification of Functioning, Disability and Health domains. Feasibility characteristics were checked according to previous feasibility studies and the following aspects: acceptability, demand, implementation, practicality, integration, and expansion. Data analysis was done in 2018. Participants' global functions were described with the Functional Independence Measure median points were 116.5. All of the outcome measures showed significant improvement at group level (P < 0.001). Most of the goals matched to one or more International Classification of Functioning, Disability and Health domains but were not covered with the Action Reach Arm test or the Fugl-Meyer tests. Association between clinically relevant change of the first Goal Attainment Scale and the other tests was not significant. Six-point Goal Attainment Scale proved to be a feasible outcome measure among subacute and chronic stroke participants. It completed the functional picture of a patient, beside standardized measures. Further studies needed to complete the psychometric properties of six-point Goal Attainment Scale among stroke patients and in other patient groups.

The effect of low-intensity aerobic training on cognitive functions of severely deconditioned subacute and chronic stroke patients: a randomized, controlled pilot study.

Our objective was to investigate the impact of low-intensity aerobic training on cognitive functions in severely deconditioned subacute and chronic stroke patients. For this purpose, a randomized, controlled pilot study was designed involving subacute and chronic stroke patients. Thirty-seven eligible patients participated in the 4-week-long randomized, controlled pilot study. Patients were randomized into study group and control group and both groups participated in conventional physiotherapy included occupational therapy. Only the study group's patients participated in a low-intensity aerobic training by cycle ergometer. Cognitive evaluations (Functional Independence Measure Cognitive part - FIM-cog; Coding and Symbol Search tasks of the Processing Speed index and Digit Span task of Working Memory index of Wechsler Adult Intelligence Scale-Fourth Edition) were performed before and after the programme. In-group analysis showed a significant improvement in study group patients regarding Coding subtest of Processing Speed domain (P = 0.003). Symbol Search subtest of Processing Speed showed significant improvements in both groups by the end of the programme (study group, P = 0.041; control group, P = 0.006). There were no significant changes in the FIM-cog and Digit Span task. The intergroup analysis did not find significant difference between the two groups. It was concluded that even the low-intensity aerobic training may improve special domains of cognitive function after stroke. Further studies are needed to confirm the impact of low-intensity aerobic training on cognitive functions.