Examining the association between balance self-efficacy and virtual balance performance in individuals with stroke: a cross-sectional study.

BACKGROUND: Balance self-efficacy is a strong predictor of fall risk after stroke and is related to performance on balance and walking tests. The use of telerehabilitation for delivering stroke rehabilitation has increased in recent years and there is a need to adapt common clinical assessments to be administered in virtual formats, but the association between balance self-efficacy and virtually administered clinical tests of balance performance has yet to be established. This study examined the association between the Activities-specific Balance Confidence (ABC) Scale and virtually administered Timed Up and Go (TUG), Tandem Stand, and Functional Reach tests (FRT) in individuals with stroke. METHODS: This was a secondary analysis of baseline data from two telerehabilitation trials with individuals with stroke. All assessments were administered by trained physical therapists through videoconferencing software. Multivariate regression analyses were used to examine the associations between the ABC scale and TUG test, Tandem Stand test, and FRT, adjusted for age and number of comorbidities. RESULTS: Data from 51 participants (n = 11 female, median age = 64 [IQR: 18] years, 9.3 ± 4.6 months poststroke) were analyzed. The ABC scores were associated with TUG (R2 = 0.56, F(3,47) = 20.26, p < 0.01), but not Tandem Stand (R2 = 0.18, F(5,45) = 1.93, p = 0.11) or FRT (R2 = 0.14, F(3,47) = 2.55, p = 0.07) tests. CONCLUSION: We observed associations between the ABC scores and virtual TUG, but not with Tandem Stand or FRT, which may be attributed to the context-specificity of balance self-efficacy. As virtual administration of outcomes assessments becomes part of common practice in stroke rehabilitation, our study supports the use of virtually administered TUG in stroke.

Exploring differences between gender expressions in exercise self-efficacy and outcome expectations for exercise in individuals with stroke.

Gender expression may be associated with exercise self-efficacy and outcome expectations for exercise in the general population. Exercising for challenge and enjoyment are associated with the instrumental traits typically held by individuals with masculine gender expressions. Conversely, exercising for weight loss to receive validation from others are in line with the expressive traits most commonly held by individuals with feminine gender expressions. Moreover, possessing neither dominant nor expressive traits (undifferentiated gender expressions) have been linked to poorer psychological outcomes. Exercise is important after stroke, but gender differences in psychosocial factors for exercise in this population were unknown. The purpose of this study was to explore whether gender expression differences exist in exercise self-efficacy and outcome expectations for exercise post-stroke. Gender expression (masculine, feminine, androgynous, undifferentiated) was assessed using the Bem Sex-Role Inventory-12 (BSRI-12) in 67 individuals with stroke. Self-efficacy and outcomes expectations for exercise were assessed using the Self-Efficacy for Physical Activity Scale and Short Outcome Expectations for Exercise Scale, respectively. One-way analysis of covariance models were conducted, adjusting for biological sex, age, and time post-stroke. There were differences in exercise self-efficacy across the four gender expression groups (F(3,60) = 4.28, p<0.01), where individuals with masculine gender expressions had higher self-efficacy than those with undifferentiated gender expressions (adjusted mean: 3.56 [SE: 0.17] vs. 2.72 [SE:0.18], p<0.01). There were no differences in outcome expectations for exercise (F(3,57) = 1.08, p = 0.36) between gender expressions. In our pairwise comparisons, we found that individuals with masculine gender expressions had higher exercise self-efficacy than individuals possessing undifferentiated gender expressions. Strategies to enhance exercise self-efficacy after stroke are needed, particularly for individuals with undifferentiated gender expression. There were no associations between gender expression and outcome expectations for exercise after stroke. Clinicians may continue reinforcing the positive expectations towards exercise across all gender expressions.

Therapeutic Quality Affects Physical Fitness Benefits of Home Exercise Interventions in Older Adults: A Systematic Review, Meta-Analysis, and Meta-Regression.

BACKGROUND AND PURPOSE: The international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool is a new instrument developed to evaluate the therapeutic quality of exercise interventions. Home-based exercise has been shown to improve physical fitness in older adults, but its effects may be influenced by therapeutic quality. The purpose of this systematic review was to describe the therapeutic quality of home-based exercise interventions for community-dwelling older adults and examine the relationship between therapeutic quality and changes in physical fitness. METHODS: Six electronic databases and 2 clinical trial registries were searched for randomized controlled trials investigating the effects of home-based exercise on physical fitness in community-dwelling older adults (≥60 years). Therapeutic quality was evaluated using the i-CONTENT tool for items of patient selection, type of exercise, safety, type/timing of outcomes, exercise dose, and adherence. International Consensus on Therapeutic Exercise aNd Training items were used to explain heterogeneity in meta-regression analyses. Risk of bias, certainty of evidence and credibility of analyses were assessed. RESULTS: Thirty-six trials (n = 6157 participants) were identified. Most studies (≥66.7%) had high or probably high therapeutic quality for i-CONTENT items, except exercise dose (47.2%) and adherence (16.7%). Interventions improved upper- (N = 20 trials; standardized mean difference [SMD] = 0.39; 95% CI, 0.13-0.64; low certainty of evidence) and lower-body strength (N = 28; SMD = 0.42; 95% CI, 0.08-0.77; very low certainty), and aerobic fitness (N = 8; SMD = 0.42; 95% CI, 0.08-0.77; very low certainty). For exercise dose, low- or probably low-quality studies negatively influenced effects on upper- (estimated ß = -.48; P = .049; moderate credibility) and lower-body strength (estimated ß = -.77; P = .048; moderate credibility). For adherence, low- or probably low-quality studies negatively influenced effects on aerobic fitness (estimated ß = -.97; P = .02; low credibility). CONCLUSIONS: Home-based exercise may improve upper- and lower-body strength, as well as aerobic fitness in older adults. However, the effectiveness of interventions is affected by inadequate dosing of exercise programs and adherence issues. Physical therapists should have the best available evidence to support their clinical decision making, especially when designing and monitoring home programs.

Aerobic exercise interventions for promoting cardiovascular health and mobility after stroke: a systematic review with Bayesian network meta-analysis.

OBJECTIVE: To determine the superiority of aerobic exercise (AE) interventions on key outcomes of stroke recovery, including cardiorespiratory fitness (V̇O2peak, primary outcome), systolic blood pressure (SBP) and mobility (6 min Walk Test (6MWT) distance and 10 m Usual Gait Speed) after stroke. DATA SOURCES: MEDLINE, EMBASE, Web of Science, CINAHL, CENTRAL, SPORTDiscus, PsycINFO and AMED Allied and Complementary Medicine were searched from inception to February 2023. ELIGIBILITY CRITERIA: Randomised controlled trials were included that compared the effects of any AE interventions (low-intensity, moderate-intensity, high-intensity continuous training (HICT), high-intensity interval training (HIIT)) to no exercise, usual care or other AE interventions in individuals poststroke. ANALYSES: Systematic review with Bayesian network meta-analysis (NMA) methodology was employed. Surface under the cumulative ranking curve (SUCRA) values were used to rank interventions. The Grading of Recommendations, Assessment, Development and Evaluation minimally contextualised framework for NMA was followed. RESULTS: There were 28 studies (n=1298) included in the NMA for V̇O2peak, 11 (n=648) for SBP, 28 (n=1494) for 6MWT and 18 (n=775) for the 10 m Usual Gait Speed. The greatest effect on V̇O2peak, 6MWT and 10 m Usual Gait Speed was observed after HIIT and HICT. No differences between interventions were found for SBP. SUCRA values identified HIIT as the superior AE intervention for all outcomes of interest. HIIT was the most effective intervention for improving V̇O2peak (2.9 mL/kg/min (95% credible interval 0.8 to 5.0) moderate certainty) compared with usual care. CONCLUSION: This NMA suggests that higher-intensity AE is superior to traditional low-intensity to moderate-intensity AE for improving outcomes after stroke.

Exploring the experiences of an exercise-based telerehabilitation program among Canadian community-dwelling adults with stroke.

PURPOSE: Telerehabilitation is emerging as a means for delivering stroke rehabilitation to address unmet lower extremity rehabilitation needs. However, there is currently limited and low-quality evidence supporting the use telerehabilitation interventions for lower extremity recovery after stroke. Thus, we developed an exercise-based telerehabilitation program (TRAIL) for safe and effective promotion of lower extremity function after stroke. This study reports on the qualitative findings from the feasibility study of the TRAIL program. METHODS: An interpretive description methodology and inductive thematic analysis approach were undertaken. One-on-one semi-structured interviews were conducted on a subset of participants who completed the TRAIL feasibility study. Participants were recruited via email and enrolled into the study based on pre-determined purposeful sampling strategies. RESULTS: Ten participants (6 men, 4 women) completed a semi-structured interview. Two main themes emerged: (i) TRAIL ingredients for success and (ii) telerehabilitation is a viable option for stroke rehabilitation. CONCLUSION: Exercise-based telerehabilitation appears to be well-received by men and women post-stroke when social support, professional guidance, and program resources are offered. TRAIL may also prolong the continuum of care that individuals receive once they are discharged back into the community, and contribute to improvements in mobility, lower extremity strength and balance.

Exercise-based telerehabilitation for individuals with stroke can be delivered safely when clinicians are trained, and social support and program resources are available.Exercise-based telerehabilitation may be viable and accessible for men and women with stroke to extend the opportunity for rehabilitation services within the first year post-event.Synchronously delivered telerehabilitation programs using user-friendly videoconference software is recommended for optimal participant satisfaction.

Optimal resistance exercise training parameters for stroke recovery: A protocol for a systematic review.

BACKGROUND: Stroke impacts nearly 14 million people annually. Muscle strength and physical function are often affected by stroke and important determinants of stroke recovery. Resistance exercise training (RT) has been shown to improve muscle strength, but RT prescriptions may be suboptimal for other aspects of stroke recovery. Parameters such as frequency, intensity, type, and duration may influence the effectiveness of RT interventions but have not been systematically evaluated. OBJECTIVES: 1) To determine the effects of RT on stroke recovery, and 2) to examine the influence of RT parameters on intervention effects. ELIGIBILITY CRITERIA: Randomized controlled trials examining the effects of RT will be eligible for this systematic review if they: 1) included only adults with stroke or transient ischemic attack, 2) compared RT to no exercise or usual care, and 3) did not apply a co-intervention. STUDY SELECTION: Eight databases (MEDLINE, EMBASE, EMCARE, AMED, PsychINFO, CINAHL, SPORTDiscus, and Web of Science) and 2 clinical trials registries (ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform) will be searched from inception. Two independent pairs of authors will compare titles, abstracts, and full-text reports against the eligibility criteria. Conflicts will be resolved by consensus or third author. MAIN OUTCOME MEASURES: The construct of interest is stroke recovery. An advisory group of clinicians, researchers, and partners with lived experience of stroke will be consulted to determine specific outcome measures of interest, and to rank their relative importance. We expect to include measures of physical function, strength, cognition, and quality of life. Random-effects meta-analyses will be used to pool results for each outcome across studies, and RT parameters (frequency, intensity, type, and duration) will be used as covariates in meta-regression analyses. CONCLUSION: The results of this review will inform the optimal RT prescription parameters for promoting stroke recovery.

TeleRehabilitation with Aims to Improve Lower extremity recovery in community-dwelling individuals who have had a stroke: protocol for a multisite, parallel group, assessor-blinded, randomised attention-controlled trial.

INTRODUCTION: Telerehabilitation is an accessible service delivery model that may support innovative lower extremity rehabilitation programmes that extend the stroke recovery continuum into the community. Unfortunately, there is limited evidence on the provision of exercises for lower extremity recovery after stroke delivered using telerehabilitation. In response, we developed the TeleRehabilitation with Aims to Improve Lower extremity recovery poststroke (TRAIL) programme, a 4-week progressive exercise and self-management intervention delivered synchronously using video-conferencing technology. Our primary hypothesis is that individual within 1-year poststroke who participate in TRAIL will experience significantly greater improvements in functional mobility than individuals in an attention-controlled education programme (EDUCATION). METHODS AND ANALYSIS: In this multisite, parallel group, assessor-blinded randomised attention-controlled trial, 96 community-living stroke survivors within 1-year poststroke will be recruited from five sites (Vancouver, Winnipeg, Toronto, London and Halifax, Canada) from the CanStroke Recovery Trials Platform which is a network of Canadian hospital sites that are affiliated with academic institutions to facilitate participant recruitment and quality trial practices. Participants will be randomised on a 1:1 basis to TRAIL or EDUCATION. Participants randomised to TRAIL will receive eight telerehabilitation sessions where they will perform exercises and receive self-management support to improve lower extremity recovery from a TRAIL physical therapist. The primary outcome will be measured using the Timed Up and Go. Secondary outcomes include lower extremity muscle strength, functional balance, motor impairment, balance self-efficacy, health-related quality of life and health service use for our economic evaluation. Measurements will be taken at baseline, immediately after the intervention, 3-month and 6-month postintervention. ETHICS AND DISSEMINATION: Ethics approval for this research has been obtained by all participating sites. All study participants will provide their informed consent prior to enrolling them in the study. Findings from this trial will be disseminated in peer-reviewed journals and presentations at international scientific meetings. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, NCT04908241.

Does peak expiratory flow moderate trajectories of cognitive function among individuals with lung diseases? A longitudinal analysis of the National Health and Aging Trends Study.

INTRODUCTION: Impaired cognitive function can co-exist in chronic respiratory diseases. However, it is not clear if peak expiratory flow (PEF) impacts changes in cognitive function. Our objective was to explore whether peak expiratory flow moderates trajectories of memory, visuospatial abilities, and executive function in individuals with chronic respiratory diseases. METHODS: This was an analysis of individuals with lung diseases from the National Health and Aging Trends Study. Multivariable-adjusted generalized linear mixed models were used to estimate trajectories of immediate and delayed recall, and clock drawing over a 10-year follow-up. The interaction between PEF and time were plotted using sex-specific values for peak expiratory flow at 10th, 50th and 90th percentiles. RESULTS: In females, interactions of time-by-PEF were found for both immediate (n = 489, t = 2.73, p<0.01) and delayed recall (n = 489, t = 3.38, p<0.01). Females in the 10th vs. 90th percentile of PEF declined in immediate recall at 0.14 vs. 0.065 words/year, and 0.17 vs. 0.032 words/year for delayed recall. Among males, recall declined linearly over 10 years (immediate recall: n = 296, t = -3.08, p < 0.01; delayed recall: n = 292, t = -2.46, p = 0.02), with no interaction with PEF. There were no time-by-PEF interactions nor declines over time in clock drawing scores in both sexes (females: n = 484, t = 0.25, p = 0.81; males: n = 291, t = -0.61, p = 0.55). CONCLUSION: Females with the lowest PEF values experienced the greatest rates of decline in immediate and delayed recall over 10 years of follow-up, whereas males experienced similar declines in memory outcomes across all levels of PEF. Clock drawing scores remained stable over 10 years in both sexes.

Undertaking Rehabilitation Research During the COVID-19 Pandemic: Emergent Strategies From a Trainee-Faculty Workshop.

Background: The COVID-19 pandemic has disrupted everyday rehabilitation research. Many academic institutions have halted in-person human research including rehabilitation sciences. Researchers are faced with several barriers to continuing their research programs. The purpose of this perspective article is to report the results of an interdisciplinary workshop aimed at understanding the challenges and corresponding strategies for conducting rehabilitation research during the COVID-19 pandemic. Methods: Twenty-five rehabilitation researchers (17 trainees and eight faculty) attended a 2-h facilitated online workshop in to discuss challenges and strategies they had experienced and employed to conduct rehabilitation research during the COVID-19 pandemic. Results: Rehabilitation researchers reported challenges with (1) pandemic protocol adjustments, (2) participant accessibility, and (3) knowledge dissemination, along with corresponding strategies to these challenges. Researchers experienced disruptions in study outcomes and intervention protocols to adhere to public health guidelines and have suggested implementing novel virtual approaches and study toolkits to facilitate offsite assessment. Participant accessibility could be improved by engaging community stakeholders in protocol revisions to ensure equity, safety, and feasibility. Researchers also experienced barriers to virtual conferences and publication, suggested opportunities for smaller networking events, and revisiting timeframes for knowledge dissemination. Conclusion: This perspective article served as a catalyst for discussion among rehabilitation researchers to identify novel and creative approaches that address the complexities of conducting rehabilitation research during the COVID-19 pandemic and beyond.

The association between global cognitive function and walking capacity in individuals with broad ranges of cognitive and physical function: Are there sex differences?

Introduction: Cognitive function is known to be associated with physical function, where greater walking capacity has been shown to have moderate to strong correlations with global cognitive function and other various domains of cognition in older adults with and without chronic conditions. Biological sex may moderate the relationship between cognitive and physical function, but whether sex differences exist in this association has not been examined in an aging population. The purpose of this study was to examine the associations between global cognitive function (Montreal Cognitive Assessment; MoCA), walking capacity (6-Minute Walk Test distance; 6 MWT) and sex in an aging population with broad ranges of cognitive and physical function. Methods: Participants were assessed for global cognitive function (MoCA) and walking capacity (6 MWT). Multivariable regression analyses were performed to examine the interaction of sex in the association between MoCA and 6 MWT. First, we presented the unadjusted model (Model 1), then the model adjusted for age, history of stroke, and height (Model 2). To determine if there were sex-based differences in the association between global cognitive function and walking capacity, we included sex and an interaction term between sex*6 MWT distance in Models 3 and 4. Results: Twenty-three females and 36 males were included in the multivariable regression analyses, respectively. Our sample represented broad ranges of cognitive and physical function levels, where MoCA scores ranged from 13 to 30, and 6 MWT distances from 203 to 750 m. 6 MWT distance was associated with MoCA in models unadjusted (R 2 = 0.17; F(1,56) = 11.4; p < 0.01) and adjusted for age, stroke history, and height (R 2 = 0.20; F(4,53) = 3.2; p = 0.02). No interaction with sex was found, but a main effect of sex was observed (R 2 = 0.26; F(5,21) = 3.72; p = 0.03). When adjusting for age, height and history of stroke, males MoCA scores were 2.9 ± 1.3 less than the mean MoCA scores for females. Discussion: Our findings confirm the positive relationship between cognitive and physical function in older adults. Notably, we also observed superior performance in global cognition among females that was consistent across a broad spectrum of walking capacity.

Sex Differences in Functional Capacity in Older Adults With Stroke: An Analysis of Data From the National Health and Aging Trends Study.

OBJECTIVE: Women experience greater disability following stroke, but biological sex differences in both overall and specific domains of functional capacity are not well understood. The primary objective of this study was to examine sex differences in overall functional capacity (Short Physical Performance Battery [SPPB] score) cross-sectionally and longitudinally over a 3-year follow-up period. The secondary objective was to determine whether sex differences exist in specific domains of functional capacity of walking speed and lower extremity functional strength. METHODS: This study was a secondary analysis of data of individuals with stroke from the National Health and Aging Trends Study. For the cross-sectional analyses, general linear models were used to examine differences between 293 men and 427 women in SPPB, walking speed, and the 5-Times Sit-to-Stand Test (5XSST). For the longitudinal analysis, survey-weighted, multivariable-adjusted generalized linear mixed models were used to compare 3-year trajectories in SPPB scores between the sexes (87 men, 153 women). RESULTS: Women had lower SPPB scores at baseline (difference = 0.9, linearized SE = 0.3) and over 3 years. SPPB scores declined similarly between men and women. Women had lower walking speed (difference = 0.08 m/s, SE = 0.02) as compared with men, but men and women had similar 5XSST scores (difference = 0.6 seconds, SE = 0.5). CONCLUSION: Older women with stroke have clinically meaningfully lower overall functional capacity as compared with older men but decline at a similar rate over time. Walking speed was lower in older women with stroke, but similar between sexes in 5XSST. IMPACT: Women with stroke have poorer functional capacity compared with men, which reinforces the importance of targeted stroke rehabilitation strategies to address these sex-specific disparities. LAY SUMMARY: Women with stroke have poorer outcomes in terms of their ability to move around the community when compared with men. However, both men and women with stroke have similar physical functioning over time.

Intensity matters: protocol for a randomized controlled trial exercise intervention for individuals with chronic stroke.

RATIONALE: Cardiovascular exercise is an effective method to improve cardiovascular health outcomes, but also promote neuroplasticity during stroke recovery. Moderate-intensity continuous cardiovascular training (MICT) is an integral part of stroke rehabilitation, yet it may remain a challenge to exercise at sufficiently high intensities to produce beneficial adaptations to neuroplasticity. High-intensity interval training (HIIT) could provide a viable alternative to achieve higher intensities of exercise by using shorter bouts of intense exercise interspersed with periods of recovery. METHODS AND DESIGN: This is a two-arm, parallel-group multi-site RCT conducted at the Jewish Rehabilitation Hospital (Laval, Québec, Canada) and McMaster University (Hamilton, Ontario, Canada). Eighty participants with chronic stroke will be recruited at both sites and will be randomly allocated into a HIIT or MICT individualized exercise program on a recumbent stepper, 3 days per week for 12 weeks. Outcomes will be assessed at baseline, at 12 weeks post-intervention, and at an 8-week follow-up. OUTCOMES: The primary outcome is corticospinal excitability, a neuroplasticity marker in brain motor networks, assessed with transcranial magnetic stimulation (TMS). We will also examine additional markers of neuroplasticity, measures of cardiovascular health, motor function, and psychosocial responses to training. DISCUSSION: This trial will contribute novel insights into the effectiveness of HIIT to promote neuroplasticity in individuals with chronic stroke. TRIAL REGISTRATION: ClinicalTrials.gov NCT03614585 . Registered on 3 August 2018.

Examining the effect of virtual reality therapy on cognition post-stroke: a systematic review and meta-analysis.

INTRODUCTION: Virtual reality (VR) are user-computer interface platforms that implement real-time simulation of an activity or environment, allowing user interaction via multiple sensory modalities. VR therapy may be an effective intervention for improving cognitive function following stroke. The aim of this systematic review was to examine the effectiveness of exercise-based VR therapy on cognition post-stroke. METHODS: Electronic databases were searched for terms related to "stroke", "virtual reality", "exercise" and "cognition". Studies were included if they: (1) were randomized-controlled trials; (2) included VR-based interventions; (3) included individuals with stroke; and (4) included outcome measures related to cognitive function. Data from included studies were synthesised qualitatively and where possible, random effects meta-analyses were performed. RESULTS: Eight studies involving 196 participants were included in the review, of which five were included in meta-analyses (n = 124 participants). Studies varied in terms of type (combination of VR therapy and conventional therapy, combination of VR therapy and computer-based cognitive training, VR therapy alone) and duration of interventions (20-180 min), sample size (n = 12-42), length of the interventions (4-8 weeks), and cognitive outcomes examined. VR therapy was not more effective than control for improving global cognition (n = 5, SMD = 0.24, 95%CI:-0.30,0.78, p = .38), memory (n = 2 studies, SMD= 0.00, 95%CI: -0.58, 0.59, p = .99), attention (n = 2 studies, MD = 8.90, 95%CI: -27.89, 45.70, p = .64) or language (n = 2 studies, SMD = 0.56, 95%CI: -0.08,1.21, p = .09). CONCLUSION: VR therapy was not superior to control interventions in improving cognition in individuals with stroke. Future research should include high-quality and adequately powered trials examining the impact of virtual reality therapy on cognition post-stroke.Implications for rehabilitationVirtual reality therapy is a promising new form of technology that has been shown to increase patient satisfaction towards stroke rehabilitation.Virtual reality therapy has the added benefits of providing instant feedback, and the difficulty can be easily modified, underscoring the user-friendliness of this form of rehabilitation.Virtual reality therapy has the potential to improve various motor, cognitive and physical deficits following stroke, highlighting its usefulness in rehabilitation settings.

The Performance of Digital Monitoring Devices for Oxygen Saturation and Respiratory Rate in COPD: A Systematic Review.

Healthcare access and delivery for individuals with chronic obstructive pulmonary disease (COPD) who live in remote areas or who are susceptible to contracting communicable diseases, such as COVID-19, may be a challenge. Telehealth and remote monitoring devices can be used to overcome this issue. However, the accuracy of these devices must be ensured before forming healthcare decisions based on their outcomes. Therefore, a systematic review was performed to synthesize the evidence on the reliability, validity and responsiveness of digital devices used for tracking oxygen saturation (SpO2) and/or respiratory rate (RR) in individuals with COPD, in remote settings. Three electronic databases were searched: MEDLINE (1996 to October 8, 2020), EMBASE (1996 to October 8, 2020) and CINAHL (1998 to October 8, 2020). Studies were included if they aimed to evaluate one or more measurement properties of a digital device measuring SpO2 or RR in individuals with COPD. Six-hundred and twenty-five articles were identified and after screening, 7 studies matched the inclusion criteria; covering 11 devices measuring SpO2 and/or RR. Studies reported on the reliability (n = 1), convergent validity (n = 1), concurrent validity (n = 2) and predictive validity (n = 2) of SpO2 devices and on the convergent validity (n = 1), concurrent validity (n = 1) and predictive validity (n = 1) of RR devices. SpO2 and RR devices were valid when compared against other respiration monitoring devices but were not precise in predicting exacerbation events. More well-designed measurement studies are needed to make firm conclusions about the accuracy of such devices.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.1945021 .

Prolonged Elevation of Arterial Stiffness Following Peak Aerobic Exercise in Individuals With Chronic Stroke.

BACKGROUND: Stroke is a highly disabling condition and is the second leading cause of death globally. Engaging in aerobic exercise is important for the prevention of a recurrent stroke through improving markers of cardiovascular health such as blood pressure and arterial stiffness. While higher intensities of aerobic exercise generally elicit greater cardioprotective effects, little is known about the acute cardiovascular effects of a single session of high intensity aerobic exercise in people with stroke. The objective of this study was to model the recovery of arterial stiffness (carotid-femoral pulse wave velocity, cfPWV), heart rate and blood pressure following peak intensity aerobic exercise in individuals with chronic stroke. METHODS: Ten participants with chronic stroke (mean ± SD age = 56.9 ± 11.8 years, median [IQR] years post-stroke = 2.9 [1.9]) performed a symptom-limited cardiopulmonary exercise test (CPET) on a recumbent stepper. Before the CPET, resting cfPWV, heart rate and blood pressure were measured. Immediately following the CPET, all outcomes were measured again continuously for 20 min to use all available observations (n = 245 observations) and capture any potential non-linear changes. Mixed model analyses were then applied to model post-exercise changes of cfPWV, heart rate and blood pressure. RESULTS: Carotid-femoral pulse wave velocity was increased from rest following the CPET (9.0 ± 0.53 to 9.9 ± 0.52 m/s, p < 0.001) and remained elevated for 20 min into post-exercise recovery, independent of heart rate (p = 0.001). Heart rate also increased from baseline (71.2 ± 3.2 to 77.4 ± 3.1 bpm, p < 0.001) and remained elevated for 10 min post-exercise (p < 0.001). Finger systolic blood pressure was reduced from rest (117.3 ± 4.7 to 111.8 ± 4.6 mmHg, p < 0.001) and remained reduced for 15 min after exercise (p < 0.001). There were no significant differences in finger diastolic or mean arterial pressures from rest. CONCLUSION: This was the first study to capture continuous changes in cfPWV following peak aerobic exercise in any clinical population. The present study revealed that cfPWV is elevated for 20 min after peak aerobic exercise in individuals with stroke, which was independent of heart rate. These findings suggest there may be autonomic imbalances in large arteries following peak intensity aerobic exercise in individuals with stroke.

The impact of the 24-h movement spectrum on vascular remodeling in older men and women: a review.

Aging is associated with increased risk of cardiovascular and cerebrovascular events, which are preceded by early, negative remodeling of the vasculature. Low physical activity is a well-established risk factor associated with the incidence and development of disease. However, recent physical activity literature indicates the importance of considering the 24-h movement spectrum. Therefore, the purpose of this review was to examine the impact of the 24-h movement spectrum, specifically physical activity (aerobic and resistance training), sedentary behavior, and sleep, on cardiovascular and cerebrovascular outcomes in older adults, with a focus on recent evidence (<10 yr) and sex-based considerations. The review identifies that both aerobic training and being physically active (compared with sedentary) are associated with improvements in endothelial function, arterial stiffness, and cerebrovascular function. Additionally, there is evidence of sex-based differences in endothelial function: a blunted improvement in aerobic training in postmenopausal women compared with men. While minimal research has been conducted in older adults, resistance training does not appear to influence arterial stiffness. Poor sleep quantity or quality are associated with both impaired endothelial function and increased arterial stiffness. Finally, the review highlights mechanistic pathways involved in the regulation of vascular and cerebrovascular function, specifically the balance between pro- and antiatherogenic factors, which mediate the relationship between the 24-h movement spectrum and vascular outcomes. Finally, this review proposes future research directions: examining the role of duration and intensity of training, combining aerobic and resistance training, and exploration of sex-based differences in cardiovascular and cerebrovascular outcomes.

The effects of exercise on cognition post-stroke: are there sex differences? A systematic review and meta-analysis.

PURPOSE: The aim of this systematic review was to investigate if sex moderated the effect of exercise on cognition in adults post-stroke. METHODS: A systematic review was conducted of randomized controlled trials that involved adults ≥18 years with stroke, any exercise intervention, and reported any outcome related to cognitive function. We compared effect sizes of cognitive outcomes between studies of lower and higher proportion of females (CRD42018092757). RESULTS: The effects of exercise did not differ between studies of higher and lower female proportions with respect to memory (χ2 =1.52, p = 0.22), executive function (χ2 = 0.56, p = 0.45; Chi2 = 0.00, p = 0.98), language (Chi2 = 3.17, p = 0.08) or global cognition (χ2 = 0.88, p = 0.35). CONCLUSION: There were no sex differences in the effects of exercise on memory, executive functioning, language or global cognition in individuals with stroke. Further research is warranted to address sex differences in individuals with stroke to enable better targeting, prevention, and interventions in stroke rehabilitation.IMPLICATIONS FOR REHABILITATIONUnderstanding sex differences and potentially similarities in the relationship between exercise and cognition is an important step in enhancing stroke rehabilitation and the development of optimal, sex-specific rehabilitation.Although our findings suggest that there is no clear rationale for incorporating sex into our clinical decision making, it is still imperative to consider sex factors in research and report results in the literature disaggregated by sex to help inform clinical practice.