Is early initiated cardiorespiratory fitness training within a model of stroke-integrated cardiac rehabilitation safe and feasible?

Natasha Machado; Gavin Williams; John Olver; Liam Johnson

doi:10.1016/j.jstrokecerebrovasdis.2023.107493

Is early initiated cardiorespiratory fitness training within a model of stroke-integrated cardiac rehabilitation safe and feasible?

J Stroke Cerebrovasc Dis. 2024 Feb;33(2):107493. doi: 10.1016/j.jstrokecerebrovasdis.2023.107493. Epub 2023 Dec 6.

Authors

Natasha Machado¹, Gavin Williams², John Olver³, Liam Johnson⁴

Affiliations

¹ Rehabilitation, Epworth HealthCare, Victoria, Australia; Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia. Electronic address: Natasha.machado@epworth.org.au.
² Rehabilitation, Epworth HealthCare, Victoria, Australia; Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia.
³ Rehabilitation, Epworth HealthCare, Victoria, Australia; Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia; Department of Medicine, Monash University, Victoria, Australia.
⁴ Rehabilitation, Epworth HealthCare, Victoria, Australia; Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia; Faculty of Health Sciences, School of Behavioural and Health Sciences, Australian Catholic University, Victoria, Australia.

PMID: 38061183
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107493

Abstract

Objective: To investigate the safety and feasibility of an early initiated stroke-integrated Cardiac Rehabilitation program.

Methods: People with acute first or recurrent ischaemic stroke, admitted to Epworth HealthCare were screened for eligibility and invited to participate. In addition to usual care neurorehabilitation, participants performed 1) cardiorespiratory fitness training 3-days/week during inpatient rehabilitation (Phase 1), and/or 2) 2-days/week centre-based cardiorespiratory fitness training plus education and 1-day/week home-based cardiorespiratory fitness training for 6-weeks during outpatient rehabilitation (Phase 2). Safety was determined by the number of adverse and serious adverse events. Feasibility was determined by participant recruitment, retention, and attendance rates, adherence to exercise recommendations, and participant satisfaction.

Results: There were no study-related adverse or serious adverse events. Of 117 eligible stroke admissions, 62 (53%) were recruited, while 10 (16.1%) participants withdrew. Participants attended 189 of 201 (94%) scheduled cardiorespiratory fitness training sessions in Phase 1 and 341/381 (89.5%) scheduled sessions in Phase 2. Only 220/381 (58%) scheduled education sessions were attended. The minimum recommended cardiorespiratory fitness training intensity (40% heart rate reserve) and duration (20 minutes) was achieved by 57% and 55% of participants respectively during Phase 1, and 60% and 92% respectively during Phase 2. All respondents strongly agreed (69%) or agreed (31%) they would recommend the stroke-integrated Cardiac Rehabilitation program to other people with stroke.

Conclusion: Cardiorespiratory fitness training in line with multiple clinical practice guidelines included within a model of stroke-integrated Cardiac Rehabilitation appears to be safe and feasible in the early subacute phase post-stroke.

Keywords: Cardiac rehabilitation; Cardiorespiratory fitness; Cerebrovascular disorders; Exercise; Stroke.

MeSH terms

Brain Ischemia* / etiology
Cardiac Rehabilitation*
Cardiorespiratory Fitness*
Exercise Therapy / adverse effects
Humans
Stroke Rehabilitation* / adverse effects
Stroke* / diagnosis
Stroke* / etiology
Stroke* / therapy
Treatment Outcome