Integrating Survivors of Stroke Into Exercise-Based Cardiac Rehabilitation Improves Endurance and Functional Strength

Elizabeth W Regan, Reed Handlery, Jill C Stewart, Joseph L Pearson, Sara Wilcox, Stacy Fritz, Elizabeth W Regan, Reed Handlery, Jill C Stewart, Joseph L Pearson, Sara Wilcox, Stacy Fritz

Abstract

Background Cardiac rehabilitation (CR) 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 similar cardiovascular risk factors, stroke is not among the covered diagnoses for CR. The purpose of this study was to examine the participant impact of integrating survivors of stroke into the exercise portion of an existing hospital-based CR program through measures of physical function and other health impacts and through qualitative evaluation of participant perception. Methods and Results Subacute and chronic survivors of stroke were integrated into a standard 12-week, 3 sessions per week, exercise-based CR program. A total of 29 began the program, 24 completed the program, and 18 were available for 6-month follow-up. Quantitative measures were compared preprogram with postprogram with t-test or equivalent, and preprogram with postprogram to 6-month follow-up with ANOVA or equivalent. Semistructured interviews were completed with 11 participants postprogram. Exercise-based CR had significant impacts on cardiovascular endurance preprogram to postprogram, with maintenance at 6-month follow-up. The participants improved on the 6-minute walk test on average by 61.92 m(95% CI, 33.99-89.84 m), and maximum metabolic equivalents improved by a median of 3.6 (interquartile range, 2.35). Five times sit to stand (functional strength) improved preprogram to postprogram by a median of 2.85 s (interquartile range, 4.03 s). Qualitative findings highlight additional health improvements. Most participants (83% [15/18]) reported continued exercise at follow-up. Conclusions Exercise-based CR has the potential to improve cardiovascular endurance, health status, and quality of life for survivors of stroke. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03706105.

Keywords: cardiac rehabilitation; exercise; stroke; stroke rehabilitation.

Conflict of interest statement

None.

Figures

Figure 1. Study flowchart.
Figure 1. Study flowchart.
COVID‐19 indicates coronavirus disease 2019; Phone, telephone; and Rehab, rehabilitation.
Figure 2. Changes over time.
Figure 2. Changes over time.
A, Improvements over time in mean 6‐minute walk test (6MWT) distance, ANOVA, n=18 (P=0.001), effect size 0.41. *Indicates 66.51‐m change (95% CI, 12.80–120.24 m): P=0.013. **Indicates 71.67‐m change (95% CI, 26.19–117.15 m): P=0.002. 6MWT distance mean (SD) preprogram, 403.18 m (108.34 m); postprogram, 474.85 m (101.49 m); and 6‐month follow‐up, 469.70 m (26.17 m). Error bars are SD. B, Improvements over time in the 5 times sit to stand (FTSS) test time in pairwise comparisons, Friedman test, n=17 (P<0.001). Faster time indicates a better score. Box plots show median, interquartile range, minimum, and maximum. FTSS median test time (interquartile range) preprogram, 14.23 s (7.15 s); postprogram, 11.88 s (5.44 s); 6‐month follow‐up, 10.75 s (6.92 s). One participant used one upper extremity for support to rise to standing during testing. **P<0.001.

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