Effects of aerobic training on physical activity in people with stroke: protocol for a randomized controlled trial

Larissa Tavares Aguiar, Sylvie Nadeau, Raquel Rodrigues Britto, Luci Fuscaldi Teixeira-Salmela, Júlia Caetano Martins, Christina Danielli Coelho de Morais Faria, Larissa Tavares Aguiar, Sylvie Nadeau, Raquel Rodrigues Britto, Luci Fuscaldi Teixeira-Salmela, Júlia Caetano Martins, Christina Danielli Coelho de Morais Faria

Abstract

Background: Post-stroke physical inactivity is explained by several factors related to the stroke, which have been suggested as the causes and consequences of functional declines and health problems. Therefore, it is important to increase physical activity levels and reduce the time spent in low-energy expenditure activities after a stroke. Since the maintenance of cardiorespiratory fitness is a significant predictor of physical activity levels post-stroke, it may be important to investigate whether aerobic training is effective in increasing physical activity levels and reducing the time spent in low-energy expenditure activities in this population. The efficacy of aerobic training on these variables is not well known. The primary objective of this trial will be to investigate the effects of aerobic treadmill training on physical activity levels and on time spent in low-energy expenditure activities in people with stroke. The secondary aim will be to evaluate the effects of the training on cardiorespiratory fitness, endurance, depression, mobility, quality of life, and participation.

Methods/design: A randomized controlled trial, with blinded assessments, will be performed in a community-based setting. Altogether, 22 adults with a diagnosis of stroke (>6 months) who are sedentary or insufficiently active will be included. Participants will be randomly assigned to either: (1) aerobic treadmill training (experimental group, at 60-80% of their heart rate reserve) or (2) walking outside (control group, below 40% of heart rate reserve). Both groups will attend 40-min training sessions, three times per week over 12 weeks, in groups of two to four participants, with a trained physiotherapist. Primary outcomes are physical activity levels and time spent in low-energy expenditure activities (Multi-sensor SenseWear Mini® and Human Activity Profile). Secondary outcomes are cardiorespiratory fitness (peak oxygen uptake VO2peak and ventilatory threshold), endurance, depression, mobility, quality of life, and participation. The effects of the training will be analyzed from the collected data using intention to treat. Between-group differences will be measured by two-way repeated measures ANOVA, considering the baseline, post-training, and 4-week follow-up.

Discussion: The results of this trial will likely provide valuable new information on the effects of aerobic treadmill training on physical activity levels and on time spent in low-energy expenditure activities of individuals with stroke, through changes in cardiorespiratory fitness.

Trial registration: ClinicalTrials.gov, NCT02798237 . Registered on 13 June 2016.

Keywords: Aerobic exercise; Health; Physical activity; Sedentary lifestyle; Stroke; Walking.

Conflict of interest statement

Ethics approval and consent to participate

All patients will provide written consent, prior to participation. This study has been approved (51454115.6.0000.5149) by the ethical review board of the Universidade Federal de Minas Gerais, Brazil.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Schedule of enrolment, interventions, and assessments
Fig. 2
Fig. 2
Flow diagram of the study

References

    1. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart disease and stroke Statistics-2017 update: a report from the American Heart Association. Circulation. 2017;135:146–603. doi: 10.1161/CIR.0000000000000485.
    1. Skolarus LE, Burke JF, Brown DL, Freedman VA. Understanding stroke survivorship: expanding the concept of poststroke disability. Stroke. 2014;45:224–230. doi: 10.1161/STROKEAHA.113.002874.
    1. Billinger SA, Arena R, Bernhardt J, Eng JJ, Franklin BA, Johnson CM, et al. Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:2532–2553. doi: 10.1161/STR.0000000000000022.
    1. Caspersen CJPK, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100:126–135.
    1. Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, Latimer-Cheung AE, et al. Sedentary behavior research network (SBRN) - terminology consensus project process and outcome. Int J Behav Nutr Phys Act. 2017;14:75. doi: 10.1186/s12966-017-0525-8.
    1. Butler EN, Evenson KR. Prevalence of physical activity and sedentary behaviour among stroke survivors in the United States. Top Stroke Rehabil. 2014;21:246–255. doi: 10.1310/tsr2103-246.
    1. Joseph C, Conradsson D, Hagstromer M, Lawal I, Rhoda A. Objectively assessed physical activity and associated factors of sedentary behavior among survivors of stroke living in Cape Town, South Africa. Disabil Rehabil. 2017:1–7.
    1. Marsden DL, Dunn A, Callister R, Levi CR, Spratt NJ. Characteristics of exercise training interventions to improve cardiorespiratory fitness after stroke: a systematic review with meta-analysis. Neurorehabil Neural Repair. 2013;27:775–788. doi: 10.1177/1545968313496329.
    1. Pang MY, Charlesworth SA, Lau RW, Chung RC. Using aerobic exercise to improve health outcomes and quality of life in stroke: evidence-based exercise prescription recommendations. Cerebrovasc Dis. 2013;35:7–22. doi: 10.1159/000346075.
    1. Saunders DH, Sanderson M, Hayes S, Kilrane M, Greig CA, Brazzelli M, et al. Physical fitness training for stroke patients. Cochrane Database Syst Rev. 2016;3:Cd003316.
    1. Faria CD, Teixeira-Salmela LF, Nadeau S. Predicting levels of basic functional mobility, as assessed by the timed “up and go” test, for individuals with stroke: discriminant analyses. Disabil Rehabil. 2013;35:146–152. doi: 10.3109/09638288.2012.690497.
    1. Polese JC, Pinheiro MB, Machado GC, Faria CDCM, Hirochi TL, Teixeira-Salmela LF. Chronic Hemiparetic subjects with higher physical activity levels report better quality of life. Rev Neuro. 2014;22:221–226.
    1. Fitzgerald JD, Johnson L, Hire DG, Ambrosius WT, Anton SD, Dodson JA, et al. Association of objectively measured physical activity with cardiovascular risk in mobility-limited older adults. J Am Heart Assoc. 2015;4:1–9. doi: 10.1161/JAHA.114.001288.
    1. Young DR, Hivert M-F, Alhassan S, Camhi SM, Ferguson JF, Katzmarzyk PT, et al. Sedentary behavior and cardiovascular morbidity and mortality: A Science Advisory From the American Heart Association. Circulation. 2016;134:262–79. doi: 10.1161/CIRCULATIONAHA.116.023081.
    1. English C, Manns PJ, Tucak C, Bernhardt J. Physical activity and sedentary behaviours in people with stroke living in the community: a systematic review. Phys Ther. 2014;94:185–196. doi: 10.2522/ptj.20130175.
    1. Aguiar L, Nadeau S, Martins J, Teixeira-Salmela L, Britto R, Faria C. Efficacy of interventions aimed to improve physical activity levels in individuals with stroke: a systematic review. Disabil Rehabil. 2018; In press
    1. Severinsen K, Jakobsen JK, Pedersen AR, Overgaard K, Andersen H. Effects of resistance training and aerobic training on ambulation in chronic stroke. Am J Phys Med Rehabil. 2014;93:29–42. doi: 10.1097/PHM.0b013e3182a518e1.
    1. Shaughnessy M, Michael K, Resnick B. Impact of treadmill exercise on efficacy expectations, physical activity, and stroke recovery. J Neurosci Nurs. 2012;44:27–35. doi: 10.1097/JNN.0b013e31823ae4b5.
    1. Teixeira-Salmela LF, Olney SJ, Nadeau S, Brouwer B. Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors. Arch Phys Med Rehabil. 1999;80:1211–1218. doi: 10.1016/S0003-9993(99)90018-7.
    1. Ivey FM, Stookey AD, Hafer-Macko CE, Ryan AS, Macko RF. Higher treadmill training intensity to address functional aerobic impairment after stroke. J Stroke Cerebrovasc Dis. 2015;24:2539–2546. doi: 10.1016/j.jstrokecerebrovasdis.2015.07.002.
    1. Harvey LA, Glinsky JV, Herbert RD. 50 tips for clinical Trialists. Brain Impair. 2018;19:59–69. doi: 10.1017/BrImp.2017.30.
    1. Ainsworth B, Cahalin L, Buman M, Ross R. The current state of physical activity assessment tools. Prog Cardiovasc Dis. 2015;57:387–395. doi: 10.1016/j.pcad.2014.10.005.
    1. Fini NA, Holland AE, Keating J, Simek J, Bernhardt J. How is physical activity monitored in people following stroke? Disabil Rehabil. 2015;37:1717–1731. doi: 10.3109/09638288.2014.978508.
    1. English C, Healy GN, Olds T, Parfitt G, Borkoles E, Coates A, et al. Reducing sitting time after stroke: a phase II safety and feasibility randomized controlled trial. Arch Phys Med Rehabil. 2016;97:273–280. doi: 10.1016/j.apmr.2015.10.094.
    1. Hiremath SV, Ding D, Farringdon J, Vyas N, Cooper RA. Physical activity classification utilizing SenseWear activity monitor in manual wheelchair users with spinal cord injury. Spinal Cord. 2013;51:705–709. doi: 10.1038/sc.2013.39.
    1. Reece JD, Barry V, Fuller DK, Caputo J. Validation of the SenseWear armband as a measure of sedentary behaviour and light activity. J Phys Act Health. 2015;12:1229–1237. doi: 10.1123/jpah.2014-0136.
    1. Centers for Disease Control and Prevention Physical activity trends - United States, 1990–1998. Morb Mort Week Rep. 2001;50:166–169.
    1. Bertolucci PH, Brucki SM, Campacci SR, Juliano Y. The Mini-Mental State Examination in a general population: impact of educational status. Arq Neuropsiquiatr. 1994;52:1–7. doi: 10.1590/S0004-282X1994000100001.
    1. Teixeira-Salmela LF, Devaraj R, Olney SJ. Validation of the human activity profile in stroke: a comparison of observed, proxy and self-reported scores. Disabil Rehabil. 2007;29:1518–1524. doi: 10.1080/09638280601055733.
    1. Globas C, Becker C, Cerny J, Lam JM, Lindemann U, Forrester LW, et al. Chronic stroke survivors benefit from high-intensity aerobic treadmill exercise: a randomized control trial. Neurorehabil Neural Repair. 2012;26:85–95. doi: 10.1177/1545968311418675.
    1. Manns PJ, Haennel RG. SenseWear armband and stroke: validity of energy expenditure and step count measurement during walking. Stroke Res Treat. 2012;2012:1–8.
    1. Moore SA, Hallsworth K, Bluck LJ, Ford GA, Rochester L, Trenell MI. Measuring energy expenditure after stroke: validation of a portable device. Stroke. 2012;43:1660–1662. doi: 10.1161/STROKEAHA.111.646257.
    1. American Thoracic Society, American College of Chest Physicians ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167:211–277. doi: 10.1164/rccm.167.2.211.
    1. Faria CD, Silva SM, Correa JC, Laurentino GE, Teixeira-Salmela LF. Identification of ICF participation categories in quality-of-life instruments utilized in cerebrovascular accident victims. Rev Panam Salud Publica. 2012;31:338–344.
    1. Pescatello LS, Arena R, Riebe D, Kluwer P. ACSM’s guidelines for exercise testing and prescription. 9th ed. Philadelphia: Wolters Kluwer; 2014.
    1. Prisnie JC, Fiest KM, Coutts SB, Patten SB, Atta CA, Blaikie L, et al. Validating screening tools for depression in stroke and transient ischemic attack patients. Int J Psychiatry Med. 2016;51:262–277. doi: 10.1177/0091217416652616.
    1. Tse T, Douglas J, Lentin P, Carey L. Measuring participation after stroke: a review of frequently used tools. Arch Phys Med Rehabil. 2013;94:177–192. doi: 10.1016/j.apmr.2012.09.002.
    1. Tyson S, Connell L. The psychometric properties and clinical utility of measures of walking and mobility in neurological conditions: a systematic review. Clin Rehabil. 2009;23:1018–1033. doi: 10.1177/0269215509339004.
    1. van Bloemendaal M, Kokkeler AM, van de Port IG. The shuttle walk test: a new approach to functional walking capacity measurements for patients after stroke? Arch Phys Med Rehabil. 2012;93:163–166. doi: 10.1016/j.apmr.2011.08.012.
    1. Vanroy C, Vanlandewijck Y, Cras P, Feys H, Truijen S, Michielsen M, et al. Is a coded physical activity diary valid for assessing physical activity level and energy expenditure in stroke patients? PLoS One. 2014;9:e98735. doi: 10.1371/journal.pone.0098735.
    1. Marzolini S, Oh P, McIlroy W, Brooks D. The feasibility of cardiopulmonary exercise testing for prescribing exercise to people after stroke. Stroke. 2012;43:1075–1081. doi: 10.1161/STROKEAHA.111.635128.
    1. Pereira DAG, Samora GAR, Alencar MCN, Vieira DSR, Parreira VF, Pereira LSM, et al. Cardiopulmonary exercise test with ramp protocol in adults with heart failure. Rev Bras Med Esporte. 2012;18:369–372. doi: 10.1590/S1517-86922012000600004.
    1. de Man-van Ginkel JM, Hafsteinsdottir T, Lindeman E, Burger H, Grobbee D, Schuurmans M. An efficient way to detect poststroke depression by subsequent administration of a 9-item and a 2-item patient health questionnaire. Stroke. 2012;43:854–856. doi: 10.1161/STROKEAHA.111.640276.
    1. Faria CD, Teixeira-Salmela LF, Neto MG, Rodrigues-de-Paula F. Performance-based tests in subjects with stroke: outcome scores, reliability and measurement errors. Clin Rehabil. 2012;26:460–469. doi: 10.1177/0269215511423849.
    1. Nascimento LRCL, Freitas DC, Morais TM, Polese JC, Teixeira-Salmela LF. Different instructions during the ten-meter walking test determined significant increases in maximum gait speed in individuals with chronic hemiparesis. Braz J Phys Ther. 2012;16:122–127. doi: 10.1590/S1413-35552012005000008.
    1. Cohen J. Statistical power analysis for the Behavioural sciences. 2. Upper Saddle River: Lawrence Erlbaum Associates; 1988.
    1. Pollock A, St George B, Fenton M, Firkins L. Top 10 research priorities relating to life after stroke--consensus from stroke survivors, caregivers, and health professionals. Int J Stroke. 2014;9:313–320. doi: 10.1111/j.1747-4949.2012.00942.x.

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