PMID- 24709146
OWN - NLM
STAT- MEDLINE
DCOM- 20150223
LR  - 20161125
IS  - 1532-8511 (Electronic)
IS  - 1052-3057 (Linking)
VI  - 23
IP  - 6
DP  - 2014 Jul
TI  - Outcomes in people after stroke attending an adapted cardiac rehabilitation 
      exercise program: does time from stroke make a difference?
PG  - 1648-56
LID - S1052-3057(14)00034-2 [pii]
LID - 10.1016/j.jstrokecerebrovasdis.2014.01.008 [doi]
AB  - BACKGROUND: Individuals referred to cardiac rehabilitation programs (CRPs) after 
      stroke have demonstrated postprogram improvements in cardiovascular fitness 
      (VO2peak). However, the effect of CRPs on other physiological/quality-of-life 
      outcomes and effect of time from stroke on these results has not been 
      investigated. The objectives of the present study are (1) to evaluate the effects 
      of a CRP in participants with motor impairment after stroke and (2) to explore 
      the effects of elapsed time from stroke on physiological/quality-of-life 
      outcomes. METHODS: The CRP included 24 weeks of resistance and aerobic training. 
      Primary outcomes in 120 participants, 25.4+/-42.3 (mean+/-standard deviation) months 
      after stroke, included 6-minute walk distance (6MWD), VO2peak, timed repeated 
      sit-to-stand performance, and affected-side isometric knee extensor strength 
      (IKES). Secondary measures included gait characteristics (cadence, step lengths, 
      and symmetry), walking speed, balance (Berg Balance Scale), affected-side range 
      of motion (ROM), elbow flexor and grip strength, anaerobic threshold, and 
      perceptions of participation/social reintegration. RESULTS: After adjusting for 
      multiple comparisons, participants demonstrated significant improvements (all 
      P<.001) in 6MWD (283.2+/-126.6 to 320.7+/-141.8 m), sit-to-stand performance 
      (16.3+/-9.5 to 13.3+/-7.1 seconds), affected-side IKES (25.9+/-10.1 to 30.2+/-11 kg as a 
      percentage of body mass), and VO2peak (15.2+/-4.5 to 17.2+/-4.9 mL.kg.min(-1)). 
      Participants also demonstrated post-CRP improvements in secondary outcomes: 
      anaerobic threshold, balance, affected-side hip/shoulder ROM, grip and isometric 
      elbow flexor strength, participation, walking speed, cadence (all P<.001), and 
      bilateral step lengths (P<.04). In a linear regression model, there was a 
      negative association between the change in 6MWD and time from stroke (beta=-42.1; 
      P=.002) independent of baseline factors. CONCLUSIONS: A CRP yields improvements 
      over multiple domains of recovery; however, those who start earlier demonstrate 
      greater improvement in functional ambulation independent of baseline factors. 
      These data support the use of adapted CRPs as a standard of care practice after 
      conventional stroke rehabilitation.
CI  - Copyright (c) 2014 National Stroke Association. Published by Elsevier Inc. All 
      rights reserved.
FAU - Marzolini, Susan
AU  - Marzolini S
AD  - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario. 
      Electronic address: Susan.marzolini@uhn.ca.
FAU - Tang, Ada
AU  - Tang A
AD  - Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, 
      Ontario; School of Rehabilitation Science, McMaster University, Hamilton, 
      Ontario.
FAU - McIlroy, William
AU  - McIlroy W
AD  - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; 
      Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, 
      Ontario; Department of Kinesiology, University of Waterloo, Waterloo, Ontario.
FAU - Oh, Paul I
AU  - Oh PI
AD  - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; 
      Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, 
      Ontario.
FAU - Brooks, Dina
AU  - Brooks D
AD  - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; 
      Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, 
      Ontario; Department of Physical Therapy, University of Toronto, Toronto, Ontario.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140405
PL  - United States
TA  - J Stroke Cerebrovasc Dis
JT  - Journal of stroke and cerebrovascular diseases : the official journal of National 
      Stroke Association
JID - 9111633
SB  - IM
MH  - Aged
MH  - Brain Ischemia/*rehabilitation
MH  - Exercise Test
MH  - Exercise Therapy/*methods
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Recovery of Function
MH  - *Stroke Rehabilitation
MH  - Time Factors
MH  - Treatment Outcome
MH  - Walking
OTO - NOTNLM
OT  - Rehabilitation
OT  - stroke care
OT  - stroke delivery
OT  - stroke recovery
EDAT- 2014/04/09 06:00
MHDA- 2015/02/24 06:00
CRDT- 2014/04/09 06:00
PHST- 2013/09/22 00:00 [received]
PHST- 2013/12/15 00:00 [revised]
PHST- 2014/01/09 00:00 [accepted]
PHST- 2014/04/09 06:00 [entrez]
PHST- 2014/04/09 06:00 [pubmed]
PHST- 2015/02/24 06:00 [medline]
AID - S1052-3057(14)00034-2 [pii]
AID - 10.1016/j.jstrokecerebrovasdis.2014.01.008 [doi]
PST - ppublish
SO  - J Stroke Cerebrovasc Dis. 2014 Jul;23(6):1648-56. doi: 
      10.1016/j.jstrokecerebrovasdis.2014.01.008. Epub 2014 Apr 5.