Integrating Aerobic Training Within Subacute Stroke Rehabilitation: A Feasibility Study

What the hell is it going to take to make a specific stroke protocol for aerobic exercise post-stroke?
Your therapy department should be contacting  their compatriots across the world to settle on a common stroke protocol for this. Anything less is incompetence. I would expect the APTA to be driving this work. We seem to have earlier research here:

The Effects of Poststroke Aerobic Exercise on Neuroplasticity: A Systematic Review of Animal and Clinical Studies 

The newest one here:

Integrating Aerobic Training Within Subacute Stroke Rehabilitation: A Feasibility Study

1. Louis Biasin (louis.biasin@uhn.ca),
2. Michael D. Sage,
3. Karen Brunton,
4. Julia Fraser,
5. Jo-Anne Howe,
6. Mark Bayley,
7. Dina Brooks,
8. William E. McIlroy,
9. Avril Mansfield and
10. Elizabeth L. Inness

+ Author Affiliations

1. L. Biasin, BSc, BScPT, Toronto Rehabilitation Institute–Mobility Team, University Health Network, Room 11-107, Toronto, Canada, M5G 2A2; and Department of Physical Therapy, University of Toronto, Toronto, Canada.
2. M.D. Sage, MSc, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; and Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada.
3. K. Brunton, BScPT, Toronto Rehabilitation Institute, University Health Network; and Department of Physical Therapy, University of Toronto.
4. J-A. Fraser, MSc, Toronto Rehabilitation Institute, University Health Network; and Graduate Department of Rehabilitation Science, University of Toronto.
5. J. Howe, DipP&OT, BScPT, Toronto Rehabilitation Institute, University Health Network; and Department of Physical Therapy, University of Toronto.
6. M. Bayley, MD, Toronto Rehabilitation Institute, University Health Network.
7. D. Brooks, PhD, Toronto Rehabilitation Institute, University Health Network; Department of Physical Therapy, University of Toronto; and Graduate Department of Rehabilitation Science, University of Toronto.
8. W.E. McIlroy, PhD, Toronto Rehabilitation Institute, University Health Network; Graduate Department of Rehabilitation Science, University of Toronto; Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto; and Department of Kinesiology, University of Waterloo, Waterloo, Canada.
9. A. Mansfield, PhD, Toronto Rehabilitation Institute, University Health Network; Department of Physical Therapy, University of Toronto; Graduate Department of Rehabilitation Science, University of Toronto; and Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute.
10. E.L. Inness, BScPT, MSc, PhD candidate, Toronto Rehabilitation Institute, University Health Network; Department of Physical Therapy, University of Toronto; and Graduate Department of Rehabilitation Science, University of Toronto.

Abstract

Background and Purpose Aerobic activity positively impacts patients recovering from stroke and is part of best practice guidelines, yet this evidence has not translated to routine practice.

Objective The objective was to evaluate the feasibility of a model of care that integrated aerobic training in an in-patient rehabilitation setting for patients in the sub-acute stage of stroke recovery. Key elements of the program were personalized training prescription based on submaximal test and supervision within a group setting.

Design Prospective cohort

Methods Patients completed sub-maximal exercise testing prior to enrolment, which was used by their treating physical therapist for exercise prescription. Feasibility was evaluated using enrolment, class attendance, adherence to prescription, and patient perceptions.

Results Overall, 31 of 78 (40%) patients were referred to and completed the exercise program. Cardiac co-morbidities were the main reason for non- referral to the fitness group. Program attendance was 77%; scheduling conflicts were the primary barrier to participation. The majority of participants (63%) achieved 20 minutes of continuous exercise by the end of the program. No adverse events were reported, all participants felt they benefited from the program, and 80% of participants expressed interest in continuing to exercise regularly after discharge.

Limitations Cardiac comorbidities prevented enrolment in 27% of individuals and strategies for inclusion in exercise programs in this population should be explored.

Conclusions This individualized exercise program within a group delivery model was feasible, however, ensuring adequate aerobic targets are met was a challenge and future work should focus on how best to include individuals with cardiac comorbidities.