Andrew Marr of the UK however blames high-intensity exercise for his stroke.
Timothy Caulfield, BS, SPT
Jonathan Rodriguez, BA, SPT
Background and Purpose: Stroke is one of the leading causes of disability worldwide. Stroke can cause deficits in one’s ability to walk independently, cause deficits in balance, and lead to a variety of other health issues as a sequela of paresis and prolonged physical inactivity.1 The purpose of this systematic review is to evaluate the efficacy of high intensity training (HIT) for the rehabilitation of patients with stroke.
Methods: A systematic review was performed utilizing five databases using search terms “stroke rehabilitation” and “high intensity training”. Article titles and abstracts were screened to include key words “stroke”, “high intensity training”, “resistance training”, “interval training”, “power training”, or “step training”. Research studies using subjects with co-morbidities other than stroke and its residuum were excluded.
Results: After meeting the selection criteria, 10 studies were selected for review. A review of each article’s subject population, tests performed, intervention, and result, reveal that many types of high intensity training have a positive effect on functional and health outcomes in patients with stroke.
Conclusion: High intensity training (HIT) has a positive effect on the rehabilitative potential of patients with stroke. HIT is shown to improve patient’s respiratory function, walking ability, balance, functional ability and other key areas.
Key words: stroke rehabilitation, high intensity training, progressive resistance training
Stroke can be defined as an acute neurologic dysfunction of vascular origin from a hemorrhagic or ischemic event causing a disruption of blood flow to tissues of the brain.2 Strokes are a global health issue affecting 16 million people each year. It is estimated that by the year 2030 there will be 77 million survivors of stroke worldwide. Each year, 114 of 100,000 people in the United States will suffer their first stroke, accounting for 75% of hospitalizations due to stroke. The remaining 25% of stroke hospitalizations are of patients with recurrent strokes. Patient risk factors for stroke include, but are not limited to hypertension, smoking, diabetes, obesity, dyslipidemia, and elevated homocysteine.3 The long-term implications of a stroke depend upon how early a stroke is recognized and treated. Clinical manifestations following a stroke can include a loss of balance, speech and visual deficits, cognitive dysfunction and hemiparesis. There is potential for the spontaneous recovery of certain deficits in the first few weeks following a stroke, however there is likelihood for long-term dysfunction. The most prevalent long-term dysfunction after a stroke are motor impairments secondary to hemiparesis; which reduces muscle mass and the force of muscle contraction causing lower limb weakness, loss of mobility and gait deficiencies of the affected side.2,3
Physical therapy based rehabilitation after stroke is often tailored to the specific functional deficits in each patient.3 Rehabilitation after the patient becomes medically stable often involves compensation, remediation, and motor control components. Compensation to regain function using external aids or environmental support, remediation in attempts to effectively reduce neurological deficits, and motor control through task specific training to facilitate the relearning of specific lost abilities.4 Therapists often utilize treadmill training, computer assisted training and robotics to normalize the gait patterns of patients after stroke, and virtual reality applications for cognitive, and memory deficits as well as functional training. Splinting, range of motion, stretching, and muscle-strengthening exercises are often incorporated to regain the strength, joint range of motion, muscle flexibility, and to decrease the spasticity in a patient.3
The rehabilitation potential for a patient after a stroke has a number of variables including the age of the patient, previous level of functioning, and co-morbidities. Outcome is also dependent upon the severity of the stroke, its location, and how quickly a stroke is diagnosed and the patient is medically stabilized thus lessening the neurological damage. There is also an association between a length of time from symptom onset and beginning of rehabilitation, to the functional outcome of the patient. It has been shown that patients with moderate to severe stroke have significantly better functional outcomes upon discharge in motor abilities, mobility, and activities of daily living if they are admitted to rehabilitation as soon as possible.3,5 Overall mortality associated with stroke has decreased over the past 20 years. However, there are still a number of complications for patients, post-stroke, including increase potential for falls, pain, depression, urinary incontinence, and difficulties with independent living.3
It is important to understand that, as stroke survival improves, there will be a need to further advance proper, evidence based, rehabilitation practices in order to provide the best possible outcome for the patient. Intensity of training during the rehabilitation process is an important factor to consider for a patient after a stroke. The intensity of exercise is a property that many coaches, athletic trainers, and physical therapists consider when creating a training regimen or plan of care and High Intensity Training (HIT), training that requires a high level of effort for brief intervals, is a new evolving concept in the field of sport and rehabilitation. HIT has shown efficacy in improving one’s cardio-respiratory system, musculoskeletal system, and overall health.6 Because the concept of high intensity training has been shown to offer a positive benefit in rehabilitation, it may be effective in the treatment process for deficits experienced in patients with stroke. This systematic review was developed to examine the effect of high intensity training on stroke rehabilitation.
More at link.