'Might' is way too milquetoast an answer. Come back when you have a protocol. 'Might' is lazy and I would have you fired for that.
Cardiac Rehab Might Benefit Stroke Survivors, Too
Mixed aerobics and walking was most beneficial
Walking and aerobic capacity improved
modestly for stroke survivors participating in group aerobic exercise
initiatives comparable to cardiac rehabilitation programs, a
meta-analysis found.
Aerobic exercise had a "small" but significant effect size of 0.38 (95% CI 0.27–0.49) for improvement in the composite mean of aerobic capacity outcome measures (6-minute walk test, VO2 peak, maximum walking speed, and self-selected walking speed).
Looking at each activity type, mixed aerobic activity had the largest effect size at 0.61, followed by walking (ES 0.37), but cycling alone had an effect size of just 0.24, reported Elizabeth Regan, PT, DPT, of the University of South Carolina in Columbia, and colleagues in the Journal of the American Heart Association.
"Cardiac rehab could work for stroke survivors, programs like cardiac rehab are beneficial, and they are beneficial regardless of how long it's been since they've had their stroke," concluded Regan in an interview with MedPage Today. "Stroke survivors could definitely benefit from community programs that have an aerobic fitness focus, and cardiac rehab could potentially fill the gap."
Offering cardiac rehabilitation to stroke survivors is an effective way of improving health status without coming up with new programs, the researchers emphasized, calling the findings clinically important for those with mild post-stroke impairment.
"Cardiac rehabilitation programs are an excellent setting to provide individualized exercise prescription and to teach patients how to exercise safely on their own," agreed Vera Bittner, MD, MSPH, of the University of Alabama in Birmingham, who was not involved in the study.
Bittner pointed out that attendance, enrollment, and completion might be problematic with stroke patients, just as they have been with heart failure and post-myocardial infarction patients, among others.
The analysis included 19 studies ("ranging from single-group convenience samples to randomized control trials with control groups and assessor blinding") with 23 treatment groups across the studies, comprising 485 participants with mean ages ranging from 54 to 71 years.
Over about a 3 month period, participants went to two to three sessions each week. Walking, mixed mode aerobic exercise, and stationary cycling were common types of activity.
VO2 peak had a pooled difference in means of 2.08 mL/kg per minute (95% CI 1.18–2.98) and a summary effect size of 0.38 (95% CI 0.17–0.60).
When it came to the 6-minute walk test, there was a pooled difference in means of 53.3 m (95% CI 36.8–69.8) and a summary effect size of 0.41 (95% CI 0.25–0.58). Similar improvement data were shown for self-selected walking speed and maximum walking speed.
Inclusion criteria for the studies were:
Limitations included the variety of study designs, lack of follow-up information, and lack of control group comparisons. Regan and colleagues noted available studies mainly focused on survivors of stroke with mild mobility impairments, and narrow frequency and duration criteria hindered the ability to determine if less frequent or shorter duration interventions offered similar benefits.
"More studies with follow-up periods after primary group intervention and evaluation of cost and healthcare use could provide insight on the importance of continued services and their economic impact," the researchers concluded.
Aerobic exercise had a "small" but significant effect size of 0.38 (95% CI 0.27–0.49) for improvement in the composite mean of aerobic capacity outcome measures (6-minute walk test, VO2 peak, maximum walking speed, and self-selected walking speed).
Looking at each activity type, mixed aerobic activity had the largest effect size at 0.61, followed by walking (ES 0.37), but cycling alone had an effect size of just 0.24, reported Elizabeth Regan, PT, DPT, of the University of South Carolina in Columbia, and colleagues in the Journal of the American Heart Association.
"Cardiac rehab could work for stroke survivors, programs like cardiac rehab are beneficial, and they are beneficial regardless of how long it's been since they've had their stroke," concluded Regan in an interview with MedPage Today. "Stroke survivors could definitely benefit from community programs that have an aerobic fitness focus, and cardiac rehab could potentially fill the gap."
Offering cardiac rehabilitation to stroke survivors is an effective way of improving health status without coming up with new programs, the researchers emphasized, calling the findings clinically important for those with mild post-stroke impairment.
"Cardiac rehabilitation programs are an excellent setting to provide individualized exercise prescription and to teach patients how to exercise safely on their own," agreed Vera Bittner, MD, MSPH, of the University of Alabama in Birmingham, who was not involved in the study.
Bittner pointed out that attendance, enrollment, and completion might be problematic with stroke patients, just as they have been with heart failure and post-myocardial infarction patients, among others.
The analysis included 19 studies ("ranging from single-group convenience samples to randomized control trials with control groups and assessor blinding") with 23 treatment groups across the studies, comprising 485 participants with mean ages ranging from 54 to 71 years.
Over about a 3 month period, participants went to two to three sessions each week. Walking, mixed mode aerobic exercise, and stationary cycling were common types of activity.
VO2 peak had a pooled difference in means of 2.08 mL/kg per minute (95% CI 1.18–2.98) and a summary effect size of 0.38 (95% CI 0.17–0.60).
When it came to the 6-minute walk test, there was a pooled difference in means of 53.3 m (95% CI 36.8–69.8) and a summary effect size of 0.41 (95% CI 0.25–0.58). Similar improvement data were shown for self-selected walking speed and maximum walking speed.
Inclusion criteria for the studies were:
- An intervention dosage of 18 to 36 visits in total over 8 to 18 weeks
- A cohort of adult survivors of stroke
- A study design that consisted of pretesting and posttesting for an intervention for one group or more
- An outcome measure that involved one or more measures of aerobic capacity
Limitations included the variety of study designs, lack of follow-up information, and lack of control group comparisons. Regan and colleagues noted available studies mainly focused on survivors of stroke with mild mobility impairments, and narrow frequency and duration criteria hindered the ability to determine if less frequent or shorter duration interventions offered similar benefits.
"More studies with follow-up periods after primary group intervention and evaluation of cost and healthcare use could provide insight on the importance of continued services and their economic impact," the researchers concluded.
The study was
funded by the Foundation for Physical Therapy, the American Heart
Association Pre-Doctoral Fellowship, the Arnold School of Public Health,
the National Institutes of Health, the National Institute of General
Medical Sciences, the University of South Carolina, and the University
of South Carolina Behavioral-Biomedical Interface Program.
Regan reported no disclosures.
Bittner disclosed relationships with Amgen, Sanofi, AstraZeneca, DalCor, The Medicines Company, and Esperion.
Regan reported no disclosures.
Bittner disclosed relationships with Amgen, Sanofi, AstraZeneca, DalCor, The Medicines Company, and Esperion.
Primary Source
Journal of the American Heart Association
Source Reference: Regan EW, et al "Are aerobic programs similar in design to cardiac rehabilitation beneficial for survivors of stroke? A systematic Review and meta-analysis" J Am Heart Assoc 2019; DOI: 10.1161/JAHA.119.012761.
No comments:
Post a Comment