Step Number and Aerobic Minute Exercise Prescription and Progression in Stroke: A Roadmap

 This is all still guidelines, NOT PROTOCOLS!

Step Number and Aerobic Minute Exercise Prescription and Progression in Stroke: A Roadmap

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Sue Peters, PhD, Tara Klassen, PhD, Amy Schneeberg, PhD, ...

First Published December 23, 2021 Research Article 

https://doi.org/10.1177/15459683211062894

Article information

Abstract

Background

While higher therapeutic intensity improves motor recovery after stroke, translating findings from successful studies is challenging without clear exercise intensity targets. We show in the DOSE trial¹ more than double the steps and aerobic minutes within a session can be achieved compared with usual care and translates to improved long-term walking outcomes.

Objective

We modeled data from this successful higher intensity multi-site RCT to develop targets for prescribing and progressing exercise for varying levels of walking impairment after stroke.

Methods

In twenty-five individuals in inpatient rehabilitation, twenty sessions were monitored for a total of 500 one-hour physical therapy sessions. For the 500 sessions, step number and aerobic minute progression were modeled using linear mixed effects regression. Using formulas from the linear mixed effects regression, targets were calculated.

Results

The model for step number included session number and baseline walking speed, and for aerobic minutes, session number and age. For steps, there was an increase of 73 steps per session. With baseline walking speed, for every 0.1 m/s increase, a corresponding increase of 302 steps was predicted. For aerobic minutes, there was an increase of .56 minutes of aerobic activity (ie, 34 seconds) per session. For every year increase in age, a decrease of .39 minutes (ie, 23 seconds) was predicted.

Conclusions

Using data associated with better walking outcomes, we provide step number and aerobic minute targets that future studies can cross-validate. As walking speed and age are collected at admission, these models allow for uptake of routine measurement of therapeutic intensity.

Registration: www.clinicaltrials.gov; NCT01915368.

Keywords

Rehabilitation, gait, outcomes, stroke, exercise

Introduction

Frequency, intensity, time, and type, or the FITT principle, is a way to outline the components of exercise prescription. While interpretation of clinical trials require the components of FITT to be depicted to allow for successful implementation, Billinger et al (2015) report that exercise intensity is only described adequately in 59% of clinical trials.² Further, no studies outline data-driven prescription and progression of therapeutic exercise intensity after stroke. In the absence of specific exercise prescription guidelines, rehabilitation therapists provide low exercise doses, despite evidence that higher intensity exercise improves neural and functional recovery.^1,3

When general targets are given to research therapists, our recent study shows more than double the steps and aerobic minutes can be achieved vs usual care and translates to improved long-term walking outcomes.¹ Yet, safety concerns keep some therapists from delivering higher exercise intensity⁴ since the subacute stroke period is a time of higher risk for cardiac complications.⁵ A roadmap highlighting key parameters that impact safe prescription and progression targets based on these parameters would be a useful clinical tool. To address this gap, we modeled data from a successful higher intensity multi-site randomized clinical trial to develop formulas for prescribing and progressing exercise for varying walking impairment levels after stroke.¹

^{More at link.}