Is early initiated cardiorespiratory fitness training within a model of stroke-integrated cardiac rehabilitation safe and feasible?

 Whom is doing the followup research that will prove what level of this training will get survivors to 100% recovery?

Is early initiated cardiorespiratory fitness training within a model of stroke-integrated cardiac rehabilitation safe and feasible?

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https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107493Get rights and content

Abstract

Objective

To investigate the safety and feasibility of an early initiated stroke-integrated Cardiac Rehabilitation program.

Methods

People with acute first or recurrent ischaemic stroke, admitted to Epworth HealthCare were screened for eligibility and invited to participate. In addition to usual care neurorehabilitation, participants performed 1) cardiorespiratory fitness training 3-days/week during inpatient rehabilitation (Phase 1), and/or 2) 2-days/week centre-based cardiorespiratory fitness training plus education and 1-day/week home-based cardiorespiratory fitness training for 6-weeks during outpatient rehabilitation (Phase 2). Safety was determined by the number of adverse and serious adverse events. Feasibility was determined by participant recruitment, retention, and attendance rates, adherence to exercise recommendations, and participant satisfaction.

Results

There were no study-related adverse or serious adverse events. Of 117 eligible stroke admissions, 62 (53%) were recruited, while 10 (16.1%) participants withdrew. Participants attended 189 of 201 (94%) scheduled cardiorespiratory fitness training sessions in Phase 1 and 341/381 (89.5%) scheduled sessions in Phase 2. Only 220/381 (58%) scheduled education sessions were attended. The minimum recommended cardiorespiratory fitness training intensity (40% heart rate reserve) and duration (20 minutes) was achieved by 57% and 55% of participants respectively during Phase 1, and 60% and 92% respectively during Phase 2. All respondents strongly agreed (69%) or agreed (31%) they would recommend the stroke-integrated Cardiac Rehabilitation program to other people with stroke.

Conclusion

Cardiorespiratory fitness training in line with multiple clinical practice guidelines included within a model of stroke-integrated Cardiac Rehabilitation appears to be safe and feasible in the early subacute phase post-stroke.

Section snippets

Methods

This study had ethical approval from Epworth HealthCare Human Research Ethics Committee (ID: EH2017-282), and the University of Melbourne Psychology Health and Applied Sciences Human Ethics Sub-Committee (ID: 1954294).

Study Design

This was a single centre, multi-site, prospective cohort feasibility study. All people with stroke were screened for eligibility after admission to subacute inpatient rehabilitation facilities at Epworth HealthCare from April 2018 to December 2020.

Participants

All potential participants that met the inclusion criteria were approached on admission to subacute rehabilitation. People with stroke were eligible to participate if they were: 1) ≥18 years of age, 2) diagnosed with an acute first or recurrent ischaemic stroke, 3) able to provide consent, and 4) able to comprehend verbal and/or written commands. People with stroke were excluded from the study if they: 1) were pregnant, 2) had significant musculoskeletal or pain issues that precluded

Procedure

Demographic data (i.e., participant's age, medical history, stroke diagnostics [date, type, location, clinical manifestations]) were collected from each participant's on-site medical record.

Intervention

Like traditional CR programs,35, 36, 37 the stroke-integrated CR program designed for this study consisted of inpatient (Phase 1) and outpatient (Phase 2) rehabilitation. To investigate the safety and feasibility of early initiated stroke-integrated CR, participants were recruited as soon as possible after admission to inpatient rehabilitation at Epworth HealthCare. Participants were able to consent to either Phase 1, Phase 2 or both. For example, participants who were unable to return to the

Demographic Data

Demographic data collected included stroke severity (National institute of Health Stroke Scale),^40,41 disability (Modified Rankin Scale),^41,42 functional measures (Functional Independence Measure),⁴³ and measures of fatigue (Fatigue Assessment Scale).^44,45

Safety

Safety was assessed by recording all adverse and serious adverse events during the study. An adverse event was defined as any untoward medical occurrence (i.e., exacerbation of a pre-existing condition, or a new condition or diagnosed after participation in the study) experienced by participants while participating in or immediately following the study. A serious adverse event was defined as an event resulting in death, was life threatening, required hospitalisation or prolonged existing

Results

We screened 164 individuals admitted to two subacute inpatient rehabilitation facilities at Epworth HealthCare in Melbourne, Australia (Fig. 2). Of the 117 (71.3%) people with stroke eligible to participate, 55 (47%) declined consent or were not recruited, with the primary reasons being too overwhelmed to participate (n= 21), declined but no reason given (n= 15), a lack of time (n= 11), no transportation to attend rehabilitation (n= 4), lived rurally (n= 3), and deceased prior to consent (n=

Discussion

The results of this study demonstrate early initiated cardiorespiratory fitness training within a model of stroke-integrated CR appears to be safe for people with mild and mild-to-moderately severe stroke, with no study-related serious adverse events observed. Despite moderate rates of recruitment (53% of eligible people with stroke) and attendance to the education sessions (57.7%), the early initiated stroke-integrated CR program tested in this study demonstrated high retention (84%) and

Conclusions

Cardiorespiratory fitness training, as recommended by multiple clinical practice guidelines, appears to be safe and feasible within a model of stroke-integrated CR in the early subacute phase. Despite high attendance and retention rates, not all people with stroke want, or were able to access centre-based CR. There is a critical need for more accessible models of post-stroke rehabilitation, potentially including home-based or telehealth models with flexible days or hours of attendance to