- Title
- Assessing and training cardiorepiratory fitness after stroke
- Creator
- Marsden, Dianne
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2016
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Introduction: Cardiorespiratory fitness levels of people after stroke are low compared to non-stroke people of the same age and sex. Improving cardiorespiratory fitness has many potential health benefits for stroke survivors. Despite this, cardiorespiratory fitness is often overlooked in post-stroke management. Access to metropolitan-based services can be difficult for residents of regional and rural communities. Aims: The aims of the project were to: 1. Identify the characteristics and to determine the effectiveness of interventions to improve cardiorespiratory fitness after stroke. ; 2. Compare cardiorespiratory responses and performance measures during three clinically-applicable exercise tests. ; 3. Examine the exercise intensity parameters achieved by stroke survivors during task-specific and ergometer workstation activities. ; 4. Explore the feasibility and efficacy of an individually-tailored home- and community-based exercise program to improve cardiorespiratory fitness in stroke survivors. Methods: Characteristics of exercise interventions were investigated by systematic review. Change in cardiorespiratory fitness, measured by peak oxygen consumption (VO2peak), was examined by meta-analysis. Community-dwelling stroke survivors were recruited. The primary outcome, oxygen consumption (VO₂) was assessed using a portable metabolic measurement system. Cardiorespiratory responses and performance measures were assessed on three exercise tests [Six-Minute Walk Test (6MWT), distance; Shuttle Walk Test (SWT), number of shuttles; cycle progressive exercise test (cPXT), final workload]. VO₂ was recorded during an individualised circuit exercise session incorporating an interval training approach on 5-minute workstations (task-specific and ergometer activities). A pilot controlled trial of an individually-tailored exercise program was undertaken. Feasibility was measured by retention, participation and adverse events. Control and intervention groups both received usual care, and the intervention group undertook the 12-week program, including once-weekly telephone/email support. Cardiorespiratory fitness was assessed at baseline and 12 weeks. Results: Aim 1: Twenty eight studies were included in the systematic review with 12 randomised controlled trials able to be included in the meta-analysis. Baseline fitness was low (8-23mL/kg/min). Interventions were typically centre-based, included an aerobic component and used three 30 to 60 minutes sessions per week at a prescribed intensity. Despite the modest dose of interventions, cardiorespiratory fitness improvement favoured intervention [increase in VO2peak of 2.27 mL/kg/min (95% CI: 1.58 to 2.95)]. Aim 2: There was no difference in VO2peak among the three exercise tests (range: 17.1- 18.1 mL/kg/min). Correlations between VO2peak and performance measures were high (r=0.78, 0.73, 0.77). Aim 3: Nine task-specific (eg walking, stairs, balance) and three ergometer (upright cycle, rower, treadmill) workstations were used. Participants exercised for at least 11 minutes on the circuit. Moderate or higher intensity was achieved for 78% of task-specific and 83% of ergometer workstations. Aim 4: All intervention participants reported undertaking their prescribed program. No adverse events occurred. VO2peak improved by 16% more in the intervention group (1.17 ± 0.29 to 1.35 ± 0.33 L/min) than the control group (1.24 ± 0.23 to 1.24 ± 0.27 L/min) (p=0.044). Conclusions: I have shown it is feasible to assess and train cardiorespiratory fitness using strategies applicable to most clinical settings. The 16% improvement in cardiorespiratory fitness observed in the home- and community-based program was similar to centre-based, resource-intensive programs. Performance measures of the 6MWT, SWT and cPXT may be clinically useful as proxies for cardiorespiratory fitness. An interval training approach using task-specific and ergometer activities appears a promising way to incorporate both cardiorespiratory fitness and functional training into post-stroke management. The studies provide preliminary data to inform the design of a future large, multicentre randomised controlled trial. This trial would the test effectiveness of the home- and community-based exercise intervention in improving cardiorespiratory fitness and functional recovery of stroke survivors living in metropolitan, regional and rural areas.
- Subject
- stroke; Cardiorespiratory fitness; training; assessment; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1312101
- Identifier
- uon:22345
- Rights
- Copyright 2016 Dianne Marsden
- Language
- eng
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| View Details Download | ATTACHMENT02 | Thesis | 3 MB | Adobe Acrobat PDF | View Details Download |