Cardiac Rehab Programs Could Improve Function, Quality of Life in Stroke Patients

Elizabeth Regan, DPT, PhD

New research from the University of South Carolina suggests an exercise-based cardiac rehabilitation program should be considered for patients who recently experienced a stroke.

Investigators suggest their research underlines the importance of cardiac rehabilitation after experiencing a major cardiovascular event and its potential for improving cardiovascular endurance, health status, and overall quality of life in stroke patients.

"Through this study, we hoped to improve controllable risk factors for stroke survivors, and potentially prevent future stroke and cardiac events," said lead study author Elizabeth W. Regan, DPT, PhD, clinical assistant professor of exercise science in the physical therapy program at the University of South Carolina, in a statement. "Increasing physical activity is an important way to prevent stroke, and we wanted to see whether the rehab that patients receive after surviving a heart attack could have similar positive outcomes for patients who survive a stroke."

Investigators point out that despite posing a serious risk to the quality of life, stroke Is not among the covered diagnoses for cardiac rehabilitation. With this in mind, Regan and a team of colleagues sought to examine the impact of integrating stroke saviors into the exercise portion of an already existing cardiac rehabilitation program.

For inclusion in the study, patients needed to be diagnosed with stroke and have their most recent stroke occur at least 3 months prior, complete physical and occupants therapy, bd cleared by treating physician or nurse practitioner to participate, demonstrate the ability to walk at least 40 meters with or without an assistive device, demonstrate the ability to transfer from sit to stand without assistance, and demonstrated ability to follow instructions and to communicate exertion, pain, and distress. Patients were excluded based on presence of a medical problem rendering exercise unsafe, complaints of significant pain that interfered with movement, or history of an additional, nonstroke, neurologic condition.

The exercise-based rehabilitation program lasted 12 weeks and consisted of training sessions 3 times per week with a target of 31-50 minutes of moderate activity each session. Investigators noted the general format of exercise sessions consisted of a warm-up, cardiovascular endurance activities, a cool down period, and optional activities. Investigators included a multitude of outcome measurements to assess the effects of cardiac rehabilitation, including a 6-minute walk test and multiple surveys and questionnaires related to fitness and quality of life.

In total, 53 patients were screened via telephone for inclusion in the study. After excluding those who declined to participate and those who failed to meet inclusion criteria, investigators identified a cohort of 29 patients for inclusion in their study. Of these 29, 24 completed the 12-week program and 18 had complete 6-month follow-up measurements.

Results of their analyses indicated exercise-based cardiac rehabilitation was appeared to play a significant role in improving cardiovascular endurance and quality of life postprogram and through the 6-month follow-up. Upon completion of the program, average 6-minute walk test distance improved by 61.92 meters (95% CI, 33.99-89.84 meters) and maximum metabolic equivalents improved by a median of 3.6 (IQR, 2.35).

Additionally, results indicated time in the 5 times sit-to-stand routine improved by a median of 2.85 seconds (IQR, 4.03). Analysis of quality of life measurements suggested cardiac rehabilitation may improve emotional health, but investigators noted further investigation was needed as initial survey scores left “little room for change”. Investigators also pointed out 15 of 18 patients with complete 6-month follow-up data reported continued exercise at follow-up.

“Based on these preliminary findings, we hope prescribing cardiac rehab will be considered for all patients following a stroke, as it is for patients after a heart attack," Regan said. "We need to place value on exercise as medicine. Exercise is health, and it is important for every individual, regardless of physical limitations or age.”

This study, “Integrating Survivors of Stroke Into Exercise-Based Cardiac Rehabilitation Improves Endurance and Functional Strength,” was published in the Journal of the American Heart Association.