Rationale and Objectives:
Both coronary artery disease and stroke share modifiable risk factors and it is not uncommon for these disease states to co-exist in patients attending a cardiac rehabilitation (CR) program. The aim of this investigation was to evaluate the effects of a 20 to 32 week CR program of resistance training (RT) and aerobic training (AT) on changes in cardiopulmonary fitness, muscle strength, joint flexibility, walking speed, and sit and stand time in stroke survivors.
Methods:
Seven male patients with a diagnosis of stroke aged 41 to 72 years (mean age 56 +/- 13 years) and 22 to 44 weeks post stroke (mean 42 +/- 17 weeks) participated in a CR program. Four of these patients had coronary artery disease. Patients participated in an AT program (walking or cycling) five times per week (once at the CR program center and 4 times at home) and a progressive individualized RT program performed twice per week (once at the center and once at home). A symptom limited maximal cycle ergometer exercise test, with collection of expired gas samples, was conducted at entry and after 32 weeks of training. Measures of isometric arm flexion and knee extension peak torque, grip strength, shoulder and hip range of motion, repeated chair sit and stand time, and 22 meter walking time were taken before and after 20 weeks of training. Effects of training were examined with Student's paired t- tests using SPSS 13.0. Data are presented as means +/- standard deviation.
Results:
Baseline VO2peak increased significantly from 16.7 +/- 5 to 20.3 +/- 5.4 ml kg-1 min-1 post training (P = 0.001) (54% and 75% of age predicted norms respectively) representing a 24% gain in cardiovascular fitness. Isometric knee extension peak torque improved 35.6 +/- 35 % (P < 0.02) on the stroke-affected side and 27.9 +/- 50% on the non stroke-affected side (N/S). Arm flexion strength improved 17.3 +/- 29.4% on the affected side and 11.2 +/- 21.2% on the non-affected side (N/S). Grip strength showed a trend for improvement on the non-affected side (78.9 +/- 68.2%) (P = 0.09) and increased by 19.6 +/- 42% on the affected side (N/S). Hip flexion range of motion on the non-affected side showed a trend for improvement (17.3 +/- 20%) (P = 0.06) while shoulder flexion range of motion showed no significant changes. Repeated chair sit and stand time improved significantly by 21.8 +/- 14 % (P < 0.02) and time to walk 22 meters decreased by 5.5 +/- 12% (N/S).
Conclusions:
Stroke patients enrolled in a CR program of RT combined with AT demonstrate significant improvements in cardiovascular fitness, sit and stand time, paretic lower extremity strength, with trends for gains in other functional measures.
Section Description
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