Background and Aims: Stroke is the leading cause of adult disability in North America. There is increasing recognition of the importance of reductions in aerobic capacity poststroke as a factor limiting function and physical activity. While exercise has been shown to benefit stroke survivors, this population infrequently accesses community-based exercise programs such as cardiac rehabilitation (CR) despite the common cardiovascular etiology. The purpose of this study was to characterize and compare the effects of cardiac rehabilitation among individuals with primary diagnosis of stroke or transient ischemic attack (TIA) versus equal random samples of individuals with secondary diagnosis of stroke or TIA and cardiac diagnoses only (no history of stroke or TIA).

Methods: Data from participants of the Toronto Rehabilitation Institute's Cardiac Rehabilitation and Secondary Prevention Program from January 1999 until November 2005 were extracted and reviewed. The following groups (n = 39 in each group) were compared for demographics, body composition, and resting and maximal exercise characteristics at baseline, reassessment, and discharge (0, 6, and 12 months): (1) Primary stroke (PS): individuals with primary diagnosis of stroke or TIA, (2) Secondary stroke (SS): those with primary cardiac and secondary stroke or TIA diagnoses, and (3) Cardiac only (CO): those with cardiac diagnoses only. Two-way repeated measures analysis of variance evaluated between-subject effects between the groups and within-subjects effects at each time point.

Results: All groups were similar at baseline (P > .05) with the exception of percent body fat (P = .03) and maximum workload achieved during the maximal exercise test (P = .01). All groups demonstrated comparable improvements in aerobic capacity by program end (time effect P = .0001): mean +/- SE Vo_2peak increased from 16.0 +/- 0.8 to 19.3 +/- 1.5 mL[middle dot]kg^-1[middle dot]min^-1 in the PS group, 16.7 +/- 0.8 to 18.8 +/- 2.2 mL[middle dot]kg^-1[middle dot]min^-1 in the SS group and 16.3 +/- 0.8 to 20.4 +/- 1.1 mL[middle dot]kg^-1[middle dot]min^-1 in the CO group, maximum workload increased from 529 +/- 40 to 710 +/- 111 kilopond meters (kP[middle dot]M) in the PS group, 615 +/- 36 to 720 +/- 79 kP[middle dot]M in the SS group and 701 +/- 45 to 864 +/- 59 kP[middle dot]M in the CO group, maximum HR from 116 +/- 4 to 128 +/- 8 beats per minute in the PS group, 116 +/- 3 to 123 +/- 7 beats per minute in the SS group and 120 +/- 4 to 130 +/- 6 beats per minute in the CO group and anaerobic threshold increased from 12.2 +/- 0.6 to 15.0 +/- 1.1 mL[middle dot]kg^-1[middle dot]min^-1 in the PS group, 11.8 +/- 0.5 to 13.0 +/- 1.3 mL[middle dot]kg^-1[middle dot]min^-1 in the SS group and 12.2 +/- 0.5 to 14.0 +/- 0.7 mL[middle dot]kg^-1[middle dot]min^-1 in the CO group. There were no group-time interaction effects.

Conclusions: Individuals with primary and secondary stroke diagnoses demonstrated similar training-related effect sizes in exercise capacity compared with non-stroke participants. A trial examining the feasibility and effects of an adapted cardiac rehabilitation program, which would allow stroke survivors with mobility restrictions to participate, is currently under way.