Patients’ perspectives on aerobic exercise early after stroke

<p><b>Purpose</b>: To describe patient perspectives of aerobic exercise during inpatient stroke rehabilitation, including their self-efficacy and beliefs towards exercise, as well as their perceptions of barriers. <b>Method</b>: A survey was conducted at three Canadian rehabilitation centres to evaluate individuals’ (<i>N</i> = 33) self-efficacy and outcome expectations for exercise. In addition, patient perceptions of other people recovering from stroke, social support, and aerobic exercise as part of rehabilitation were assessed. <b>Results</b>: Thirty-two people completed the survey. Of these, 97% were willing to participate in aerobic exercise 5.9 ± 8.8 days after admission to inpatient rehabilitation. While outcome expectations for exercise were high, participants reported lower self-efficacy for exercise. Patients reported barriers related to the ability to perform exercise (other health problems (i.e., arthritis), not being able to follow instructions and physical impairments) more often than safety concerns (fear of falling). The lack of support from a spouse and family were commonly identified, as was a lack of information on how to perform aerobic exercise. <b>Conclusion</b>: Patients with stroke are willing to participate in aerobic exercise within a week after admission to inpatient rehabilitation. However, they perceive a lack of ability to perform aerobic exercise, social support from family and information as barriers.Implications for rehabilitation</p><p>Aerobic exercise is recognized as part of comprehensive stroke rehabilitation.</p><p>There is a need to better understand patient perspectives to develop and implement more effective interventions early after stroke.</p><p>Patients lack confidence in their ability to overcome barriers early after stroke.</p><p>Patients are concerned with their ability to perform exercise, fall risk, lack of support from a spouse and family, and limited information on aerobic exercise.</p><p>There is a need to reinforce education with practical experience in structured aerobic exercise programs that show patients and caregivers how to manage disability and complex health needs.</p><p></p> <p>Aerobic exercise is recognized as part of comprehensive stroke rehabilitation.</p> <p>There is a need to better understand patient perspectives to develop and implement more effective interventions early after stroke.</p> <p>Patients lack confidence in their ability to overcome barriers early after stroke.</p> <p>Patients are concerned with their ability to perform exercise, fall risk, lack of support from a spouse and family, and limited information on aerobic exercise.</p> <p>There is a need to reinforce education with practical experience in structured aerobic exercise programs that show patients and caregivers how to manage disability and complex health needs.</p

Physiotherapists’ perspectives on aerobic exercise early after stroke: A preliminary study

<p>Aerobic exercise is recognized as part of comprehensive stroke rehabilitation in best-practice and clinical guidelines, yet many individuals remain physically inactive during their hospitalization. The purpose of this study was to identify the perspectives of physiotherapists on aerobic exercise prescription and implementation at in-patient stroke rehabilitation centers with and without a structured aerobic exercise program. A survey was conducted at three Canadian rehabilitation centers to evaluate physiotherapist perceptions of individuals recovering from stroke, the practice environment, and their training on aerobic exercise in stroke. Physiotherapists at centers without a structured aerobic exercise program (<i>n</i> = 10) reported the lack of necessary resources and therapeutic support staff and the individuals’ physical impairment as the greatest barriers. In contrast, physiotherapists at the center with a structured aerobic exercise program (<i>n</i> = 6) reported therapy selection (insufficient time in a single physiotherapy session) and concern for the individuals’ cardiovascular risk and cognitive impairment as the greatest barriers. Both groups of physiotherapists indicated that fatigue was a barrier. Only physiotherapists at the center with a structured aerobic exercise program had received continuing education on aerobic exercise in stroke. The lack of resources at rehabilitation centers without a structured aerobic exercise program needs to be addressed. There remains a need for continuing education on aerobic training in stroke, specifically on assessment and prescription using a standardized approach.</p

Mean (± 1 standard deviation) HR (left axis) and VR (right axis) for each participant

<p><b>Copyright information:</b></p><p>Taken from "Ambulatory monitoring of activity levels of individuals in the sub-acute stage following stroke: a case series"</p><p>http://www.jneuroengrehab.com/content/4/1/41</p><p>Journal of NeuroEngineering and Rehabilitation 2007;4():41-41.</p><p>Published online 26 Oct 2007</p><p>PMCID:PMC2174493.</p><p></p> Statistical analysis was conducted using the data of the group as a whole. Though individual differences were observed, overall, the Kruskal-Wallis non-parametric analysis of variance revealed that both HR (black square; p = 0.0207) and VR (black circle; p < 0.0001) generally increased as AC increased HR and VR increased. For participant S2, the standard deviations for both HR and VR in ACare small and therefore the SD bars do not extend beyond the size of the symbol used in the figure. For all participants, there were no differences for both HR (p = 0.1858) and VR (p = 0.5225) between the two lowest activity levels (AC, AC). For HR there was no difference between ACand AC(p = 0.8874). HR for ACwas significantly greater than for AC(p = 0.0105) and AC(p = 0.0396); there was no statistical difference (p = 0.094) between ACand AC. VR was significantly greater for ACthan for AC(p = 0.0018) and AC(p = 0.0186), and VR for ACwas significantly greater than for AC(p = 0.0107)

Is quadriceps endurance reduced in COPD?: A systematic review

BACKGROUND: Although the aerobic profile of the quadriceps muscle is reduced in COPD, there is conflicting evidence regarding whether this leads to reduced quadriceps muscle endurance. We, therefore, performed a systematic review of studies comparing quadriceps endurance in individuals with COPD with that in healthy control subjects. METHODS: Relevant studies were identified by searching six electronic databases (1946-2011). Full-text articles were obtained after two researchers independently reviewed the abstracts. The results were combined in a random effects meta-analysis, and metaregression models were fitted to assess the influence of the type of measurement. RESULTS: Data were extracted from 21 studies involving 728 individuals with COPD and 440 healthy control subjects. Quadriceps endurance was reduced in those with COPD compared with healthy control subjects (standardized mean difference, 1.16 [95% CI, 1.02-1.30]; P < .001) with a 44.5 s (4.5-84.5 s; P = .029) reduction in COPD (large effect size) when measured using a nonvolitional technique. The relationship between quadriceps endurance in those with COPD and control subjects did not differ when comparing nonvolitional and volitional techniques (P = .22) or when high- or low-intensity tasks (P = .44) were undertaken. CONCLUSIONS: Quadriceps endurance is reduced in individuals with COPD compared with healthy control subjects, independent of the type of task performed