Spearman Rank Correlations between Patient's diary versus Researcher's Diary and versus Activity monitor in 16 stroke patients for physical activity (METs*minutes) and energy expenditure.

<p>Abbreviations: ** =  p<0.01.</p

Comparing total Mets*minutes in 16 stroke patients: activity monitor versus patient diary.

<p>Total Mets*minutes of activity monitor was compared with diary of stroke patients. Broken horizontal lines represent percentiles 25 and 75, bold solid lines represent the median value of difference. Data analysis showed no good level of agreement between patient diary and the activity monitor (Median = 352.24; P25 = 242.44; P75 = 601.46). Visual inspection revealed no systematic bias.</p

Comparing energy expenditure in 16 stroke patients: observational diary versus patient diary.

<p>Energy expenditure (kcal/12 h) of observer activity diary was compared with diary of stroke patients. Broken horizontal lines represent percentiles 25 and 75 value, bold solid lines represent the median value of difference. Data analysis showed good agreement between both diaries (Median = 91.90; P25 = 2.57; P75 = 194.51). Most data are clustered around the zero point.</p

Demographic and clinical characteristics of included patients.

<p>Abbreviations: d = days, SD =  standard deviation, % =  percentage, RMA-GF =  Rivermead Motor Assessment Gross Function, FAC =  Functional Ambulation Categories, n =  number, IQR =  Interquartile Range.</p

METs*minutes and Energy Expenditure values measured by two activity diaries and an Activity monitor in 16 stroke patients.

<p>Abbreviations: P25-P75 =  percentile 25–75. <u>Metabolic Equivalents (METs)-values</u>: Diary: METs- values per activity based on Compendium of Ainsworth²⁰×30 minutes, subdivided in sedentary activity (≤1 METs), light activity (>1-<3 METs), moderate activity (3–6 METs), vigorous activity (>6 METs). Activity monitor: calculated by SenseWear Pro 2 armband. <u>Energy expenditure kilocalories (kcal/12 h)-values</u>: Diary: kcal/12 h calculated by ((METs valuereported per activity ×3.5×patients weight)/200×30minutes)²³×24. Activity monitor: kcal/12 h calculated by SenseWear Pro 2 armband.</p

Comparing energy expenditure in 16 stroke patients: activity monitor versus patient diary.

<p>Energy expenditure (kcal/12 h) of observer activity diary was compared with diary of stroke patients. Broken horizontal lines represent percentiles 25 and 75 value, bold solid lines represent the median value of difference. The activity monitor is underestimating data for all patients in comparison to the diary filled in by the patient (Median = 507.27; P25 = 301.05; P75 = 804.44).</p

Does a cycling program combined with education and followed by coaching promote physical activity in subacute stroke patients? A randomized controlled trial

<p><b>Background:</b> To investigate the effects of a three month active cycling program followed by coaching on physical activity in subacute stroke patients.</p> <p><b>Methods:</b> Patients (<i>n</i> = 59; mean age =65.4 ± 10.3) aged ≤80 years with first stroke and able to cycle at 50 revolutions/minute enrolled 3–10 weeks post stroke. Patients were randomly allocated to three month active cycling group (<i>n</i> = 33) or to a control group (<i>n</i> = 26), 3 x 30 minutes training/week. Afterwards, the active cycling group was randomized into a coaching (<i>n</i> = 15) versus non-coaching group (<i>n</i> = 16) for nine months. Physical activity was measured by objective and self-reported measures, which were taken before/after the active cycling program and during six and 12 months, except the Baecke-questionnaire, which was used at baseline and 12 months.</p> <p><b>Results:</b> A significant difference was found in Baecke/sport (95% confidence interval: 0.06, 2.24; <i>p</i> = 0.039) between the active cycling group and the control group, in patients with severe motor function deficits at baseline. Patients in the control group performed significant less sports at 12 months (mean Baecke/sport_baseline =3.07 ± 1.21, mean Baecke/sport_12months = 1.43 ± 0.98; <i>p</i> = 0.01). Furthermore, all groups showed significant changes over time in all measures at three months (except: Physical Activity Scale for Individuals with Physical Disabilities, diary/Mets*minutes-moderate) and 12 month and additionally in a subgroup with severe motor function deficits (except diary Mets*minutes-sedentary).</p> <p><b>Conclusion:</b> When active cycling combined with education is used in subacute patients with severe motor function deficits, more sport participation might be observed after one year. No other significant group differences were found over time. In all groups, however, patients showed significant improvement over time in physical activity measures. Future work is needed to explore the most effective coaching approach after an aerobic training program.Implications for Rehabilitation</p><p>The active cycling program combined with education is applicable in subacute stroke patients as it required little stand-by assistance due to chip cards, the intensity was gradually built and the involvement of caregivers in the educational sessions. This training approach also revealed applicable in severely impaired stroke patients and might facilitate sport participation on the long-term.</p><p>This randomized controlled study aims to quantify physical activity after stroke by using a combination of objective and self-report measures, which revealed detailed information about different aspects of physical activity levels.</p><p>There is a need for coaching approaches that facilitate aerobic exercise after ending a supervised program. A coaching approach needs to guide patients in adopting aerobic exercise as a part of a lifestyle change and needs to be less time consuming.</p><p></p> <p>The active cycling program combined with education is applicable in subacute stroke patients as it required little stand-by assistance due to chip cards, the intensity was gradually built and the involvement of caregivers in the educational sessions. This training approach also revealed applicable in severely impaired stroke patients and might facilitate sport participation on the long-term.</p> <p>This randomized controlled study aims to quantify physical activity after stroke by using a combination of objective and self-report measures, which revealed detailed information about different aspects of physical activity levels.</p> <p>There is a need for coaching approaches that facilitate aerobic exercise after ending a supervised program. A coaching approach needs to guide patients in adopting aerobic exercise as a part of a lifestyle change and needs to be less time consuming.</p

CD8 signaling in post-stroke brain.

<p><b>(A)</b> Expression of innate immune receptors and of <b>(B)</b> signal transduction molecules of respective pathways (indicated in brackets) involved in M1 polarization analyzed 4 days after stroke in the perilesional areas of the ischemic hemisphere. <b>(C)</b> Quantification of CD8+CD68+ cells as average (Av) counts ± SEM per field of 0.125 mm² <b>(D)</b> Proportion of CD68+ cells expressing CD8 for MCAO animals. Sham animals are not plotted that lacked either or both CD8+ or CD68+ cells showed ratio was either 0 or a/0. <i>A</i>-<i>D</i>: Data are presented as mean ± SEM. * <i>P</i> < 0.05; ** <i>P</i> < 0.01; *** <i>P</i> < 0.001.</p

CD8-expressing cells in post-stroke brain.

<p><b>(A–B)</b> Upper panel shows representative triple-labeled immunostaining of CD8+CD68+ cells expressing iNOS or Arg1 in the perilesional areas of the ischemic hemisphere at 6 h, and at days 1, 2, 3 and 4 after stroke. Lower panel shows quantification data. <b>(C)</b> Proportion of CD8+CD68+ cells expressing either Arg1 or iNOS at 4 d after stroke. Data in <i>A</i>–<i>C</i> is presented as average ± SEM. Scale bars represent 32 μm. * <i>P</i> < 0.05; ** <i>P</i> < 0.01; *** <i>P</i> < 0.001.</p

M2 microglia/macrophages are recruited early after MCAO and progress towards M1 phenotype.

<p>(<b>A–B</b>) Upper panels are representative double-labeled immunohistochemistry for iNOS+CD68+ (M1, <b><i>A</i></b>) and Arg1+CD68+ (M2, <b><i>B</i></b>) cells in the infarct border after stroke. Arrows indicate double positive cells and arrowheads indicate CD68+ cells not stained with Arg1 or iNOS, respectively. Scale bars represent 16 μm. The quantification of these cells at different time points are presented in the lower panels. Data are presented as average (Av) counts ± SEM per field of 0.125 mm² (<b>C</b>) iNOS+CD68+ and Arg1+CD68+ cells shown as a proportion of total CD68+ cell population. (<b>D</b>) The dramatic increase in M1 cells by 4 days after stroke was confirmed by brain transcript analysis of M1 marker Cd86/B7-2. <i>A</i>–<i>D</i>: Data are presented as mean ± SEM. * <i>P</i> < 0.05; ** <i>P</i> < 0.01; *** <i>P</i> < 0.001.</p