Susan M Linder1, Sara Davidson2, Anson Rosenfeldt3, John Lee4, Mandy Miller Koop3, Francois Bethoux4, Jay L Alberts5. 1. Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH; Concussion Center, Cleveland Clinic, Cleveland, OH. Electronic address: linders@ccf.org. 2. Concussion Center, Cleveland Clinic, Cleveland, OH. 3. Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH. 4. Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH. 5. Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH; Concussion Center, Cleveland Clinic, Cleveland, OH; Center for Neurologic Restoration, Cleveland Clinic, Cleveland, OH.
Abstract
OBJECTIVES: To determine the efficacy of high-intensity cycling to improve walking capacity in individuals with chronic stroke, identify variables that predict improvement in walking capacity, and quantify the relationship between the 6-minute walk test (6MWT) and cardiopulmonary exercise (CPX) test variables. DESIGN: Secondary analysis of data from 2 randomized controlled trials. SETTING: Research laboratory. PARTICIPANTS: Individuals with chronic stroke (N=43). INTERVENTIONS: Participants were randomized to 1 of the following time-matched interventions, occurring 3 times per week for 8 weeks: (1) forced aerobic exercise and upper extremity repetitive task practice (FE+RTP [n=16]), (2) voluntary aerobic exercise and upper extremity repetitive task practice (VE+RTP [n=14]), or (3) a non-aerobic control group (n=13). MAIN OUTCOME MEASURE: Change in walking capacity as measured by the 6MWT from baseline to the end of treatment (EOT). RESULTS: Significant increases were observed in distance traveled during the 6MWT at the EOT compared with baseline in the FE+RTP (P<.001) and VE+RTP (P<.001) groups, but not in the control group (P=.21). Among aerobic exercise participants, a multivariate regression analysis revealed that cycling cadence, power output, and baseline 6MWT distance were significant predictors of change in walking capacity. CONCLUSIONS: An 8-week aerobic cycling intervention prescribed at 60% to 80% of heart rate reserve and moderate to high cadence and resistance led to significant improvements in walking capacity in our cohort of individuals with chronic stroke. Individuals with low baseline walking capacity levels may benefit most from aerobic cycling to improve over ground locomotion. Although the 6MWT did not elicit a cardiorespiratory response comparable to the maximal exertion CPX test, the 6MWT can be considered a valid and clinically relevant submaximal test of cardiorespiratory function in individuals with chronic stroke.
OBJECTIVES: To determine the efficacy of high-intensity cycling to improve walking capacity in individuals with chronic stroke, identify variables that predict improvement in walking capacity, and quantify the relationship between the 6-minute walk test (6MWT) and cardiopulmonary exercise (CPX) test variables. DESIGN: Secondary analysis of data from 2 randomized controlled trials. SETTING: Research laboratory. PARTICIPANTS: Individuals with chronic stroke (N=43). INTERVENTIONS: Participants were randomized to 1 of the following time-matched interventions, occurring 3 times per week for 8 weeks: (1) forced aerobic exercise and upper extremity repetitive task practice (FE+RTP [n=16]), (2) voluntary aerobic exercise and upper extremity repetitive task practice (VE+RTP [n=14]), or (3) a non-aerobic control group (n=13). MAIN OUTCOME MEASURE: Change in walking capacity as measured by the 6MWT from baseline to the end of treatment (EOT). RESULTS: Significant increases were observed in distance traveled during the 6MWT at the EOT compared with baseline in the FE+RTP (P<.001) and VE+RTP (P<.001) groups, but not in the control group (P=.21). Among aerobic exercise participants, a multivariate regression analysis revealed that cycling cadence, power output, and baseline 6MWT distance were significant predictors of change in walking capacity. CONCLUSIONS: An 8-week aerobic cycling intervention prescribed at 60% to 80% of heart rate reserve and moderate to high cadence and resistance led to significant improvements in walking capacity in our cohort of individuals with chronic stroke. Individuals with low baseline walking capacity levels may benefit most from aerobic cycling to improve over ground locomotion. Although the 6MWT did not elicit a cardiorespiratory response comparable to the maximal exertion CPX test, the 6MWT can be considered a valid and clinically relevant submaximal test of cardiorespiratory function in individuals with chronic stroke.
Authors: Elaine L Miller; Laura Murray; Lorie Richards; Richard D Zorowitz; Tamilyn Bakas; Patricia Clark; Sandra A Billinger Journal: Stroke Date: 2010-09-02 Impact factor: 7.914
Authors: Pamela W Duncan; Katherine J Sullivan; Andrea L Behrman; Stanley P Azen; Samuel S Wu; Stephen E Nadeau; Bruce H Dobkin; Dorian K Rose; Julie K Tilson; Steven Cen; Sarah K Hayden Journal: N Engl J Med Date: 2011-05-26 Impact factor: 91.245
Authors: Susan M Linder; Anson B Rosenfeldt; Andrew S Bazyk; Mandy Miller Koop; Sarah Ozinga; Jay L Alberts Journal: Top Stroke Rehabil Date: 2018-02-15 Impact factor: 2.119
Authors: Marilyn MacKay-Lyons; Sandra A Billinger; Janice J Eng; Alex Dromerick; Nicholas Giacomantonio; Charlene Hafer-Macko; Richard Macko; Emily Nguyen; Peter Prior; Neville Suskin; Ada Tang; Marianne Thornton; Karen Unsworth Journal: Phys Ther Date: 2020-01-23
Authors: Susan M Linder; Anson B Rosenfeldt; Sara Davidson; Nicole Zimmerman; Amanda Penko; John Lee; Cynthia Clark; Jay L Alberts Journal: Neurorehabil Neural Repair Date: 2019-07-17 Impact factor: 3.919