Study: Exercise-Based Cardiac Rehab Added to Stroke Recovery Improved Strength, Cardiac Endurance

Stroke is not among the covered diagnoses for cardiac rehab, despite many similar cardiovascular risk factors, according to the study.

New research published in the Journal of the American Heart Association found that stroke survivors who completed a cardiac rehabilitation program that focused on aerobic exercise—currently not prescribed to stroke survivors—significantly improved their ability to transition from sitting to standing and how far they could walk during a 6-minute walking test, according to a press release.

Cardiac rehabilitation is a structured exercise program prevalent in the United States for people with cardiovascular disease and has been shown to increase cardiovascular endurance and improve quality of life. Stroke is not among the covered diagnoses for cardiac rehab, despite many similar cardiovascular risk factors, according to the study.

More than 75% of all US patients who survive a stroke are not receiving the guideline-recommended amount of exercise, as exercise-based cardiac rehab programs are not the standard of care provided to stroke survivors in the United States, the researchers noted.

“Through this study, we hoped to improve controllable risk factors for stroke survivors, and potentially prevent future stroke and cardiac events,” said lead study author Elizabeth W. Regan, DPT, PhD, in a press release. “Increasing physical activity is an important way to prevent stroke, and we wanted to see whether the rehab that patients receive after surviving a heart attack could have similar positive outcomes for patients who survive a stroke.”

A pilot study was launched at a North Carolina medical center to investigate the benefits of a cardiac rehab program for stroke survivors. Twenty-four participants between 33 and 81 years of age who had a stroke from 3 months to 10 years earlier were enrolled in the cardiac rehab program, including 30- to 51-minute aerobic exercise sessions 3 times a week for 3 months.

Participants were evaluated for physical function at the beginning of the program, such as cardiovascular endurance and functional strength, and other health measures, such as a mental health questionnaire and a balance test. In a post-program assessment, participants repeated these evaluations. At a 6-month follow-up appointment, they completed the same tests a final time and answered life and exercise habit questionnaires, according to the study authors.

At the initial post-program assessment, researchers found that compared to the beginning of the study, participants saw an improvement in the distance they could walk during a 6-minute walking test. On average, each participant improved their distance by 203 feet.

Further, participants improved their ability to quickly move from sitting to standing in the 5-times-sit-stand test. Improvements on this test correspond to increased leg strength and can correspond to a reduced fall risk for people after stroke.

According to the study authors, participants improved their metabolic equivalent of task level—or the maximum level of the amount of energy generated by the average person to perform a specific task—by about 3.6. For example, 1 metabolic equivalent of task is defined as the energy it takes to watch television and 7 are required for jogging.

At the 6-month follow-up visit, participants had maintained these gains, and 83.3% of participants reported that they were still exercising at least once a week, according to the study authors.

“Our most important goal as health care professionals is to help stroke survivors reduce as many risk factors as possible to prevent future stroke or cardiovascular disease. Based on these preliminary findings, we hope prescribing cardiac rehab will be considered for all patients following a stroke, as it is for patients after a heart attack,” Regan said in a press release. “We need to place value on exercise as medicine. Exercise is health, and it is important for every individual, regardless of physical limitations or age. Hopefully, increasing physical activity can be one of the first steps to improving overall health following a stroke.”

Larger studies are needed to confirm these preliminary results, since this study included a small patient sample and was a pilot study at a single center in a multi-center health system.

REFERENCE

Exercise-based cardiac rehab added to stroke recovery improved strength, cardiac endurance. American Heart Association. https://newsroom.heart.org/news/exercise-based-cardiac-rehab-added-to-stroke-recovery-improved-strength-cardiac-endurance#:~:text=In%20a%20small%20study%2C%20stroke,at%20least%20once%20a%20week. Published January 27, 2021. Accessed January 28, 2021.