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Aerobic Exercise in Subacute Stroke Improves Cardiovascular Health and Physical Performance

Billinger, Sandra A. PT, PhD; Mattlage, Anna E. BS; Ashenden, Abigail L. SPT, BS; Lentz, Angela A. DPT, BS; Harter, Gabe DPT, BS; Rippee, Michael A. MD

Journal of Neurologic Physical Therapy: December 2012 - Volume 36 - Issue 4 - p 159–165
doi: 10.1097/NPT.0b013e318274d082
Research Articles
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Background and Purpose: Cardiovascular health is often impaired after stroke. Reduced exercise capacity (

O2peak) and changes in the vascular system in the stroke-affected limb may impact performance of physical activities such as walking. There is little information regarding the role of prescribed moderate- to high-intensity exercise in subacute stroke. The purpose of this study was to examine whether an 8-week aerobic exercise intervention would improve cardiovascular health and physical performance in participants with subacute stroke.

Methods: Ten subjects were enrolled in the study and 9 of them completed the intervention. Participants were aged 61.2 ± 4.7 years old, were 66.7 ± 41.5 days poststroke, and had minor motor performance deficits (Fugl-Meyer score, 100.3 ± 29.3). Outcome measures were taken at baseline, postintervention, and at 1-month follow-up. Brachial artery vasomotor reactivity (flow-mediated dilation [FMD]) of both arms was used to assess vascular health, and a peak exercise test was used to assess exercise capacity. The 6-minute walk test (6MWT) was used to assess physical performance. Participants exercised on a recumbent stepper 3 times per week for 8 weeks at a prescribed heart rate intensity.

Results: At baseline, we identified between-limb differences in brachial artery FMD and low

O2peak values. After the intervention, significant improvements were observed in the FMD in both arms, resting systolic blood pressure, and the 6MWT. Although we also observed improvements in the resting diastolic blood pressure, heart rate, and

O2peak values, these changes were not significantly different.

Discussion and Conclusion: Aerobic exercise in participants with subacute stroke was beneficial for improving cardiovascular health, reducing cardiac risk, and improving physical performance (6MWT).

Video abstract available: (see the Video, Supplemental Digital Content 1, for more insights from the authors.

Departments of Physical Therapy and Rehabilitation Science (S.A.B., A.E.M., A.L.A., A.A.L., G.H.) and Neurology (M.A.R.), University of Kansas Medical Center, Kansas City, Kansas.

Correspondence: Sandra A. Billinger, PT, PhD, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, Mail Stop 2002, Kansas City, KS (

A part of this study was presented as a poster at the International Stroke Conference, American Heart Association, New Orleans, LA, on February 1–3, 2012.

The authors have no conflict of interest to disclose.

Sandra A. Billinger was supported in part by K01HD067318 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and in part by Frontiers: The Heartland Institute for Clinical and Translational Research (University of Kansas Medical Center's Clinical and Translational Science Award; UL1RR033179). Anna E. Mattlage and Abigail L. Ashenden were supported in part by T32HD057850 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health & Human Development or the National Institutes of Health. Research in Exercise and Cardiovascular Health laboratory space was supported by the Georgia Holland Endowment Fund.

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© 2012 Neurology Section, APTA