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Aerobic Exercise Prescription in Stroke Rehabilitation: A Web-Based Survey of US Physical Therapists

Boyne, Pierce PT, DPT, NCS; Billinger, Sandra PT, PhD, FAHA; MacKay-Lyons, Marilyn MSPT, PhD; Barney, Brian BS; Khoury, Jane PhD; Dunning, Kari PT, PhD

Journal of Neurologic Physical Therapy: April 2017 - Volume 41 - Issue 2 - p 119–128
doi: 10.1097/NPT.0000000000000177
Research Articles
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Background and Purpose: Best practice recommendations indicate that aerobic exercise (AEX) should be incorporated into stroke rehabilitation. However, this may be challenging in clinical settings. The purpose of this study was to assess physical therapist (PT) AEX prescription for patients with stroke, including AEX utilization, barriers to AEX prescription, dosing parameters, and safety considerations.

Methods: A cross-sectional Web-based survey study was conducted. Physical therapists with valid e-mail addresses on file with the state boards of Florida, New Jersey, Ohio, Texas, and Wyoming were eligible to participate. Survey invitations were e-mailed to all licensed PT in these states. Analysis focused on respondents who were currently involved with clinical stroke rehabilitation in common practice settings.

Results: Results from 568 respondents were analyzed. Most respondents (88%) agreed that AEX should be incorporated into stroke rehabilitation, but 84% perceived at least one barrier. Median prescribed AEX volume varied between practice settings from 20- to 30-minute AEX sessions, 3 to 5 days per week for 2 to 8 weeks. Prescribed intensity was most commonly light or moderate; intensity was determined by the general response to AEX and patient feedback. Only 2% of respondents reported that the majority of their patients with stroke had stress tests.

Discussion and Conclusions: Most US PTs appear to recognize the importance of AEX for persons poststroke, but clinical implementation can be challenging. Future studies and consensus are needed to clarify best practices and to develop implementation interventions to optimize AEX utilization in stroke rehabilitation.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A167).

Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati (P.B., B.B., K.D.), Department of Environmental Health, College of Medicine, University of Cincinnati (P.B., J.K., K.D.), and Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center (J.K.), Cincinnati, Ohio; Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City (S.B.); and School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada (M.M.-L.).

Correspondence: Pierce Boyne, PT, DPT, NCS, 3202 Eden Ave, Cincinnati, OH 45267 (Pierce.Boyne@uc.edu).

A portion of this work was presented at the IV Step Conference, Columbus, Ohio, July 2016. This work was conducted in partial fulfillment of the requirements for a PhD in Epidemiology (P.B.) in the Department of Environmental Health at the University of Cincinnati College of Medicine.

Conflicts of interest: None.

This research was supported by a Promotion of Doctoral Studies Scholarship from the Foundation for Physical Therapy (P.B.). Institutional support was provided by an NIH Clinical and Translational Science Award (8UL1-TR000077). S.B. was supported in part by K01HD067318 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 and Human Development.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jnpt.org).

© 2017 Academy of Neurologic Physical Therapy, APTA