Effects of task-oriented aerobic exercise training on cardiorespiratory fitness and cerebral blood flow in hronic stroke patients
Date Issued
2008
Date
2008
Author(s)
Lai, Chung-Chun
Abstract
Background and purpose: Aerobic exercise training has beneficial effects on cardiorespiratory fitness in chronic stroke patients. Some studies have indicated that functional exercise training, known as the task-oriented exercise, improved cerebral blood flow. However, the effects of task-oriented aerobic exercise training on chronic stroke patients were unknown. The study was designed to investigate the effects of task-oriented aerobic exercise training on cardiorespiratory fitness, functional performance, physical activity, cerebral blood flow in patients with chronic stroke, and the association between the changes of measured outcomes. Methods: Patients with chronic ischemic stroke (post-stroke duration > 6 months) were recruited and assigned to exercise intervention group or control group by the stratified randomization according to the gender and severity of stroke. The intervention group underwent task-oriented aerobic exercise training for 12 weeks, while control group was asked to maintain regular physical activities by weekly telephone checks. Outcome measures included variables in a symptom-limited exercise test, 6-minute walk distance, selective walking speed from a 10-meter walk test, Rivermead mobility index (RMI), instrumental activity of daily living scale (IADL), physical activity scales for individuals with physical disabilities (PASIPD) and Doppler measurements before and after 12 weeks. All statistical analyses were performed by SPSS 11.5 (SPSS Inc., Chicago, USA). A two-tailed p value less than 0.05 were considered statistically significant. Independent t test and chi-square test were used to compare baseline data between two groups. A mixed model ANOVA was used to compare the exercise capacity, functional performance and physical activity between groups across time. A 2×2 two-way ANCOVA was performed to analyze the cerebral blood flow between two groups with age, gender and resting mean blood pressure as covariates. The relationships between changes of outcomes were analyzed by partial correlation coefficient. Results: There were no significant group differences in baseline data except comorbidity and respiratory exchange ratio derived from the exercise test. Significant interaction was noted in variables of peak oxygen consumption, peak oxygen pulse, peak minute ventilation, 6 minute walk test, selective walking speed and mean blood flow velocity of anterior cerebral artery in non-affected hemisphere. In addition, participants in exercise group showed significant time main effect without interaction in RMI, PASIPD, mean flow velocity and flow volume of internal carotid artery in non-affected hemisphere, and total flow volume of extracrainial arteries in non-affected hemisphere after 12 weeks. The change of selective walking speed moderately correlated with the change of IADL (r=0.469), PASIPD (r=0.676), peak oxygen consumption (r=0.503), peak oxygen pulse (r=0.573), and peak minute ventilation (r=0.649). Moreover, the change of peak workload and the change of mean flow velocity of anterior cerebral artery in affected hemisphere showed moderate negative correlation as well (r=-0.800). Conclusion: Task-oriented aerobic exercise training improved cardiorespiratory fitness, ambulatory capacity and cerebral blood flow of specific region (territory of anterior cerebral artery in non-affected hemisphere) in our chronic stroke patients. The improvement in cerebral blood flow demonstrated significant correlation with the improvement in cardiorespiratory fitness.
Subjects
Stroke
Exercise
Physical fitness
Walking
Cerebrovascular circulation
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