To examine the effectiveness of so-called cardiac rehab programs for stroke survivors, researchers looked at several measures of aerobic capacity, including how far people walked in six-minute treadmill tests and what’s known as peak VO2, the amount of oxygen the body is capable of using in one minute. Stroke survivors in the study could walk an average of 53.3 meters further in six-minute tests after cardiac rehab than they could before, according to the new study, published in August 2019 in the Journal of the American Heart Association. That difference might be enough for some stroke survivors to go from being mainly housebound to getting out into their community and regaining some independence. Exercise capacity also improved. Before cardiac rehab, stroke survivors had peak VO2 levels ranging from 11.24 mL/kg (milliliters of oxygen per kilogram of body mass) to 20.88 mL/kg. Afterward, peak VO2 levels were 2.08 mL/kg higher. That difference is enough to make it easier for more impaired stroke survivors to complete daily tasks like dressing and bathing, and to make it possible for more functional stroke survivors to get more exercise and less sedentary time. “A large amount of sedentary activity for stroke survivors, depending on disability level, can impact their ability to independently perform daily activities, such as self-care, cooking, shopping, and social or community activity,” says Elizabeth Regan, lead author of the study and a researcher at the University of South Carolina in Columbia. “Physical activity and exercise have the opposite effect by increasing the endurance and strength of an individual, so they have more energy available to perform the daily requirements of life and the activities they care about,” Regan says. Stroke survivors typically take less than one-half the daily steps of their healthy counterparts and spend more than 78 percent of their time engaged in sedentary behaviors like watching television, Regan and colleagues wrote. While many stroke survivors outside the United States receive therapy designed to improve aerobic fitness, these programs are only offered to heart patients in America, researchers noted. The lack of focus on aerobic fitness puts U.S. stroke survivors at an increased risk for falls and repeat strokes, Regan says. Cardiac rehab programs typically involve exercising for at least 30 minutes two to three times a week, supervised by a nurse or physiologist, for 8 to 18 weeks, the study team reports. The effects of cardiac rehab for stroke survivors were similar with walking, cycling, and mixed aerobic activity. Researchers analyzed data from 19 previously published studies that tested 485 stroke survivors’ exercise capacity in a variety of ways before and after completing fitness programs similar to what’s typically offered in cardiac rehab. One limitation of the study is that researchers had limited information about long-term outcomes after cardiac rehab. It also wasn’t clear from the analysis what precise exercise regimen or what frequency or duration of rehab workouts might be ideal for stroke survivors. Still, the findings suggest that stroke survivors should start cardiac rehab as soon as possible, says Khurram Nasir, MD, of the Center for Outcomes Research and Evaluation at Yale University School of Medicine in New Haven, Connecticut. “Rehabilitation is a great setting to initiate these monitored activities, even as walking on a treadmill and using a stationary bicycle to reduce the risk of falls due to reduced balance, increasing the capacity in stages under supervision depending upon individualized needs,” Dr. Nasir says. Starting earlier may help minimize long-term functional impairment and help stroke survivors achieve more physical independence, Nasir adds. The supervised structure of cardiac rehab programs may also help stroke survivors learn how to exercise safely and give them the confidence they need to live less sedentary lives, says Amytis Towfighi, MD, an associate professor of neurology and preventive medicine at the University of Southern California in Los Angeles. “Stroke survivors are often hesitant to engage in physical activities given their uncertainty about physical limitations, fear of falling, balance and coordination issues, and deconditioning,” Dr. Towfighi says. But if they don’t focus on exercise capacity as part of rehab, they may experience these exact problems — and many more. “Physical inactivity can lead to numerous deleterious physical effects, such as development of blood clots in the legs, pneumonia, spasticity (muscle tightness) and pain in the weak limbs, and physical deconditioning,” Towfighi says. “In addition, it can lead to obesity, abnormal cholesterol, diabetes, high blood pressure, repeat strokes, heart attack, and higher risk of death after stroke.”
