Aerobic Exercise in Subacute Stroke Improves Cardiovascular Health and Physical Performance.
Aerobic Exercise in Subacute Stroke Improves Cardiovascular Health and Physical Performance.
Filed under: Rehab Centers
J Neurol Phys Ther. 2012 Oct 29;
Billinger SA, Mattlage AE, Ashenden AL, Lentz AA, Harter G, Rippee MA
BACKGROUND AND PURPOSE:: Cardiovascular health is often impaired after stroke. Reduced exercise capacity (VO2peak) 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 report between-limb differences in brachial artery FMD and low VO2peak values. After the intervention, significant improvements were reported 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 VO2peak 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, http://links.lww.com/JNPT/A29) for more insights from the authors.
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Incremental effects of restless legs syndrome on nocturnal blood pressure in hypertensive patients and normotensive individuals.
Filed under: Rehab Centers
Blood Press Monit. 2012 Oct 29;
Erden EC, Erden I, Türker Y, Sivri N, Dikici S, Oz?ahin M
BACKGROUND: Few studies have evaluated the role of restless legs syndrome (RLS) in the development of nondipping 24 h blood pressure (BP) patterning/sleep-time hypertension, which has been shown to be an independent predictor of cardiovascular risk. These were indirect studies that had reported the relation between BP and RLS attacks during polysomnographic investigations in the lab. The aim of the present study was to assess the relationship between RLS, which was diagnosed clinically, and night-time BP patterns in a relatively large young cohort who had not been treated before. PATIENTS AND METHODS: After applying the exclusion criteria, this cross-sectional study included 230 consecutive patients with never-treated hypertension who presented to our institution for initial evaluation of hypertension. RLS was assessed using a self-administered questionnaire based on the International Restless Legs Study Group criteria. The questions on RLS were completed by 214 patients and ambulatory BP monitoring was carried out for all patients. RESULTS: In the study group, 133 patients were diagnosed as hypertensive (53.4% nondippings) and 81 patients as normotensives (54.3% nondippings). RLS was present in 61 patients (28.5%) in the total sample. The prevalence of RLS, overall, was significantly higher in nondippings compared with dippings (34.7 vs. 21.2%, respectively; P=0.028). Logistic regression analysis showed that the RLS is an independent determinant for both hypertension (odds ratio=0.43, 95% confidence interval=0.21-0.83; P=0.013) and the nondipping BP patterns (odds ratio=1.96, 95% confidence interval=1.05-3.67; P=0.035). CONCLUSION: We have shown that clinically diagnosed RLS was associated with the nondipping pattern, which has been shown to be an independent predictor of cardiovascular risk.
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Efficacy of a long-term secondary prevention programme following inpatient cardiovascular rehabilitation on risk and health-related quality of life in a low-education cohort: a randomized controlled study.
Filed under: Rehab Centers
Eur J Prev Cardiol. 2012 Oct 30;
Mayer-Beger W, Simic D, Mahmoodzad J, Burtscher R, Kohlmeyer M, Schwitalla B, Redaèlli M
Objective: The aim of this study was to evaluate the efficacy of a long-term secondary prevention programme following inpatient cardiovascular rehabilitation on cardiovascular risk and health-related quality of life in a cohort of middle-aged (?58 years) coronary artery disease (CAD) patients of low educational level compared to usual care.Design and methods: The study included 600 patients with CAD, with 271 in the intervention group (IG) and 329 in the control group (CG). The average age was nearly 50 years in both groups, nearly 90% were male, and 77% had less than 10 years of school education. No significant differences existed between the groups at baseline. Both groups had a 3-week comprehensive cardiovascular inpatient rehabilitation programme at the beginning, the intervention consisted of one further rehabilitation session in hospital after 6 months and regular telephone reminders over a period of 36 months. Analyses were conducted on an intention-to-treat basis. To evaluate the individual risk level, we used the PROCAM score and intima-media thickness (IMT) was measured at the common carotid artery on both sides following international standards. Health-related quality of life was assessed with the EUROQOL and HADS.Results: Patients in the IG showed better 3-year risk profile outcomes. The PROCAM score increased by 3.0 (IG) and by 3.7 (CG) from the beginning to after 3 years (p > 0.05 intention-to-treat). The average IMT increased by 0.04 mm in the CG and was reduced by 0.03 mm in the IG (p = 0.014 for the difference). The IG had a significant improvement in health-related quality of life. Mortality, myocardial infarction, and stroke were not different although ‘other cardiac events’ (cardiac surgery or intervention) were significantly lower in the IG than the CG patients (p < 0.05).Conclusion: This long-term secondary prevention programme with inpatient rehabilitation at the beginning and telephone reminder for a 3-year period was successful. There were significant differences in health-related quality of life between the IG and CG, despite the relatively positive outcomes in the CG. In this low-education (predominantly male), middle-aged cohort, the positive impact on cardiovascular risk was pronounced in the high-risk subgroup (PROCAM 10-year risk 10-40%). HubMed – rehab
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