Exercise Induces Peripheral Muscle But Not Cardiac Adaptations After Stroke: A Randomized Controlled Pilot Trial

doi:10.1016/j.apmr.2015.12.018

Randomized Controlled Trial

. 2016 Apr;97(4):596-603.

doi: 10.1016/j.apmr.2015.12.018. Epub 2016 Jan 4.

Exercise Induces Peripheral Muscle But Not Cardiac Adaptations After Stroke: A Randomized Controlled Pilot Trial

Sarah A Moore¹, Djordje G Jakovljevic², Gary A Ford³, Lynn Rochester⁴, Michael I Trenell²

Affiliations

¹ Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom. Electronic address: s.a.moore@ncl.ac.uk.
² Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Research Councils UK, Newcastle Centre for Ageing and Vitality, Newcastle upon Tyne, United Kingdom.
³ University of Oxford, Oxford, United Kingdom.
⁴ Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom.

PMID: 26763949
PMCID: PMC5813708
DOI: 10.1016/j.apmr.2015.12.018

Randomized Controlled Trial

Exercise Induces Peripheral Muscle But Not Cardiac Adaptations After Stroke: A Randomized Controlled Pilot Trial

Sarah A Moore et al. Arch Phys Med Rehabil. 2016 Apr.

. 2016 Apr;97(4):596-603.

doi: 10.1016/j.apmr.2015.12.018. Epub 2016 Jan 4.

Authors

Sarah A Moore¹, Djordje G Jakovljevic², Gary A Ford³, Lynn Rochester⁴, Michael I Trenell²

Affiliations

¹ Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom. Electronic address: s.a.moore@ncl.ac.uk.
² Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Research Councils UK, Newcastle Centre for Ageing and Vitality, Newcastle upon Tyne, United Kingdom.
³ University of Oxford, Oxford, United Kingdom.
⁴ Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom.

PMID: 26763949
PMCID: PMC5813708
DOI: 10.1016/j.apmr.2015.12.018

Abstract

Objective: To explore the physiological factors affecting exercise-induced changes in peak oxygen consumption and function poststroke.

Design: Single-center, single-blind, randomized controlled pilot trial.

Setting: Community stroke services.

Participants: Adults (N=40; age>50y; independent with/without stick) with stroke (diagnosed >6 mo previously) were recruited from 117 eligible participants. Twenty participants were randomized to the intervention group and 20 to the control group. No dropouts or adverse events were reported.

Interventions: Intervention group: 19-week (3 times/wk) progressive mixed (aerobic/strength/balance/flexibility) community group exercise program. Control group: Matched duration home stretching program.

Main outcome measures: (1) Pre- and postintervention: maximal cardiopulmonary exercise testing with noninvasive (bioreactance) cardiac output measurements; and (2) functional outcome measures: 6-minute walk test; timed Up and Go test, and Berg Balance Scale.

Results: Exercise improved peak oxygen consumption (18±5 to 21±5 mL/(kg⋅min); P<.01) and peak arterial-venous oxygen difference (9.2±2.7 to 11.4±2.9 mL of O2/100 mL of blood; P<.01), but did not alter cardiac output (17.2±4 to 17.7±4.2 L/min; P=.44) or cardiac power output (4.8±1.3 to 5.0±1.35 W; P=.45). A significant relation existed between change in peak oxygen consumption and change in peak arterial-venous oxygen difference (r=.507; P<.05), but not with cardiac output. Change in peak oxygen consumption did not strongly correlate with change in function.

Conclusions: Exercise induced peripheral muscle, but not cardiac output, adaptations after stroke. Implications for stroke clinical care should be explored further in a broader cohort.

Keywords: Cardiac output; Exercise; Physical fitness; Rehabilitation; Stroke.

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Figures

**Fig 1**
Flow diagram of study participants (CONsolidated Standards Of Reporting Trials diagram). Abbreviations: MMSE, Mini-Mental Scale Examination; MRI, magnetic resonance imaging.

**Fig 2**
Relation (A) between peak oxygen consumption and cardiac output and (B) between peak oxygen consumption and arterial-venous oxygen difference.

See this image and copyright information in PMC

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References

1. Smith A.C., Saunders D.H., Mead G. Cardiorespiratory fitness after stroke: a systematic review. Int J Stroke. 2012;7:499–510. - PubMed
1. Hackam D.G., Spence D. Combining multiple approaches for the secondary prevention of vascular events after stroke: a quantitative modeling study. Stroke. 2007;38:1881–1885. - PubMed
1. Bassett D.R., Howley E.T. Limiting factors for maximum oxygen uptake and determinants of endurance performance. Med Sci Sports Exerc. 2000;32:70–84. - PubMed
1. Tomczak C.R., Jelani A., Haennel R.G., Haykowsky M.J., Welsh R., Manns P.J. Cardiac reserve and pulmonary gas exchange kinetics in patients with stroke. Stroke. 2008;39:3102–3106. - PubMed
1. Jakovljevic D.G., Moore S.A., Tan L.-B., Rochester L., Ford G.A., Trenell M.I. Discrepancy between cardiac and physical functional reserves in stroke. Stroke. 2012;43:1422–1425. - PubMed

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[1] Smith A.C., Saunders D.H., Mead G. Cardiorespiratory fitness after stroke: a systematic review. Int J Stroke. 2012;7:499–510. - PubMed

[2] Smith A.C., Saunders D.H., Mead G. Cardiorespiratory fitness after stroke: a systematic review. Int J Stroke. 2012;7:499–510. - PubMed

[3] Hackam D.G., Spence D. Combining multiple approaches for the secondary prevention of vascular events after stroke: a quantitative modeling study. Stroke. 2007;38:1881–1885. - PubMed

[4] Hackam D.G., Spence D. Combining multiple approaches for the secondary prevention of vascular events after stroke: a quantitative modeling study. Stroke. 2007;38:1881–1885. - PubMed

[5] Bassett D.R., Howley E.T. Limiting factors for maximum oxygen uptake and determinants of endurance performance. Med Sci Sports Exerc. 2000;32:70–84. - PubMed

[6] Bassett D.R., Howley E.T. Limiting factors for maximum oxygen uptake and determinants of endurance performance. Med Sci Sports Exerc. 2000;32:70–84. - PubMed

[7] Tomczak C.R., Jelani A., Haennel R.G., Haykowsky M.J., Welsh R., Manns P.J. Cardiac reserve and pulmonary gas exchange kinetics in patients with stroke. Stroke. 2008;39:3102–3106. - PubMed

[8] Tomczak C.R., Jelani A., Haennel R.G., Haykowsky M.J., Welsh R., Manns P.J. Cardiac reserve and pulmonary gas exchange kinetics in patients with stroke. Stroke. 2008;39:3102–3106. - PubMed

[9] Jakovljevic D.G., Moore S.A., Tan L.-B., Rochester L., Ford G.A., Trenell M.I. Discrepancy between cardiac and physical functional reserves in stroke. Stroke. 2012;43:1422–1425. - PubMed

[10] Jakovljevic D.G., Moore S.A., Tan L.-B., Rochester L., Ford G.A., Trenell M.I. Discrepancy between cardiac and physical functional reserves in stroke. Stroke. 2012;43:1422–1425. - PubMed

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Exercise Induces Peripheral Muscle But Not Cardiac Adaptations After Stroke: A Randomized Controlled Pilot Trial

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Exercise Induces Peripheral Muscle But Not Cardiac Adaptations After Stroke: A Randomized Controlled Pilot Trial

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