Early functional improvement after stroke correlates with cardiovascular fitness

Abstract

Cardiovascular fitness exerts directly beneficial effects on functional and cognitive outcomes in patients of chronic stroke. However, the effect of early rehabilitation on cardiovascular function has not yet been thoroughly examined. We tested whether complementary rehabilitation program could influence cardiovascular fitness in an early stage of stroke patients. The associations for post-acute stroke functional recovery with cardiovascular fitness were explored. Thirty-seven patients with mean poststroke interval of 8.6 ± 3.8 days underwent inpatient rehabilitation of 22.8 ± 3.8 days. Functional outcomes of 15.3 points (17.2%) in functional independence measure improved after rehabilitation program. The therapeutic cardiovascular fitness was determined in ramp exercise test on a cycling ergometer. Peak oxygen uptake (V˙O_2peak) significantly increased by 24.8% after early stroke rehabilitation. Multivariate regression analysis was performed to assess for associations of functional improvement with respect to change in V˙O_2peak and extremities motor impairment. V˙O_2peak gain accounted for more functional recovery than extremities motor improvement (R² = 0.42). In conclusion, these results suggest that cardiovascular fitness appears to increase after complementary program in early stroke rehabilitation, and better cardiovascular fitness may be associated with greater functional improvement.

Keywords: Fitness; Oxygen uptake; Rehabilitation; Stroke.

Figure 1

Study testing timeline. All subjects completed two assessment sessions. Assessment sessions took place upon enrollment and in the 4th week. Dotted line indicates study enrollment; dashed‐dotted line indicates the post‐rehabilitation assessment enrollment.

Figure 2

Functional improvement is promoted after early stroke rehabilitation. A Motor function on the Fugl‐Meyer scale significantly improved after contemporary stroke rehabilitation (n = 37). B Independence in total‐items and motor‐item of functional independence measure increased after early stroke rehabilitation (n = 37). All data are represented as means ± SD. Pre = pre‐rehabilitation; Post = post‐rehabilitation. *p < 0.05.

Figure 3

Cardiovascular fitness on exercise testing improves after early stroke rehabilitation. Peak workload (A), oxygen uptake (B), heart rate (C), and oxygen pulse (D) significant increased after contemporary stroke rehabilitation. All data are represented as means ± SD, n = 37. Pre = pre‐rehabilitation; Post = post‐rehabilitation. *p < 0.05.