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Cardiac Rehabilitation

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Leading cause of neurological disability in adults. 40, ... Semi-recumbent cycle. ergometry. VO2peak. Peak Work Rate. Peak Heart Rate. 6-Minute Walk Test (6MWT) ... – PowerPoint PPT presentation

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Title: Cardiac Rehabilitation


1
Cardiac Rehabilitation for Stroke Patients Dina
Brooks, Associate Professor University of
Toronto
2
  • Is it really survival of the fittest?

3
Why study stroke?
  • Leading cause of neurological disability in
    adults
  • 40,000 50,000 strokes per year
  • 300,000 stroke survivors in Canada
  • 60 have functional impairments

4
Physical impairments
  • Weakness
  • Reduced range of motion
  • Sensory changes
  • Altered muscle tone
  • Impaired coordination
  • Reduced exercise capacity/fitness level

5
Impact of reduced fitness
  • Activities of Daily Living
  • Altered walking
  • 2/3 of stroke survivors have impaired walking
    function
  • 1/2 of stroke survivors are unable to walk at all

6
Functional ambulation
  • The capacity to execute safe, efficient walking
    within time and environmental constraints
    encountered in everyday life

Sensorimotor Control
Fitness
Functional Ambulation
7
Implications for function
  • Cardiorespiratory and walking deficits may
    mutually reinforce one another

HEALTH RELATED QUALITY OF LIFE
8
In addition..
  • 75 with history of heart disease
  • 50 - 84 have high blood pressure
  • 40 have severe coronary artery disease

9
Stroke risk factors
  • Hypertension
  • Smoking
  • Diabetes
  • Carotid stenosis
  • Atrial fibrillation
  • High cholesterol
  • Obesity
  • Physical Inactivity

Risk of second stroke or heart attack
10
Cardiovascular event
  • Stroke Rehab
  • ? 1-2 months
  • Functional recovery
  • Little exercise training
  • Little formal education
  • Cardiac Rehab
  • Up to 12 months
  • Supervised exercise program
  • Education
  • Nutritional Support

11
Fitness in strokeWhat does the literature say?
  • Exercise program feasible in stroke
  • Results in
  • improved fitness level
  • reduced neurological impairment
  • enhanced lower extremity function
  • Changes in fitness levels from 8 to 23
  • Not uniform effect throughout the groups

12
Fitness in strokeWhat does the literature say?
  • Studies focus on exercise exclusively
  • Generally less than three months
  • Why not use an established and common model of
    care (cardiac rehabilitation) and apply to the
    stroke population?

13
Cardiac rehabilitation model
  • Cardiac Rehab
  • Up to 12 months
  • Supervised exercise program
  • Education
  • Nutritional Support

14
Effects of Cardiac Rehabilitation for Individuals
Following Stroke
  • Heart Stroke Foundation of Ontario
  • Stroke Rehabilitation Special Competition SRA
    5977

15
Purpose
  • Establish feasibility of cardiac rehabilitation
    for individuals with stroke
  • Determine the effects on
  • Exercise, walking capacity and ability
  • Community re-integration
  • Quality of life
  • Risk factors for subsequent stroke

16
Design
  • Before and after experimental design with
    baseline period
  • Participants
  • Community-dwelling stroke survivors
  • gt 3 months post stroke
  • Mild to moderate impairment

17
Design
Cardiac Rehab program
Baseline
18
Outcomes
  • Maximal exercise test
  • Semi-recumbent cycleergometry
  • VO2peakPeak Work RatePeak Heart Rate
  • 6-Minute Walk Test (6MWT)
  • Stroke Impact Scale (SIS)
  • Risk factor profile
  • Community reintegration

19
Intervention Cardiac Rehab
  • Aerobic training 4-5 days / weekResistance
    training 2 days / week
  • Education sessions
  • Training once a week at Centre
  • Exercise diary

20
Progress to date Research
  • 53 people have been recruited for the study
  • 10 people were not entered, leaving 43
    participants who enrolled into the study.
  • 17 were able to walk without use of gait aids, 18
    used a single point cane, 1 used a quad cane and
    7 used a walker or rollator.

21
Preliminary results
  • Participant Demographics - All
  • n43 completed Baseline testing

22
Preliminary results
  • Changes during 3-month baseline period
  • (n34)

23
Preliminary results
  • Changes following program completion
  • (n27)

24
Preliminary results
  • No change in function during baseline 3 months
  • Attended 85 of scheduled classes
  • 14 improvement in fitness level
  • 9 reductions in BP
  • 10 greater walking ability
  • 6 lower relative stroke risk

25
Preliminary results
  • Subjects extremely satisfied with the program and
    wish to continue
  • Adaptation required for the program
  • Partners satisfied and wish to participate

26
Discussion
  • Aerobic and functional capacity in this
    population is low.
  • In the absence of formal community-based
    exercise, these measures remain unchanged.
  • Preliminary results suggest positive benefit to
    cardiorespiratory fitness, blood pressure and
    lower stroke risk
  • Ongoing data collection

27
How this research addresses the gap in stroke
care?
  • Present rehab programs for Stroke
  • ? 1-2 months
  • Functional recovery
  • Little exercise training
  • Little formal education
  • That is not enough!

28
Impact on the community
  • It is time that we start using an established and
    common model of care (cardiac rehabilitation) in
    individuals with stroke

29
Key messages
  • Fitness levels very low in stroke patients
  • Rehabilitation should include a formal exercise
    component
  • Cardiac rehabilitation can be adapted for
    patients with stroke
  • AND WE WILL CHANGE PRACTICE!

30
Acknowledgements
  • Toronto Rehabilitation Institute Neuro Rehab and
    Cardiac Rehab Programs for their ongoing support
    and assistance

31
Research Team
  • William McIlroy and Dina Brooks

Ada Tang Kathryn Sibley Valerie Closson Cynthia
Danells Hannah Cheung
  • Scott Thomas
  • Mark Bayley
  • Paul Oh
  • Sandra Black
  • Jim Salhas

32
Thank you!
  • Questions, comments
  • Dina Brooks PhD
  • dina.brooks_at_utoronto.ca

33
Fitness in Community for Chronic Stroke
34
Purpose
  • To determine the proportion of fitness facilities
    in the Greater Toronto Area (GTA) that provide
    programs specifically developed for stroke
    survivors.
  • To identify the components and resources utilized
    by stroke specific fitness programs.
  • To determine perceived and actual barriers to
    offering fitness programs for stroke survivors.

35
Methods
  • Cross-sectional descriptive study
  • Questionnaire was distributed to 784 fitness
    facilities in the GTA asking

36
Results
  • Of 213 respondents, 146 facilities reported that
    individuals with a chronic disability
    participated
  • 62 facilities offered specific fitness programs
    for individuals with a chronic disability
  • 26 with stroke-specific fitness programs

37
Findings
  • Typical stroke fitness programs operated as
    not-for-profit organizations, in large facilities
  • Specific acceptance criteria for stroke survivors
    to participate
  • Stroke-specific programs included aerobic,
    flexibility training and strengthening.
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