An 8-week Forced-rate Aerobic Cycling Program Improves Cardiorespiratory Fitness in Persons With Chronic Stroke: A Randomized Controlled Trial

Susan M Linder; John Lee; Francois Bethoux; Daniel Persson; Andrea Bischof-Bockbrader; Sara Davidson; Yadi Li; Brittany Lapin; Julie Roberts; Alexandra Troha; Logan Maag; Tamanna Singh; Jay L Alberts

doi:10.1016/j.apmr.2024.01.018

An 8-week Forced-rate Aerobic Cycling Program Improves Cardiorespiratory Fitness in Persons With Chronic Stroke: A Randomized Controlled Trial

Arch Phys Med Rehabil. 2024 Feb 11:S0003-9993(24)00091-1. doi: 10.1016/j.apmr.2024.01.018. Online ahead of print.

Authors

Affiliations

¹ Cleveland Clinic, Department of Physical Medicine and Rehabilitation, Cleveland, OH; Cleveland Clinic, Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH. Electronic address: linders@ccf.org.
² Cleveland Clinic, Department of Physical Medicine and Rehabilitation, Cleveland, OH.
³ Ohio University Heritage College of Osteopathic Medicine, Athens, OH.
⁴ Cleveland Clinic, Concussion Center, Neurologic Institute, Cleveland, OH.
⁵ Cleveland Clinic, Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, OH; Cleveland Clinic, Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland, OH.
⁶ Cleveland Clinic, Department of Cardiovascular Medicine; Heart, Vascular, and Thoracic Institute, Cleveland, OH.
⁷ Cleveland Clinic, Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH; Cleveland Clinic, Concussion Center, Neurologic Institute, Cleveland, OH.

PMID: 38350494
DOI: 10.1016/j.apmr.2024.01.018

Abstract

Objective: To examine the cardiorespiratory effects of a forced-rate aerobic exercise (FE) intervention among individuals with chronic stroke compared with an upper extremity repetitive task practice (UE RTP) control group.

Design: Secondary analysis of data from a randomized controlled trial.

Setting: Research laboratory.

Participants: Individuals with chronic stroke (N=60).

Interventions: Participants completed 24 sessions of FE followed by RTP (FE+RTP, N=30) or time matched RTP alone (N=30). The FE+RTP group was prescribed exercise at 60%-80% of heart rate reserve on a motorized stationary cycle ergometer for 45 minutes followed by 45 minutes of RTP. The control group completed 90 minutes of RTP.

Main outcome measures: Metabolic exercise stress tests on a cycle ergometer were conducted at baseline and post-intervention. Outcomes included peak oxygen consumption (peak V̇o₂) and anaerobic threshold (AT).

Results: Fifty participants completed the study intervention and pre/post stress tests. The FE+RTP group demonstrated significantly greater improvements in peak V̇o₂ from 16.4±5.7 to 18.3±6.4 mL/min/kg compared with the RTP group (17.0±5.6 to 17.2±5.6 mL/min/kg, P=.020) and significantly greater improvements in AT from 10.3±2.8 to 11.5±3.6 mL/min/kg compared with the RTP group (10.8±3.9 to 10.4±3.2 mL/min/kg, P=.020). In analyzing predictors of post-intervention peak V̇o₂, the multivariable linear regression model did not reveal a significant effect of age, sex, body mass index, or beta blocker usage. Similarly, bivariate linear regression models for the FE group only did not find any exercise variables (aerobic intensity, power, or cycling cadence) to be significant predictors of peak V̇o₂.

Conclusions: While the aerobic exercise intervention was integrated into rehabilitation to improve UE motor recovery, it was also effective in eliciting significant and meaningful improvements in cardiorespiratory fitness. This novel rehabilitation model may be an effective approach to improve motor and cardiorespiratory function in persons recovering from stroke.

Keywords: Aerobic exercise; Cardiopulmonary exercise test; Cardiorespiratory fitness; Rehabilitation.