Outcomes in People after Stroke Attending an Adapted Cardiac Rehabilitation Exercise Program: Does Time from Stroke Make a Difference?

Background: Individuals referred to cardiac rehabilitation programs (CRPs) after stroke have demonstrated postprogram improvements in cardiovascular fitness (VO2peak). However, the effect of CRPs on other physiological/quality-of-life outcomes and effect of time from stroke on these results has not been investigated. The objectives of the present study are (1) to evaluate the effects of a CRP in participants with motor impairment after stroke and (2) to explore the effects of elapsed time from stroke on physiological/quality-of-life outcomes. Methods: The CRP included 24 weeks of resistance and aerobic training. Primary outcomes in 120 participants, 25.4 6 42.3 (mean 6 standard deviation) months after stroke, included 6minute walk distance (6MWD), VO2peak, timed repeated sit-to-stand performance, and affected-side isometric knee extensor strength (IKES). Secondary measures included gait characteristics (cadence, step lengths, and symmetry), walking speed, balance (Berg Balance Scale), affected-side range of motion (ROM), elbow flexor and grip strength, anaerobic threshold, and perceptions of participation/social reintegration. Results: After adjusting for multiple comparisons, participants demonstrated significant improvements (all P > <<.001) in 6MWD (283.2 +/- 126.6 to 320.7 +/- 141.8 m), sit-to-stand performance (16.3 +/- 9.5 to 13.3 +/- 7.1 seconds), affected-side IKES (25.9 +/- 10.1 to 30.2 +/- 11 kg as a percentage of body mass), and VO2peak (15.2 +/- 4.5 to 17.2 +/- 4.9 mL$ kg$ min 21). Participants also demonstrated post-CRP improvements in secondary outcomes: anaerobic threshold, balance, affected-side hip/shoulder ROM, grip and isometric elbow flexor strength, participation, walking speed, cadence (all P,. 001), and bilateral step lengths (P,. 04). In a linear regression model, there was a negative association between the change in 6MWD and time from stroke (b5242.1; P 5.002) independent of baseline factors. Conclusions: A CRP yields improvements over multiple domains of recovery; however, those who start earlier demonstrate greater improvement in functional ambulation independent of baseline factors. These data support the use of adapted CRPs as a standard of care practice after conventional stroke rehabilitation.