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Rehabilitation Practice and Science

Translated Title

中風後門診物理治療是否達到心肺功能訓練目標－某醫學中心之現況

Abstract

Study background and objectives: Reduced cardiopulmonary function after stroke has drawn increasing attention. Cardiovascular function and muscle fiber composition change after stroke, leading to a decline in physical fitness. Some studies have also reported decreased maximum oxygen uptake after stroke, which would further reduce patient ability to perform daily life functions, inducing a circle of disability and reduced mobility. Cardiopulmonary rehabilitation after early or late strokes has been found to improve cardiopulmonary function; these improvements are especially noticeable in patients with lower levels of physical activity before their stroke onset. However, traditional rehabilitation programs mostly focus on recovery of limb muscle power and ability on the affected side, while the goal of cardiopulmonary rehabilitation is less prioritized. For patients able to walk, aerobic training of the large muscle groups of the lower limbs, such as walking, treadmill, cycling, stair climbing, etc., is the main method used for moderate-intensity cardiopulmonary rehabilitation. This study evaluated whether stroke patients could achieve moderate-intensity cardiopulmonary rehabilitation during the course of outpatient neurorehabilitation. Study method: By applying the case reviewarticle method, data were collected from a total of 38 patients who received outpatient rehabilitation at Taipei Veterans General Hospital between July and December of 2014 due to hemiplegia caused by stroke and also met the study inclusion criteria. After applying the exclusion criteria, a total of 34 cases were analyzed. Patient data included general information, heart rate during exercise, types of lower limb rehabilitation, and rehabilitation time. Study results: After applying the exclusion criteria, a total of 34 cases were included in the statistical analysis. Records from 129 sessions were obtained over two weeks of tracking. The average patient age was 58.7±16.1 years and 28 patients (82.4%) were male; 19 subjects (55.9%) had experienced ischemic strokes, with an average elapsed time of 36.2±26.2 months since stroke onset. Among rehabilitation regimens, 16 patients received treadmill training, one walked, none participated in stair climbing, and 17 patients underwent rehabilitation that involved cycling. The average heart rate before exercise was 81.6±14.7 beats per min, climbing to 93.6±14.1 during exercise; the average HRR (heart rate reserve) was 13%, with average maximum and median HRR of 25% and 21%, respectively. The predetermined cardiopulmonary intensity of 40% HRR for 20 min was not observed during exercise. Intergroup analysis between treadmill and cycling training showed that treadmill training achieved an average maximum HRR of 32%, compared to 18% for cycling training, a statistically significant difference (p＜0.05). Conclusion: A reviewarticle of the existing literature revealed that most studies that used HRR as a cardiopulmonary rehabilitation index for neurorehabilitation after stroke achieved HRR of 23~25%, short of the goal set by the American College of Sports Medicine. The 25% HRR obtained through statistical analysis of this study is consistent with the results of other studies that also failed to achieve the predetermined cardiopulmonary intensity of a 40% HRR maintained for 20 min or over several 10-min sets. Hence, future stroke physiotherapy should include gradual adjustment of exercise intensity for cardiopulmonary rehabilitation in addition to muscle power, balance, and daily life skill training; incorporating these combined rehabilitation goals may reduce risk factors for recurrent stroke and improve physical fitness and daily living activities.

Language

Traditional Chinese

First Page

91

Last Page

97

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