Designing aerobic exercise interventions for stroke rehabilitation

Kelly, Liam P. (2021) Designing aerobic exercise interventions for stroke rehabilitation. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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More than 405,000 Canadians are currently living with the life-altering effects of stroke. Cardiorespiratory fitness is characteristically low after stroke and has negative consequences for functional recovery, cardiovascular risk, and quality of life in this population. Although scientific evidence supports incorporating moderate-intensity aerobic exercise during stroke recovery, these findings have not translated into clinical care where patients are very sedentary and cardiorespiratory fitness levels remain in the “very poor” category. Among the challenges to incorporating aerobic exercise include a lack of access to the specialized equipment needed to accommodate stroke-related impairments. Also, hemiparesis can limit stroke survivors’ ability to sustain the workloads needed to reach moderate levels of aerobic intensity. Accordingly, the current thesis aimed to develop exercise strategies that can overcome these barriers. The first study investigated whether incorporating task-oriented activities typically offered during stroke rehabilitation into circuits that pair more metabolically demanding tasks with less demanding ones is an acceptable method to sustain moderate-intensity aerobic workloads over a single session. The second study evaluated the feasibility and preliminary effects of the task-oriented circuit-training protocol compared to treadmill aerobic exercise over a 10-week intervention period among 40 chronic hemiparetic stroke survivors. The final study investigated the safety and feasibility of pairing treadmill walking exercise with moderate normobaric hypoxia as a means to increase the cardiovascular strain of submaximal exercise among stroke survivors. The task-oriented circuit training protocol was associated with at least moderateintensity aerobic workloads over a single session and, compared to treadmill aerobic exercise, similar proportions of participants were able to maintain the exercise criteria over a 10-week intervention period. One participant reported mild symptoms of nausea during treadmill walking under conditions of moderate normobaric hypoxia. No other adverse events were observed, and participants maintained constant absolute workloads during exercise in normobaric hypoxia, which was associated with a 10% increase in relative effort. The task-oriented circuit training protocol is a promising strategy to provide moderate-intensity aerobic exercise training stimulus without specialized equipment. Initial data also supports simulated altitude exposure as a safe and feasible method to increase the cardiovascular stress of submaximal exercise among chronic hemiparetic stroke survivors.

Item Type: Thesis (Doctoral (PhD))
Item ID: 15238
Additional Information: Includes bibliographical references (pages 158-182).
Keywords: stroke, rehabilitation, aerobic exercise, cardiorespiratory fitness, secondary prevention
Department(s): Medicine, Faculty of
Date: October 2021
Date Type: Submission
Digital Object Identifier (DOI):
Library of Congress Subject Heading: Stroke; Stroke Rehabilitation; Cardiorespiratory Fitness; Exercise; Circuit-Based Exercise

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