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Exercise-induced changes in cardiovascular function after stroke: a randomized controlled trial

Authors

  • Ada Tang,

    1. Faculty of Medicine, Department of Physical Therapy, Vancouver Coastal Health, University of British Columbia, Vancouver, British Columbia, Canada
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  • Janice J. Eng,

    Corresponding author
    1. Faculty of Medicine, Department of Physical Therapy, Vancouver Coastal Health, International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
    • Correspondence: Janice J. Eng, Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, Canada V6T 1Z3.

      E-mail: janice.eng@ubc.ca

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  • Andrei V. Krassioukov,

    1. Faculty of Medicine, Division of Physical Medicine and Rehabilitation, Vancouver Coastal Health, International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
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  • Kenneth M. Madden,

    1. Faculty of Medicine, Division of Geriatric Medicine, Vancouver Coastal Health, University of British Columbia, Vancouver, British Columbia, Canada
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  • Azam Mohammadi,

    1. Faculty of Medicine, Division of Cardiology, Vancouver Coastal Health, University of British Columbia, Vancouver, British Columbia, Canada
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  • Michael Y. C. Tsang,

    1. Faculty of Medicine, Division of Cardiology, Vancouver Coastal Health, University of British Columbia, Vancouver, British Columbia, Canada
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  • Teresa S. M. Tsang

    1. Faculty of Medicine, Division of Cardiology, Vancouver Coastal Health, University of British Columbia, Vancouver, British Columbia, Canada
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  • Conflict of interest: None declared.
  • Funding: Study funded by the Vancouver Foundation/Carl and Elsie Halterman Research Fund and the Canadian Institutes of Health Research (CIHR) (MOP-111183). AT was supported by CIHR (MFE-98550) and the Michael Smith Foundation for Health Research (MSFHR) (ST-PDF-03003 ()CLIN), JJE is supported by CIHR (MSH-63617) and the MSFHR, AVK is supported by CIHR, Heart and Stroke Foundation of British Columbia and Yukon, Christopher and Dana Reeve Foundation and the Rick Hansen Institute, KMM is supported by CIHR Institute of Aging.
  • Clinical Trial Registration Information: http://www.clinicaltrials.gov. Unique identifier: NCT01189045

Abstract

Background and aims

Cardiovascular co-morbidities are prevalent after stroke, with heart disease, hypertension and impaired glucose tolerance present in the majority of cases. Exercise has the potential to mediate cardiovascular risk factors commonly present in people with stroke. This single-blinded randomized controlled trial compared the effects of high versus low intensity exercise on fitness, cardiovascular risk factors, and cardiac function after stroke.

Methods

Fifty participants (age 50–80 y, >1 y post-stroke) were randomized to a high-intensity Aerobic Exercise (AE) or low-intensity non-aerobic Balance/Flexibility (BF) program (6 months, 3 60-min sessions/week). Outcomes assessed by VO2peak (primary outcome), arterial stiffness, ambulatory capacity, hemodynamics and cardiac function using echocardiography, and lipid, glucose and homocysteine levels. Assessors were blinded to group allocation.

Results

Twenty-three (92%) of 25 AE group participants (withdrawals unrelated to the intervention) and all BF group participants completed the program. One BF group participant experienced 2 non-injurious falls during class. No other adverse events occurred. There were no changes in VO2peak in either group (AE 16·9 ± 7 to 17·4 ± 7 ml●kg−1●min−1 vs. BF 16·9 ± 6 to 16·6 ± 5 ml●kg−1●min−1, P = 0·45), but AE group demonstrated greater improvement in right atrial emptying fraction (AE 30 ± 22 to 37 ± 22% vs. BF 35 ± 20 to 31 ± 20%, P = 0·04). Both groups demonstrated improvements in lipid profiles, glucose and homocysteine levels, and ambulatory capacity (P < 0·04).

Conclusions

This was the first study to examine the effects of aerobic exercise after stroke on cardiovascular hemodynamics. High-intensity exercise improved right-sided function and early myocardial relaxation. Low-intensity exercise may also benefit plasma lipid, glucose and inflammatory markers, and ambulatory capacity. This study is an important step towards understanding mechanisms by which exercise may reduce cardiovascular risk and function.

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