Introduction
Study Objective:
To examine the heart rates of CVA patients during physiotherapy PACE (Passive/ Active Cycle Ergometer) sessions against the American Heart Association current guidelines for aerobic training post CVA
Background:
Evidence has shown that the measure of cardio respiratory fitness in ambulatory stroke survivors is half of that expected in healthy people matched for age and gender. Current guidelines suggest low to moderate intensity aerobic activity should be routinely incorporated in the management of stroke survivors. Recent research has shown that early commencement of aerobic activity is feasible, over a timeline from 6 days to 6 months after stroke. However, research has shown that heart rate increase during normal physiotherapy interventions is minimal and therefore formal cardiovascular training is required to reach the standards set by the American Heart Association (AHA) Physical Activity and Exercise Recommendations for Stroke Survivors. Current physiotherapy intervention in the MMUH and the Isolda Unit, St Marys Hospital incorporates cardiovascular components however this may not be a primary focus of the intervention or be of cardiovascular benefit. This audit is required to compare current practice versus documented standards of best practice.
Methodology
All participants were cleared to participate in the audit by the medical team. A sub maximal graded exercise test was performed on the PACE on initial assessment for 8 patients. This was used as a baseline fitness measurement post CVA. A heart rate monitor was used to measure heart rate (HR) every minute while the participant was participating in the PACE sessions. Following this all physiotherapy interventions were part of current practice for patients following an acute stroke. This data collected was recorded and a comparison was made against international recommendations for aerobic fitness for stroke survivors.
Results
8 participants were recruited and participated in the audit.
The average age of participants was 71.6 years old (min 49 years old - max 81 years old). A total of 348 physiotherapy sessions was completed (max 134 sessions – min sessions 6) with an average of 40.25% of sessions involving cardio vascular exercise using PACE. The average peak HR was 88.6 beats per minute with an average increase in HR of 25.1 beats per minute per PACE session. Only 3 PACE sessions reached the target heart rate necessary to meet the AHA standards from a total number of 127 session. Within these 3 sessions the target heart rate was only achieved for 1 minute of the recommended 20 minutes within the standard.
Summary of Results
Collectively patients did not achieve the minimum target of cardiovascular exercise 3 times per week.
Reaching and sustaining target heart rate is very difficult, possibly due to physical and cognitive deficits post CVA.
The frequency of PACE session was reduced due to time constraints.
Priority was given to other treatment techniques.
Conclusion
Currently aerobic exercise is not routine in our acute and rehabilitation setting for patients following an acute stroke.
Current PACE sessions do increase HR to meet AHA standards
Physiotherapy management of patients following an acute stroke should incorporate formal cardiovascular sessions in order to meet best practice standards.
The feasibility of the AHA standard appears limited to a select cohort of patients.
Ethical Approval
Ethical approval was obtained from the Mater Misericordiae University Hospital Ethics Board.
References
Exercise and Fitness Training after Stroke. A handbook for evidence based practice. Gillian Mead and Frederike van Wijck 2013
Effects of cardiovascular exercise early after stroke: systematic review and meta-analysis. BMC Neurol. 2012: 12-45 Stoller O et al
The Physical Activity and Exercise Recommendations for Stroke Survivors – AHA/ASA Scientific Statement. Billinger et al, http:// stroke.ahajournal.org 2014
