Despite the importance of regaining independent ambulation after stroke, the amount of daily walking completed during in-patient rehabilitation is low. The purpose of this study is to determine if (1) walking-related heart rate responses reached the minimum intensity necessary for therapeutic aerobic exercise (40%–60% heart rate reserve) or (2) heart rate responses during bouts of walking revealed excessive workload that may limit walking (>80% heart rate reserve). Eight individuals with subacute stroke attending in-patient rehabilitation were recruited. Participants wore heart rate monitors and accelerometers during a typical rehabilitation day. Walking-related changes in heart rate and walking bout duration were determined. Patients did not meet the minimum cumulative requirements of walking intensity (>40% heart rate reserve) and duration (>10？minutes continuously) necessary for cardiorespiratory benefit. Only one patient exceeded 80% heart rate reserve. The absence of significant increases in heart rate associated with walking reveals that patients chose to walk at speeds well below a level that has meaningful cardiorespiratory health benefits. Additionally, cardiorespiratory workload is unlikely to limit participation in walking. Measurement of heart rate and walking during in-patient rehabilitation may be a useful approach to encourage patients to increase the overall physical activity and to help facilitate recovery. 1. Background Regaining independent ambulation is important to those with stroke [1, 2] and is the most frequently reported rehabilitation goal [3, 4]. Therefore, walking should be an integral part of in-patient rehabilitation. However, accelerometer-based monitoring of walking activity has revealed that the amount of daily walking completed by individuals with stroke during in-patient rehabilitation is low [5, 6]. Importantly, the majority of walking bouts are of short duration (<1 minute) [5–7] and typically involve walking to essential activities (e.g., washroom, dining area, or therapy) . While activity monitors provide insight into total daily activity [5–10], they do not inform the possible determinants or consequences of this activity. Aerobic capacity is reduced in the early months following stroke [11–13]. Furthermore, poststroke gait is inefficient, and there are increased aerobic demands on those with stroke when walking compared to healthy controls, even when walking at the same speed . Therefore, individuals with stroke are closer to their maximal aerobic threshold when walking than healthy controls. This
S. E. Lord, K. McPherson, H. K. McNaughton, L. Rochester, and M. Weatherall, “Community ambulation after stroke: how important and obtainable is it and what measures appear predictive?” Archives of Physical Medicine and Rehabilitation, vol. 85, no. 2, pp. 234–239, 2004.
S. Hesse, “Recovery of gait and other motor functions after stroke: novel physical and pharmacological treatment strategies,” Restorative Neurology and Neuroscience, vol. 22, no. 3-4, pp. 359–369, 2004.
S. K. Prajapati, W. H. Gage, D. Brooks, S. E. Black, and W. E. McIlroy, “A novel approach to ambulatory monitoring: investigation into the quantity and control of everyday walking in patients with subacute stroke,” Neurorehabilitation and Neural Repair, vol. 25, no. 1, pp. 6–14, 2011.
E. Haeuber, M. Shaughnessy, L. W. Forrester, K. L. Coleman, and R. F. Macko, “Accelerometer monitoring of home- and community-based ambulatory activity after stroke,” Archives of Physical Medicine and Rehabilitation, vol. 85, no. 12, pp. 1997–2001, 2004.
J. O. Kelly, S. L. Kilbreath, G. M. Davis, B. Zeman, and J. Raymond, “Cardiorespiratory fitness and walking ability in subacute stroke patients,” Archives of Physical Medicine and Rehabilitation, vol. 84, no. 12, pp. 1780–1785, 2003.
P. Zamparo, M. P. Francescato, G. De Luca, L. Lovati, and P. E. di Prampero, “The energy cost of level walking in patients with hemiplegia,” Scandinavian Journal of Medicine & Science in Sports, vol. 5, no. 6, pp. 348–352, 1995.
A. Tang, K. M. Sibley, D. Brooks, S. Thomas, and W. E. McIlroy, “Early exercise intervention after stroke: influence on aerobic and functional capacity: a pilot study,” Journal of Aging and Physical Activity, vol. 12, pp. 318–319, 2004.
G. Kwakkel, R. C. Wagenaar, J. W. R. Twisk, G. J. Lankhorst, and J. C. Koetsier, “Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial,” The Lancet, vol. 354, no. 9174, pp. 191–196, 1999.
G. Kwakkel, R. C. Wagenaar, T. W. Koelman, G. J. Lankhorst, and J. C. Koetsier, “Effects of intensity of rehabilitation after stroke: a research synthesis,” Stroke, vol. 28, no. 8, pp. 1550–1556, 1997.
K. M. Michael, J. K. Allen, and R. F. MacKo, “Reduced ambulatory activity after stroke: the role of balance, gait, and cardiovascular fitness,” Archives of Physical Medicine and Rehabilitation, vol. 86, no. 8, pp. 1552–1556, 2005.
C. Tudor-Locke, C. L. Craig, Y. Aoyagi et al., “How many steps/day are enough? For older adults and special populations,” International Journal of Behavioral Nutrition and Physical Activity, vol. 8, article 80, 2011.
S. Kuys, S. Brauer, and L. Ada, “Routine physiotherapy does not induce a cardiorespiratory training effect post-stroke, regardless of walking ability,” Physiotherapy Research International, vol. 11, no. 4, pp. 219–227, 2006.
W. H. Gage, K. F. Zabjek, K. M. Sibley, A. Tang, D. Brooks, and W. E. McIlroy, “Ambulatory monitoring of activity levels of individuals in the sub-acute stage following stroke: a case series,” Journal of NeuroEngineering and Rehabilitation, vol. 4, article 41, 2007.
S. F. H. Mackintosh, K. Hill, K. J. Dodd, P. Goldie, and E. Culham, “Falls and injury prevention should be part of every stroke rehabilitation plan,” Clinical Rehabilitation, vol. 19, no. 4, pp. 441–451, 2005.
L. Yardley and H. Smith, “A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people,” Gerontologist, vol. 42, no. 1, pp. 17–23, 2002.