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Cardiovascular Responses Associated with Daily Walking in Subacute Stroke

DOI: 10.1155/2013/612458

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Abstract:

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) [5]. 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 [14]. Therefore, individuals with stroke are closer to their maximal aerobic threshold when walking than healthy controls. This

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