Search

BACKGROUND: Spinal cord injury (SCI) leads to various physical, psychological, and social challenges. Sport is a holistic physical activity that may target these challenges. No literature systematically summarizes the overall impact of sport participation for those with SCI. OBJECTIVE: To comprehensively report the findings of quantitative studies investigating the impact of sport on the physical, psychological, and social health of individuals with SCI. METHODS: Six databases were searched: APA PsycInfo, CINAHL, Embase, Emcare, Ovid Medline, and PubMed (non-Medline). Studies were included if (a) participants were adults with SCI for ≥12 months, (b) outcomes resulting from ≥3 months of sport participation were investigated, (c) sport occurred in the community setting, and (d) comparisons of sport and non-sport conditions were analyzed. Details regarding study characteristics, participants, sport(s), and outcomes were extracted. Methodological quality was assessed using the Modified Downs and Black checklist. RESULTS: Forty-nine studies were included. Study quality ranged from poor to moderate. Sport participation showed favourable results for outcomes including function, quality of life, and community integration. Mixed results were found for outcomes including cardiac function, depressive symptoms, and employment. No significant associations were found for postural control, resilience, and education. CONCLUSIONS: The review findings suggest sport may be a promising intervention for addressing some challenges associated with SCI.

Nonexercise predictions of peak oxygen uptake (V˙o2peak) are used clinically, yet current equations were developed from cohorts of apparently healthy individuals and may not be applicable to individuals with cardiovascular disease (CVD). Our purpose was to develop a CVD-specific nonexercise prediction equation for V˙o2peak.Participants were from the Fitness Registry and Importance of Exercise International Database (FRIEND) with a diagnosis of coronary artery bypass surgery (CABG), myocardial infarction (MI), percutaneous coronary intervention (PCI), or heart failure (HF) who met maximal effort criteria during a cardiopulmonary exercise test (n = 15 997; 83% male; age 63.1 ± 10.4 yr). The cohort was split into development (n = 12 798) and validation groups (n = 3199). The prediction equation was developed using regression analysis and compared with a previous equation developed on a healthy cohort.Age, sex, height, weight, exercise mode, and CVD diagnosis were all significant predictors of V˙o2peak. The regression equation was:V˙o2peak (mL · kg-1 · min-1) = 16.18 - (0.22 × age [yr]) + (3.63 × sex [male = 1; female = 0]) + (0.14 × height [cm]) - (0.12 × weight [kg]) + (3.62 × mode [treadmill = 1; cycle = 0]) - (2.70 × CABG [yes = 1, no = 0]) - (0.31 × MI [yes = 1, no = 0]) + (0.37 × PCI [yes = 1, no = 0]) - (4.47 × HF [yes = 1, no = 0]). Adjusted R2 = 0.43; SEE = 4.75 mL · kg-1 · min-1.Compared with measured V˙o2peak in the validation group, percent predicted V˙o2peak was 141% for the healthy cohort equation and 100% for the CVD-specific equation.The new equation for individuals with CVD had lower error between measured and predicted V˙o2peak than the healthy cohort equation, suggesting population-specific equations are needed for predicting V˙o2peak; however, errors associated with nonexercise prediction equations suggest V˙o2peak should be directly measured whenever feasible.

We have been amid unhealthy living and related chronic disease pandemics for several decades. These longstanding crises have troublingly synergized with the coronavirus disease 2019 (COVID-19) pandemic. The need to establish research priorities in response to COVID-19 can be used to address broad health and wellbeing, social and economic impacts for the future is emerging. Accordingly, this paper sets out a series of research priorities that could inform interdisciplinary collaboration between clinical sciences, public health, business, technology, economics, healthcare providers, and the exercise science/sports medicine communities, among others. A five-step methodology was used to generate and evaluate the research priorities with a focus on broad health and well-being impacts. The methodology was deployed by an international and interdisciplinary team from the Healthy Living for Pandemic Event Protection (HL- PIVOT) network. This team were all engaged in responding to the Pandemic either on the 'front-line' and/or in leadership positions ensuring the currency and authenticity of the process. Eight research priorities were identified clustered into two groups: i) SocietalEnvironmental, and ii) Clinical. Our eight research priorities are presented with insight from previously published research priorities from other groups.

Vanzella, LM, Lawand, R, Shuaib, M, Oh, P, Corbett, D, and Marzolini, S. Validity of bioelectric impedance in relation to dual-energy x-ray absorptiometry for measuring baseline and change in body composition after an exercise program in stroke. J Strength Cond Res 36(12): 3273-3279, 2022-Exercise is an important strategy to improve fat-free mass (FFM) and reduce percent fat mass (FM%). However, no study has reported on a valid, cost-effective method to measure changes in body composition after stroke. The purpose of the study is to determine the level of agreement between bioelectrical impedance analysis (BIA) and dual-energy x-ray absorptiometry (DXA) for assessing baseline and change in FFM and FM% after an exercise training intervention for individuals with mobility deficits after stroke. Fat-free mass and FM% were measured by BIA and DXA at the beginning and after 6 months of participation in an exercise program for individuals with mobility deficits after stroke. Forty-two subjects after stroke were included. Overall, Bland-Altman plots revealed that BIA overestimated the baseline FFM and FM% by only -0.4 ± 1.8 kg and -2.8 ± 1.8%, respectively. BIA underestimated changes in FFM by 0.33 ± 0.45 kg and overestimated changes in FM% by -0.40 ± 0.68%. The 95% CI of the mean bias for baseline FFM was -7.1 to 6.3 kg and -11.8 to 6.0% for FM%, demonstrating good agreement. The 95% CI for the change in FFM was -3.8 to 4.5 kg and -5.0 to 4.2% for FM%, which reflected good agreement. BIA is a good tool for assessing qualitative baseline and change in FFM and FM%. Body composition is important for the prescription and evaluation of rehabilitation programs designed for individuals after stroke. Our results provide clinicians and researchers with a better understanding of the utility of BIA to measure body composition at baseline and in response to exercise interventions in this population.

Oxygen delivery and demand are reduced in the paretic leg of post-stroke individuals. However, it is unknown how muscle oxygenation, the balance between delivery and utilization of oxygen at the muscle is altered post-stroke during aerobic exercise and how it relates to mobility.The objective of this study was to monitor muscle oxygenation changes between the paretic and nonparetic legs of post-stroke individuals during treadmill exercise and the six-minute walk test and analyze the association with mobility.Cross-sectional study.Cardiac rehabilitation program.Eleven male subjects were enrolled in the study. Ten male subjects (30.8±4.1 months post-stroke; age 63.9±13.9 years) with hemiparetic gait pattern finished the study.Not applicable.Muscle oxygenation was measured with near-infrared spectroscopy placed on the vastus lateralis of each leg during treadmill exercise at the first ventilatory threshold and during a six-minute walk test.The desaturation slope during treadmill exercise was significantly steeper (p=0.047) in the paretic (-0.7±0.6%/s) compared to the nonparetic leg (-0.3±0.2%/s). There was no other significant difference between legs. The six-minute walk test distance was not correlated with six-minute walk test muscle oxygenation in either leg (paretic: r=0.20, p=0.590; nonparetic: r=0.42, p=0.232).At the onset of treadmill exercise, the paretic leg was unable to effectively match oxygen demand and extraction as well as the nonparetic leg, suggesting the need for an immediate cardiovascular warmup prior to initiating moderate intensity exercise in this population. Since the exercise desaturation rate is thought to indicate increased anaerobic metabolism and lactate production, efforts to delay rapid desaturation could improve sustainability of activities of daily living and exercise.

This study compared characteristics and program utilization in women electing to participate in mixed-sex, women-only, or home-based cardiac rehabilitation (CR). In this retrospective cohort study, electronic records of CR participants in Toronto who were offered the choice of program model between January 2017-February 2020 were analyzed. There were 727 women (74.7% mixed, 22.0% women-only, 3.3% home-based) who initiated CR. There were significantly more women who were not working in women-only than mixed-sex (80.4% vs 64.1%

Background Physical exercise has positive impacts on health and can improve angiogenesis, which is impaired during aging, but the underlying mechanisms of benefit are unclear. This meta-analysis and systematic review investigated the effects of exercise on several peripheral angiogenesis markers in older adults to better understand the relationship between exercise and angiogenesis. Methods MEDLINE, Embase, and Cochrane CENTRAL were searched for original, peer-reviewed reports of peripheral concentrations of angiogenesis markers before and after exercise interventions in older adults (> 50 years). The risk of bias was assessed with standardized criteria. Standardized mean differences (SMD) with 95% confidence intervals (CIs) were calculated from random-effects models. Publication bias was assessed with Egger’s test, funnel plots, and trim-and-fill. A priori subgroup analyses and meta-regressions were performed to investigate heterogeneity where possible. Results Of the 44 articles included in the review, 38 were included in meta-analyses for five proteins. Vascular endothelial growth factor (VEGF) was found to be higher after exercise (SMD[95%CI] = 0.18[0.03, 0.34], p = 0.02), and e-selectin (CD62E) was found to be lower after exercise (SMD[95%CI]= -0.72[-1.42, -0.03], p = 0.04). Endostatin (SMD[95%CI] = 0.28[-0.56, 1.11], p = 0.5), fibroblast growth factor 2 (SMD[95%CI] = 0.03[-0.18, 0.23], p = 0.8), and matrix metallopeptidase-9 (SMD[95%CI] = -0.26[-0.97, 0.45], p = 0.5) levels did not change after exercise. Conclusions Of the five angiogenesis blood markers evaluated in this meta-analysis, only VEGF and CD62E changed with exercise. Although more studies are needed, changes in angiogenesis markers may explain the beneficial effects of exercise on angiogenesis and health in older adults.

PURPOSE There is a lack of high-quality evidence about the effects of exercise or physical activity interventions for adults with lower limb amputations (LLAs). A planning meeting involving stakeholders (i.e., people with LLA, community advocates, health care providers, researchers) was organized to identify key research priorities related to exercise and physical activity for people with LLAs. METHODS We used a collaborative prioritized planning process with a pre-meeting survey and 2-day virtual meeting that included: identification and prioritization of challenges or gaps; identification and consolidation of solutions; and action planning. This process integrated a modified Delphi approach, including anonymous feedback in two surveys. RESULTS Thirty-five stakeholders participated. Six challenges related to exercise and physical activity for people with LLA were prioritized. One solution was prioritized for each challenge. After consolidation of solutions, participants developed five research action plans for research including: developing an on-line interface; developing and evaluating peer-support programs to support physical activity; examining integration of people with LLA into cardiac rehabilitation; development and evaluation of health provider education; and determining priority outcomes related to physical activity and exercise. CONCLUSIONS This collaborative process resulted in an action plan for amputation research and fostered collaborations to move identified priorities into action.IMPLICATIONS FOR REHABILITATIONLower limb amputations impact mobility leading to lower levels of physical activity.There are research gaps in our understanding of the effects of exercise or physical activity interventions for adults with lower limb amputations.Through a collaborative planning process, participants prioritized research directions on physical activity and exercise for people with LLA to advance research in the field.Action plans for research focused on developing online resources, peer support, cardiac rehabilitation for people with LLA, health provider education and determining priority outcomes related to physical activity and exercise.

Purpose:This study determines barriers and facilitators to including people with lower limb amputation (LLA) in cardiovascular rehabilitation programmes (CRPs).Method:Canadian CRP managers and exercise therapists were invited to complete a questionnaire.Results:There were 87 respondents. Of the 32 CRP managers, 65.6% reported that people with LLA were eligible for referral but of these, 61.9% only accepted LLA with cardiac disease, and 38.1% only accepted them with ≥ 1 cardiovascular risk factor. CRP eligibility progressively decreased as mobility severity increased, with 94% of programmes accepting those with mild mobility deficits but only 48% accepting those with severe deficits. Among therapists in CRPs that accepted LLAs, 54.3% reported not having an LLA participant within the past three years. Among all responding therapists and managers who were also therapists ( n = 58), 43% lacked confidence in managing safety concerns, and 45%, 16%, and 7% lacked confidence in prescribing aerobic exercise to LLA with severe, moderate, and no mobility deficits respectively. There was a similar finding with prescribing resistance training. LLA-specific education had not been provided to any respondent within the past three years. The top barriers were lack of referrals (52.6%; n = 30) and lack of knowledge of the contraindications to exercise specific for LLA (43.1%; n = 31). Facilitators included the provision of a resistance-training tool kit (63.4%; n = 45), education on exercise safety (63.4%; n = 45), and indications for physician intervention/inspection (63.6%; n = 42).Conclusion:Most of the CRPs surveyed only accept people with LLA if they have co-existing cardiac disease or cardiovascular risk factors. Few people with LLA participate. Education on CRP delivery for LLAs is needed to improve therapists’ confidence and exercise safety.

This mixed-method study aimed to compare physical activity (PA) patterns of a cross-over cardiac rehabilitation (CR) cohort with a center-based CR cohort and to explore barriers and facilitators of participants transitioning and engaging in virtual CR. It included the retrospective self-reported PA of a cross-over CR cohort (n = 75) and a matched center-based CR cohort (n = 75). Some of the participants included in the cross-over cohort (n = 12) attended semi-structured focus group sessions and results were interpreted in the context of the PRECEDE-PROCEED model. Differences between groups were not observed (p > 0.05). The center-based CR cohort increased exercise frequency (p = 0.002), duration (p = 0.007), and MET/minutes (p = 0.007) over time. The cross-over cohort increased exercise duration (p = 0.04) with no significant change in any other parameters. Analysis from focus groups revealed six overarching themes classified under predisposing factors (knowledge), enabling factors (external support, COVID-19 restrictions, mental health, personal reasons/preferences), and reinforcing factors (recommendations). These findings suggest an improvement of the PA levels of center-based CR cohort participants pre-pandemic and mitigated improvement in those who transitioned to a virtual CR early in the pandemic. Improving patients’ exercise-related knowledge, provider endorsements, and the implementation of group videoconferencing sessions could help overcome barriers to participation in virtual CR.

Purpose: The purpose of this study was to understand the perceived benefits and clinical utility of cardiopulmonary exercise testing (CPET) from the perspectives of physiotherapists and patients and to explore the factors that influence adopting CPET in a stroke rehabilitation setting. Method: A qualitative descriptive study was conducted. Physiotherapists ( n = 6) participated in a focus group to discuss the use of CPET in practice. Patients ( n = 8) who had completed CPET during stroke rehabilitation participated in a semi-structured interview to explore their experiences. Thematic analysis was performed. Results: CPET increased the physiotherapists’ confidence in prescribing exercise, especially for medically complex patients. Ongoing medical management early post-stroke was a barrier to referral. Physiotherapists expressed decreased confidence in interpreting test results. Consultation with local experts facilitated the use of CPET. Patients described how CPET increased their confidence to participate in exercise. They desired more information before and after CPET to better understand the purpose and results and their relation to their rehabilitation goals. Conclusions: Both physiotherapists and patients described the benefit of having CPET available to support them as they participated in exercise in a stroke rehabilitation setting. Physiotherapists would benefit from having educational tools to support their interpretation and application of test results, and patients would benefit from improved communication and education to support their understanding of the relevance of CPET to their rehabilitation goals. Future research should explore these findings in other stroke rehabilitation settings.

Purpose Cardiac rehabilitation (CR) yields improvements in cardiorespiratory fitness (peak oxygen uptake [VO2peak]). Predictors of change in VO2peak have been reported among patients with coronary artery disease (CAD) but have not been compared with peripheral artery disease (PAD). This study determined predictors of improved VO2peak among patients with PAD, CAD, and concomitant PAD and CAD (PAD/CAD) following a 6-mo home-based outpatient CR program (1supervised and 4 home weekly sessions). Methods This study was a retrospective (2006-2017) multiple linear regression analysis of CR patients with PAD (n = 63), CAD (n = 63), and PAD/CAD (n = 164). Peripheral artery disease and CAD were matched for age, sex, smoking status, diabetes, and year in program. Results Mean age of all patients was 68.9±10.1 yr, 72% were male, and mean improvement in VO2peak was 2.1 ± 3.3 mL/kg/min (14.5% improvement) following CR. In CAD, younger age (β= .30, P = .015), male sex (β = -.29, P = .019), and more recent year of entry (β = .26, P = .035) were predictors of improved VO2peak. In PAD, only male sex (β = -.36, P = .004) and in PAD/CAD, not having diabetes (β = -.24, P = .002), not smoking (β = -.25, P = .001), and shorter elapsed time from referring diagnosis to entry (β=-.19, P = .016) were predictors. Conclusions While younger age and male sex were predictors of improved VO2peak in CAD, age did not influence PAD, and neither age nor sex influenced PAD/CAD. Peripheral artery disease-related limitations may override some demographic factors, and strategies for improving VO2peak should be explored. Managing smoking and comorbid diagnoses including diabetes and a timely entry to CR may yield greater improvements in VO2peak among individuals with PAD.

Introduction: The importance of cardiorespiratory fitness (CRF) for stratifying mortality risk and guiding clinical care in patients with cardiovascular disease (CVD) is well-established. An American Heart Association Scientific Statement suggests routine clinical assessment of CRF using non-exercise prediction equations when direct assessment from a cardiopulmonary exercise test is not feasible. However, current prediction equations have been created from cohorts of apparently healthy individuals. Hypothesis: A CVD-specific non-exercise equation would have higher accuracy for predicting CRF compared to an equation developed from a cohort without known CVD. Methods: Participants from the Fitness Registry and Importance of Exercise International Database (FRIEND) with a diagnosis of coronary artery bypass surgery (CABG), myocardial infarction (MI), percutaneous coronary intervention (PCI), or heart failure (HF) who performed a cardiopulmonary exercise test were studied (83% [10,417 of 12,578] male; age 62.7 ± 10.3 years). The cohort (12,578 tests; 49% [6,190] treadmill tests) was split into development (10,062) and validation (2,516) groups. The prediction equation was developed using multiple regression analysis and comparisons were made with a CRF prediction equation developed on an apparently healthy cohort using FRIEND. Results: Age, sex, height, body mass, exercise mode, and CVD diagnosis were all significant predictors of CRF. The regression equation was: CRF (mL/kg/min) = 17.03 – (0.21 * age [years]) + (3.60 * sex [male = 1; female = 0]) + (0.12 * height [cm]) – (0.11 * body mass [kg]) + (3.75 * mode [treadmill = 1; cycle = 0]) – (2.40 * CABG [yes = 1, no = 0]) – (0.29 * MI [yes = 1, no = 0]) + (0.75 * PCI [yes = 1, no = 0]) – (3.90 * HF [yes = 1, no = 0]) (adjusted R 2 = 0.42, SEE = 4.74 mL/kg/min). When compared to measured CRF in the validation group (19.6 ± 6.2 mL/kg/min), predicted CRF was similar for the CVD equation (19.8 ± 4.1 mL/kg/min [101%]) and higher for the healthy cohort equation (28.2 ± 7.0 mL/kg/min [144%]; P P Conclusions: As hypothesized, the CVD-specific non-exercise equation was a better predictor of CRF in a cohort of individuals with CVD. The new equation for individuals with CVD provided a lower mean error between measured and predicted CRF than an equation developed from an apparently healthy cohort. Thus, population specific equations are needed for predicting CRF; however, the error associated with non-exercise prediction equations suggests CRF should be directly measured whenever feasible.

Background:Recurrent events account for approximately one-third of all strokes and are associated with greater disability and mortality than first-time strokes. Blood pressure (BP) is the most important modifiable risk factor. Objectives were to determine the proportion of post-stroke patients enrolled in cardiac rehabilitation (CR) meeting systolic and diastolic BP (SBP/DBP) targets and to determine correlates of meeting these targets.Methods:A retrospective study of 1,804 consecutively enrolled post-stroke patients in a CR program was conducted. Baseline data (database records 2006–2017) included demographics, anthropometrics, clinical/medication history, and resting BP. Multivariate analyses determined predictors of achieving BP targets.Results:Mean age was 64.1 ± 12.7 years, median days from stroke 210 (IQR 392), with most patients being male (70.6%; n = 1273), overweight (66.8%; n = 1196), and 64.2% diagnosed with hypertension (n = 1159), and 11.8% (n = 213) with sleep apnea. A mean of 1.69 ± 1.2 antihypertensives were prescribed, with 26% (n = 469) of patients prescribed 3–4 antihypertensives. SBP target was met by 71% (n = 1281) of patients, 83.3% (n = 1502) met DBP target, and 64.3% (n = 1160) met both targets. Correlates of meeting SBP target were not having diabetes, younger age, fewer prescribed antihypertensives, and more recent program entry. Correlates of meeting DBP target were not having diabetes, older age, fewer prescribed antihypertensives, and more recent stroke.Conclusions:Up to one-third of patients were not meeting BP targets. Patients with diabetes, and those prescribed multiple antihypertensives are at greater risk for poorly controlled SBP and DBP. Reasons for poor BP control such as untreated sleep apnea and medication non-adherence need to be investigated.

Background: Evidence supports establishing a continuum of care from stroke rehabilitation (SR) to cardiac rehabilitation programs (CRPs). It is not known to what extent people poststroke are being integrated. This study aimed to determine the proportion of CRPs that accept referrals poststroke, barriers/facilitators, and eligibility criteria. Methods: A web-based questionnaire was sent to CRPs across Canada. Results: Of 160 questionnaires sent, 114 representatives (71%) of 130 CRPs responded. Of respondents, 65% (n = 74) reported accepting people with a diagnosis of stroke and doing so for a median of 11 years, 11 offering stroke-specific classes and an additional 6 planning inclusion. However, 62.5% of CRPs reported that < 11 patients participated in the last calendar year despite 88.5% reporting no limit to the number they could enroll. Among CRPs, 25% accepted only patients with concurrent cardiac diagnoses, living in the community (47.8%), and without severe mobility (70.1%), communication (80.6%), or cognitive (85.1%) deficits. The 2 most influential barriers and facilitators among all CRPs were funding and staffing. The fourth greatest barrier was lack of poststroke referrals, and third to sixth facilitators were SR/CRP collaboration to ensure appropriate referrals (third) and to increase referrals (sixth), toolkits for prescribing resistance (fourth), and aerobic training (fifth). CRP characteristics associated with accepting stroke were a hybrid program model, a medium program size, and having a falls prevention component. Conclusions: Most CRPs accept patients poststroke, but few participate. Therefore, establishing SR/CRP partnerships to increase appropriate referrals, using a toolkit to help operationalize exercise components, and allocating funding/resources to CRPs may significantly increase access to secondary prevention strategies. Résumé: Contexte: Les données recueillies appuient la continuité des soins entre les programmes de réadaptation après un accident vasculaire cérébral (PR-AVC) et les programmes de réadaptation cardiaque (PRC). On ne sait toutefois pas dans quelle mesure les patients qui ont subi un accident vasculaire cérébral (AVC) sont intégrés à un PRC. L’étude visait donc à déterminer la proportion de PRC admettant les patients ayant subi un AVC, les obstacles à l’intégration de ces derniers et les éléments qui la facilitent, ainsi que les critères d’admissibilité. Méthodologie: Des responsables de PRC de partout au Canada ont été invités à répondre à un questionnaire en ligne. Résultats: Au total, 160 invitations ont été envoyées et 114 (71 %) responsables rattachés à 130 PRC y ont répondu. Parmi ces répondants, 65 % (n = 74) ont dit que leur programme admettait depuis un nombre médian de 11 ans les patients ayant reçu un diagnostic d’AVC; 11 programmes offraient des cours spécialement destinés aux patients ayant subi un AVC et 6 autres prévoyaient de le faire. Toutefois, 62,5 % des répondants ont souligné que moins de 11 patients avaient participé à leur programme au cours de l’année qui précédait, malgré le fait que dans 88,5 % des cas, il n’y avait pas de limite au nombre de participants admis. Parmi les PRC, 25 % n’admettaient que des patients ayant aussi reçu un diagnostic d’atteinte cardiaque, vivant dans la collectivité (47,8 %) et n’ayant pas de déficit sévère sur les plans de la mobilité (70,1 %), de la communication (80,6 %) ou de la fonction cognitive (85,1 %). Dans tous les cas, les deux facteurs influant le plus (positivement ou négativement, selon le cas) sur l’intégration des patients ayant subi un AVC étaient les ressources financières et les ressources humaines. Le quatrième obstacle en importance était le faible nombre de patients ayant subi un AVC orientés vers les programmes; les autres éléments facilitateurs également recensés étaient la collaboration entre les PR-AVC et les PRC afin d’assurer l’orientation des patients concernés (3e place), l’augmentation du nombre de ces orientations (6e place), ainsi que les outils permettant de prescrire un programme d’entraînement musculaire (4e place) et un programme d’entraînement aérobique (5e place). Les PRC admettant des patients ayant subi un AVC avaient en commun les caractéristiques suivantes : ils reposaient sur un modèle hybride, ils étaient de taille moyenne et ils comprenaient un volet sur la prévention des chutes. Conclusions: Si la plupart des PRC admettent les patients qui ont subi un AVC, ces derniers sont peu nombreux à y participer. L’établissement de partenariats entre les PR-AVC et les PRC afin d’augmenter le nombre de patients orientés, la mise en place d’outils facilitant l’exécution de programmes d’exercice physique et l’affectation de fonds et de ressources aux PRC pourraient donc augmenter considérablement l’accès aux stratégies de prévention secondaire.

Objective The benefits of aerobic exercise early after stroke are well known, but concerns about cardiovascular risk are a barrier to clinical implementation. Symptom-limited exercise testing with electrocardiography (ECG) is recommended but not always feasible. The purpose of this study was to determine the frequency of and corresponding exercise intensities at which ECG abnormalities occurred during submaximal exercise testing that would limit safe exercise prescription beyond those intensities. Methods This study was a retrospective analysis of ECGs from 195 patients who completed submaximal exercise testing during stroke rehabilitation. A graded submaximal exercise test was conducted with a 5- or 12-lead ECG and was terminated on the basis of predetermined endpoint criteria (heart rate, perceived exertion, signs, or symptoms). ECGs were retrospectively reviewed for exercise-induced abnormalities and their associated heart rates. Results The peak heart rate achieved was 65.4% (SD = 10.5%) of the predicted maximum heart rate or 29.1% (SD = 15.5%) of the heart rate reserve (adjusted for beta-blocker medications). The test was terminated more often because of perceived exertion (93/195) than because of heart rate limits (60/195). Four patients (2.1%) exhibited exercise-induced horizontal or downsloping ST segment depression of ≥1 mm. Except for 1 patient, the heart rate at test termination was comparable with the heart rate associated with the onset of the ECG abnormality. Conclusion A graded submaximal exercise test without ECG but with symptom monitoring and conservative heart rate and perceived exertion endpoints may facilitate safe exercise intensities early after stroke. Symptom-limited exercise testing with ECG is still recommended when progressing to higher intensity exercise. Impact Concerns about cardiovascular risk are a barrier to physical therapists implementing aerobic exercise in stroke rehabilitation. This study showed that, in the absence of access to exercise testing with ECG, submaximal testing with conservative heart rate and perceived exertion endpoints and symptom monitoring can support physical therapists in the safe prescription of aerobic exercise early after stroke. Lay Summary It is recommended that people with stroke participate in aerobic exercise as early as possible during their rehabilitation. A submaximal exercise test with monitoring of heart rate, perceived exertion, blood pressure, and symptoms can support physical therapists in safely prescribing that exercise.

PURPOSE Supervised exercise is recommended for patients with peripheral artery disease (PAD) and patients with coronary artery disease (CAD). Both conditions share common etiology as atherosclerotic diseases. The clinical profile, cardiorespiratory fitness, and exercise prescriptions of PAD, CAD, and patients with concomitant PAD and CAD (BOTH) have yet to be compared upon entry into cardiac rehabilitation (CR). METHODS Cardiopulmonary, demographic, and anthropometric assessments were conducted at entry to CR between January 2006 and December 2017. RESULTS Among 9701 consecutively enrolled patients, there were 94.6% with CAD (n = 9179), 1.5% with PAD (n = 143), and 3.9% with BOTH (n = 379). Only 5.4% (n = 522) of all patients entering CR had a diagnosis of PAD. Compared with CAD, patients with PAD and BOTH were older (mean ± SD = 62.5 ± 11.1 vs 67.9 ± 11.4 and 69.2 ± 9.8 yr, P < .01), had higher resting systolic blood pressure (124 ± 17 vs 130 ± 17 and 133 ± 18 mm Hg, P < .01), had lower cardiorespiratory fitness (19.7 ± 6.3 vs 15.6 ± 4.8 and 15 ± 4.5 mL/kg/min, P < .01), and were more likely to have diabetes (25% vs 35% and 41%, P < .01), abdominal obesity (39% vs 54% and 51%, P < .01), and initially prescribed lower-intensity exercise (84.4 ± 14.1 vs 74.1 ± 15.7 and 70.0 ± 14.6 m/min exercise pace, P < .01), reflecting the complex nature of patients diagnosed with PAD. CONCLUSIONS Patients referred with PAD have a cardiovascular risk profile that places them at a greater risk for a repeat or first cardiac event compared with patients with CAD. Referral to structured exercise and risk factor modification programs should be considered to aid in the management of PAD.

Peripheral arterial disease (PAD) is frequently underdiagnosed and undertreated. This review identifies specific subgroups within older adults more likely to develop PAD, and describes methods to diagnose PAD and provide evidence in support of systematic referral to cardiac rehabilitation programs to enhance successful comprehensive management. Clear evidence and guidelines support the routine use of supervised exercise therapy to improve function, reduce risk of cardiovascular morbidity and mortality, and enhance the success of endovascular interventions.

Home-based telehealth pulmonary rehabilitation (HTPR) for chronic obstructive pulmonary disease (COPD) is increasingly common partly due to the COVID-19 pandemic. However, optimal HTPR programming has not been described. This review provides a comprehensive overview of the design, delivery, and effects of HTPR for people with COPD.Relevant databases were searched to July 2021 for studies on adults with COPD utilizing information or communication technology to monitor or deliver HTPR. A meta-analysis was performed on a subset of randomized controlled trials.Of 3124 records retrieved, 38 studies evaluating 1993 individuals with stable COPD (age 54-75 and FEVThis review revealed the heterogeneity of HTPR program designs in COPD. HTPR programs had similar effects to outpatient PR programs and greater effects than usual care for people with COPD.

Our aim in this study was to determine sex differences and predictors of noncompletion of a comprehensive adapted cardiac rehabilitation program (CRP) for people with type 2 diabetes (no known cardiac disease).Reasons for noncompletion of a 6-month adapted diabetes exercise-based CRP were ascertained by interview between 2006 and 2017. Regression analyses were conducted to determine demographic, cardiopulmonary, medical and psychosocial predictors of noncompletion in all participants and in females and males separately.Among all participants (460 females and 375 males), predictors of dropout included higher depression score, being unemployed, higher glycated hemoglobin (A1C), younger age and fewer comorbidities. There was no difference in completion rate between females and males in bivariate (28% vs 28.3%, p=0.9) or multivariate (odds ratio=1.089, 95% confidence interval 0.79 to 1.5, p=0.6) analyses, but predictors of dropout varied. In females, these predictors included being married/partnered, living with obesity and having a higher depression score, A1C and triglycerides level, independent of age. For males, only higher depression score and younger age predicted dropout. There was no difference in medical dropouts between females and males (37.2% vs 34% of all dropouts, p=0.6) or in reasons for dropout (p0.05 for all) or attendance to prescheduled sessions in completers (69.2±16.8% vs 70.4±18.8%, p=0.5) or dropouts (24.7±15.7% vs 25.2±16.1%, p=0.8), respectively.There was no sex difference in noncompletion, attendance or reasons for dropout from a diabetes CRP. However, being married/partnered, living with obesity and having higher A1C and triglycerides were unique predictors of dropout for females and younger age for males. Being unemployed, glycemic control and depressive symptoms are targets for promoting completion in all participants that can be addressed by multidisciplinary CRP teams.

Background: Healthy diet and exercise are associated with reduced risk of dementia in older adults. Evidence for the impact of clinical trials on brain health is less consistent, especially with dietary interventions which often rely on varying intervention approaches. Our objective was to evaluate the feasibility and preliminary efficacy of a 6-month intervention combining exercise with a novel dietary counselling approach among older adults with vascular risk factors (VRFs) and early dementia risk. Methods: Participants with VRF’s and SCD or early MCI were cluster randomized into the intervention (exercise + Baycrest Brain-healthy Eating Approach (EX+DIET)) or control group (exercise + brain health education (EX+ED)). Both groups participated in 1-hour of supervised exercise per week and were prescribed additional exercise at home. EX+DIET involved 1-hour per week of group-based dietary counselling comprising didactic education focused on brain healthy eating recommendations, goal setting and strategy training. Whereas, EX+ED involved 1-hour per week of group-based brain health education. The primary outcome was change in hippocampal volume from baseline to 6 months. Secondary outcomes included fitness, diet, cognition, and blood biomarkers. Recruitment challenges and early discontinuation of the trial due to COVID-19 necessitated a revised focus on feasibility and preliminary efficacy. Results: Of 190 older adults contacted, 14 (7%) were eligible and randomized, constituting 21% of our recruitment target. All participants completed the intervention and attended 90% of exercise and diet/education sessions on average. All 6-month follow-up assessments pre-COVID-19 were completed but disruptions to testing during the pandemic resulted in incomplete data collection. No serious adverse events occurred and all participants expressed positive feedback about the intervention. Mean improvements in peak oxygen consumption were observed in both EX+DIET (d = .98) and EX+ED (d =1.15) groups. Substantial improvements in diet and HbA1c were observed in the EX+DIET group compared to EX+ED (d = 1.75 and 1.07, respectively). Conclusions: High adherence and retention rates were observed among LEAD participants and preliminary findings illustrate improvements in cardiorespiratory fitness and diet quality. These results indicate that a larger trial is feasible if difficulties surrounding recruitment can be mitigated. Trial Registration: ClinicalTrials.gov identifier: NCT03056508