Aerobni trening v subakutnem obdobju po možganski kapi: Aerobic training in subacute stroke patients

Introduction: We present the effects of individually prescribed aerobic training using exercise bike on aerobic capacity, functional status and walking performance of patients in the subacute stage after stroke. Methods: Forty stroke patients admitted to comprehensive inpatient stroke rehabilitation program were randomised into control and treatment group. In addition to standard neurorehabilitation program in both groups, the patients in the treatment group had individually prescribed aerobic training on exercise bike. With weekly progression of intensity and duration of exercise, the patients reached 30 minutes of aerobic training per day, five times a week at the intensity of 80% of peak work capacity achieved on stress-testing performed at admission. In all patients, the number of training units of dynamic exercises were recorded and oxygen consumption (VO2peak), 6-minute walking test (6 MWT), Stand up and Go test and Functional Independence Measure (FIM) assessment were performed before and after four weeks of exercise. Results: Thirty-eight patients were included in the statistical analysis (19 in each group). The groups were balanced regarding age, gender, time to admission, mean oxygen consumption, walking distance during 6MWT, the time to perform the Stand up and Go test and the Functional Independence Measure score. After four weeks of training all the measured parameters improved in both groups, the improvement being larger in the treatment group, though not statistically significantly. Only the number of training units of dynamic exercises in was statistically significantly higher in the test group. Conclusion: The individually prescribed aerobic training improves cardiovascular performance, walking ability and functional performance in patients in the subacute stage after stoke. The four-week period of aerobic training was probably too short for demonstrating chronic cardiovascular and metabolic adaptation on regularly aerobic activity. The most important goal of the training is that the patients gain knowledge and feeling of how to continue the program after discharge from inpatient rehabilitation. Uvod: V članku prikazujemo učinke individualno načrtovane in stopnjevane aerobne vadbe na sobnem kolesu na povečanje telesne zmogljivosti, hojo ter funkcijsko stanje v subakutnem obdobju po možganski kapi. Metode: V raziskavo smo vključili 40 bolnikov v subakutnem obdobju po možganski kapi in jih naključno razdelili v testno in kontrolno skupino. Testna skupina je poleg ustaljenega programa rehabilitacije izvajala individualno načrtovan aerobni trening na sobnem kolesu. S postopnim večanjem intenzivnosti in daljšanjem trajanja treninga so bolniki ob koncu treninga vadili pol ure dnevno, pet dni v tednu, z intenzivnostjo 80 % maksimalne obremenitve, dosežene pri obremenitvenem testu na kolesu ob sprejemu. Pri vseh bolnikih smo beležili število vadbenih enot dinamične vadbe, pred pričetkom in po štirih tednih vadbe pa izmerili največjo porabo kisika (VO2peak), v šestih minutah prehojeno razdaljo, izvedli časovni test vstani in pojdi in ocenili funkcijsko stanje bolnikov z Lestvico funkcijske neodvisnosti (FIM). Rezultati: V statistično analizo je bilo vključenih 38 bolnikov, po 19 v vsaki skupini. Skupini sta bili izenačeni po spolu, starosti, času od nastopa možganske kapi do pričetka rehabilitacije, začetni povprečni vrednosti VO2peak, po prehojeni razdalji v šestih minutah, času izvedbe testa vstani in pojdi in oceni FIM. Po štiritedenski vadbi smo pri bolnikih obeh skupin beležili izboljšanje vseh merjenih parametrov, večje v testni skupini, vendar razlike med skupinama niso bile statistično značilne. Statistično značilno večje je bilo le število vadbenih enot dinamične vadbe v testni skupini. Zaključek: Individualno predpisana aerobna vadba ima ugoden učinek na telesno zmogljivost, hojo in funkcijsko stanje bolnikov tudi v subakutnem obdobju po možganski kapi. Štiritedensko obdobje izvajanja aerobnega treninga pri naših bolnikih je bilo prekratko, da bi se pokazali učinki prilagoditve srca in ožilja ter presnove v mišicah zaradi redne aerobne telesne dejavnosti. Bolniki pa so pridobili znanje in občutek, na kakšen način lahko z aerobnimi aktivnostmi varno nadaljujejo po odpustu iz rehabilitacijske ustanove.