There is compelling evidence that regular physical activity is likely to play a role in the secondary prevention of stroke and comorbid coronary artery disease. However, structured physical activity programs are not widely available for people following stroke. Cardiac rehabilitation programs (CRP) are well suited to provide exercise training following traditional stroke rehabilitation. However, people following stroke may be limited by a constellation of neurological deficits that may prevent them from effectively participating in and benefiting from an adapted CRP. Accordingly, the objectives of this work were to 1) examine the utility of cardiopulmonary exercise stress testing (CPET) for developing an exercise prescription in people ≥3 months post-stroke with mild/moderate motor impairments 2) determine ability to achieve minimal recommended exercise training levels reported to elicit health benefits during a single standard CR session following completion of a CRP 3) evaluate the physiological, and cognitive effects of a 24-week CRP of resistance and aerobic exercise and the effect of stroke-recovery-time. It was hypothesized that most patients (>50%) would reach a level of exertion on the CPET that would provide recommended exercise prescription target levels and that individuals would be able to systematically reach these target levels during a CR session. Moreover, the established exercise program would result in physiological and cognitive benefit independent of time-from-stroke. Study 1 demonstrated that most patients achieved a level of exertion during the CPET sufficient to inform an exercise prescription. In Study 2 patients with motor impairments were able to meet or exceed minimal recommended exercise target levels of intensity, duration and energy expenditure. In Study 3 a CRP yielded improvements over multiple domains of recovery (cardiovascular fitness, functional ambulation, sit-to-stand performance, and muscular strength). While those referred ≤1 year and >1 year post-stroke derived benefits from a CRP, those who started earlier (≤1 year) had greater improvements in ambulatory performance. In Study 4 combined aerobic and resistance exercise resulted in improvements in cognitive function. Change in cognition was positively associated with change in fat-free mass and change in anaerobic threshold. In summary people post-stroke are able to effectively participate in and benefit from an adapted CRP.

There is compelling evidence that regular physical activity is likely to play a role in the secondary prevention of stroke and comorbid coronary artery disease. However, structured physical activity programs are not widely available for people following stroke. Cardiac rehabilitation programs (CRP) are well suited to provide exercise training following traditional stroke rehabilitation. However, people following stroke may be limited by a constellation of neurological deficits that may prevent them from effectively participating in and benefiting from an adapted CRP. Accordingly, the objectives of this work were to 1) examine the utility of cardiopulmonary exercise stress testing (CPET) for developing an exercise prescription in people ≥3 months post-stroke with mild/moderate motor impairments 2) determine ability to achieve minimal recommended exercise training levels reported to elicit health benefits during a single standard CR session following completion of a CRP 3) evaluate the physiological, and cognitive effects of a 24-week CRP of resistance and aerobic exercise and the effect of stroke-recovery-time. It was hypothesized that most patients (>50%) would reach a level of exertion on the CPET that would provide recommended exercise prescription target levels and that individuals would be able to systematically reach these target levels during a CR session. Moreover, the established exercise program would result in physiological and cognitive benefit independent of time-from-stroke. Study 1 demonstrated that most patients achieved a level of exertion during the CPET sufficient to inform an exercise prescription. In Study 2 patients with motor impairments were able to meet or exceed minimal recommended exercise target levels of intensity, duration and energy expenditure. In Study 3 a CRP yielded improvements over multiple domains of recovery (cardiovascular fitness, functional ambulation, sit-to-stand performance, and muscular strength). While those referred ≤1 year and >1 year post-stroke derived benefits from a CRP, those who started earlier (≤1 year) had greater improvements in ambulatory performance. In Study 4 combined aerobic and resistance exercise resulted in improvements in cognitive function. Change in cognition was positively associated with change in fat-free mass and change in anaerobic threshold. In summary people post-stroke are able to effectively participate in and benefit from an adapted CRP.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24188号 / 医博第4882号 / 新制||医||1060(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 古川 壽亮, 教授 中山 健夫, 教授 寺田 智祐 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM