Patient characteristics associated with cardiorespiratory exercise participation in Ontario stroke rehabilitation
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Key Takeaway
Note that cardiac disease, poor LV function, and mental health history associate with lower cardiorespiratory exercise participation odds.
This observational cohort study included 601 patients admitted to four stroke rehabilitation centres in Ontario, Canada. The analysis evaluated patient characteristics such as age, sex, mobility status, and medical history to determine their association with participation in cardiorespiratory exercise. Secondary outcomes included exercise characteristics and completion of recommended intensity and duration.
Regarding primary outcomes, 40.1% of stroke patients participated in cardiorespiratory exercise, while 26.4% had it included in their treatment plan. Only 1.5% of patients (N=9 of 601) completed cardiorespiratory exercise with recommended intensity and duration. Several factors were associated with lower odds of participation, including diagnosed cardiac disease (OR=0.74), poor left ventricular function (OR=0.09), history of mental health conditions (OR=0.69), lower functional ambulation ability (OR=0.74), and wheelchair use at admission (OR=0.46). Conversely, use of a walker or rollator (OR=3.22) and having a cardiorespiratory exercise goal (OR=2.13) were associated with higher odds of participation. Longer lengths of stay were also associated with higher odds (OR=1.01).
No adverse events, serious adverse events, discontinuations, or tolerability issues were reported. However, as an observational study, these findings describe associations rather than causal relationships. The data do not support definitive clinical recommendations for specific interventions based on these associations alone. Improving participation may require addressing identified barriers related to cardiovascular health, mental health, and mobility.
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View Original Abstract ↓
Objectives: Among individuals attending stroke rehabilitation, we aimed to determine the proportion who participated in cardiorespiratory exercise, identify patient characteristics predicting participation, and describe exercise characteristics. Design, setting, and participants: This was an observational cohort study involving all patients admitted to four stroke rehabilitation centres in Ontario, Canada, during March or October 2019, or over 12 months starting in 2021. Main measures: Patient characteristics extracted during chart review included age, sex, marital status, employment status, date of stroke, time post-stroke at admission, length of stay for rehabilitation, past medical history that could affect exercise participation, Functional Independence Measure, Functional Ambulation Category, mobility aid use, Chedoke-McMaster Stroke Assessment, Montreal Cognitive Assessment, National Institutes of Health Stroke Scale, and details describing cardiorespiratory exercise completed. Results: 40.1% of stroke patients participated in cardiorespiratory exercise, with 26.4% having it included in their treatment plan. Diagnosed cardiac disease (OR=0.74), poor left ventricular function (OR=0.09), history of mental health conditions (OR=0.69), lower functional ambulation ability (OR=0.74), and wheelchair use at rehabilitation admission (OR=0.46) were associated with lower odds of participating in cardiorespiratory exercise after stroke (p-values<0.05). Use of a walker or rollator at rehabilitation admission (OR=3.22), having a cardiorespiratory exercise goal (OR=2.13), and longer lengths of stay (OR=1.01) were associated with higher odds of participating in cardiorespiratory exercise after stroke (p-values<0.05). Only 1.5% of patients (N=9/601) who participated in cardiorespiratory exercise completed it with recommended intensity and duration. Conclusion: Improving participation in cardiorespiratory exercise during stroke rehabilitation may require addressing cardiovascular, mental health, and mobility-related barriers.
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