Michael Kathleen M, Allen Jerilyn K, Macko Richard F
Division of Gerontology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Arch Phys Med Rehabil. 2005 Aug;86(8):1552-6. doi: 10.1016/j.apmr.2004.12.026.
To determine ambulatory activity in a sample of community-dwelling people with chronic hemiparetic stroke and to examine whether deficits in balance and gait and cardiovascular and metabolic fitness are key determinants of ambulatory activity levels.
Descriptive correlational.
Home and community.
Twenty-eight men and 22 women (N=50) over the age 45 years with more than 6 months of hemiparetic gait after ischemic stroke.
Not applicable.
Ambulatory activity (total daily step activity), mobility deficit severity (Berg Balance Scale [BBS] scores, timed 10-m walks), and cardiovascular fitness (energy costs of hemiparetic gait, peak exercise capacity [VO2peak]).
Mean ambulatory activity profiles were extremely low (2837 steps/d vs reported 5000-6000 steps/d in sedentary older adults). Ambulatory activity levels were strongly associated with BBS scores (r=.581, P<.001) and self-selected floor walking velocity (r=.554, P<.001). Participants also had profound cardiovascular deconditioning (mean VO2peak, 11.7+/-2.8 mL.kg(-1).min(-1)). The energy costs of hemiparetic gait were high (8.7+/-1.7 mL.kg(-1).min(-1)), representing 76% of physiologic fitness reserve. Although the relationships of economy of gait and VO2peak to ambulatory activity was not statistically significant, both the VO2peak and the physiologic fitness reserve, as expressed by fractional utilization, were strongly related to balance (r=.374, P=.02; r=-.430, P< .01, respectively.) The BBS predicted 30% of the variance in ambulatory activity.
Ambulatory activity levels and cardiovascular fitness in patients with chronic stroke are extremely low. Mobility deficits, particularly in balance, are associated with low ambulatory activity. Balance-related inactivity may be an important factor in deconditioning. Further studies are needed to better understand whether task-oriented exercise enhances balance and whether increases in daily ambulatory activity yield improved cardiovascular fitness in chronic stroke survivors.
确定社区居住的慢性偏瘫性卒中患者的日常活动情况，并研究平衡和步态缺陷以及心血管和代谢健康状况是否是日常活动水平的关键决定因素。
描述性相关性研究。
家庭和社区。
28名男性和22名女性（N = 50），年龄超过45岁，缺血性卒中后偏瘫步态超过6个月。
不适用。
日常活动（每日总步数活动）、运动功能障碍严重程度（伯格平衡量表[BBS]评分、10米定时步行）和心血管健康状况（偏瘫步态的能量消耗、峰值运动能力[VO2峰值]）。
平均日常活动量极低（2837步/天，而久坐不动的老年人报告为5000 - 6000步/天）。日常活动水平与BBS评分（r = 0.581，P < 0.001）和自我选择的地面行走速度（r = 0.554，P < 0.001）密切相关。参与者还存在严重的心血管功能失调（平均VO2峰值为11.7±2.8 mL·kg⁻¹·min⁻¹）。偏瘫步态的能量消耗很高（8.7±1.7 mL·kg⁻¹·min⁻¹），占生理健康储备的76%。尽管步态经济性和VO2峰值与日常活动的关系无统计学意义，但VO2峰值和以利用率表示生理健康储备均与平衡密切相关（分别为r = 0.374，P = 0.02；r = -0.430，P < 0.01）。BBS可预测日常活动中30%的方差。
慢性卒中患者的日常活动水平和心血管健康状况极低。运动功能障碍，尤其是平衡功能障碍，与低日常活动量相关。与平衡相关的活动不足可能是功能失调的一个重要因素。需要进一步研究以更好地理解以任务为导向的运动是否能增强平衡能力，以及慢性卒中幸存者每日日常活动量的增加是否能改善心血管健康状况。
