Davidson Sara, Bischof-Bockbrader Andrea, Zimmerman Eric, Rosenfeldt Anson B, Alberts Jay L, Linder Susan M
Sara Davidson, PTA, BSAS, is Administrative Program Coordinator, Concussion Center, Cleveland Clinic, Cleveland, OH;
Andrea Bischof-Bockbrader, PTA, BA, is Physical Therapist Assistant, Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH.
Am J Occup Ther. 2024 Mar 1;78(2). doi: 10.5014/ajot.2024.050478.
Although the cardiopulmonary benefits of aerobic exercise poststroke are well-established, typical stroke rehabilitation does not elicit an aerobic response.
To characterize heart rate response during upper extremity repetitive task practice (RTP) and determine factors that predict a higher aerobic intensity during RTP.
Secondary analysis of a subset of data from a randomized clinical trial.
Research laboratory in a large academic medical center.
Patients with chronic stroke (N = 19).
Participants received 90 min of RTP for 24 sessions across 8 wk.
Aerobic intensity as measured by heart rate reserve (HRR) during RTP.
A total of 2,968 tasks were included in the analysis. Of the tasks performed, approximately 79.5% elicited a very light aerobic response (<30% HRR), 10.2% elicited a light aerobic response (30%-39% HRR), and 10.3% elicited a moderate to vigorous intensity aerobic response (≥40% HRR). Of the tasks that elicited a moderate to vigorous intensity aerobic response, 54.1% were performed in standing, 79.7% were gross motor in nature, and 27.9% had targets at or above shoulder height. Standing position, targets at or above shoulder height, and gross motor tasks predicted higher HRR (all ps < .001).
To maximize aerobic intensity during poststroke RTP, therapists should include gross motor tasks trained in standing with targets at or above shoulder height. Plain-Language Summary: The study characterizes heart rate response in stroke rehabilitation and identifies factors that predict a higher aerobic intensity during upper extremity repetitive task practice. Certain task characteristics were more likely to produce an aerobic response, including gross motor, targets at or above the shoulder, and a standing position. Occupational therapists should include gross motor tasks trained in standing with targets at or above shoulder height to maximize aerobic intensity during poststroke repetitive task practice. Monitoring heart rate may improve awareness of aerobic response to training.
尽管有氧运动对中风后心肺功能的益处已得到充分证实，但典型的中风康复训练并不能引发有氧运动反应。
描述上肢重复性任务练习（RTP）期间的心率反应，并确定预测RTP期间更高有氧运动强度的因素。
对一项随机临床试验的部分数据进行二次分析。
大型学术医疗中心的研究实验室。
慢性中风患者（N = 19）。
参与者在8周内接受24次、每次90分钟的RTP训练。
通过RTP期间的心率储备（HRR）测量有氧运动强度。
分析共纳入2968项任务。在完成的任务中，约79.5%引发了非常轻微的有氧运动反应（<30% HRR），10.2%引发了轻度有氧运动反应（30%-39% HRR），10.3%引发了中度至剧烈强度的有氧运动反应（≥40% HRR）。在引发中度至剧烈强度有氧运动反应的任务中，54.1%是在站立位完成的，79.7%本质上是大肌肉群运动，27.9%的目标在肩部高度或以上。站立位、肩部高度或以上的目标以及大肌肉群运动任务预测了更高的HRR（所有p值<0.001）。
为了在中风后RTP期间最大化有氧运动强度，治疗师应包括在站立位进行训练、目标在肩部高度或以上的大肌肉群运动任务。
该研究描述了中风康复中的心率反应，并确定了预测上肢重复性任务练习期间更高有氧运动强度的因素。某些任务特征更有可能产生有氧运动反应，包括大肌肉群运动、肩部或以上的目标以及站立位。职业治疗师应包括在站立位进行训练、目标在肩部高度或以上的大肌肉群运动任务，以在中风后重复性任务练习期间最大化有氧运动强度。监测心率可能会提高对训练有氧运动反应的认识。
