Yan Yunyi, Eng Janice J, Hung Stanley H, Bayley Mark T, Best Krista L, Connell Louise A, Donkers Sarah J, Dukelow Sean P, Ezeugwu Victor E, Milot Marie-Hélène, Sakakibara Brodie M, Sheehy Lisa, Wong Hubert, Yao Jennifer, Peters Sue
School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada.
Rehabilitation Research Program, G.F. Strong Rehabilitation Centre and Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
PLoS One. 2025 Jul 28;20(7):e0328930. doi: 10.1371/journal.pone.0328930. eCollection 2025.
Rehabilitation is important for regaining mobility poststroke. Clinical practice guidelines suggest a high number of repetitive stepping activities to optimize subacute recovery especially when undertaken at intensities that challenge cardiovascular fitness. However, adherence to these guidelines is unclear. The objective of this study was to quantify aerobic minutes and step number in usual care inpatient stroke rehabilitation unit physical therapy sessions across Canada and identify characteristics of participants who met guideline aerobic intensity minutes at a session midpoint in their rehabilitation.
To gain insight into usual care, we analyzed cross-sectional data from the usual care arm of the Walk 'n Watch implementation trial; trial sites included Canadian rehabilitation units that were not typically involved in research studies. To be included, medically stable patients were admitted for inpatient stroke rehabilitation, and able to take > 5 steps with a maximum of one person assisting. We assessed a midpoint physical therapy session with a wrist-based heart monitor (aerobic minutes) and ankle-based step counter (step number). Means, histograms, and correlations between aerobic minutes (> 40% heart rate reserve) and steps were calculated.
There were 166 participants (69 females, age 69 standard deviation (SD)12 years) with stroke (138 Ischemic/ 27 Hemorrhagic) included. Participants had a mean of 10(SD11) aerobic minutes and 985(SD579) steps. The relationship between step number and aerobic minutes was negligible (R2 = 0.003). More participants with ≥20 aerobic minutes in a session were male, with lower 6 Minute Walk Test distance, and have a subcortical stroke location.
The number of steps has increased, but aerobic minutes has not changed and remains extremely low compared to published reports in the past several years. Given that increasing activity levels are critical for stroke recovery, further investigation into the potential barriers to achieving targets set by guidelines is recommended.
ClinicalTrials.gov NCT04238260.
康复对于中风后恢复活动能力至关重要。临床实践指南建议进行大量重复性步行活动，以优化亚急性期恢复，尤其是在进行挑战心血管健康的强度下进行时。然而，对这些指南的遵循情况尚不清楚。本研究的目的是量化加拿大各地常规护理住院中风康复单元物理治疗课程中的有氧运动分钟数和步数，并确定在康复中期达到指南有氧运动强度分钟数的参与者特征。
为深入了解常规护理情况，我们分析了“边走边看”实施试验常规护理组的横断面数据；试验地点包括加拿大通常不参与研究的康复单元。纳入标准为病情稳定的中风住院康复患者，且在最多一人协助下能够行走超过5步。我们使用基于手腕的心率监测器（有氧运动分钟数）和基于脚踝的步数计数器（步数）评估了一次物理治疗课程的中期情况。计算了有氧运动分钟数（>40%心率储备）与步数之间的均值、直方图和相关性。
共纳入166名中风患者（69名女性，年龄69岁，标准差[SD]12岁）（138例缺血性/27例出血性）。参与者的有氧运动分钟数平均为10（SD11）分钟，步数为985（SD579）步。步数与有氧运动分钟数之间的关系可忽略不计（R2 = 0.003）。在一次课程中有≥20分钟有氧运动时间的参与者中，男性更多，6分钟步行试验距离更低，且中风部位为皮质下。
步数有所增加，但有氧运动分钟数没有变化，与过去几年发表的报告相比仍然极低。鉴于增加活动水平对中风恢复至关重要，建议进一步调查实现指南设定目标的潜在障碍。
ClinicalTrials.gov NCT04238260。
