Recommended moderate to vigorous physical activity levels for people in the chronic phase of stroke can be achieved in outpatient physiotherapy: a multicentre observational study.

BACKGROUND: Rehabilitation in the chronic phase of stroke should include 20 minutes of moderate to vigorous physical activity (MVPA). However, the level of compliance with MVPA guidelines in outpatient physiotherapy is unknown. OBJECTIVES: To investigate (1) whether people in the chronic phase of stroke perform the recommended 20 minutes of MVPA during outpatient physiotherapy sessions in France, (2) whether the person's clinical characteristics influence MVPA time and (3) which interventions contribute to achievement of recommended MVPA time. METHODS: This was a multicentre, cross-sectional observational study of routine outpatient physiotherapy sessions in France in people in the chronic phase of stroke. The main measures included MVPA time (determined using a heart rate monitor), clinical tests and types of physiotherapy interventions (recorded by external investigator during 2 sessions for each participant). RESULTS: 84 people in the chronic phase of stroke and 152 outpatient physiotherapy sessions in 29 outpatient clinics were included (2021-2022). Median (interquartile range) MVPA time was 25 (7-45) minutes across all sessions. Fifty-nine percent of the sessions fulfilled MVPA guidelines. Among clinical tests, only the Mini-Mental Scale Examination was significantly associated with MVPA time. Endurance, balance, and functional lower limb training were associated with the achievement of MVPA guidelines. CONCLUSION: Outpatient physiotherapy sessions have the potential to meet the MVPA guidelines. Further research is needed to understand the variability of compliance with MVPA guidelines and to develop strategies to increase the integration of MVPA into outpatient physiotherapy sessions.

The value of action observation in speech and language rehabilitation: A systematic review and meta-analysis.

In this systematic review and meta-analysis, our aim was to identify and quantify evidence of action observation therapy (AOT) efficacy in managing language deficits in patients with aphasia. This study conducts two quantitative investigations: firstly, comparing the effects of AOT and conventional control therapy in different groups, and secondly, analyzing within AOT group to explore potential moderators of AOT effectiveness. Four databases were searched up until August 2023 to find studies utilizing AOT for aphasia management. Seven eligible studies were included. The main analyses revealed moderate evidence of improvement in naming tasks, with a large effect size (Hedge's g = 1.27, 95 %CI [0.44; 2.09], p = 0.003, I2 < 25) following AOT compared to control interventions. Furthermore, to be efficient, AOT should focus on human actions (e.g., running, jumping) rather than non-human actions (e.g., meowing or barking). These findings indicate that AOT is a promising alternative complementary approach for patients with aphasia. Future research should confirm the potential benefits of AOT with more randomized controlled studies and aim to clarify the minimal dose necessary and the possibility of transfer to various language tasks.

Comparison of motion sensor and heart rate monitor for assessment of physical activity intensity in stroke outpatient rehabilitation sessions: an observational study.

OBJECTIVE: To compare the estimation of time spent on 4 categories of physical activity intensity (sedentary behaviour, light physical activity, moderate physical activity, and vigorous physical activity) between a motion sensor and a heart rate monitor during a stroke outpatient rehabilitation session. DESIGN: A multicentre cross-sectional observational study. SUBJECTS/PATIENTS: Participants with stroke (> 6 months) undergoing outpatient rehabilitation sessions. METHODS: Participants wore the SenseWear Armband motion sensor and the Polar H10 heart rate monitor during 2 rehabilitation sessions. The times estimated by each device were compared using a generalized linear mixed model and post-hoc tests. RESULTS: Ninety-nine participants from 29 clinics were recruited and data from 146 sessions were included in the analysis. The estimated times depended on the devices and the physical activity intensity category (F = 135, p < 0.05). The motion sensor estimated more time spent in sedentary behaviour and less time spent in moderate physical activity and vigorous physical activity than the heart rate monitor. CONCLUSION: The motion sensor and heart rate monitor provide different estimates of physical activity intensity during stroke rehabilitation. Further research is needed to establish the most appropriate device for each physical activity category.

Effect of exercise modalities on postexercise hypotension in pre- and postmenopausal women: a systematic review and meta-analysis.

Hormonal changes associated with menopause increase the risk of hypertension. Postexercise hypotension (PEH) is an important tool in the prevention and management of hypertension; however, menopause may alter this response. The aim of this systematic review and meta-analysis [International Prospective Registered of Systematic Review (PROSPERO): CRD42023297557] was to evaluate the effect of exercise modalities (aerobic, AE; resistance, RE; and combined exercise, CE: AE + RE) on PEH in women, according to their menopausal status (premenopausal or postmenopausal). We searched controlled trials in PubMed, Web of Science, EBSCO, and Science Direct published between 1990 and March 2023. Inclusion criteria were normotensive, pre- and hypertensive, pre- and postmenopausal women who performed an exercise session compared with a control session and reported systolic blood pressure (SBP) and diastolic blood pressure (DBP) for at least 30 min after the sessions. Methodological quality was assessed using the PEDro scale. Standardized mean differences (Hedge's g) and their 95% confidence intervals (CIs) were calculated, and Q-test and Z-test were conducted to assess differences between moderators. Forty-one trials with 718 women (474 menopausal) were included. Overall, we found with moderate evidence that SBP and DBP decreased significantly after exercise session (SBP: g = -0.69, 95% CI -0.87 to -0.51; DBP: g = -0.31, 95% CI -0.47 to -0.14), with no difference between premenopausal and postmenopausal women. Regarding exercise modalities, RE is more effective than AE and CE in lowering blood pressure (BP) in women regardless of menopausal status. In conclusion, women's menopausal status does not influence the magnitude of PEH, and the best modality to reduce BP in women seems to be RE.NEW & NOTEWORTHY This meta-analysis has demonstrated that a single bout of exercise induces postexercise hypotension (PEH) in women and that the hormonal shift occurring with menopause does not influence the magnitude of PEH. However, we have shown with moderate evidence that the effectiveness of exercise modalities differs between pre- and postmenopausal women. Resistance and combined exercises are the best modalities to induce PEH in premenopausal women, whereas resistance and aerobic exercises are more effective in postmenopausal women.

Impact of Active Physiotherapy on Physical Activity Level in Stroke Survivors: A Systematic Review and Meta-Analysis.

BACKGROUND: Stroke survivors are frequently physically inactive. However, evidence of the effectiveness of active physiotherapy on physical activity level in stroke survivors is scarce. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement, covering electronic searches from inception to March 16, 2022. Participants: Stroke survivors living in the community. Intervention: Any active physiotherapy, that is, involving exercises that require voluntary effort. Outcome measure: Objective and subjective physical activity level. RESULTS: Of 5590 identified references, 25 randomized controlled trials were eligible, and 21 had available data. The random-effects meta-analysis resulted in a small, significant effect size in favor of active physiotherapy measured using objective or subjective tools (21 studies, 1834 participants, standardized mean difference, 0.22 [95% CI, 0.04-0.40]; heterogeneity I2=65%), and a medium significant effect when objective tools were used (9 studies, 424 participants, standardized mean differences, 0.48 [95% CI, 0.03-0.92]; I2=73%). Meta-regression showed that 35% of the variance in trial outcome was explained by the measurement tool (objective or subjective) and 23% by age. None of the variances were associated with a specific dosage in terms of frequency, time, exercise duration, or the severity of the disability. CONCLUSIONS: Active physiotherapy seems to increase objective physical activity in community-dwelling stroke survivors. However, the evidence is of very low certainty. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42022315639.