Decannulation protocol in pediatric patients: case series study.

OBJECTIVE: The aim of this study was to describe the phases of a decannulation protocol and the results from its application in hospitalized children. METHODS: This is a retrospective, observational study. Data were collected from medical records of decannulated patients followed up in a pediatric hospital in Belo Horizonte, Minas Gerais between 2011 and 2021. RESULTS: Among the children followed up in the service (n=526), 23% (n=120) were successfully decannulated. Children aged between 2 months and 16 years, with a mean age of 4 years, 69% of whom were male, were evaluated. About 75% of the patients have tracheostomy due to upper airway obstruction and 60% of these due to acquired subglottic stenosis. At the beginning of the decannulation protocol, 5.5% of the patients had moderate oropharyngeal dysphagia, while 80.4% had normal swallowing. Correction in the upper airway pre-decannulation was performed in 39.5% of the patients, dilation in 63.8%, and endoscopic correction was performed in 55.3%. After performing the decannulation, none of the patients had complications. CONCLUSIONS: The described decannulation protocol is safe, since no complications such as death and need for recannulation happened.

Fatigue in individuals with multiple sclerosis: Is there a relationship with walking speed and mobility?

BACKGROUND: Fatigue is a common symptom in patients with multiple sclerosis and it can lead to activity limitations. Thus, it is important to analyze the relationship between fatigue and activity outcomes, such as walking speed and mobility. OBJECTIVES: To investigate the relationship between fatigue and walking speed and mobility in individuals with multiple sclerosis. METHODS: A cross-sectional study was performed. Adults with multiple sclerosis, without cognitive impairments and who were able to walk were recruited. Fatigue was assessed with the Modified Fatigue Impact Scale (MFIS). Walking speed, usual and fast, was assessed with the 10-meter Walk Test (10MWT), and mobility with the Timed Up and Go Test (TUG). Pearson correlation analysis was performed. A significance level of 5 % was used. RESULTS: Thirty participants were included, most of the relapsing-remitting multiple sclerosis (n = 24, 80 %). A mean age of 41 (11) years and the median Expanded Disability Status Scale (EDSS) score was 2.65 (2.18) points. Mean MFIS score was 41.87 ± 19.42 points, mean usual walking speed was 1.02 ± 0.28 m/s, mean fast walking speed was 1.55 ± 0.48 m/s, and the mean total time in the TUG was 10.07 ± 3.05 s. A significant negative correlation of moderate magnitude was found between fatigue and usual walking speed (r=₋0.51, p < 0.05). A significant negative correlation of moderate magnitude was found between fatigue and fast walking speed (r=₋0.54, p < 0.05). A significant, positive correlation of moderate magnitude was found between fatigue and mobility (r = 0.54, p < 0.05). CONCLUSION: There was a correlation between fatigue and walking speed and mobility in individuals with multiple sclerosis. These results highlight the need to assess fatigue in individuals with multiple sclerosis, since the presence of fatigue is associated with reduced walking speed and mobility.

A single trial of the five-repetition sit-to-stand test provides adequate measures in community-dwelling older adults: A cross-sectional study.

PURPOSE: To investigate whether the number of trials would affect the results of the Five-Repetition Sit-to-Stand Test (5STSt) and its measurement properties in community-dwelling older adults. METHODS: Three trials of the 5STSt, after familiarization, were performed by 50 older adults (69.9 ± 5.5 years). The one-way ANOVA was used to compare the number of trials of the 5STSt (the first trial, the best trial, the mean of two trials, and the mean of three trials). Intraclass Correlation Coefficient (ICC) was calculated to investigate inter-rater and test-retest reliabilities, and SEM and MDC95% were also calculated. The magnitude of the correlations was classified as very low≤0.25; low = 0.26-0.49; moderate = 0.50-0.69; high = 0.70-0.89; and very high = 0.90-1.00. (α = 0.05). RESULTS: The values provided by different numbers of trials were similar in session-1 (F = 1.315; p = 0.271), as well as in session-2 (F = 0.668; p = 0.574). Inter-rater and test-retest reliabilities were significant and classified as moderate to high for all number of trials (0.63

The telephone-based application of the modified fatigue impact scale in individuals with multiple sclerosis: An investigation of measurement properties.

BACKGROUND: Fatigue is one of the most common symptoms reported by individuals with multiple sclerosis and it contributes to the reduction of the functionality. Therefore, it is important to assess the impact of fatigue on daily living of individuals with multiple sclerosis. The Modified Fatigue Impact Scale (MFIS) is an instrument to assess the perception of the impact of fatigue. However, there have been no investigations about the measurement properties of this instrument administered over the telephone for individuals with multiple sclerosis. OBJECTIVES: To verify the concurrent validity, the test-retest reliability, the standard error of measurement (SEM) and the minimal detectable change (MDC) of the MFIS applied over the telephone to assess the perception of the impact of fatigue of individuals with multiple sclerosis. METHODS: The MFIS, composed of 21 items covering three domains: physical, cognitive and psychosocial, was applied at three different moments with an interval of 5-7 days. To establish the concurrent criterion validity, the face-to-face application and the first evaluation by telephone were used. The two telephone assessments were used to assess the test-retest reliability The intraclass correlation coefficient (ICC) with 95 % confidence interval (CI) and the Bland-Altman method were used. The standard error of measurement (SEM) and the MDC was calculated according to reliability results. RESULTS: Thirty individuals (40.83 ± 10.61, 60 % female) were included. The median score on the Expanded Disability Status Scale was 2.00 (±4.00). The majority of participants experienced fatigue (n = 17; 56.67 %). A significant and high magnitude correlation (0.70 ≤ ICC ≤ 0.87, p < 0.001) was found in the investigation of concurrent criterion validity. The Bland-Altman method showed a mean difference between 0.70 to 2.17 points between face-to-face and telephone-based application of the MFIS. For test-retest reliability, a significant and very high magnitude correlation (0.91 ≤ ICC ≤ 0.97, p < 0.001) was found. The Bland-Altman method showed a mean difference between -0.03 and -0.77 points between two telephone-based applications. The SEM and the MDC were 0.71 and 1.97 points. CONCLUSION: The telephone-based application of the MFIS to assess the perceived impact of fatigue in individuals with multiple sclerosis demonstrated adequate measurement properties, and may be a valuable tool to assess patients in clinical practice.

Are age-predicted equations valid in predicting maximum heart rate in individuals after stroke?

PURPOSE: To investigate the validity of six age-predicted maximum heart rate (HRmax) equations after stroke. MATERIAL AND METHODS: Sixty individuals (54 (12) years; 64 (69) months after stroke) were included. A Cardiopulmonary Exercise Test (CPET) performed on a treadmill obtained the HRmax. The most used age-predicted equations were investigated: (1) 220-age, proposed by Fox; (2) 206.9- (0.67 × age), proposed by Gellish; (3) 208- (0.7 × age), proposed by Tanaka; (4) 216.6- (0.84 × age), proposed by Astrand; (5) 164- (0.72 × age) and (6) 200- (0.92 × age) proposed by Brawner. RESULTS: No statistically significant agreement was found between the HRmax obtained by the CPET and the one predicted by the equations 1-5 (-0.18 ≤ 95% confidence interval ≤0.79). A significant and moderate agreement was found between the HRmax obtained by the CPET and the one predicted by equation (6) (95% CI= 0.05-0.75; Intraclass Correlation Coefficient= 0.51). Bland-Altman plots showed that equations (1-4) and (6) overestimated the HRmax. Equation (6) presented the lower mean difference. CONCLUSIONS: The equations developed for non-disabled individuals (1-4) are not adequate to be used in individuals after a stroke. Equation (6) (Brawner) showed the best results to be used in individuals after stroke; however, it should be used cautiously.

Prediction equations for maximum heart rate (HR_max) are commonly used to prescribe aerobic exercise for individuals following a stroke.The equations developed for non-disabled individuals are not valid for use with individuals after stroke, leading to an overestimation of the HR_max.An age-predicted HR_max equation developed for individuals with coronary heart disease may provide outcomes that are more accurate for stroke survivors, but care should still be taken when using it.

An Equation With Clinical Applicability and Adequate Validity to Predict the Maximum Oxygen Consumption of Individuals Post-stroke.

OBJECTIVE: To develop an equation with clinical applicability and adequate validity to predict the maximum oxygen consumption (V̇o2max) of individuals post-stroke. DESIGN: A cross-sectional study. SETTING: A university laboratory. PARTICIPANTS: Individuals post-stroke in the chronic phase (at least 6 months post-stroke). Step-1 (equation development): n=50, aged 55±12 years; Step-2 (validity investigation): n=20, aged 58±8 years (N=50 [step 1], N=20 [step 2]). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Step-1 (equation development): multiple linear regression analysis was performed. DEPENDENT VARIABLE: V̇o2max (mL/kg/min) in the cardiopulmonary exercise test. INDEPENDENT VARIABLES: age (years), sex (1-women, 2-men), body mass index (BMI) (kg/m2), and distance (meters) in the Six-Minute Walk Test (6MWT) (6MWT-Equation) or in the Incremental Shuttle Walk Test (ISWT) (ISWT-Equation). Step-2 (validity investigation): agreement between the V̇o2max measured and predicted was evaluated with the intraclass correlation coefficient (ICC) with 95% confidence interval (CI) and the Bland-Altman method (α=5%). RESULTS: In step-1 (equation development), the 4 independent variables for each equation were retained (6MWT-Equation: R2=0.68, P<.001; ISWT-Equation: R2=0.58, P<.001). In step-2 (validity investigation), the 6MWT-Equation showed an ICC of 0.73 (95% CI=0.30, 0.89; P=.004) and a mean bias of 0.003 mL/kg/min; and the ISWT-Equation showed an imprecise ICC of 0.55 (95% CI=-0.12, 0.82; P=.045) and a mean bias of 0.971 mL/kg/min. 6MWT-Equation (V̇o2max=22.239+0.02 × distance in the 6MWT+4.039 × sex-0.157 × age-0.265 × BMI) showed adequate validity. CONCLUSIONS: An equation with clinical applicability and adequate validity in the investigated sample was developed to predict the V̇o2max of individuals post-stroke in the chronic phase (6MWT-Equation). Future studies with larger sample should investigate its external validity.

Relationship between lower limb motor impairment and biomechanical strategies used during mobility activities in post-stroke individuals / Relación entre el deterioro motor de las extremidades inferiores y las estrategias biomecánicas utilizadas durante las actividades de movilidad en individuos pos accidente cerebrovascular / Relação entre comprometimento motor de membro inferior e estratégias biomecânicas utilizadas durante atividades de mobilidade em indivíduos pós-acidente vascular encefálico

ABSTRACT Motor impairment and mobility limitations are frequently observed in post-stroke individuals and are associated with functional dependence and low perceived quality of life. Therefore, evaluating the association between motor impairment and the biomechanical strategies used by post-stroke individuals in performing mobility activities is necessary. This study aimed to evaluate the correlation between lower limb motor impairment assessed by the motor section of the Fugl-Meyer assessment (FMA) scale and the mobility of post-stroke individuals considering the biomechanical strategies assessed by the timed "up and go" assessment of biomechanical strategies (TUG-ABS). This exploratory cross-sectional study included 100 individuals in the chronic phase after stroke with a mean age of 55.02±12.57 years. The FMA was used to assess lower limb motor impairment and the TUG-ABS to assess mobility during the following activities performed sequentially: changing from sitting to standing position, walking, turning 180°, and changing from standing to sitting position. Spearman's correlation was used to evaluate the relationship between variables (α=5%). Lower limb motor impairment and mobility considering the biomechanical strategies adopted by post-stroke individuals in the aforementioned activities (changing from sitting to standing position, walking, turning 180°, and changing from standing to sitting position) showed a significant (p<0.001), positive correlation of moderate magnitude (rs=0.60). This indicates that motor impairment is an important outcome to be considered during the rehabilitation of post-stroke individuals with mobility limitations, as assessed by the TUG-ABS.

RESUMEN El deterioro motor y la limitación de la movilidad se observan con frecuencia en individuos pos-accidente cerebrovascular (ACV) y se asocian con una dependencia funcional y baja percepción de la calidad de vida. Por ello, es importante evaluar la relación entre el deterioro motor y las estrategias biomecánicas que utilizan los individuos pos-ACV durante las actividades de movilidad. El objetivo de este estudio fue evaluar la correlación entre el deterioro motor de las extremidades inferiores, evaluado por la sección motora de la escala de Fugl-Meyer (EFM), y la movilidad de los individuos pos-ACV, teniendo en cuenta las estrategias biomecánicas evaluadas por la prueba timed "up and go" assessment of biomechanical strategies (TUG-ABS). Se trata de un estudio transversal, exploratorio, en el cual participaron 100 individuos en la fase crónica pos-ACV, de edad media de 55,02±12,57 años. Para evaluar el deterioro motor de las extremidades inferiores se utilizó la EFM, y se aplicó la prueba TUG-ABS para evaluar la movilidad durante las actividades de sentarse a ponerse de pie, caminar, girar y ponerse de pie a sentarse, realizadas secuencialmente. La correlación de Spearman se realizó para verificar la relación entre las variables (α=5%). El deterioro motor de las extremidades inferiores y la movilidad teniendo en cuenta las estrategias biomecánicas adoptadas por los individuos pos-ACV durante las actividades propuestas mostraron una significativa correlación (p<0,001), positiva y de magnitud moderada (rs=0,60). Esto indica que el deterioro motor es importante para tener en cuenta en el proceso de rehabilitación de individuos pos-ACV con limitaciones de movilidad como las evaluadas por el TUG-ABS.

RESUMO O comprometimento motor e a limitação da mobilidade são frequentemente observadas em indivíduos após o acidente vascular encefálico (AVE) e estão associadas à dependência funcional e à baixa percepção da qualidade de vida. Portanto, é preciso investigar a relação do comprometimento motor e as estratégias biomecânicas utilizadas por indivíduos pós-AVE na realização de atividades de mobilidade. O objetivo deste estudo foi avaliar a correlação entre o comprometimento motor de membro inferior, avaliado pela seção motora da escala de Fugl-Meyer (EFM), e a mobilidade de indivíduos pós-AVE considerando as estratégias biomecânicas avaliadas pelo teste timed "up and go" assessment of biomechanical strategies (TUG-ABS). Trata-se de um estudo transversal exploratório, no qual participaram 100 indivíduos na fase crônica pós-AVE, com média de idade de 55,02±12,57 anos. Foi utilizada a EFM para avaliação do comprometimento motor de membro inferior e o teste TUG-ABS para avaliação da mobilidade durante as atividades de sentado para de pé, marcha, giro e de pé para sentado realizadas sequencialmente. Foi realizada a correlação de Spearman para verificar a relação entre as variáveis (α=5%). O comprometimento motor de membro inferior e a mobilidade considerando as estratégias biomecânicas adotadas por indivíduos pós-AVE durante as atividades propostas apresentaram correlação significativa (p<0,001), positiva e de moderada magnitude (rs=0,60). Isso indica que o comprometimento motor é um desfecho importante para se considerar no processo de reabilitação de indivíduos pós-AVE que apresentam limitações de mobilidade como as avaliadas pelo TUG-ABS.

Assessment of V̇o2peak and Exercise Capacity After Stroke: A Validity Study of the Human Activity Profile Questionnaire.

OBJECTIVE: To investigate the concurrent validity of the Human Activity Profile (HAP) in individuals after stroke to provide the peak oxygen uptake (V̇o2peak) and the construct validity of the HAP to assess exercise capacity, and to provide equations based on the HAP outcomes to estimate the distance covered in the Incremental Shuttle Walking Test (ISWT). DESIGN: Cross-sectional study. SETTING: University laboratory. PARTICIPANTS: Individuals (N=57) aged 54±11 years who have experienced stroke. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Agreement between the V̇o2peak provided by the HAP (lifestyle energy consumption [LEC] outcome, in mL/kg-1/min-1) and the criterion standard measure of the V̇o2peak (mL/kg-1/min-1), obtained through the symptom-limited Cardiopulmonary Exercise Test (CPET). Correlation between the HAP outcomes (LEC, maximum activity score [MAS], and adjusted activity score [AAS]) and the construct measure: the distance covered (in meters) in the ISWT. An equation to estimate the distance covered in the ISWT was determined. RESULTS: High magnitude agreement was found between the V̇o2peak, in mL/kg-1/min-1, obtained by the symptom-limited CPET and the value of V̇o2peak, in mL/kg-1/min-1, provided by the HAP (LEC) (intraclass correlation coefficient, 0.75; P<.001). Low to moderate magnitude correlations were found between the distance covered in the ISWT and the HAP (LEC/MAS/AAS) (0.34≤ρ≤0.58). The equation to estimate the distance covered in the ISWT explained 31% of the variability of the ISWT (ISWTestimated, -361.91+(9.646xAAS)). CONCLUSION: The HAP questionnaire is a clinically applicable way to provide a valid value of V̇o2peak (in mL/kg-1/min-1) and to assess the exercise capacity of individuals after stroke. Furthermore, an equation to estimate the distance covered in the submaximal field exercise test (ISWT) based on the result of the AAS (in points) was provided.

How to Score the Peak Oxygen Consumption Obtained Through Cardiopulmonary Exercise Test in Individuals after Stroke?

OBJECTIVES: To compare five distinct methods to score the peak of oxygen consumption (VO2peak) obtained through the cardiopulmonary exercise testing (CPET) in individuals after stroke. MATERIALS AND METHODS: The VO2peak was obtained through the CPET with five methods: method-1: the highest value of the test; method-2: the highest value of the last 30 seconds at peak exercise; method-3: the mean of the last 30 seconds at peak exercise; method-4: the mean of the last 20 seconds at peak exercise; method-5: the highest value averaged of the 3 last blocks of 10 seconds at peak exercise. The coefficient of variance (CV) and the mean differences with 95% confidence interval (CI) between the scoring methods were calculated. A post-hoc test (Tukey HSD) was performed to calculate the adjusted 95%CI. RESULTS: Fifty-nine individuals were included (54±12 years, 56±60 months after stroke). The CV of the methods 1-to-5 were, respectively: 27.91%, 25.77%, 23.38%, 23.83%, and 23.33%. There was no difference between method-1 and method-2 (95%CI: -1.10 to 4.69) and between methods 3 to 5: method-3 and method-4 (95%CI: -2.97 to 2.82); method-3 and method-5 (95%CI: -3.57 to 2.22); method-4 and method-5 (95%CI: -3.49 to 2.30). However, method-1 and -2 provided VO2peak values different from that of methods 3-to-5. CONCLUSIONS: The scoring method of obtaining the VO2peak has an influence on its magnitude. Since methods 3-to-5 showed lower CV and provided similar values, they should be used to calculate the VO2peak obtained through the CPET in individuals after stroke.

Stroke survivors with the same levels of exercise as healthy individuals have lower levels of physical activity.

BACKGROUND: Physical activity and exercise are different constructs. However, professionals usually employ heterogeneous definitions for these distinct constructs, resulting in nonspecific and inaccurate assessments, which compromise clinical decision making. PURPOSE: The aim of this study was to verify if the levels of physical activity behave similarly between individuals with stroke and healthy-control individuals with the same levels of exercise. METHODS: Seventy-five stroke survivors and 75 healthy-control individuals matched by levels of exercise, age, and sex were evaluated. The level of exercise was classified as inactive, insufficient, and moderate/vigorous according to the Centers for Disease Control and Prevention criteria. The level of physical activity was assessed with the Human Activity Profile (HAP) and classified as "inactive," "moderately active," and "active." The physical activity level was compared between groups of subjects (stroke versus healthy-control) and subgroups of the level of exercise ("inactive," "insufficient," and "moderate/vigorous" level of exercise) (α = 5%). RESULTS: Stroke survivors had a significantly lower level of physical activity (HAP: 51 ± 22 and 71 ± 19 points, respectively). Only for individuals with stroke, a statistically significant difference was found in the levels of physical activity between subgroups of level of exercise, specifically between "inactive" and "moderate/vigorous" subgroups (HAP:47 ± 22 and 70 ± 8 points, respectively). CONCLUSIONS: Physical activity behaved differently between individuals with stroke and healthy-control individuals with the same levels of exercise. Individuals with stroke had worse physical activity levels than matched controls. Furthermore, different from individuals with stroke, in healthy-control individuals with different levels of exercise, the level of physical activity was similar.

Perspectives, satisfaction, self-efficacy, and barriers to aerobic exercise reported by individuals with chronic stroke in a developing country.

PURPOSE: To describe the perspectives, satisfaction, and self-efficacy towards aerobic exercise and to investigate the barriers to aerobic exercise identified by individuals with stroke in a developing country. MATERIALS AND METHODS: A cross-sectional study was performed with 15 individuals (55 ± 12 years, 69 ± 77 months post-stroke), who received a 12-week vigorous intensity aerobic treadmill training (three 30-min sessions/week). To assess participants' perspectives, satisfaction, self-efficacy, and barriers to aerobic exercise, a standardized interview and the Short Self-Efficacy for Exercise scale were employed. RESULTS: Participants considered aerobic exercise important (100% (IQR 20%), out of 100), recognized that it improves recovery (93%) and heart health (100%) and were satisfied with the training (80%). Self-efficacy was high (4 (IQR 1), out of 5). The main barriers were lack of information (86.7%), fear of falling (80%), lack of equipment (73.3%) or support (66.7%-73.3%), cognitive (66.7%) and physical impairments (60%) and severe weather conditions (60%). Most of them preferred to exercise in groups (93%). CONCLUSIONS: Individuals with stroke in a developing country considered aerobic exercise important. However, they perceived barriers related to safety, individual ability, social support, and aerobic exercise. It is necessary to improve education of these individuals, family members, and health care professionals regarding aerobic exercises.IMPLICATIONS FOR REHABILITATIONIndividuals after stroke in developing countries consider aerobic exercise important and recognized that it improves stroke recovery and health, although they perceived barriers related to safety, individual ability, social support, and aerobic exercise itself.It is important to improve education to stroke survivors, family members and healthcare professionals in developing countries about the possibilities, risks, and benefits of aerobic exercises.Rehabilitation professionals should provide aerobic exercise for individuals after stroke in groups.Rehabilitation professionals might use cycle ergometers or partial body weight support to overcome fear of falling and facilitate implementation of aerobic exercise after stroke.

The modified sphygmomanometer test for assessment of muscle strength of community-dwelling older adults in clinical practice: reliability and validity.

PURPOSE: (a) to investigate the test-retest and inter-rater reliabilities and the criterion-related validity of the modified sphygmomanometer test (MST) for the assessment of muscle strength in community-dwelling older adults, (b) to calculate the standard error of measurement (SEM) and the smallest real difference (SRD); (c) to verify whether the number of trials affect the results. METHODS: Bilateral strength of lower limbs (LL) and grip muscles were evaluated with the MST and with portable dynamometers in 50 older adults (69.92 ± 5.52 years). Intra-class Correlation Coefficients (ICC) was used to evaluate the inter-rater and test-retest reliabilities and Pearson Correlations was used to investigate the criterion-related validity of the MST. SEM and SRD were also calculated. Analysis of variance was used to investigate whether the number of trials affects the results. RESULTS: Significant correlations with high to very high magnitude were found for all muscle groups evaluated for test-retest and inter-rater reliabilities (0.80 ≤ ICC ≤ 0.99; p < 0.001) and validity (0.80 ≤ r ≤ 0.91; p < 0.001). Moreover, the values provided by different numbers of trials were similar. The SEM (3.66 ≤ SEM ≤ 20.46) and the SRD (10.15 ≤ SRD95% ≤ 56.70) were considered low for all outcome measures. CONCLUSION: The MST showed adequate results for all the measurement properties evaluated for the assessment of the muscle strength of older adults.Implications for rehabilitationOlder adults often develop sarcopenia and dynapenia that are associated with an increased number of falls and fractures and loss of independence.Portable dynamometer is the standard instrument to evaluate isometric muscle strength, however this instrument is expensive and it is not readily available in the underdeveloped or in developed countries.The Modified Sphygmomanometer Test is an alternative method for the clinical measurement of muscle strength, is portable, has a low-cost and provides an objective measurement.In this study the Modified Sphygmomanometer Test showed adequate results for all the measurement properties evaluated for the assessment of the muscle strength in community-dwelling older adults and a single trial after test familiarization can be used to measure the muscle strength in this population.

The Distance Covered in Field Tests is more Explained by Walking Capacity than by Cardiorespiratory Fitness after Stroke.

OBJECTIVES: To investigate if the distance covered in the Six-Minute Walk Test (6MWT) and in the Incremental Shuttle Walk Test (ISWT) is most strongly explained by walking capacity or cardiorespiratory fitness (CRF) measures in individuals after chronic stroke. MATERIALS AND METHODS: This is a cross-sectional study. Individuals after chronic stroke aged at least 20 years old and able to walk at least 10 minutes independently were included. The distance covered (meters) in the 6 MWT and ISWT (dependent variables), comfortable and fast gait speed obtained by the 10 m walk test (10 mWT) (walking capacity measures; independent variables) and peak oxygen consumption (VO2peak; CRF measure; independent variable) (ml.kg-1.min-1) obtained by the cardiopulmonary exercise test (CPET) were obtained. Linear regression analyses were performed (α = 5%). RESULTS: Fifty individuals (mean age of 55±12 years and mean time after stroke of 67±74 months) were included. Comfortable and fast gait speeds were the variables that most strongly explained the distance covered in the field tests: 6MWT (R² = 0.614, ß = 0.784, p < 0.001 and R² = 0.615, ß = 0.778, p < 0.001, respectively) and ISWT (R² = 0.450, ß = 0.671, p < 0.001 and R² = 0.456, ß = 0.746, p < 0.001, respectively). On the other hand, for the VO2peak, the following models were generated: 6MWT (R² = 0.280, ß = 0.530, p < 0.001) and ISWT (R² = 0.154, ß = 0.393, p = 0.005). CONCLUSIONS: The distance covered in the field tests (6MWT and ISWT) is more suitable to support inferences about the walking capacity than about the CRF of individuals after chronic stroke.

Effects of detraining on cardiorespiratory fitness of individuals with chronic stroke.

BACKGROUND: Aerobic training can improve cardiorespiratory fitness in individuals after stroke. However, the effects of short-term and long-term detraining are not well known. OBJECTIVE: To determine the effects of short-term (1-month) and long-term (6-month) detraining on cardiorespiratory fitness (VO2peak) of individuals after stroke, who participated in aerobic training. METHODS: A cohort study was developed. Twenty adults (57 ± 11 years old) with stroke were included. After completing an outpatient aerobic training, participants were divided into gain group (VO2peak increase >1.3 ml.kg-1.min-1 from before to immediately after the training) or non-gain group (VO2peak change ≤1.3 ml.kg-1.min-1). Cardiorespiratory fitness (VO2peak), obtained by the cardiopulmonary exercise test was assessed one and 6 months after the end of the training (short- and long-term detraining, respectively), or collected retrospectively from patient chart (before and after the training). RESULTS: There was found a significant interaction effect (time*group) for VO2peak (F= 6.108;p < 0,001). Higher values in the VO2peak observed in the gain group with the aerobic training (F = 25.86; p< .001) were significantly reduced with short-term detraining, reaching values similar to that observed before the training and to that of the non-gain group (F = 14.81;p= .001). Both groups had similar VO2peak values within long-term detraining (F = 2.70;p= .12), with no significant differences from the values observed before the training and after short-term detraining (0.11 ≤ p≤ 1.00). CONCLUSIONS: Detraining on cardiorespiratory fitness of individuals after chronic stroke occurred within only 1 month. Therefore, it is important to maintain aerobic training throughout life.

Reliability and validity of the incremental shuttle walking test in individuals after stroke.

BACKGROUND: There are limitations to perform the cardiopulmonary exercise test (CPET) and the six-minute walking test (6MWT) in clinical settings. The incremental shuttle walking test (ISWT) might be an alternative assessment of exercise capacity and an estimation of cardiopulmonary fitness after stroke. OBJECTIVES: To investigate the test-retest and inter-rater reliabilities, the standard error of measurement (SEM) and the minimal detectable change (MDC) of the ISWT, its construct validity to assess exercise capacity and its concurrent validity to estimate cardiopulmonary fitness after stroke. METHODS: Prospective diagnostic accuracy study. Fifty-one individuals (54 ± 11 years) at the chronic phase (65 ± 73 months after stroke) were included. The distance walked, in meters, during the 12-stage-ISWT and the 6MWT and the peak oxygen uptake (VO2peak, ml.kg-1.min-1) in the CPET (gold standard) were assessed. RESULTS: Significant and high to very high magnitude test-retest and inter-rater reliabilities (0.88≤ICC≤0.93) of the ISWT was found. The SEM for both reliabilities was small (-23.35 m≤ SEM≤41.47 m). The MDC for test-retest and inter-rater reliabilities were 114.63 m and 64.53 m, respectively. For construct validity, a significant and high magnitude correlation between the ISWT and the 6MWT was found (ICC = 0.82). For the concurrent validity, a significant, but low magnitude correlation was found between the ISWT and the VO2peak (rho = 0.42). CONCLUSIONS: The ISWT demonstrated adequate reliabilities and construct validity for exercise capacity assessment. However, the concurrent validity of the ISWT as an estimation of cardiopulmonary fitness still requires further research.

Efficacy of task-specific circuit training on physical activity levels and mobility of stroke patients: A randomized controlled trial.

BACKGROUND: Impaired mobility is related to low physical activity (PA) levels observed after stroke. Therapeutic approaches, such as task-specific circuit training (TSCT), used to improve mobility in individuals with stroke, could also improve PA levels. OBJECTIVE: To investigate the efficacy of TSCT, focused on both upper (UL) and lower (LL) limbs, in improving PA levels and mobility (primary outcomes), as well as muscle strength, exercise capacity, and quality of life (secondary outcomes) in subjects with stroke. METHODS: A randomized controlled trial with 36 subjects with chronic stroke was conducted. Experimental group: TSCT, involving both UL and LL. CONTROL GROUP: global stretching, memory exercises, and education sessions. Both groups received 60 minute sessions/week over 12 weeks. Outcomes were measured at baseline, post-intervention and 16 week follow-up. RESULTS: No changes were found for primary and secondary outcomes (0.11≤p≤0.99), except for quality of life, which improved in the experimental group post-intervention and 16 week follow-up (p = 0.02). CONCLUSION: TSCT focused on both UL and LL was not effective on PA levels and mobility of individuals with chronic stroke, however, improvements in quality of life were observed. Since this is the first study to investigate this combined training aimed at improving PA levels, future studies are necessary to better understand the impact of this type of intervention.

Cardiopulmonary exercise testing and aerobic treadmill training after stroke: Feasibility of a controlled trial.

PURPOSE: To investigate the feasibility and safety of a randomized controlled trial that performed cardiopulmonary exercise testing and 12 weeks of aerobic treadmill training in individuals in the chronic phase after stroke. METHODS: The following data were recorded: number of individuals contacted to participate, that attended in the evaluation session, and that were included (recruited) in the study; retention, attendance and adherence rates; reasons for exclusion, withdrawal, non-attendance and non-completing exercise; adverse events. RESULTS: From 230 individuals that were contacted, 39 (17%) attended the evaluation session and 22 (9.6%) were recruited in the study, 11 in each group (control and experimental). The main source of recruitment was other research projects (43.5%). The main reason for exclusion was unavailability (22%). Six out of 39 individuals (15.4%) that attended in the evaluation session were not able to perform the cardiopulmonary exercise testing. All subjects included showed a respiratory exchange ratio ≥1.0 (considered as maximal effort in the CPET). Retention rate was 81% and the main reason of withdrawal was unavailability (75%). The overall attendance rate was 88% and the main reason for non-attendance was illness/sickness (20.8%). The adherence rate was 99% and the reasons for non-completing sessions were illness/sickness (60%) or delay (40%). No serious adverse events occurred. CONCLUSION: Recruitment rate was low, retention rate was moderate, attendance and adherence rates were high. No serious adverse events occurred. It was feasible and safe to execute a randomized clinical trial that performed cardiopulmonary exercise testing and 12 weeks of aerobic treadmill training.

Effects of aerobic training on physical activity in people with stroke: A randomized controlled trial.

BACKGROUND: Individuals with stroke have low physical activity levels and spend high amount of time in low-energy expenditure activities. OBJECTIVE: To investigate the effects of aerobic treadmill training on physical activity levels and time spent in low-energy expenditure activities (primary outcomes), as well as on cardiorespiratory fitness, endurance, depression, mobility, quality of life and participation (secondary outcomes) after stroke. METHODS: A randomized controlled trial, with 22 adults with chronic stroke was performed. Experimental group: aerobic treadmill training at 60-80% of heart rate reserve. CONTROL GROUP: outdoor-overground walking below 40% of heart rate reserve. Both groups: three 40 min sessions/week over 12 weeks. Outcomes were measured at baseline, post-training, and 16-week follow-up. RESULTS: No changes in the primary outcomes were found for any of the groups. The experimental group showed greater improvements in quality of life at 16-week follow-up (13 points;95% CI:3.5-23). Both groups improved depression (2.2 points;95% CI:0.01-4.3), endurance (Six-minute walk test:31 m;95% CI:5.6-57, Incremental shuttle-walk test:55 m;95% CI:3.8-107), and mobility (0.12 m/s;95% CI:0.02-0.2). CONCLUSION: Aerobic treadmill training improved quality of life. Aerobic treadmill training or outdoor-overground walking improved depression, endurance and mobility. Further studies are needed to clarify the effects of aerobic training on physical activity levels and time spent in low-energy expenditure activities after stroke.

Efficacy of interventions aimed at improving physical activity in individuals with stroke: a systematic review.

Purpose: To identify interventions employed to increase post-stroke physical activity, evaluate their efficacy, and identify the gaps in literature.Materials and methods: Randomized controlled trials published until March 2018 were searched in MEDLINE, PEDro, EMBASE, LILACS, and SCIELO databases. The quality of each study and overall quality of evidence were assessed using the PEDro and the GRADE scales.Results: Eighteen studies were included (good PEDro and very low GRADE-scores). In seven, the experimental groups showed significant increases in physical activity (aerobics, resistance, and home-based training; counseling, aerobics, resistance, and home-based training; electrical stimulation during walking; functional-task training; robot-assisted arm therapy; accelerometer-based feedback, and physical activity encouragement). In seven, there were no significant between-group differences (physical activity plan; stretching, use of toe-spreaders, standard treatment; counseling; circuit video-game; functional-task; counseling and cognitive training). The combined experimental and control groups showed significant declines in physical activity in one study (aerobic training or stretching) and increases in three others (aerobic, resistance or sham resistance training; stroke-with advice or only stroke-counseling; aerobic training, educational sessions, standard treatment, and coaching, or mobilization and standard treatment). A meta-analysis could not be performed, due to heterogeneity.Conclusions: Some interventions improved physical activity after stroke. However, the interpretability is limited.Implications for rehabilitationIndividuals with stroke show low physical activity, which may compromise function and health.The use of interventions aimed at improving and maintaining physical activity of individuals with stroke are recommended.Some interventions, such as aerobic, resistance, and combined home-based training, electrical stimulation during walking, functional task training, and arm robot-assisted therapy, could improve the physical activity after stroke.