Open cardiac outpatient rehabilitation programs for stroke patients
across Canada, researchers urge
MONTREAL, Oct. 16, 2013 /CNW/ - Stroke patients who participate in a
cardiac rehabilitation program for six months make rapid gains in how
far and fast they can walk, the use of weakened limbs and their ability
to sit and stand, according to a study presented today at the Canadian
On average, participants saw a 21-per-cent improvement in the strength
and range of motion of weakened limbs; a 19-per-cent improvement in
walking speed; and a 16-per-cent improvement in the distance they could
"There should be a seamless referral of patients with mild to moderate
effects of stroke to the network of established outpatient cardiac
rehab programs in Canada," says lead researcher Dr. Susan Marzolini of
Toronto Rehabilitation Institute/University Health Network. "Early
referral is also important. In our study, those who started the cardiac
rehab program earlier had the strongest results."
Cardiac rehabilitation incorporates exercise training (aerobic and
resistance/strength training), nutrition counseling, risk factor
counseling and management (lipids, blood pressure, diabetes, weight
management, smoking cessation and psychosocial management,) delivered
by an interprofessional health care team.
All of the 120 patients who participated in the study saw improved
The largest gains in walking function were among those who were referred
to the program the earliest. Participants were, on average, two years
post-stroke but the study included people who had experienced a stroke
from three months to five years previously.
In most cases, rehabilitation ends at three months post-stroke, when it
has been assumed that spontaneous recovery is over and people reach a
plateau, Dr. Marzolini says.
For those who entered the six-month cardiac rehab program after standard
care, "we didn't see a plateau, we saw a huge improvement in the group.
We're finding even more benefits from exercise alone than we ever
"We have manufactured these three-month plateaus with our biases about
how the brain works," says Dr. Dale Corbett, Scientific Director of the
Canadian Partnership for Stroke Recovery (CPSR), a joint initiative of
the Heart and Stroke Foundation and Canada's leading stroke research
centres, which funded the study. "Recovery continues for months and
years after stroke."
A 2011 audit of stroke services in Canada found that only 37 per cent of
stroke patients with moderate to severe impairments receive standard
rehabilitation in the weeks after stroke, despite overwhelming evidence
of its benefits.
"The results of this study are exciting because this exercise program is
a very cost-effective intervention for improving the quality of life
for those living with the effects of stroke," says Canadian Stroke
Congress Co-Chair Dr. Mark Bayley, noting that there are 50,000 strokes
in Canada every year.
Although standardized outpatient rehabilitation programs have been in
place for cardiac patients across Canada for more than 40 years - and
are usually associated with a hospital or community facility -
structured programs are not widely available or accessible for stroke
Participants in the study attended one 90-minute session a week and
received an "exercise prescription" for personalized walking and
strength training exercises to complete four times a week at home.
Besides physical improvements, the study found stroke patients reported
big social gains and began to attend more activities in their
communities, partly because they could walk better and get in and out
of cars more easily. An earlier study by the research team found
increased fitness led to improvements in cognition and mental health.
"The key message here is to open up existing outpatient cardiac rehab
programs, which are already in place, to stroke patients," says Ian
Joiner, director of stroke for the Heart and Stroke Foundation. "Stroke
recovery is a journey that continues throughout life. And programs such
as this can be an integral part of that journey."
The next phase of the study will identify the barriers to referral for
stroke patients. Other CPSR researchers involved in the study include
Dr. Ada Tang of McMaster University, Dr. William McIlroy of the
University of Waterloo, Dr. Paul Oh of Toronto Rehab/UHN and senior
author Dr. Dina Brooks of the University of Toronto.
The value of exercise on the brain is a key research focus of the
Canadian Partnership for Stroke Recovery. An award-winning CPSR study
presented at the Canadian Stroke Congress by Dr. Walter Swardfager of
Sunnybrook Research Institute uses new imaging technology to measure
the impact of exercise on blood flow to the brain following stroke.
Preliminary results indicate that fitness has a protective effect and
primes the brain for recovery.
The Canadian Stroke Congress is a joint initiative of the Canadian
Stroke Network, Heart and Stroke Foundation of Canada and Canadian
Statements and conclusions of study authors are solely those of the
study authors and do not necessarily reflect Vascular 2013 host
organizations' policy or position. They make no representation or
warranty as to their accuracy or reliability.
The Canadian Stroke Network, canadianstrokenetwork.ca, is a national research network headquartered at the University of
Ottawa. It includes scientists, clinicians and health-policy experts
committed to reducing the impact of stroke.
The Heart and Stroke Foundation's mission is to prevent disease, save lives and promote recovery. A
volunteer-based health charity, we strive to tangibly improve the
health of every Canadian family, every day. 'Healthy lives free of
heart disease and stroke. Together we will make it happen.' Heartandstroke.ca
Vascular 2013 is a unique, one-time Canadian event bringing four separate scientific
meetings together under one roof: the Canadian Cardiovascular Congress,
the Canadian Diabetes Association/Canadian Society of Endocrinology and
Metabolism Professional Conference, the Canadian Stroke Congress and
the Canadian Hypertension Congress. vascular2013.ca
It is a joint initiative of the Canadian Cardiovascular Society,
Canadian Diabetes Association/Canadian Society of Endocrinology and
Metabolism, the Canadian Stroke Network, the Heart and Stroke
Foundation, and Hypertension Canada.
SOURCE: Heart and Stroke Foundation
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