New Assessment of Overall Tolerance in the Rehabilitation of Patients in the Early Recovery Period of Ischemic Stroke

Abstract

Aim. To study the dynamics of overall tolerance in patients in the early recovery period of ischemic stroke (IS) with mild and moderatelysevere paresis, to evaluate the effect of aerobic training in this group of patients on exercise tolerance during inpatient treatment asof Compulsory Medical Insurance (CMI).Material and methods. The first group of 30 patients were examined (17 women, 13 men, the average age – 60,6±6,45 years old)during the 4-6 week of IS. Total points of the FIM scale were 118±5,2 /121,8±4,5. The second group- control group consisted of 30patients with chronic cerebral ischemia (CCI). The following were mainly dominated among the vascular risk factors in both groupsof patients: atherosclerosis of brachiocephalic artery of various degrees of severity poorly controlled arterial hypertension, smoking,dyslipidemia. Physical exercise tolerance was assessed by cardiopulmonary testing on a bicycle ergometer using the Quark CPETspiroergometer system from COSMED (Italy). The peak oxygen consumption (VO2 peak), the maximum load performed in metabolicunits (MET), the percentage of the proper maximum oxygen consumption (% pred VО2 peak) with constant ECG monitoring, bloodpressure during the exercise test were evaluated. Patients with stroke received aerobic training during rehabilitation treatment – 10-12sessions according to the target indicators.Results and discussion. The minimum required values of VO2 peak to provide an active daily life equals on average 15 -18 ml/min*kg of oxygen. Analysis of the results of our study showed a decrease in the VO2 peak in group 1 of stroke patients to 13.22 ± 3.32ml/min * kg. The VO2 peak at stroke is only 54.96% ± 12.82 of the proper average values of VO2 and corresponds to 3.73 ± 0.92 MET.The results of the study confirm a very low level of exercise tolerance in the stroke group, which is significantly lower than in the CCIgroup (VO2 peak is 19.43 ± 4.77 ml/min * kg, which is 83.96 ± 12.93% of the proper average values and corresponds to 5.74 ± 1 .65MET). The results of the study confirm a very low level of exercise tolerance in the stroke group, which is significantly lower than inthe CCI group (VO2 peak is 19.43 ± 4.77 ml/min * kg, which is 83.96 ± 12.93% of the proper average values and corresponds to 5.74± 1.65 MET). Cardiopulmonary testing showed the absence of reliable dynamics of VO2 peak (p=0.29) and MET (p= 0.4) at the end ofthe rehabilitation course. A significant increase in VO2 peak was observed only in some patients who reached a load intensity level of70% or more of the peak heart rate during training. Later a control study was conducted among 16 patients of the stoke group after 6months. Cardiopulmonary testing showed the absence of reliable dynamics of the studied parameters in the absence of cardio trainingambulatory. Our study of the patients’ with stroke condition in dynamics showed that there was no possibility of spontaneous (withoutaerobic exercise) restoration of exercise tolerance.Conclusion. In the early recovery period of IS, patients have a persistent long-term decrease of overall tolerance. Aerobic exercises haveshown safety and good tolerance in IS rehabilitation programs. Aerobic exercises should be long-term, begin in a hospital and continueduring ambulatory treatment. The intensity of training is a key parameter in the adjustment of Aerobic exercises for the patients with IS.

Keywords

• cardiopulmonary testing
• ischemic stroke
• aerobic exercises
• overall tolerance
• arterial hypertension