The Feasibility of a Telehealth Exercise Program Aimed at Increasing Cardiorespiratory Fitness for People After Stroke
Keywords:Cardiorespiratory fitness, Exercise, Stroke, Telemedicine, Telerehabilitation
Background: Accessing suitable fitness programs post-stroke is difficult for many. The feasibility of telehealth delivery has not been previously reported.
Objectives: To assess the feasibility of, and level of satisfaction with home-based telehealth-supervised aerobic exercise training post-stroke.
Methods: Twenty-one ambulant participants (?3 months post-stroke) participated in a home-based telehealth-supervised aerobic exercise program (3 d/week, moderate-vigorous intensity, 8-weeks) and provided feedback via questionnaire postintervention. Session details, technical issues, and adverse events were also recorded.
Results: Feasibility was high (83% of volunteers met telehealth eligibility criteria, 85% of sessions were conducted by telehealth, and 95% of participants rated usability favourably). Ninety-five percent enjoyed telehealth exercise sessions and would recommend them to others. The preferred telehealth exercise program parameters were: frequency 3 d/week, duration 20-30 min/session, program length 6-12 weeks.
Conclusion: The telehealth delivery of exercise sessions to people after stroke appears
Barengo, N. C., Antikainen, R., Borodulin, K., Harald, K., & Jousilahti, P. (2017). Leisure-time physical activity reduces total and cardiovascular mortality and cardiovascular disease incidence in older adults. Journal of the American Geriatrics Society, 65, 504-510. doi:10.1111/jgs.14694
Benvenuti, F., Stuart, M., Cappena, V., Gabella, S., Corsi, S., Taviani, A., . . . Weinrich, M. (2014). Community-based exercise for upper limb paresis: A controlled trial with telerehabilitation. Neurorehabilitation & Neural Repair, 28, 611-620. doi:http://dx.doi.org/10.1177/1545968314521003
Bernocchi, P., Vanoglio, F., Baratti, D., Morini, R., Rocchi, S., Luisa, A., & Scalvini, S. (2016). Home-based telesurveillance and rehabilitation after stroke: A real-life study. Topics in Stroke Rehabilitation, 23, 106-115. doi:http://dx.doi.org/10.1080/10749357.2015.1120453
Billinger, S. A., Arena, R., Bernhardt, J., Eng, J. J., Franklin, B. A., Johnson, C. M., . . . Council on Clinical, C. (2014). Physical activity and exercise recommendations for stroke survivors: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45, 2532-2553. doi:10.1161/STR.0000000000000022
Billinger, S. A., Coughenour, E., Mackay-Lyons, M. J., & Ivey, F. M. (2012). Reduced cardiorespiratory fitness after stroke: Biological consequences and exercise-induced adaptations. Stroke Res Treat, 2012, 959120. doi:10.1155/2012/959120
Borg, G. A. (1982). Psychophysical bases of perceived exertion. Medicine & Science in Sports & Exercise, 14, 377-381.
Chan, C., Yamabayashi, C., Syed, N., Kirkham, A., & Camp, P. G. (2016). Exercise telemonitoring and telerehabilitation compared with traditional cardiac and pulmonary rehabilitation: A systematic review and meta-analysis. Physiotherapy Canada, 68, 242-251. doi:10.3138/ptc.2015-33
Chen, J., Jin, W., Zhang, X.-X., Xu, W., Liu, X.-N., & Ren, C.-C. (2015). Telerehabilitation approaches for stroke patients: Systematic review and meta-analysis of randomized controlled trials. Journal of Stroke & Cerebrovascular Diseases, 24, 2660-2668. doi:https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.09.014
Clark, R. A., Conway, A., Poulsen, V., Keech, W., Tirimacco, R., & Tideman, P. (2015). Alternative models of cardiac rehabilitation: A systematic review. European Journal of Preventive Cardiology, 22(1), 35-74. doi:http://dx.doi.org/10.1177/2047487313501093
Cox, N. S., Alison, J. A., Button, B. M., Wilson, J. W., & Holland, A. E. (2015). Feasibility and acceptability of an internet-based program to promote physical activity in adults with cystic fibrosis. Respiratory Care, 60, 422-429. doi:http://dx.doi.org/10.4187/respcare.03165
Crotty, M., Killington, M., van den Berg, M., Morris, C., Taylor, A., & Carati, C. (2014). Telerehabilitation for older people using off-the-shelf applications: Acceptability and feasibility. Journal of Telemedicine & Telecare, 20, 370-376. doi:10.1177/1357633X14552382
Cumming, T. B., Tyedin, K., Churilov, L., Morris, M. E., & Bernhardt, J. (2012). The effect of physical activity on cognitive function after stroke: A systematic review. International Psychogeriatrics, 24, 557-567.
English, C., Manns, P. J., Tucak, C., & Bernhardt, J. (2014). Physical activity and sedentary behaviors in people with stroke living in the community: A systematic review. Physical Therapy, 94, 185-196. doi:10.2522/ptj.20130175
Evenson, K. R., & Fleury, J. (2000). Barriers to outpatient cardiac rehabilitation participation and adherence. Journal of Cardiopulmonary Rehabilitation and Prevention, 20, 241-246.
Fini, N. A., Holland, A. E., Keating, J., Simek, J., & Bernhardt, J. (2017). How physically active are people following stroke? Systematic review and quantitative synthesis. Physical Therapy, 97, 707-717. doi:10.1093/ptj/pzx038
Galloway, M. (2019). An exploration of low doses of exercise on cardiorespiratory fitness in people with chronic stroke (Unpublished doctoral dissertation). University of Newcastle, Callaghan, Australia. http://hdl.handle.net/1959.13/1407802
Hill, A. J., Theodoros, D. G., Russell, T. G., Cahill, L. M., Ward, E. C., & Clark, K. M. (2006). An Internet-based telerehabilitation system for the assessment of motor speech disorders: A pilot study. American Journal of Speech-Language Pathology, 15, 45-56. doi:10.1044/1058-0360(2006/006)
Hoffmann, T. C., Glasziou, P. P., Boutron, I., Milne, R., Perera, R., Moher, D., . . . Michie, S. (2014). Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide. British Medical Journal, 348, g1687. doi:10.1136/bmj.g1687
Holden, M. K., Gill, K. M., Magliozzi, M. R., Nathan, J., & Piehl-Baker, L. (1984). Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Physical Therapy, 64, 35-40.
Hwang, R., Bruning, J., Morris, N., Mandrusiak, A., & Russell, T. (2015). A systematic review of the effects of telerehabilitation in patients with cardiopulmonary diseases. Journal of Cardiopulmonary Rehabilitation and Prevention, 35, 380-389. doi:10.1097/HCR.0000000000000121
Jackson, S., Mercer, C., & Singer, B. J. (2018). An exploration of factors influencing physical activity levels amongst a cohort of people living in the community after stroke in the south of England. Disability and Rehabilitation, 40, 414-424. doi:10.1080/09638288.2016.1258437
Keteyian, S. J., Brawner, C. A., Savage, P. D., Ehrman, J. K., Schairer, J., Divine, G., . . . Ades, P. A. (2008). Peak aerobic capacity predicts prognosis in patients with coronary heart disease. American Heart Journal, 156, 292-300. doi:10.1016/j.ahj.2008.03.017
Lee, D. C., Sui, X., Ortega, F. B., Kim, Y. S., Church, T. S., Winett, R. A., . . . Blair, S. N. (2011). Comparisons of leisure-time physical activity and cardiorespiratory fitness as predictors of all-cause mortality in men and women. British Journal of Sports Medicine, 45, 504-510. doi:10.1136/bjsm.2009.066209
Maddison, R., Rawstorn, J. C., Stewart, R. A. H., Benatar, J., Whittaker, R., Rolleston, A., . . . Gant, N. (2018). Effects and costs of real-time cardiac telerehabilitation: Randomised controlled non-inferiority trial. Heart. doi:10.1136/heartjnl-2018-313189
Marsden, Dunn, A., Callister, R., Levi, C., & Spratt, N. (2013). Characteristics of exercise training interventions to improve cardiorespiratory fitness after stroke: A systematic review with meta-analysis. Neurorehabilitation & Neural Repair, 27, 775-788. doi:http://dx.doi.org/10.1177/1545968313496329
Marsden, Dunn, A., Callister, R., McElduff, P., Levi, C. R., & Spratt, N. J. (2016). A home- and community-based physical activity program can improve the cardiorespiratory fitness and walking capacity of stroke survivors. Journal of Stroke & Cerebrovascular Diseases, 25, 2386-2398.
Marzolini, S., Balitsky, A., Jagroop, D., Corbett, D., Brooks, D., Grace, S. L., . . . Oh, P. I. (2016). Factors affecting attendance at an adapted cardiac rehabilitation exercise program for individuals with mobility deficits poststroke. Journal of Stroke and Cerebrovascular Diseases, 25(1), 87-94. doi: 10.1016/j.jstrokecerebrovasdis.2015.08.039
Morris, J. H., Macgillivray, S., & McFarlane, S. (2014). Interventions to promote long-term participation in physical activity after stroke: A systematic review of the literature. Archives of Physical Medicine and Rehabilitation, 95, 956-967. doi:http://dx.doi.org/10.1016/j.apmr.2013.12.016
Nicholson, S., Sniehotta, F. F., van Wijck, F., Greig, C. A., Johnston, M., McMurdo, M. E., . . . Mead, G. E. (2013). A systematic review of perceived barriers and motivators to physical activity after stroke. International Journal of Stroke, 8, 357-364. doi:http://dx.doi.org/10.1111/j.1747-4949.2012.00880.x
Norton, K., Norton, L., & Sadgrove, D. (2010). Position statement on physical activity and exercise intensity terminology. Journal of Science and Medicine in Sport, 13, 496-502. doi:10.1016/j.jsams.2009.09.008
O'Brien, C., Kelly, J., Lehane, E. A., Livingstone, V., Cotter, B., Butt, A., . . . Corrigan, M. A. (2015). Validation and assessment of a technology familiarity score in patients attending a symptomatic breast clinic. World Journal of Surgery, 39, 2441-2449. doi:https://dx.doi.org/10.1007/s00268-015-3134-1
O'Donnell, M. J., Chin, S. L., Rangarajan, S., Xavier, D., Liu, L., Zhang, H., . . . Interstroke Investigators. (2016). Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): A case-control study. Lancet, 388, 761-775. doi:10.1016/S0140-6736(16)30506-2
Olney, S. J., Nymark, J., Brouwer, B., Culham, E., Day, A., Heard, J., . . . Parvataneni, K. (2006). A randomized controlled trial of supervised versus unsupervised exercise programs for ambulatory stroke survivors. Stroke, 37, 476-481. doi:10.1161/01.STR.0000199061.85897.b7
Parmanto, B., Lewis, A. N., Jr., Graham, K. M., & Bertolet, M. H. (2016). Development of the Telehealth Usability Questionnaire (TUQ). International Journal of Telerehabiitation, 8(1), 3-10. doi:10.5195/ijt.2016.6196
Prout, E. C., Mansfield, A., McIlroy, W. E., & Brooks, D. (2017). Patients' perspectives on aerobic exercise early after stroke. Disability and Rehabilitation, 39, 684-690. doi:10.3109/09638288.2016.1161833
Ragupathi, L., Stribling, J., Yakunina, Y., Fuster, V., McLaughlin, M. A., & Vedanthan, R. (2017). Availability, use, and barriers to cardiac rehabilitation in LMIC. Global Heart, 12, 323-334.e310. doi:https://doi.org/10.1016/j.gheart.2016.09.004
Rawstorn, J. C., Gant, N., Direito, A., Beckmann, C., & Maddison, R. (2016). Telehealth exercise-based cardiac rehabilitation: A systematic review and meta-analysis. Heart, 102, 1183-1192. doi:10.1136/heartjnl-2015-308966
Reinholdsson, M., Palstam, A., & Sunnerhagen, K. (2018). Prestroke physical activity could influence acute stroke severity (part of PAPSIGOT). Neurology (Epub 19/9/18).
Royal College of Physicians. (2016). National clinical guidelines for stroke. 5th ed. Retrieved from https://www.strokeaudit.org/SupportFiles/Documents/Guidelines/2016-National-Clinical-Guideline-for-Stroke-5t-(1).aspx
Sarfo, F. S., Ulasavets, U., Opare-Sem, O. K., & Ovbiagele, B. (2018). Tele-Rehabilitation after stroke: An updated systematic review of the literature. Journal of Stroke and Cerebrovascular Diseases, 27, 2306-2318. doi:10.1016/j.jstrokecerebrovasdis.2018.05.013
Saunders, D. H., Greig, C. A., & Mead, G. E. (2014). Physical activity and exercise after stroke: Review of multiple meaningful benefits. Stroke, 45, 3742-3747. doi:10.1161/STROKEAHA.114.004311
Saunders, D. H., Sanderson, M., Hayes, S., Kilrane, M., Greig, C. A., Brazzelli, M., & Mead, G. E. (2016). Physical fitness training for stroke patients. Cochrane Database Systematic Review, 3, CD003316. doi:10.1002/14651858.CD003316.pub6
Shulver, W., Killington, M., Morris, C., & Crotty, M. (2017). 'Well, if the kids can do it, I can do it': Older rehabilitation patients' experiences of telerehabilitation. Health Expectations, 20, 120-129. doi:10.1111/hex.12443
Smith, A. C., Saunders, D. H., & Mead, G. (2012). Cardiorespiratory fitness after stroke: A systematic review. International Journal of Stroke, 7, 499-510. doi:10.1111/j.1747-4949.2012.00791.x
Southard, B. H., Southard, D. R., & Nuckolls, J. (2003). Clinical trial of an Internet-based case management system for secondary prevention of heart disease. Journal of Cardiopulmonary Rehabilitation and Prevention, 23, 341-348.
Stroke Foundation. (2017). Clinical Guidelines for Stroke Management. Retrieved from https://informme.org.au/Guidelines/Clinical-Guidelines-for-Stroke-Management-2017
Thilarajah, S., Mentiplay, B. F., Bower, K. J., Tan, D., Pua, Y. H., Williams, G., . . . Clark, R. A. (2018). Factors associated with post-stroke physical activity: A systematic rand meta-analysis. American Journal of Physical Medicine & Rehabilitation, 99, 1876-1889. doi:https://dx.doi.org/10.1016/j.apmr.2017.09.117
Tyagi, S., Lim, D. S. Y., Ho, W. H. H., Koh, Y. Q., Cai, V., Koh, G. C. H., & Legido-Quigley, H. (2018). Acceptance of tele-rehabilitation by stroke patients: Perceived barriers and facilitators. Archives of Physical Medicine & Rehabilitation, 99, 2472-2477 e2472. doi:10.1016/j.apmr.2018.04.033
Whittaker, F., & Wade, V. (2014). The costs and benefits of technology-enabled, home-based cardiac rehabilitation measured in a randomised controlled trial. Journal of Telemedicine & Telecare, 20, 419-422. doi:10.1177/1357633X14552376
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