Survivors of serious stroke can reduce their chances of dying within the year by 76% if they complete a modified cardiac rehabilitation programme that includes medically supervised exercise, prescribed therapy, and physician follow-up, according to a study, in the Journal of Stroke & Cerebrovascular Diseases.
The research stems from the ongoing Stroke-HEARTTM trials at Hackensack Meridian JFK Johnson Rehabilitation Institute in the USA. It shows that participants in the JFK Johnson Stroke Recovery Programme also significantly improved exercise capacity, mobility, self-care, and cognition.
“Many caregivers of stroke survivors discourage their patients from being active and mobile,” said Dr Sara Cuccurullo, chair and medical director of JFK Johnson and a co-principal investigator of the study. “But we are showing that even survivors of serious stroke can exercise safely in a supervised programme, and benefit enormously.”
The JFK Johnson Stroke Recovery Programme (SRP) provides 36 sessions of medically monitored interval cardiovascular training as well as follow-up visits with a physical medicine and rehabilitation physician, along with psychological, nutritional, and educational support and risk factor (like smoking, diet, and exercise) management. The research found that patients, even those who may experience hemiplegia, can exercise safely with some modifications, such as the use of recumbent bicycles.
The research follows survivors with strokes serious enough to require inpatient hospital rehabilitation at JFK Johnson. So far it has included more than 1,600 stroke survivors. Because stroke can vary greatly from one survivor to the next, the study created a subgroup closely matched for gender, race, type of stroke, age, medical complexity, and functional scores at hospital discharge.
Of 449 patients in this subgroup, 246 completed the programme. Among those who completed it, four died within a year of their stroke. Among the non-participants, 14 patients died. This translates into a four-fold reduction in one-year all-cause mortality.
The study also found the participants improved in other ways, seeing a 78% increase in their cardiovascular capacity. (Many people with stroke also have cardiovascular disease.) Additionally, they showed steady improvement in scores related to mobility, self-care, and communication/cognition.
Research results show the matched pairs function similarly at the beginning of the study; over time, the study SRP participants perform better compared to the non-participants as they move forward with the Stroke Recovery Programme.
“You see a real divergence,” Cuccurullo added. “What this means to patients is that instead of just walking around the house, maybe they can walk around the block. They can feed and take care of themselves at a much higher level of independence. We also see speech and cognition improve. Exercise has significant and multiple benefits, including promoting overall improvement in circulation, especially promoting enhanced circulation to the brain.”
Future phases of Stroke-HEARTTM Trials will include other rehabilitation institutes as the research expands nationally.
Study details
Stroke Recovery Program with Modified Cardiac Rehabilitation Improves Mortality, Functional & Cardiovascular Performance.
Sara Cuccurullo, Talya Fleming, Stavros Zinonos, Nora Cosgrove, Javier Cabrera, John Kostis, Christine Greiss, Arlen Razon Ray, Anne Eckert, Rosann Scarpati, Mooyeon Oh Park, Martin Gizzi, William Kostis.
Published in the Journal of Stroke and Cerebrovascular Diseases on 1 March 2022
Abstract
Background
Physical activity and exercise after stroke is strongly recommended, providing many positive influences on function and secondary stroke prevention. The purpose of this study was to investigate the effect of a stroke recovery program (SRP) integrating modified cardiac rehabilitation on mortality and functional outcomes for stroke survivors.
Methods
This study used a retrospective analysis of data from a prospectively collected stroke rehabilitation database which followed 449 acute stroke survivors discharged from an inpatient rehabilitation facility between 2015 and 2020. For 1-year post-stroke, 246 SRP-participants and 203 nonparticipants were compared. The association of the SRP including modified cardiac rehabilitation with all-cause mortality and functional performance was assessed using the following statistical techniques: log rank test, Cox proportional hazard model and linear mixed effect models. Cardiovascular performance over 36 sessions of modified cardiac rehabilitation was assessed using linear effect model with Tukey procedure. The primary outcome measure was 1-year all-cause mortality rate. Secondary outcomes were functional performance measured in Activity Measure of Post-Acute Care scores and cardiovascular performance measured in metabolic equivalent of tasks times minutes.
Results
The SRP-participants had: (1) a significantly reduced 1-year post-stroke mortality rate from hospital admission corresponding to a four-fold reduction in mortality (P = 0.005, CI for risk ratio = [0.08, 0.71]), (2) statistically and clinically significant improvement of function in all Activity Measure of Post-Acute Care domains (P < 0.001 for all, 95% CI for differences in Basic Mobility [5.9, 10.1], Daily Activity [6.2, 11.8], and Applied Cognitive [3.0, 6.8]) compared to the matched cohort and (3) an improvement in cardiovascular performance over 36 sessions with an increase of 78% metabolic equivalent of tasks times minutes (P < 0.001, 95% CI [70.6, 85.9%]) compared to baseline.
Conclusions
Stroke survivors who participated in a comprehensive stroke recovery program incorporating modified cardiac rehabilitation had decreased all-cause mortality, improved overall function, and improved cardiovascular performance.
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