Aerobic Training in Canadian Stroke Rehabilitation Programs

Aerobic Training in Canadian Stroke Rehabilitation Programs

• Aerobic training is recommended for people after stroke.

• Yet the uptake and operationalization of AT in clinical practice at a program level in Canada has not been measured.

C. Nathoo, S. Buren, R. El-Haddad, K. Feldman, E. Schroeder, D. Brooks, E. L. Inness, and S. Marzolini

Purpose

1.Determine prevalence of structured AT in public inpatient and outpatient stroke

rehabilitation programs across Canada 2.Explore how these practices are

operationalized

3.Determine the barriers/challenges to implementation of AT

Aerobic Training in Stroke Rehab

• Canada (Nathoo C et al., 2018)

• 78% of stroke rehab programs implement AT (n=36/46)

• 61% of stroke rehab programs prescribe AT to >50%

of patients

• United States (Boyne P et al., 2017)

• 89% of acute/nonacute care PTs implement AT (n=429/484)

• 55% of acute/nonacute care PTs prescribe AT to

>50% of people post stroke

Boyne P et al. JNPT 41:119-128, 2017

Barriers Reported

1. Insufficient time within therapy session

2. Insufficient length-of-stay

3. Lack of knowledge/skills of AT prescription for high risk

populations

4. Lack of equipment for prescription/assessment

5. Interferes with other therapy schedules

• 91% do not conduct GXT with ECG monitoring

• 79% do not measure BG in those at risk for hypoglycemia during the exercise session

• 37% do not measured BP in people with hypertension

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28% of programs exclude all patients with cardiac conditions 75% exclude those with severe stroke

Gaps with Guideline Recommendations

Stroke Rehabilitation

Conclusion

• Most stroke rehabilitation programs across Canada include AT.

• People with severe physical impairment and those with cardiac, metabolic and hemodynamic

comorbidities may be excluded or not

appropriately monitored during exercise.

• More detailed guidelines, training practices,

resources are needed to address these challenges.