A pilot randomized controlled trial to evaluate the benefit of the cardiac rehabilitation paradigm for the non-acute ischaemic stroke population

Objective: To evaluate risk factor reduction and health-related quality of life following a 10-week cardiac rehabilitation programme in non-acute ischaemic stroke subjects. Design: Single-blinded randomized control trial. Setting: Outpatient rehabilitation. Subjects: Forty-eight community-dwelling ischaemic stroke patients (38 independently mobile, 9 requiring assistance, 1 non-ambulatory) were randomly assigned to intervention or control groups by concealed allocation. Intervention: The trial consisted of a 10-week schedule with measures taken at weeks 1 and 10. Both groups continued usual care (excluding aerobic exercise); intervention subjects attended 16 cycle ergometry sessions of aerobic-training intensity and two stress-management classes. Main outcome measures: Cardiac risk score (CRS); VO2 (mL O-2/kg per minute) and Borg Rate of Perceived Exertion (RPE) assessed during a standardized ergometry test; Hospital Anxiety and Depression Scale (HADS); Frenchay Activity Index; Fasting Lipid Profiles and Resting Blood Pressure. Results: Group comparison with independent t-tests showed significantly greater improvement at follow-up by intervention subjects than controls in VO2 (intervention 10.6 +/- 1.6 to 12.0 +/- 2.2, control 11.1 +/- 1.8 to 11.1 +/- 1.9 t=4.734, P < 0.001) and CRS (intervention 13.4 +/- 10.1 to 12.4 +/- 10.5, control 9.4 +/- 6.7 to 15.0 +/- 6.1 t=-2.537, P < 0.05). RPE rating decreased in intervention subjects (13.4 +/- 12.2 to 12.4 +/- 2.0) and increased in controls (13.8 +/- 1.8 to 14.4 +/- 1.6); Mann-Whitney U(U=173.5, P<0.05). Within-group comparison showed significant decrease in the HADS depression subscale in the intervention group alone (5.1 +/- 3.4 to 3.0 +/- 2.8) (Wilcoxon signed ranks test Z= -3.278, P < 0.001). Conclusion: Preliminary findings suggest non-acute ischaemic stroke patients can improve their cardiovascular fitness and reduce their CRS with a cardiac rehabilitation programme. The intervention was associated with improvement in self-reported depression.