- Title
- The measurement and improvement of fitness post stroke
- Creator
- Dunn, Ashlee Kate
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2016
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- The increasing number of people surviving stroke and living in the community with fitness levels below that required to perform activities of daily living is a rising global concern. Previous research has identified the major benefits exercise can provide following stroke, including improvements in quality of life, community participation, addressing additional co-morbidities, as well as assisting in preventing secondary stroke. Previous exercise interventions have demonstrated a lack of i) individualised, tailored programs, ii) exercises that can be conducted at home or in the community, and iii) programs that focus on the improvement and maintenance of fitness over the long term. Therefore, the central component and primary aim of this thesis was the development and long term evaluation of the How Fit is the Stroke Survivor? (HowFITSS?), an individually tailored, home and community based exercise program for stroke survivors. However, secondary aims 1, 2 and 3 have been presented first. These aims investigate exercise testing in stroke and provide context for the HowFITSS? trial. Prior to the development of the program, we investigated the feasibility of various tests of cardiorespiratory fitness (CRF) in stroke. Oxygen consumption (VO2peak) and performance measures were compared between the traditional graded cycle ergometer test (cGXT), the commonly used six-minute walk test (6MWT) and a new walking test of CRF, the Shuttle Walk Test (SWT). Results demonstrated that all three tests are indicators of CRF in stroke, with similar VO2peak (range: 17.08 - 18.09mL.kg-1.min-1). All three tests were determined feasible, with all stroke survivors completing the 6MWT. One was unable to perform the SWT due to instability identified during the 6MWT and three could not perform the cGXT due to pre-existing lower limb arthritic conditions. Results from this sub-study informed the inclusion of all three tests as outcome measures for the long term evaluation of the HowFITSS? program. Following baseline assessments, it was identified that there is a lack of reported data for independently ambulant, community dwelling stroke survivors. An age and gender matched comparison group were recruited and assessed using the same fitness tests as stroke survivors, including measures of fatigue, depression and quality of life. Despite the mild deficits evident in this stroke group, they significantly under performed on all fitness tests, including: 6MWT VO2peak (stroke group: 16.46±3.66mL·kg-1·min-1·; comparison group: 21.03±8.32mL·kg-1·min-1). ; 6MWT distance (stroke group: 464±121m, comparison group: 606±129m). ; SWT VO2peak (stroke group: 17.44±4.94mL·kg-1·min-1, comparison group: 23.11±9.48mL·kg-1·min-1). ; SWT distance (stroke group: 415±174m, comparison group: 651±236m). ; cGXT VO2peak (stroke: 17.0±6.3mL·kg-1·min-1, comparison: 22.4±6.5mL·kg-1·min-1). ; and cGXT final workload (stroke: 118±32W, comparison: 157±42W). Stroke survivors also walked slower compared to the non-stroke group. These results further reinforced the need for an exercise intervention in stroke survivors even those with only mild to no motor deficits. The primary aim of this thesis was to assess the long term effects of the 12-week How Fit is the Stroke Survivor? (HowFITSS?) exercise program on stroke survivors from pre-intervention to 12 month follow up. The HowFITSS? trial was therefore designed as a home and community based program with minimal therapist support. Results found improvements in CRF for the intervention group compared to the control group at 12 weeks. The control group were then provided with the intervention, and both groups followed up at 6 and 12 months. Therapist support was tapered to no communication from the 6 to 12 month time points. Stroke survivors significantly improved VO2peak and performance measures during the 6MWT (ES=0.75 p=0.002) and cGXT (ES=1.09 p=<0.001) from baseline to 12-months follow up, with non-significant but promising improvements on the SWT (ES=0.23 p=0.251). Similarly, quality of life, balance and walking speed significantly improved, with all measures of fitness maintained during the follow up period alone. The HowFITSS? model shows promising results as a cost effective, feasible method for improving fitness in stroke survivors over the long term. Both research and clinical practice may benefit from employing the HowFITSS? model, in improving fitness, quality of life, fatigue and depressive symptoms in people after stroke. Further translational studies are required to investigate the HowFITSS? model in a health care setting, with wide dissemination to community dwelling stroke survivors.
- Subject
- stroke; cardiorespiratory fitness; oxygen consumption; aeorobic; cardiopulmonary exercise test; physical capacity
- Identifier
- http://hdl.handle.net/1959.13/1322004
- Identifier
- uon:24490
- Rights
- Copyright 2016 Ashlee Kate Dunn
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
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| View Details Download | ATTACHMENT01 | Thesis | 6 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 275 KB | Adobe Acrobat PDF | View Details Download |