Intensive aerobic cycling training with lower limb weights in Chinese patients with chronic stroke: discordance between improved cardiovascular fitness and walking ability

Abstract

Purpose: To evaluate the effect of aerobic cycling training with lower limb weights on cardiovascular fitness (peak VO₂) and walking ability in chronic stroke survivors, and to investigate the relationship between changes in these parameters. Methods: 133 Chinese patients with chronic hemiparetic stroke (mean age 58 years) were randomized to either 8-week (5×/week) aerobic cycling training with lower limb weights group (n = 68) or a low-intensity overground walking group (n = 65). Peak VO₂, 6-minute walk distance (6MWD), knee muscle strength, balance and spasticity were measured before and after intervention. Results: Cycling training increased peak VO₂ (24% vs. 3%, p < 0.001), 6MWD (2.7% vs. 0.5%, p < 0.001), paretic (11% vs. 1.6%, p < 0.001) and nonparetic knee strength (16% vs. 1.0%, p < 0.001). In the cycling group, percent changes in peak VO₂ were positively associated with those in paretic (r = 0.491, p < 0.001) and nonparetic knee strength (r = 0.432, p < 0.001). Increased 6MWD correlated significantly with improved balance, spasticity and paretic knee strength by the stepwise regression analysis (r² = 0.342, p = 0.004), but not fitness gains. Conclusions: The enhanced cardiovascular fitness after aerobic cycling training in Chinese patients with chronic stroke is not associated with the increased walking ability. Unparallel improvements in these parameters related different determinants may have implications for intervention strategy.

Implications for Rehabiliation

• Patients with chronic stroke have residual physical impairments secondary to low activity levels and are often severely deconditioned.

• Exercise therapy is important to improve recovery in mobility and optimize cardiovascular health after stroke.

• The randomized control study shows that the intensive aerobic cycling training with lower limb weights improves both cardiovascular fitness and walking ability in Chinese patients with chronic stroke. However, these improvements after intervention were not parallel, indicating the determinants of improvements in these two parameters are different and may have implications for therapy prescription.

Keywords::

• Aerobic exercise
• physical fitness
• walking
• stroke

Acknowledgments

The authors thank the participants in this study, the nurses and exercise physiologists in the rehabilitation center who assisted with the research testing and exercise training.

Declaration of Interests: The authors report no declarations of interest statement. No commercial party has a direct financial interest in the results of the research supporting, and this paper will confer a benefit upon the author(s) or upon the organization with which the author(s) is/are associated.