Aerobic exercise and cognitive health among stroke survivors

Welsh, Alison (2020) Aerobic exercise and cognitive health among stroke survivors. Doctoral thesis, University of East Anglia.

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Abstract

Background
In the United Kingdom (UK), there are 1.2 million stroke survivors; of which approximately 36% are living with severe movement impairments and 83% experience poor cognitive health. Evidence suggests that aerobic exercise is beneficial for improving cardiovascular and cognitive health. However, the nature of the relationship between cardiovascular and cognitive health among stroke survivors is yet to be quantified. Studies evaluating the impact of exercise in people with stroke tend to exclude those who are living with moderate to severe post-stroke movement impairments. The feasibility of appropriate outcome measures for evaluating the impact of exercise, and suitable exercise-based interventions are yet to be established for this population.
Aim
To explore the influence of exercise after stroke on cardiorespiratory fitness, with a view to maintain cognitive health.
Methods
A narrative systematic review was undertaken to explore the nature of the relationship between cardiorespiratory fitness and cognitive health, among stroke survivors.
A mixed method, randomised feasibility study was undertaken. Two modes of cardiopulmonary exercise testing (CPET) were explored: treadmill with body-weight support harness (BWS) and cycle ergometry. Participants were allocated to a six-week exercise-based intervention, of either aerobic exercise, strength training, or a combination of aerobic exercise and strength training. Outcomes included feasibility components, peak aerobic capacity (VO2peak), cognitive function, quality of life and activities of daily living. The acceptability and satisfaction of CPET procedures and exercise-based interventions were explored in semi-structured interviews.
Results
There is a lack of evidence to quantify the relationship between cardiorespiratory fitness and cognitive functioning domains and the evidence that exists is of low quality. A systematic review of eight studies found heterogeneity in assessment tools for cognitive function and little standardisation in CPET protocols.
Overall, CPET and a six-week exercise-based intervention of either aerobic exercise, strength training or a combination of aerobic exercise and strength training, was safe and feasible for stroke survivors with moderate to severe movement impairments. Participants found it to be acceptable and satisfactory. This was primarily attributed to their enjoyment, increased confidence and a feeling of a sense of community with other participants.
Conclusion:
The evidence provided in this thesis provides preliminary work to support the implementation of exercise-based interventions, with a view to maintain the cognitive health of stroke survivors. There is a need for well-designed studies to understand the nature and the strength of the relationship between cardiorespiratory fitness and cognitive function among stroke survivors. The feasibility study demonstrated inclusive adaptations for CPET and exercise training for those who are living with moderate to severe post-stroke movement impairments. It is hoped that based on the learnings of the feasibility study, further research may determine optimal methods for implementing exercise after stroke interventions, with a view to maintain cognitive health.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Nicola Veasy
Date Deposited: 21 Jun 2021 10:51
Last Modified: 21 Jun 2021 10:51
URI: https://ueaeprints.uea.ac.uk/id/eprint/80304
DOI:

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