Susan Marzolini

Background Oxygen delivery and demand are reduced in the paretic leg of individuals after stroke. However, it is unknown how muscle oxygenation, the balance between delivery and utilization of oxygen at the muscle, is altered post‐stroke during aerobic exercise and how it relates to mobility. Objective To monitor muscle oxygenation changes between the paretic and nonparetic legs of individuals after stroke during treadmill exercise and the 6‐minute walk test and analyze the association with mobility. Design Cross‐sectional study. Setting Cardiac rehabilitation program. Patients Eleven male participants were enrolled in the study. Ten men (30.8 ± 4.1 months post‐stroke; age 63.9 ± 13.9 years) with hemiparetic gait pattern finished the study. Methods or interventions Not applicable. Main outcome measures Muscle oxygenation was measured with near‐infrared spectroscopy placed on the vastus lateralis of each leg during treadmill exercise at the first ventilatory threshold and during a 6‐minute walk test. Results The desaturation slope during treadmill exercise was significantly steeper ( p = .047) in the paretic (−0.7 ± 0.6%/s) compared to the nonparetic leg (−0.3 ± 0.2%/s). There was no other significant difference between legs. The 6‐minute walk test distance was not correlated with 6‐minute walk test muscle oxygenation in either leg (paretic: r = 0.20, p = 0.590; nonparetic: r = 0.42, p = .232). Conclusions At the onset of treadmill exercise, the paretic leg was unable to effectively match the oxygen demand and extraction of the nonparetic leg, suggesting the need for an immediate cardiovascular warmup prior to initiating moderate intensity exercise in this population. Because the exercise desaturation rate is thought to indicate increased anaerobic metabolism and lactate production, efforts to delay rapid desaturation could improve the sustainability of activities of daily living and exercise.

Purpose: This study determines barriers and facilitators to including people with lower limb amputation (LLA) in cardiovascular rehabilitation programmes (CRPs). Method: Canadian CRP managers and exercise therapists were invited to complete a questionnaire. Results: There were 87 respondents. Of the 32 CRP managers, 65.6% reported that people with LLA were eligible for referral but of these, 61.9% only accepted LLA with cardiac disease, and 38.1% only accepted them with ≥ 1 cardiovascular risk factor. CRP eligibility progressively decreased as mobility severity increased, with 94% of programmes accepting those with mild mobility deficits but only 48% accepting those with severe deficits. Among therapists in CRPs that accepted LLAs, 54.3% reported not having an LLA participant within the past three years. Among all responding therapists and managers who were also therapists ( n = 58), 43% lacked confidence in managing safety concerns, and 45%, 16%, and 7% lacked confidence in prescribing aerobic exercise to LLA with severe, moderate, and no mobility deficits respectively. There was a similar finding with prescribing resistance training. LLA-specific education had not been provided to any respondent within the past three years. The top barriers were lack of referrals (52.6%; n = 30) and lack of knowledge of the contraindications to exercise specific for LLA (43.1%; n = 31). Facilitators included the provision of a resistance-training tool kit (63.4%; n = 45), education on exercise safety (63.4%; n = 45), and indications for physician intervention/inspection (63.6%; n = 42). Conclusion: Most of the CRPs surveyed only accept people with LLA if they have co-existing cardiac disease or cardiovascular risk factors. Few people with LLA participate. Education on CRP delivery for LLAs is needed to improve therapists’ confidence and exercise safety.