Higher intensity walking improves global cognition during inpatient rehabilitation: a secondary analysis of a randomized control trial
Cognitive deficits are common poststroke. Cognitive rehabilitation is typically used to improve cognitive deficits. It is unknown whether higher doses of exercise to promote motor recovery influence cognitive outcomes. Our recent trial, Determining Optimal Post-Stroke Exercise (DOSE), shows more tha...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-06-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1023488/full |
| _version_ | 1797808251267448832 |
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| author | Sue Peters Keith R. Lohse Tara D. Klassen Teresa Liu-Ambrose Teresa Liu-Ambrose Sean P. Dukelow Mark T. Bayley Michael D. Hill Sepideh Pooyania Jennifer Yao Jennifer Yao Janice J. Eng Janice J. Eng |
| author_facet | Sue Peters Keith R. Lohse Tara D. Klassen Teresa Liu-Ambrose Teresa Liu-Ambrose Sean P. Dukelow Mark T. Bayley Michael D. Hill Sepideh Pooyania Jennifer Yao Jennifer Yao Janice J. Eng Janice J. Eng |
| author_sort | Sue Peters |
| collection | DOAJ |
| description | Cognitive deficits are common poststroke. Cognitive rehabilitation is typically used to improve cognitive deficits. It is unknown whether higher doses of exercise to promote motor recovery influence cognitive outcomes. Our recent trial, Determining Optimal Post-Stroke Exercise (DOSE), shows more than double the steps and aerobic minutes can be achieved during inpatient rehabilitation versus usual care, and translates to improved long-term walking outcomes. Thus, the secondary analysis aim was to determine the effect of the DOSE protocol on cognitive outcomes over 1-year poststroke. The DOSE protocol progressively increased step number and aerobic minutes during inpatient stroke rehabilitation over 20 sessions. The Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), and Trail Making Test B were completed at baseline, post-intervention, and 6- and 12-months poststroke, administered using standardized guidelines. Using the DOSE data, we used mixed-effect spline regression to model participants’ trajectories of cognitive recovery, controlling for relevant covariates. Participants (Usual Care n = 25, DOSE n = 50) were 56.7(11.7) years old, and 27(10) days post stroke. For the MoCA, there were statistically significant Group × Trajectory(p = 0.019), and Group × ΔTrajectory (p = 0.018) interactions with a substantial clinically meaningful difference, from +5.44 points/month improvement of the DOSE group compared to +1.59 points/month improvement with Usual Care during the 4-week intervention. The DSST and Trails B improved over time but were not different between groups. Taking advantage of this early difference may lend support to continued efforts to increase intensity, during and after discharge from inpatient rehabilitation, to improve cognition.Clinical trial registration: www.clinicaltrials.gov, NCT01915368. |
| first_indexed | 2024-03-13T06:35:01Z |
| format | Article |
| id | doaj.art-310f69ba5de24220a535de8a40e17a1a |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-13T06:35:01Z |
| publishDate | 2023-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neurology |
| spelling | doaj.art-310f69ba5de24220a535de8a40e17a1a2023-06-09T05:17:04ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-06-011410.3389/fneur.2023.10234881023488Higher intensity walking improves global cognition during inpatient rehabilitation: a secondary analysis of a randomized control trialSue Peters0Keith R. Lohse1Tara D. Klassen2Teresa Liu-Ambrose3Teresa Liu-Ambrose4Sean P. Dukelow5Mark T. Bayley6Michael D. Hill7Sepideh Pooyania8Jennifer Yao9Jennifer Yao10Janice J. Eng11Janice J. Eng12School of Physical Therapy, University of Western Ontario, London, ON, CanadaProgram in Physical Therapy and Department of Neurology, Washington University School of Medicine, Saint Louis, MO, United StatesDepartment of Physical Therapy, University of British Columbia, Vancouver, BC, CanadaDepartment of Physical Therapy, University of British Columbia, Vancouver, BC, CanadaCentre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, CanadaDepartment of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, CanadaDivision of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, CanadaDepartment of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, CanadaDivision of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, MB, CanadaCentre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, CanadaDivision of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, CanadaDepartment of Physical Therapy, University of British Columbia, Vancouver, BC, CanadaCentre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, CanadaCognitive deficits are common poststroke. Cognitive rehabilitation is typically used to improve cognitive deficits. It is unknown whether higher doses of exercise to promote motor recovery influence cognitive outcomes. Our recent trial, Determining Optimal Post-Stroke Exercise (DOSE), shows more than double the steps and aerobic minutes can be achieved during inpatient rehabilitation versus usual care, and translates to improved long-term walking outcomes. Thus, the secondary analysis aim was to determine the effect of the DOSE protocol on cognitive outcomes over 1-year poststroke. The DOSE protocol progressively increased step number and aerobic minutes during inpatient stroke rehabilitation over 20 sessions. The Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), and Trail Making Test B were completed at baseline, post-intervention, and 6- and 12-months poststroke, administered using standardized guidelines. Using the DOSE data, we used mixed-effect spline regression to model participants’ trajectories of cognitive recovery, controlling for relevant covariates. Participants (Usual Care n = 25, DOSE n = 50) were 56.7(11.7) years old, and 27(10) days post stroke. For the MoCA, there were statistically significant Group × Trajectory(p = 0.019), and Group × ΔTrajectory (p = 0.018) interactions with a substantial clinically meaningful difference, from +5.44 points/month improvement of the DOSE group compared to +1.59 points/month improvement with Usual Care during the 4-week intervention. The DSST and Trails B improved over time but were not different between groups. Taking advantage of this early difference may lend support to continued efforts to increase intensity, during and after discharge from inpatient rehabilitation, to improve cognition.Clinical trial registration: www.clinicaltrials.gov, NCT01915368.https://www.frontiersin.org/articles/10.3389/fneur.2023.1023488/fullrehabilitationcognitiongaitoutcomesstrokeexercise |
| spellingShingle | Sue Peters Keith R. Lohse Tara D. Klassen Teresa Liu-Ambrose Teresa Liu-Ambrose Sean P. Dukelow Mark T. Bayley Michael D. Hill Sepideh Pooyania Jennifer Yao Jennifer Yao Janice J. Eng Janice J. Eng Higher intensity walking improves global cognition during inpatient rehabilitation: a secondary analysis of a randomized control trial Frontiers in Neurology rehabilitation cognition gait outcomes stroke exercise |
| title | Higher intensity walking improves global cognition during inpatient rehabilitation: a secondary analysis of a randomized control trial |
| title_full | Higher intensity walking improves global cognition during inpatient rehabilitation: a secondary analysis of a randomized control trial |
| title_fullStr | Higher intensity walking improves global cognition during inpatient rehabilitation: a secondary analysis of a randomized control trial |
| title_full_unstemmed | Higher intensity walking improves global cognition during inpatient rehabilitation: a secondary analysis of a randomized control trial |
| title_short | Higher intensity walking improves global cognition during inpatient rehabilitation: a secondary analysis of a randomized control trial |
| title_sort | higher intensity walking improves global cognition during inpatient rehabilitation a secondary analysis of a randomized control trial |
| topic | rehabilitation cognition gait outcomes stroke exercise |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1023488/full |
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