The effect of early active cycling on physical activity and cardiorespiratory fitness in stroke patients

169 Pages·2017·4.23 MB·English

The effect of early active cycling on physical
activity and cardiorespiratory fitness in stroke
patients

Proefschrift voorgelegd tot het behalen van de graad van doctor in de Medische Wetenschappen aan
de Universiteit Antwerpen en graad van doctor in de Revalidatiewetenschappen en Kinesitherapie
aan de Katholieke Universiteit Leuven te verdedigen door

Christel Vanroy

Promotoren: prof. dr. Patrick Cras (Universiteit Antwerpen)
prof. dr. Yves Vanlandewijck (Katholieke Universiteit Leuven)
prof. dr. Steven Truijen (Universiteit Antwerpen)

Copromotoren: prof. dr. Hilde Feys (Katholieke Universiteit Leuven)
prof. dr. Dirk Vissers (Universiteit Antwerpen)

Faculteit Geneeskunde en Gezondheidswetenschappen
Antwerpen 2017
Faculteit Bewegings- en Revalidatiewetenschappen
Leuven 2017

The effect of early active cycling on physical
activity and cardiorespiratory fitness in stroke
patients

Het effect van vroegtijdig actief fietsen op fysieke
activiteit en cardiorespiratoire fitheid bij personen
met een beroerte

Proefschrift voorgelegd tot het behalen van de graad van doctor in de Medische Wetenschappen aan
de Universiteit Antwerpen en graad van doctor in de Revalidatiewetenschappen en Kinesitherapie
aan de Katholieke Universiteit Leuven te verdedigen door

Christel Vanroy

Promotoren: prof. dr. Patrick Cras (Universiteit Antwerpen)
prof. dr. Yves Vanlandewijck (Katholieke Universiteit Leuven)
prof. dr. Steven Truijen (Universiteit Antwerpen)

Copromotoren: prof. dr. Hilde Feys (Katholieke Universiteit Leuven)
prof. dr. Dirk Vissers (Universiteit Antwerpen)

Faculteit Geneeskunde en Gezondheidswetenschappen
Antwerpen 2017
Faculteit Bewegings- en Revalidatiewetenschappen
Leuven 2017
Photo cover: Ivan Deleus ([email protected]) and A.J.
Jury

Promotors: prof. dr. Patrick Cras (Universiteit Antwerpen)
prof. dr. Yves Vanlandewijck (Katholieke Universiteit Leuven)
prof. dr. Steven Truijen (Universiteit Antwerpen)

Copromotors: prof. dr. Hilde Feys (Katholieke Universiteit Leuven)
prof. dr. Dirk Vissers (Universiteit Antwerpen)

Chair: prof. dr. Jan Gielen (Universiteit Antwerpen)

Members: prof. dr. Gaetane Stassijns (Universiteit Antwerpen)
prof. dr. Geert Verheyden (Katholieke Universiteit Leuven)
prof. dr. Gert Kwakkel (Vrije Universiteit Amsterdam)
prof. dr. Thomas Janssen (Vrije Universiteit Amsterdam)

“Knowledge is power. Information is liberating.
Education is the premise of progress, in every society, in every family.”
Kofi Annan
Table of contents

List of abbreviations 1
List of figures 2
List of tables 3

General introduction 7
Background 9
Conclusions from the literature, questions remaining and aims of this thesis 15

Part A: The assessments of physical activity after stroke 25
Chapter 1 Physical activity monitoring in stroke: SenseWear Pro 2 Activity 27
Accelerometer versus Yamax Digi-walker SW-200 Pedometer.
Chapter 2 Is a coded physical activity diary valid for assessing physical activity 43
level and energy expenditure in stroke patients?
Chapter 3 Physical activity in chronic home-living and sub-acute hospitalized 61
stroke patients using objective and self-reported measures.

Part B: The effectiveness of an aerobic training program in stroke patients 75
Chapter 4 Effectiveness of Active Cycling in Subacute Stroke Rehabilitation: 77
A Randomized Controlled Trial.
Chapter 5 Does a cycling program combined with education and followed by coaching 101
promote physical activity in subacute stroke patients? A Randomized
Controlled trial.

General discussion 121
Introduction 123
Discussion of research questions and main findings of Part A 124
Discussion of research questions and main findings of Part B 127
Clinical implications 130
Methodological issues 130
Recommendations for future research 133

Summary 139
Samenvatting 145
Dankwoord 151
Curriculum Vitae 157
List of abbreviations

AC Active cycling
A-Cap Aerobic capacity
ACG Active cycling group
ADL Activities of daily living
AT Aerobic training
CG Control group
Co-ACG Active cycling group with coaching
CRF Cardiorespiratory fitness
EE Energy expenditure
FAC Functional Ambulation Categories
HOM home-living stroke patients
HOS Stroke patients hospitalized in a rehabilitation center
HR Heart rate
METs Metabolic Equivalents
Nco-ACG Active cycling group without coaching
PA Physical activity
PASIPD Physical Activity Scale for Individuals with Physical Disabilities
RCT Randomized clinical trial
RMA-GF Rivermead Motor Assessment gross function scale
SAM Stepwatch Activity monitor
SWP2A SenseWear Pro2 Accelerometer
THR Heart rate training zones
VO Oxygen consumption
2
VO Maximum rate of oxygen consumption
2max
VO Peak rate of oxygen consumption
2peak
Watt Workload
Watt Last fulfilled increment in workload during the maximal graded exercise test
peak
YDWP Yamax Digi-Walker SW-200 pedometer

1
List of figures

Introduction
Figure 1 Scheme describing the relationship between physical activity and health- 11
related fitness and many confounding factors.
Figure 2 VO levels (mean; standard deviation represented by error bars) of chronic 13
2
stroke patients (n=131) relative to the energy requirements for activities of
daily living.

Chapter 1
Figure 1 Agreement between the measured steps with the pedometer worn at the 36
knee and the counted steps in healthy participants and stroke patients while
walking on ground level surface at two different walking speeds.
Figure 2 Agreement between the measured energy expenditure with the SWP2A and 37
the criterion standard in healthy participants and stroke patients while
walking on a treadmill at 1.5 km/h.

Chapter 2
Figure 1 Comparing total Mets*minutes in 16 stroke patients: observational diary 50
versus patient diary.
Figure 2 Comparing total Mets*minutes in 16 stroke patients: activity monitor versus 51
patient diary.
Figure 3 Comparing energy expenditure in 16 stroke patients: observational diary 52
versus patient diary.
Figure 4 Comparing energy expenditure in 16 stroke patients: activity monitor versus 52
patient diary.

Chapter 3
Figure 1 Post-hoc analysis with unpaired t-test by means and standard deviations to 67
visualize significant differences in number of steps and energy expenditure
between two groups of stroke patients.
Figure 2 Time spent on four activity levels in two groups of stroke patients during three 69
consecutive days by Medians and Interquartile ranges: A= sedentary activity
level (≤1 METs), B= light activity level (>1-<3 METs), C= moderate activity level
(≥3-6≤ METs), D= vigorous activity level (>6 METs).

Chapter 4
Figure 1 Flow diagram of study participants through each stage of the trial. 83
Supplement A Design of the study used in the Active Cycling group and the control group 94
over four measurement points (A1-A4).

2
List of tables

In troduction
Table 1 Schematic overview of the chapters in the doctoral thesis. 18

Chapter 1
Table 1 Activity protocol. 32
Table 2 Demographic and clinical characteristics of participants. 33
Table 3 Number of steps measured by Yamax Digi-Walker SW-200 Pedometer (YDWP), 34
SenseWear Pro2 Armband (SWP2A) and criterion standard while walking on a flat
level surface at two different speeds in stroke and healthy adults.
Table 4 Spearman correlation coefficient for number of steps and energy expenditure in 34
stroke and healthy participants while executing simulated functional activities.
Table 5 Intraclass correlation coefficient in stroke and healthy participants for the 35
number of steps and the energy expenditure calculated for the repeated
measures.

Chapter 2
Table 1 Demographic and clinical characteristics of included patients. 48
Table 2 METs*minutes and Energy Expenditure values measured by two activity diaries 49
and an Activity monitor in 16 stroke patients.
Table 3 Spearman Rank Correlations between Patient’s diary versus Researcher’s Diary 50
and versus Activity monitor in 16 stroke patients for physical activity
(METs*minutes) and energy expenditure.
Supplement A Activity diary. 58
Supplement B Scheme of codes that are used to fill in the activity diary. 59

Chapter 3
Table 1 Demographic and clinical characteristics of included stroke patients. 66
Table 2 Difference in physical activity measured by a pedometer, activity monitor, 68
activity diary in two groups of stroke patients.

Chapter 4
Table 1 Patient characteristics at study onset. 84
Table 2 Analysis of outcome parameters per treatment group based on a Mixed effects 85
model.
Table 2 continued Analysis of outcome parameters per treatment group based on a Mixed effects 86
model.
Table 3 Analysis of outcome measures in stroke patients who could not walk 10 meter 87
independently at baseline divided in two groups based on a Linear mixed effects
model.
Supplement B The training program of Phase I to the Active cycling group. 95
Supplement C Number of patients for outcome measures reported in Tables 2, 2 continued and 96
3.
Supplement D Estimates and Confidence intervals based on a Mixed effects model (Phase I) for 97
outcome parameters reported in Table 2 and 2 continued.
Supplement E Estimates and Confidence intervals based on a Mixed effects model (Phase II) for 98
outcome parameters reported in tables 2.
Supplement F Estimates and Confidence intervals based on a Mixed effects model (Phase II) for 99
outcome parameters reported in Table 3.

Chapter 5
Table 1 Analysis of outcome parameters per treatment group based on a Linear Mixed 107
Effects model.
Table 2 Analysis of outcome measures in stroke patients who could not walk 10 meter 116
independently at baseline.
3
Supplement A Estimates and Confidence intervals based on a Mixed Effects model (Phase I) for 116
outcome parameters reported in Tables 1.
Supplement B Estimates and Confidence intervals based on a Mixed Effects model (Phase II) for 117
outcome parameters reported in Tables 1.
Supplement C Number of patients for outcome measures reported in Table 1 and Table 2 118
Supplement D Estimates and Confidence intervals based on a Mixed Effects model (Phase II) for 119
outcome parameters reported in Table 2.

Discussion
Table 1 Schematic overview of the hypotheses and research questions in the doctoral 123
thesis.

4