Effect of an aerobic exercise program on cardiac remodeling and functional capacity in patients with stroke: CRONuS trial

Abstract

BACKGROUND: Aerobic exercise training leads to cardiovascular changes and improves cardiovascular performance and functional capacity after a stroke. However, the effect of aerobic exercise on cardiac remodeling in patients with stroke has been poorly explored. This study aimed to investigate the effects of a physical exercise program on morphofunctional echocardiographic variables and the functional capacity of post-stroke patients. METHODS: This randomized, controlled clinical trial included patients with stroke, categorized into the control group (CG), conventional physiotherapeutic care, and intervention group (IG). The IG underwent a cardiovascular rehabilitation program consisting of warm-up, aerobic exercise, and muscle cooling. Both conventional and test interventions lasted 45 min, three times a week for 16 weeks. The patients underwent transthoracic echocardiography, a 6-minute walk test, neurological and nutritional evaluation, laboratory tests, and QoL assessment initially and at 16 weeks after the intervention. RESULTS: The IG showed significant reduction in the following morphological echocardiographic variables compared to the CG after intervention: diastolic thicknesses of the posterior wall (<i>p</i> = 0.0001) and interventricular septum (<i>p</i> = 0.004), relative wall thickness (<i>p</i> = 0.001), left ventricular mass (LVM, <i>p</i> &lt; 0.001), LVM index (<i>p</i> &lt; 0.0001), and left atrial diameter (<i>p</i> = 0.003). Regarding systolic and diastolic functions, the IG showed a significant increase in LV ejection fraction (<i>p</i> = 0.001) and tricuspid ring systolic excursion (<i>p</i> = 0.0002), and a reduction in the left atrial volume index (<i>p</i> = 0.001) and E/E' ratio (<i>p</i> = 0.01) compared to the CG. In addition, the IG showed an increase in the distance covered compared to the CG after the intervention (<i>p</i> = 0.04). CONCLUSIONS: The cardiovascular rehabilitation program improved the cardiac morphological and functional parameters and had a positive impact on the functional capacity of patients with chronic ischemic stroke. TRIAL REGISTRATION: REBEC, RBR-4wk4b3. Registered on 19 September 2016.