Cardiac rehabilitation after stroke-need and opportunity

In North America, established long-term rehabilitation programs are commonly available for individuals following a cardiac event but are largely unavailable for stroke survivors. The purpose of this study was to determine (1) the availability of cardiac rehabilitation (CR) for individuals poststroke (survey of all programs in Ontario, Canada) and (2) the effects of CR, comparing individuals with primary and secondary diagnoses of stroke versus those with cardiac diagnoses only (retrospective review of a large outpatient North American program).

An Ontario-wide survey was disseminated to CR programs to determine barriers to enrollment of stroke participants. Additionally, a retrospective analysis of data from 9,173 participants in 1 CR program in Toronto, Ontario, compared 3 subgroups (n = 19 each): (1) primary diagnosis of stroke or transient ischemic attack (TIA), (2) primary cardiac diagnosis and occurrence of stroke or TIA, and (3) cardiac diagnoses only.

Twenty-four of 40 (60%) programs surveyed included stroke participants, although the proportion was small (<5% of total enrollment). Barriers to enrollment included issues around primary diagnosis and degree of stroke-related disability. While those with a history of stroke or TIA had a lower baseline peak oxygen uptake, all 3 groups showed comparable postprogram improvements in peak oxygen uptake and anaerobic threshold (time effect, P < .001). There were no group-time interaction effects.

Despite the common cardiovascular etiology of stroke and heart disease, individuals with stroke are not routinely included in CR in Ontario. However, individuals with stroke demonstrated similar training-related improvements in exercise capacity compared with nonstroke participants.