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Objective: To evaluate the construct validity and responsiveness of the Rapid Assessment of Physical Activity (RAPA) for measuring physical activity (PA) in adults living with HIV., Design: Secondary analysis of an interrupted time-series intervention study., Setting: Community-based fitness facility in Toronto, Canada., Participants: Sixty-seven adults (N=67) living with HIV (n=5 women; mean age, 51.8±11.6 years) with available baseline data to assess for construct validity of the RAPA, of which 50 (n=4 women; age, 53.2±11.4 years) had follow-up data to evaluate responsiveness., Interventions: Two months of a community-based exercise intervention involving thrice weekly multicomponent exercises., Main Outcome Measures: We used a single-item PA questionnaire as a convergent outcome to the RAPA, while peak oxygen consumption, general health status, and number of concurrent health conditions were divergent outcomes. We tested 11 a priori hypotheses (6 construct validity, 5 responsiveness) using Spearman ρ, Wilcoxon signed-rank tests, Cohen's d , standardized effect size (SES), and standardized response mean (SRM). We considered acceptable construct validity and responsiveness if >75% of hypotheses were confirmed., Results: All of the hypotheses (100%) for construct validity were confirmed. The RAPA demonstrated moderate correlations with the single-item PA questionnaire (ρ=0.61), and negligible correlations with divergent outcome measures (ρ=0.08-0.21). Two of the 5 hypotheses (40.0%) for responsiveness were confirmed. RAPA scores were significantly greater after 2 months of training ( P <.001) and demonstrated a small to moderate effect size ( d =0.50, SES=0.47, SRM=0.48). There was a low correlation between change in RAPA scores and change in single-item PA questionnaire scores (ρ=0.48)., Conclusions: The RAPA demonstrated acceptable construct validity and poor responsiveness in adults living with HIV. Therefore, the RAPA can be used cross-sectionally but may be used in conjunction with other measures of PA for adults living with HIV., (© 2021 The Authors.)

Aging is associated with increased risk of cardiovascular and cerebrovascular events, which are preceded by early, negative remodeling of the vasculature. Low physical activity is a well-established risk factor associated with the incidence and development of disease. However, recent physical activity literature indicates the importance of considering the 24-h movement spectrum. Therefore, the purpose of this review was to examine the impact of the 24-h movement spectrum, specifically physical activity (aerobic and resistance training), sedentary behavior, and sleep, on cardiovascular and cerebrovascular outcomes in older adults, with a focus on recent evidence (<10 yr) and sex-based considerations. The review identifies that both aerobic training and being physically active (compared with sedentary) are associated with improvements in endothelial function, arterial stiffness, and cerebrovascular function. Additionally, there is evidence of sex-based differences in endothelial function: a blunted improvement in aerobic training in postmenopausal women compared with men. While minimal research has been conducted in older adults, resistance training does not appear to influence arterial stiffness. Poor sleep quantity or quality are associated with both impaired endothelial function and increased arterial stiffness. Finally, the review highlights mechanistic pathways involved in the regulation of vascular and cerebrovascular function, specifically the balance between pro- and antiatherogenic factors, which mediate the relationship between the 24-h movement spectrum and vascular outcomes. Finally, this review proposes future research directions: examining the role of duration and intensity of training, combining aerobic and resistance training, and exploration of sex-based differences in cardiovascular and cerebrovascular outcomes.

Objective: The benefits of aerobic exercise early after stroke are well known, but concerns about cardiovascular risk are a barrier to clinical implementation. Symptom-limited exercise testing with electrocardiography (ECG) is recommended but not always feasible. The purpose of this study was to determine the frequency of and corresponding exercise intensities at which ECG abnormalities occurred during submaximal exercise testing that would limit safe exercise prescription beyond those intensities., Methods: This study was a retrospective analysis of ECGs from 195 patients who completed submaximal exercise testing during stroke rehabilitation. A graded submaximal exercise test was conducted with a 5- or 12-lead ECG and was terminated on the basis of predetermined endpoint criteria (heart rate, perceived exertion, signs, or symptoms). ECGs were retrospectively reviewed for exercise-induced abnormalities and their associated heart rates., Results: The peak heart rate achieved was 65.4% (SD = 10.5%) of the predicted maximum heart rate or 29.1% (SD = 15.5%) of the heart rate reserve (adjusted for beta-blocker medications). The test was terminated more often because of perceived exertion (93/195) than because of heart rate limits (60/195). Four patients (2.1%) exhibited exercise-induced horizontal or downsloping ST segment depression of ≥1 mm. Except for 1 patient, the heart rate at test termination was comparable with the heart rate associated with the onset of the ECG abnormality., Conclusion: A graded submaximal exercise test without ECG but with symptom monitoring and conservative heart rate and perceived exertion endpoints may facilitate safe exercise intensities early after stroke. Symptom-limited exercise testing with ECG is still recommended when progressing to higher intensity exercise., Impact: Concerns about cardiovascular risk are a barrier to physical therapists implementing aerobic exercise in stroke rehabilitation. This study showed that, in the absence of access to exercise testing with ECG, submaximal testing with conservative heart rate and perceived exertion endpoints and symptom monitoring can support physical therapists in the safe prescription of aerobic exercise early after stroke., Lay Summary: It is recommended that people with stroke participate in aerobic exercise as early as possible during their rehabilitation. A submaximal exercise test with monitoring of heart rate, perceived exertion, blood pressure, and symptoms can support physical therapists in safely prescribing that exercise., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background and Purpose: Aerobic exercise is a recommended part of stroke best practices; yet, access to aerobic exercise programs within stroke rehabilitation remains limited and inconsistent. The purpose of this scoping review was to describe the nature and extent of barriers and facilitators to aerobic exercise implementation with adults post-stroke as reported by health care professionals., Methods: MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, and AMED Allied and Complementary Medicine were searched from inception to October 16, 2019. Research studies that examined health care professionals' barriers and facilitators to aerobic exercise implementation in adults post-stroke were included. Two reviewers independently conducted title and abstract screening, full-text evaluation, data extraction, and quality appraisal. The Theoretical Domains Framework was used to map the identified barriers or facilitators and to analyze and interpret the results., Results: Four studies were included in the review. All studies involved surveys conducted among physical therapists and reported barriers related to "environmental context and resources" (eg, lack of equipment, time, staff), insufficient "knowledge" and "skills" (eg, safe aerobic exercise prescription and implementation), "beliefs about capabilities" (eg, uncertainty about exercise intensity and screening tools), and professional role and identity (eg, aerobic exercise not a priority). Access to and continued education in structured aerobic exercise programs and safety monitoring were identified facilitators., Discussion and Conclusions: Some of the identified barriers could be overcome with modeling and training in best practice, while others may require interventions targeting organizational environment and leadership. Future knowledge translation interventions should target the identified barriers and facilitators to implementing aerobic exercise.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A312).

Most stroke survivors have very low levels of cardiovascular fitness, which limits mobility and leads to further physical deconditioning, increased sedentary behavior, and heightened risk of recurrent stroke. Although clinical guidelines recommend that aerobic exercise be a part of routine stroke rehabilitation, clinical uptake has been suboptimal. In 2013, an international group of stroke rehabilitation experts developed a user-friendly set of recommendations to guide screening and prescription-the Aerobic Exercise Recommendations to Optimize Best Practices in Care after Stroke (AEROBICS 2013). The objective of this project was to update AEROBICS 2013 using the highest quality of evidence currently available. The first step was to conduct a comprehensive review of literature from 2012 to 2018 related to aerobic exercise poststroke. A working group of the original consensus panel members drafted revisions based on synthesis. An iterative process was used to achieve agreement among all panel members. Final revisions included: (1) addition of 115 new references to replace or augment those in the original AEROBICS document, (2) rewording of the original recommendations and supporting material, and (3) addition of 2 new recommendations regarding prescription. The quality of evidence from which these recommendations were derived ranged from low to high. The AEROBICS 2019 Update should make it easier for clinicians to screen for, and prescribe, aerobic exercise in stroke rehabilitation. Clinical implementation will not only help to narrow the gap between evidence and practice but also reduce current variability and uncertainty regarding the role of aerobic exercise in recovery after stroke., (© 2019 American Physical Therapy Association.)

Objective: To determine whether there are differences in exercise-associated changes in cognitive func-tion between males and females living with stroke., Design: Secondary analysis of data from a prospective assessor-blinded randomized controlled trial., Participants: Fifty participants (50-80 years, > 1 year post-stroke, able to walk ≥ 5 m)., Methods: Participants were allocated into a 6-month aerobic exercise programme (14 males, 11 females) or balance and flexibility programme (15 males, 10 females). Working memory (Verbal Digit Span Backwards Test), selective attention and conflict resolution (Stroop Colour-Word Test), and set shifting/cognitive flexibility (Trail-Making Test B) were assessed before and after the programmes., Results: There was a group × time interaction in females (effect size 0.28, p = 0.03), which was not observed in males (effect size 0.01, p = 0.62). Females demonstrated a Stroop Colour-Word Interference test change of -2.3 s, whereas males demonstrated a change of +5.5 s following aerobic exercise. There were no differences between exercise groups in either sex for any of the other outcomes (working memory and set-shifting/cognitive flexibility)., Conclusion: Females living with stroke may demonstrate a greater response to exercise on selective attention and conflict resolution compared with males with stroke. These findings suggest that there may be sex-specific effects of exercise on cognitive func-tion in individuals with stroke.

Background: Accurate measurement of physical behaviour is paramount to better understand lifestyle, health, and functioning, particularly in adults with physical disability as they may be at higher risk of sedentary lifestyle and subsequent negative health consequences. This study aimed: 1) to evaluate the criterion validity of a novel and clinically applicable activity monitor (AM, Activ8), in the detection of body postures and movements in adults with spastic cerebral palsy (CP); and 2) to evaluate the extent that the AM's positioning affects validity., Methods: In this cross-sectional study, 14 ambulatory adults with CP [9 men; mean (SD) age, 35.4 (13.1) years] performed standardized activities while wearing three Activ8 monitors - frontolateral thigh (primary position), frontal thigh, and pant pocket - and being video recorded (criterion measure). AM activity output was compared to synchronized video recordings. Absolute (seconds) and relative [(video time-AM time)/mean time, %] time differences between methods were calculated. Relative time differences of < 10% were indicative of good validity. Comparison of AM attachment positions was completed using Spearman Rho correlation coefficients and Meng's tests., Results: Criterion validity of the AM (frontolateral thigh) was good (average relative time differences: 0.25% for sitting, 4.69% for standing, 2.46% for walking, 1.96% for upright activity, 3.19% for cycling), except for running (34.6%). Spearman Rho correlation coefficients were greater between video/frontolateral thigh position than video/frontal thigh position and video/pant pocket position for body posture and movement categories sitting, standing, walking, and upright activity (p < 0.01 for all)., Conclusions: The AM, positioned on the frontolateral thigh, demonstrated good criterion validity in ambulatory adults with CP. Though the Activ8 offers potential as an objective measure of physical activity, appropriate positioning is paramount for valid measurement.

Background: Despite known associations between fitness and recurrent cardiovascular events, changes in cardiorespiratory fitness (CRF) and muscle strength with long-term cardiac rehabilitation (CR) have not been extensively examined. The objectives of this study were to (1) examine changes in CRF and muscle strength associated with long-term CR program enrollment in men, and (2) compare these changes to previously published rates of decline (2.0% per year for CRF and 2.36% per year for muscle strength in healthy age-matched individuals)., Methods: Data were extracted from the program charts of 160 men (64 ± 9 years) who were enrolled ≥ 1 year in a maintenance-phase CR program and who completed ≥ 2 exercise tests. CRF was represented by peak oxygen consumption (VO 2peak , mL/min/kg). The skeletal muscle strength was assessed using 1-repetition maximum tests for chest press, seated row, and knee extension. Mixed model analyses with polynomial functions were used to determine changes in CRF (up to 5.5 years) and muscle strength (up to 10 years)., Results: CRF increased nonlinearly up to 3 years (range, 0.33%-3.23% per year) and then declined nonlinearly to the 5.5-year endpoint (range, 1.03%-2.59% per year). Chest press and seated row strength declined at < 1% per year over 10 years, whereas knee extension increased nonlinearly by 0.18%-1.40% per year from baseline until 4 years and then declined nonlinearly at 1.00%-3.58% per year until the 10-year endpoint. All declines were similar to literature rates., Conclusions: The results indicate that significant health benefits are associated with maintenance-phase CR programs for men. Enrollment was associated with preserved CRF and lower body muscle strength for 3-4 years., (Copyright © 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

ABSTRACTCanadian older adults with complex health problems are often considered ineligible for traditional rehabilitation programs but may benefit from slow stream rehabilitation (SSR). This scoping review summarizes the literature related to SSR for older adults, within single-payer health care systems., Methods: Peer-reviewed and grey-literature documents relevant to older adults in SSR were systematically reviewed., Results: 1,445 documents were screened independently by two reviewers [Cohen Kappa value of 0.78 (CI = 0.73, 0.83)], and included 18 documents. SSR programs were found to be multidisciplinary with a mean duration ranging from 30 to 141.2 days. SSR participants were more likely to be female, with a mean age range of 72-82 years, multiple co-morbidities and mild-to-moderate cognitive impairments. SSR participants demonstrated improvements in physical and functional measures., Discussion: SSR programs have the potential to be an integral part of the continuum of care for older adults with complex medical histories.

Stroke results in low physical activity, high sedentary behavior (SB), and elevated C-reactive protein (CRP), which are associated with stroke recurrence. This study examined the association between physical activity, SB, and CRP in stroke. CRP data from 185 stroke survivors ( M age  = 65 years) from the National Health and Nutritional Examination Survey 2009-2010 were analyzed using weighted regression analysis. There was an interaction between physical activity and SB on CRP (estimated-β = -0.079, 95% confidence interval [-0.14, -0.02], p  = .011). SB was associated with CRP among those who did not engage in physical activity (estimated-β = 0.068, 95% confidence interval [0.02, 0.11], p  = .005), but not among those who did (estimated-β = 0.0003, 95% confidence interval [-0.03, 0.03], p  = .988). Physical activity and SB are important modifiable risk factors to lower the risk of recurrent stroke. These findings provide insight into the inflammatory consequences of SB after stroke, particularly among those who also do not engage in physical activity.

Nazari, G, MacDermid, JC, Sinden, KE, Richardson, J, and Tang, A. Reliability of Zephyr Bioharness and Fitbit Charge measures of heart rate and activity at rest, during the modified Canadian Aerobic Fitness Test, and recovery. J Strength Cond Res 33(2): 559-571, 2019-The purpose of this study was to determine the intrasession and intersession reliability of Zephyr Bioharness (ZB) and Fitbit Charge variables in both healthy men and women at rest, during the Modified Canadian Aerobic Fitness Test (mCAFT), and throughout recovery. Stratified convenience and snowball sampling were used to recruit 60 participants (30 women, 48 ± 15 years) and (30 men, 48 ± 15 years) from McMaster University student, staff, and faculty population. At rest, intrasession average heart rate (b·min). Intraclass correlation coefficients (ICCs) and Standard Error of Measurement [SEM] for Zephyr ranged from (0.94-0.97) [1.17-1.70] to (0.92-0.97) [1.45-2.10] for Fitbit Charge. During the mCAFT, the Zephyr ICCs and (SEM) ranged from 0.31-0.99 (1.28-8.10) to 0.45-0.99 (1.45-8.71) for the Fitbit Charge. Throughout the recovery, the ICCs and (SEM) ranged from 0.44-0.98 (1.26-10.47) to 0.45-0.98 (1.15-11.90) for Zephyr and Fitbit devices, respectively. At rest, intersession ICCs (SEM) for Zephyr and Fitbit ranged from 0.90-0.94 (1.73-2.37) to 0.88-0.94 (1.83-2.67), respectively. At mCAFT, the Zephyr ICCs (SEM) ranged from 0.91-0.97 (3.12-4.64) to 0.85-0.98 (3.28-4.88) for the Fitbit. Throughout the recovery, the ICCs (SEM) ranged from 0.93-0.97 (2.65-4.66) to 0.76-0.91 (3.17-4.67) for Zephyr and Fitbit devices, respectively. To conclude, both the ZB and Fitbit Charge devices demonstrated excellent reliability measures throughout the 3 phases. The findings from our study add to the existing pool of literature regarding the reliability parameters of wearable devices and suggest that stable and consistent measures of heart rate and physical activity can be obtained using ZB and Fitbit Charge devices among healthy male and female participants at rest, during a standardized submaximal fitness test (mCAFT), and throughout recovery.

Background: Technological development and improvements in Wearable Physiological Monitoring devices, have facilitated the wireless and continuous field-based monitoring/capturing of physiologic measures in healthy, clinical or athletic populations. These devices have many applications for prevention and rehabilitation of musculoskeletal disorders, assuming reliable and valid data is collected. The purpose of this study was to appraise the quality and synthesize findings from published studies on psychometric properties of heart rate measurements taken with the Zephyr Bioharness device., Methods: We searched the Embase, Medline, PsycInfo, PuMed and Google Scholar databases to identify articles. Articles were appraised for quality using a structured clinical measurement specific appraisal tool. Two raters evaluated the quality and conducted data extraction. We extracted data on the reliability (intra-class correlation coefficients and standard error of measurement) and validity measures (Pearson/Spearman's correlation coefficients) along with mean differences. Agreement parameters were summarised by the average biases and 95% limits of agreement., Results: A total of ten studies were included: quality ratings ranged from 54 to 92%. The intra-class correlation coefficients reported ranged from 0.85-0.98. The construct validity coefficients compared against gold standard calibrations or other commercially used devices, ranged from 0.74-0.99 and 0.67-0.98 respectively. Zephyr Bioharness agreement error ranged from - 4.81 (under-estimation) to 3.00 (over-estimation) beats per minute, with varying 95% limits of agreement, when compared with gold standard measures., Conclusion: Good to excellent quality evidence from ten studies suggested that the Zephyr Bioharness device can provide reliable and valid measurements of heart rate across multiple contexts, and that it displayed good agreements vs. gold standard comparators - supporting criterion validity., Competing Interests: Not Applicable.Not ApplicableThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Objective: This review aimed to investigate the effects of exercise-based interventions on cardiovascular risk factors in individuals with stroke or transient ischemic attack., Data Sources: MEDLINE, EMBASE, PsycINFO, and CINAHL were searched from inceptions to 28 December 2016., Review Methods: Randomized controlled trials were included that involved exercise with or without other interventions, included participants of any age, with diagnosis of transient ischemic attack or stroke, at any stage of severity or time period following the event, and reported cardiovascular risk factor outcomes. Review Manager (version 5.3) was used to aggregate data from all studies and from those involving only exercise interventions., Results: This review included 18 randomized controlled trials (930 participants) in the qualitative synthesis, 14 of which were included in the quantitative analysis (720 participants; ranging from 84 to 438 participants within individual meta-analyses). All interventions were effective in reducing resting systolic blood pressure (mean difference (MD): -5.32 mmHg, 95% confidence interval (CI): -9.46 to -1.18, P = 0.01), fasting glucose (MD: -0.11 mmol/L, 95% CI: -0.17 to -0.06, P < 0.0001), and fasting insulin (MD: -17.14 pmol/L, 95% CI: -32.90 to -1.38, P = 0.03), and increasing high-density lipoprotein cholesterol (MD: 0.10 mmol/L, 95% CI: 0.03-0.18, P = 0.008). Effects were maintained following meta-analysis of only exercise interventions., Conclusion: Findings suggest that exercise-based interventions are effective in reducing systolic blood pressure, fasting glucose, and fasting insulin, and increasing high-density lipoprotein cholesterol after stroke or transient ischemic attack, providing evidence for their implementation as a strategy for secondary prevention.

Objective: To determine the effects of high versus low-intensity exercise on cognitive function following stroke., Design: Secondary analysis from a randomized controlled trial with blinded assessors., Subjects: 50-80 years old, living in the community, > 1 year post-stroke., Methods: Participants were randomized into a high-intensity Aerobic Exercise or low-intensity non-aerobic Balance/Flexibility program. Both programs were 6 months long, with 3 60-min sessions/week. Verbal item and working memory, selective attention and conflict resolution, set shifting were assessed before and after the program., Results: Forty-seven participants completed the study (22/25 in Aerobic Exercise group, 25/25 in Balance/Flexibility group). There was an improvement in verbal item memory in both groups (time effect p = 0.04), and no between-group differences in improvement in the other outcomes (p > 0.27). There was no association between pre-exercise cognitive function and post-exercise improvement., Conclusions: In contrast to a small body of previous research suggesting positive benefits of exercise on cognition post-stroke, the current study found that 6 months of high or low intensity exercise was not effective in improving cognitive function, specifically executive functions. Further research in this area is warranted to establish the effectiveness of post-stroke exercise programs on cognition, and examine the mechanisms that underlie these changes.

Purposes: The purposes of this study was to 1) perform a cross-cultural Arabic translation for the Patient-Rated Wrist and Hand Evaluation (PRWHE-A) using standardized guidelines and, 2) to test the psychometrics properties of the translated measure., Methods: A total of 48 patients with variety of hand disabilities, a mean age of 47 ± 16 years were recruited and assessed two times. The intraclass correlation coefficient (ICC) was used for assessing test-retest reliability of the PRWHE-A and its subscales while Cronbach's alpha (CA) was used for assessing the internal consistency. Construct validity was assessed by examining the strength of the correlation between the PRWHE-A and the Arabic version of the Disability of the Arm, Shoulder and Hand (DASH-A)., Results: The PRWHE-A demonstrated excellent test-retest reliability (ICC= 0.97) and internal consistency (CA= 0.96). The DASH-A demonstrated moderately to low correlation (r= 0.64) with the PRWHE-A., Conclusions: The results of this study indicated that PRWHE-A is a reliable and valid assessment tool and can be used in patients with different wrist/hand disabilities whose primary language is Arabic., (Copyright © 2015 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.)

Background: Individuals referred to cardiac rehabilitation programs (CRPs) after stroke have demonstrated postprogram improvements in cardiovascular fitness (VO2peak). However, the effect of CRPs on other physiological/quality-of-life outcomes and effect of time from stroke on these results has not been investigated. The objectives of the present study are (1) to evaluate the effects of a CRP in participants with motor impairment after stroke and (2) to explore the effects of elapsed time from stroke on physiological/quality-of-life outcomes., Methods: The CRP included 24 weeks of resistance and aerobic training. Primary outcomes in 120 participants, 25.4±42.3 (mean±standard deviation) months after stroke, included 6-minute walk distance (6MWD), VO2peak, timed repeated sit-to-stand performance, and affected-side isometric knee extensor strength (IKES). Secondary measures included gait characteristics (cadence, step lengths, and symmetry), walking speed, balance (Berg Balance Scale), affected-side range of motion (ROM), elbow flexor and grip strength, anaerobic threshold, and perceptions of participation/social reintegration., Results: After adjusting for multiple comparisons, participants demonstrated significant improvements (all P<.001) in 6MWD (283.2±126.6 to 320.7±141.8 m), sit-to-stand performance (16.3±9.5 to 13.3±7.1 seconds), affected-side IKES (25.9±10.1 to 30.2±11 kg as a percentage of body mass), and VO2peak (15.2±4.5 to 17.2±4.9 mL·kg·min(-1)). Participants also demonstrated post-CRP improvements in secondary outcomes: anaerobic threshold, balance, affected-side hip/shoulder ROM, grip and isometric elbow flexor strength, participation, walking speed, cadence (all P<.001), and bilateral step lengths (P<.04). In a linear regression model, there was a negative association between the change in 6MWD and time from stroke (β=-42.1; P=.002) independent of baseline factors., Conclusions: A CRP yields improvements over multiple domains of recovery; however, those who start earlier demonstrate greater improvement in functional ambulation independent of baseline factors. These data support the use of adapted CRPs as a standard of care practice after conventional stroke rehabilitation., (Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Background: Physical inactivity contributes to atherosclerotic processes, which manifest as increased arterial stiffness. Arterial stiffness is associated with myocardial demand and coronary perfusion and is a risk factor for stroke and other adverse cardiac outcomes. Poststroke mobility limitations often lead to physical inactivity and sedentary behaviors. This exploratory study aimed to identify functional correlates, reflective of daily physical activity levels, with arterial stiffness in community-dwelling individuals >1 year poststroke., Methods: Carotid-femoral pulse wave velocity (cfPWV) was measured in 35 participants (65% men; mean ± SD age 66.9 ± 6.9 years; median time poststroke 3.7 years). Multivariable regression analyses examined the relationships between cfPWV and factors associated with daily physical activity: aerobic capacity (VO2 peak), gait speed, and balance ability (Berg Balance Scale). Age and the use of antihypertensive medications, known to be associated with pulse wave velocity, were also included in the model., Results: Mean cfPWV was 11.2 ± 2.4 m/s. VO2 peak and age were correlated with cfPWV (r = -0.45 [P = .006] and r = 0.46 [P = .004], respectively). In the multivariable regression analyses, age and the use of antihypertensive medication accounted for 20.4% of the variance of cfPWV, and the addition of VO2 peak explained an additional 4.5% of the variance (R2 = 0.249)., Conclusions: We found that arterial stiffness is elevated in community-dwelling, ambulatory individuals with stroke relative to healthy people. Multivariable regression analysis suggests that aerobic capacity (VO2 peak) may contribute to the variance of cfPWV after accounting for the effects of age and medication use. Whether intense risk modification and augmented physical activity will improve arterial stiffness in this population remains to be determined., (Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Objective: Community exercise programs are effective in improving aerobic capacity after stroke, but individual variability in training responses has not previously been studied. This study examined explanatory factors for post-program responses in aerobic capacity (VO2peak) with respect to training parameters and participant characteristics., Design: Secondary analysis of data from a prospective cohort study., Subjects: Thirty-two participants, mean age 63 years (standard deviation (SD) 13), 29 months (SD 26) post-stroke., Method: Following a 6-month community exercise program, multivariate regression analysis was performed to assess for correlates with change in VO2peak with respect to training parameters (exercise duration and intensity) and participant characteristics (lower limb and balance impairment, aerobic and walking capacity)., Results: The mean improvement in VO2peak was 11% (SD 19), but individually, changes ranged from 32% decline to 56% improvement. Regression analysis revealed that only 2 variables, baseline aerobic capacity and balance impairment, accounted for the training-related change in VO2peak (R2 = 0.20, p = 0.045)., Conclusions: There is considerable inter-individual variability in stroke exercise program responses in aerobic capacity. Lower baseline aerobic capacity and better balance were associated with greater training-related improvements in VO2peak. Identifying individuals who are more likely to respond to exercise programs may inform future work in establishing effective interventions suited for different subsets of the stroke population.