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Purpose: Telerehabilitation is emerging as a means for delivering stroke rehabilitation to address unmet lower extremity rehabilitation needs. However, there is currently limited and low-quality evidence supporting the use telerehabilitation interventions for lower extremity recovery after stroke. Thus, we developed an exercise-based telerehabilitation program (TRAIL) for safe and effective promotion of lower extremity function after stroke. This study reports on the qualitative findings from the feasibility study of the TRAIL program. Methods: An interpretive description methodology and inductive thematic analysis approach were undertaken. One-on-one semi-structured interviews were conducted on a subset of participants who completed the TRAIL feasibility study. Participants were recruited via email and enrolled into the study based on pre-determined purposeful sampling strategies. Results: Ten participants (6 men, 4 women) completed a semi-structured interview. Two main themes emerged: (i) TRAIL ingredients for success and (ii) telerehabilitation is a viable option for stroke rehabilitation. Conclusion: Exercise-based telerehabilitation appears to be well-received by men and women post-stroke when social support, professional guidance, and program resources are offered. TRAIL may also prolong the continuum of care that individuals receive once they are discharged back into the community, and contribute to improvements in mobility, lower extremity strength and balance. IMPLICATIONS FOR REHABILITATION: Exercise-based telerehabilitation for individuals with stroke can be delivered safely when clinicians are trained, and social support and program resources are available. Exercise-based telerehabilitation may be viable and accessible for men and women with stroke to extend the opportunity for rehabilitation services within the first year post-event. Synchronously delivered telerehabilitation programs using user-friendly videoconference software is recommended for optimal participant satisfaction. [ABSTRACT FROM AUTHOR]

Background: Balance self-efficacy is a strong predictor of fall risk after stroke and is related to performance on balance and walking tests. The use of telerehabilitation for delivering stroke rehabilitation has increased in recent years and there is a need to adapt common clinical assessments to be administered in virtual formats, but the association between balance self-efficacy and virtually administered clinical tests of balance performance has yet to be established. This study examined the association between the Activities-specific Balance Confidence (ABC) Scale and virtually administered Timed Up and Go (TUG), Tandem Stand, and Functional Reach tests (FRT) in individuals with stroke. Methods: This was a secondary analysis of baseline data from two telerehabilitation trials with individuals with stroke. All assessments were administered by trained physical therapists through videoconferencing software. Multivariate regression analyses were used to examine the associations between the ABC scale and TUG test, Tandem Stand test, and FRT, adjusted for age and number of comorbidities. Results: Data from 51 participants (n = 11 female, median age = 64 [IQR: 18] years, 9.3 ± 4.6 months poststroke) were analyzed. The ABC scores were associated with TUG (R2 = 0.56, F(3,47) = 20.26, p < 0.01), but not Tandem Stand (R2 = 0.18, F(5,45) = 1.93, p = 0.11) or FRT (R2 = 0.14, F(3,47) = 2.55, p = 0.07) tests. Conclusion: We observed associations between the ABC scores and virtual TUG, but not with Tandem Stand or FRT, which may be attributed to the context-specificity of balance self-efficacy. As virtual administration of outcomes assessments becomes part of common practice in stroke rehabilitation, our study supports the use of virtually administered TUG in stroke. [ABSTRACT FROM AUTHOR]

Emerging evidence suggests that sex-and gender-based factors may influence responses to exercise post-stroke. The Sex and Gender Equity in Research (SAGER) guidelines (2016) published international standards for terminology and considerations for research design and trial reporting. The extent to which sex- and gender-based considerations have been implemented in stroke exercise trials is currently unknown. The objective of this cross-sectional study was to compare the proportion of studies that have implemented sex/gender considerations before and after the publication of the SAGER guidelines. We conducted a comprehensive search of the literature to identify exercise-based trials in individuals with stroke. Study titles, abstracts, introductions (hypothesis statements), methods, results and discussions were assessed for adherence to the SAGER guidelines. The proportion of studies adhering to SAGER guidelines published prior to and including December 31, 2016 and from 2017-March 2023 were compared. Of the 245 studies identified, 150 were published before December 31, 2016, of which 0 (0%) titles/abstracts, 0 (0%) introductions, 21 (14.0%) methods, 8 (5.3%) results, and 7 (4.7%) discussion sections adhered to the SAGER guidelines, and 35 (23.3%) reported proper sex and gender terminology. Of the 95 studies published between 2017–2023, 0 (0%) title/abstracts, 1 (1.0%) introduction, 16 (16.8%) methods, 5 (5.3%) results, and 10 (10.5%) discussion sections adhered to the guidelines, and 37 (38.9%) of studies included proper terminology. The implementation of sex- and gender-based considerations in stroke exercise trials is low, but positively the reporting of proper terminology has increased since the publication of standardized reporting guidelines. This study serves as a call to action for stroke rehabilitation researchers to incorporate sex- and gender-based considerations in all stages of research studies, to improve the rigour and generalizability of findings, and promote health equity. [ABSTRACT FROM AUTHOR]

Background and Purpose: The international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool is a new instrument developed to evaluate the therapeutic quality of exercise interventions. Home-based exercise has been shown to improve physical fitness in older adults, but its effects may be influenced by therapeutic quality. The purpose of this systematic review was to describe the therapeutic quality of home-based exercise interventions for community-dwelling older adults and examine the relationship between therapeutic quality and changes in physical fitness. Methods: Six electronic databases and 2 clinical trial registries were searched for randomized controlled trials investigating the effects of home-based exercise on physical fitness in community- dwelling older adults (≥60 years). Therapeutic quality was evaluated using the i-CONTENT tool for items of patient selection, type of exercise, safety, type/timing of outcomes, exercise dose, and adherence. International Consensus on Therapeutic Exercise aNd Training items were used to explain heterogeneity in meta-regression analyses. Risk of bias, certainty of evidence and credibility of analyses were assessed. Results: Thirty-six trials (n = 6157 participants) were identified. Most studies (≥66.7%) had high or probably high therapeutic quality for i-CONTENT items, except exercise dose (47.2%) and adherence (16.7%). Interventions improved upper- (N = 20 trials; standardized mean difference [SMD] = 0.39; 95% CI, 0.13-0.64; low certainty of evidence) and lower-body strength (N = 28; SMD = 0.42; 95% CI, 0.08-0.77; very low certainty), and aerobic fitness (N = 8; SMD = 0.42; 95% CI, 0.08-0.77; very low certainty). For exercise dose, low- or probably low-quality studies negatively influenced effects on upper- (estimated β = -.48; P = .049; moderate credibility) and lower-body strength (estimated β = -.77; P = .048; moderate credibility). For adherence, low- or probably low-quality studies negatively influenced effects on aerobic fitness (estimated β = -.97; P = .02; low credibility). Conclusions: Home-based exercise may improve upper- and lower-body strength, as well as aerobic fitness in older adults. However, the effectiveness of interventions is affected by inadequate dosing of exercise programs and adherence issues. Physical therapists should have the best available evidence to support their clinical decision making, especially when designing and monitoring home programs. [ABSTRACT FROM AUTHOR]

Virtual reality (VR) are user-computer interface platforms that implement real-time simulation of an activity or environment, allowing user interaction via multiple sensory modalities. VR therapy may be an effective intervention for improving cognitive function following stroke. The aim of this systematic review was to examine the effectiveness of exercise-based VR therapy on cognition post-stroke. Electronic databases were searched for terms related to "stroke", "virtual reality", "exercise" and "cognition". Studies were included if they: (1) were randomized-controlled trials; (2) included VR-based interventions; (3) included individuals with stroke; and (4) included outcome measures related to cognitive function. Data from included studies were synthesised qualitatively and where possible, random effects meta-analyses were performed. Eight studies involving 196 participants were included in the review, of which five were included in meta-analyses (n = 124 participants). Studies varied in terms of type (combination of VR therapy and conventional therapy, combination of VR therapy and computer-based cognitive training, VR therapy alone) and duration of interventions (20–180 min), sample size (n = 12–42), length of the interventions (4–8 weeks), and cognitive outcomes examined. VR therapy was not more effective than control for improving global cognition (n = 5, SMD = 0.24, 95%CI:−0.30,0.78, p =.38), memory (n = 2 studies, SMD= 0.00, 95%CI: −0.58, 0.59, p =.99), attention (n = 2 studies, MD = 8.90, 95%CI: −27.89, 45.70, p =.64) or language (n = 2 studies, SMD = 0.56, 95%CI: −0.08,1.21, p =.09). VR therapy was not superior to control interventions in improving cognition in individuals with stroke. Future research should include high-quality and adequately powered trials examining the impact of virtual reality therapy on cognition post-stroke. Virtual reality therapy is a promising new form of technology that has been shown to increase patient satisfaction towards stroke rehabilitation. Virtual reality therapy has the added benefits of providing instant feedback, and the difficulty can be easily modified, underscoring the user-friendliness of this form of rehabilitation. Virtual reality therapy has the potential to improve various motor, cognitive and physical deficits following stroke, highlighting its usefulness in rehabilitation settings. [ABSTRACT FROM AUTHOR]

The aim of this systematic review was to investigate if sex moderated the effect of exercise on cognition in adults post-stroke. A systematic review was conducted of randomized controlled trials that involved adults ≥18 years with stroke, any exercise intervention, and reported any outcome related to cognitive function. We compared effect sizes of cognitive outcomes between studies of lower and higher proportion of females (CRD42018092757). The effects of exercise did not differ between studies of higher and lower female proportions with respect to memory (χ2 =1.52, p = 0.22), executive function (χ2 = 0.56, p = 0.45; Chi2 = 0.00, p = 0.98), language (Chi2 = 3.17, p = 0.08) or global cognition (χ2 = 0.88, p = 0.35). There were no sex differences in the effects of exercise on memory, executive functioning, language or global cognition in individuals with stroke. Further research is warranted to address sex differences in individuals with stroke to enable better targeting, prevention, and interventions in stroke rehabilitation. Understanding sex differences and potentially similarities in the relationship between exercise and cognition is an important step in enhancing stroke rehabilitation and the development of optimal, sex-specific rehabilitation. Although our findings suggest that there is no clear rationale for incorporating sex into our clinical decision making, it is still imperative to consider sex factors in research and report results in the literature disaggregated by sex to help inform clinical practice. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: To identify sex- and gender-based variables associated with immediate and delayed recall in individuals with stroke., Design: This was a secondary analysis of data from the National Health and Aging Trends Study (NHATS) using general linear models with a standard stepwise approach., Setting: Community INTERVENTIONS: Not Applicable PARTICIPANTS: Participants were eligible for the current analysis if they had a self-reported history of stroke at NHATS Round 1 (2011), and data available on our variables of interest. The final analyses included 366 participants for the immediate recall model and 365 participants for the delayed recall model., Main Outcome Measures: Independent variables of interested included sex- (eight variables, for example biological sex, depression and anxiety, and comorbidities) and gender-related factors (fourteen variables, for example education, income, independence with banking). The dependent variables of interest were the 10-word immediate and delayed recall tests, respectively., Results: Higher immediate recall scores were associated with younger age, female biological sex, independence with banking, higher income, giving financial gifts, not requiring assistance with ADLs, and higher education (p<0.001-0.04). Higher delayed recall scores were associated with younger age, higher BMI, higher education, placing importance in socializing, and independence with banking (p<0.001-0.04)., Conclusion: We conducted the largest analysis to date of sex- and gender-based factors associated with cognition in individuals with stroke. Stroke rehabilitation scientists and clinicians may consider both biological and sociodemographic factors associated with cognitive function, which may guide holistic post-stroke assessments and interventions., Competing Interests: Declaration of competing interest The authors have no conflicts of interests to declare., (Copyright © 2024. Published by Elsevier Inc.)

Objective: To examine the effects of strength training on patient-important outcomes of stroke recovery and to quantify the influence of the exercise prescription on treatment effects., Design: Systematic review and meta-analysis., Data Sources: Eight electronic databases (MEDLINE, EMBASE, EMCARE, AMED, PsycINFO, CINAHL, SPORTDiscus, and Web of Science) and two clinical trial registries (ClinicalTrials.gov and WHO International Clinical Trials Registry Platform) were searched from inception to 19 June 2024., Eligibility Criteria: Randomised controlled trials were eligible if they examined the effects of strength training compared with no exercise or usual care and reported at least one exercise prescription parameter. An advisory group of community members with lived experience of stroke helped inform outcomes most relevant to stroke recovery., Results: Forty-two randomised trials (N=2204) were included. Overall risk of bias was high across most outcomes. Strength training improved outcomes rated as 'critical for decision-making' by the advisory group, including walking capacity (standardised mean difference (SMD)=0.95 (95% CI 0.34-1.56)), balance (SMD=1.13 (0.51-1.75)), functional ability and mobility (SMD=0.61 (0.09-1.14)), and habitual (mean difference (MD)=0.05 m/s (0.02-0.09)) and fast-paced walking speed (MD=0.09 m/s (0.01-0.17)), with very low to moderate certainty of evidence, mainly due to risk of bias and inconsistency. More frequent strength training, traditional strength training programmes and power-focused intensities (ie, emphasis on movement velocity) were positively associated with walking capacity, health-related quality of life and fast-paced walking speed., Conclusion: Strength training alone or combined with usual care improves stroke recovery outcomes that are important for decision-making. More frequent strength training, power-focused intensities and traditional programme designs may best support stroke recovery., Prospero Registration Number: CRD42023414077., Competing Interests: Competing interests: SMP reports grants or contracts currently held or in the last 5 years from the US National Dairy Council, Dairy Farmers of Canada, Roquette Freres, Nestle Health Sciences, National Science and Engineering Research Council, Canadian Institutes for Health Research and the US NIH during the conduct of the study; personal fees from US National Dairy Council, non-financial support from Enhanced Recovery, outside the submitted work. In addition, SMP has a patent Canadian and US patents assigned to Exerkine, but reports no financial gains from any patent or related work. KSN is supported by an Ontario Graduate Scholarship and the McMaster Collaborative for Health and Aging Trainee Engagement Fund. The Trainee Engagement Fund provided financial support for the community advisory group of people with lived experience. There was no other specific funding for this work. KM is supported by an Ontario Graduate Scholarship. EW is supported by MIRA and AGEWELL NCE Inc., a member of the Networks of Centres of Excellence programme. EH was supported by a Canadian Institute for Health Research-Masters (CIHR CGSM) Scholarship. GMB is jointly funded by the Canadian Institutes of Health Research and Michael Smith Health Research BC. MKB and SMP are supported by the Canada Research Chairs Program. AT was supported by a Clinician-Scientist Award (Phase II) from the Ontario Heart and Stroke Foundation (P-19-TA-1192)., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: After menopause, reductions in ovarian hormones increase the risk of cardiovascular disease. Aerobic exercise training has been shown to reduce cardiovascular risk in older adults, but its effectiveness in postmenopausal females is less definitive., Objectives: The objectives of this study were to examine the: (1) effects of aerobic training, and (2) association between aerobic training intensity and cardiometabolic health outcomes in postmenopausal females., Design: Systematic review and meta-analysis of randomized controlled trials., Data Sources and Methods: Six electronic databases were searched from inception to July 21, 2023 for aerobic training interventions reporting cardiometabolic outcomes in postmenopausal females. Data were synthesized qualitatively and random-effects meta-analyses and subgroup analyses (light, moderate, and vigorous intensity) were performed. Grading of Recommendations, Assessment, Development and Evaluation was used to assess the certainty of evidence., Results: Fifty-nine studies ( n  = 4,225; 45-78 years old) were identified, 53 ( n  = 3,821) were included in the quantitative analyses. Aerobic training interventions varied in frequency (3-21×/week), intensity, type, time (8-60 min/session), and duration (3-52 weeks). Aerobic training improved systolic blood pressure (mean difference (MD) = -4.41 mmHg, 95% confidence interval (95%CI) [-7.29, -1.52], p  = 0.01), resting heart rate (MD = -3.08 bpm, 95%CI [-5.11, -1.05], p  < 0.01), body mass index (BMI, MD = -0.65 kg/m 2 , 95%CI [-0.99, -0.31], p  < 0.01), waist circumference (MD = -2.03 cm, 95%CI [-2.65, -1.41], p  < 0.01), body fat (MD = -2.57 kg, 95%CI [-3.65, -1.49], p  < 0.01), low-density lipoprotein cholesterol (MD = -10.46 mg/dL, 95%CI [-16.31, -4.61], p  < 0.01), high-density lipoprotein cholesterol (MD = 3.28 mg/dL, 95%CI [0.20, 6.36], p  = 0.04) and cardiorespiratory fitness (standardized MD = 1.38, 95%CI [1.13, 1.64], p  < 0.01). There was a very low certainty of evidence for all outcomes. In subgroup analyses, light- and vigorous intensities were beneficial for BMI with no effect for moderate-intensity exercise ( p  < 0.01). Light intensity showed a beneficial effect ( p  = 0.02) for glucose levels ( p  < 0.01) and triglycerides; there was no effect with moderate or vigorous intensities., Conclusion: Aerobic training may improve cardiometabolic health outcomes in postmenopausal females. There may be differential effects of exercise intensity on BMI, blood triglycerides, and blood glucose; however, this warrants further investigation., Registration: PROSPERO-CRD42022313350.

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.