Cardiorespiratory Fitness and the Risk for Stroke in Men
Research Institute of Public Health, University of Kuopio, Kuopio, Finland. Archives of Internal Medicine
(Impact Factor: 17.33).
07/2003; 163(14):1682-8. DOI: 10.1001/archinte.163.14.1682
Low cardiorespiratory fitness is considered to be a major public health problem. We examined the relationship of cardiorespiratory fitness, as indicated by maximum oxygen consumption VO(2)max with subsequent incidence of stroke. We also compared VO(2)max with conventional risk factors as a predictor for future strokes.
Population-based cohort study with an average follow-up of 11 years from Kuopio and surrounding communities of eastern Finland. Of 2011 men with no stroke or pulmonary disease at baseline who participated in the study, 110 strokes occurred, of which 87 were ischemic. The VO(2)max was measured directly during exercise testing at baseline.
The relative risk for any stroke in unfit men VO(2)max, <25.2 mL/kg per minute) was 3.2 (95% confidence interval [CI], 1.71-6.12; P<.001; P<.001 for the trend across the quartiles); and for ischemic stroke, 3.50 (95% CI, 1.66-7.41; P =.001; P<.001 for trend across the quartiles), compared with fit men VO(2)max, >35.3 mL/kg per minute), after adjusting for age and examination year. The associations remained statistically significant after further adjustment for smoking, alcohol consumption, socioeconomic status, energy expenditure of physical activity, prevalent coronary heart disease, diabetes, systolic blood pressure, and serum low-density lipoprotein cholesterol level for any strokes or ischemic strokes. Low cardiorespiratory fitness was comparable with systolic blood pressure, obesity, alcohol consumption, smoking, and serum low-density lipoprotein cholesterol level as a risk factor for stroke.
Our findings show that low cardiorespiratory fitness was associated with an increased risk for any stroke and ischemic stroke. The VO(2)max was one of the strongest predictors of stroke, comparable with other modifiable risk factors.
Available from: Byron W Lai
- "Prolonged inactivity can increase the risk for secondary complications, such as cardiovascular disease, metabolic syndrome, muscular atrophy, osteoporosis and type-II diabetes (Ramnemark et al., 1999; Ryan et al., 2002; Pang et al., 2005; Hamilton et al., 2007). In addition, the risk of recurrent stroke is significantly increased by having a compromised cardiovascular capacity with an inactive lifestyle in people post-stroke (Kurl et al., 2003). Rosamond et al. (2008) reported 13% of men and 22% of women who have had a stroke can be at high risk for a recurrent stroke within 5 years. "
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ABSTRACT: This study aimed to compare the cardiorespiratory responses between aquatic treadmill walking (ATW) and overground treadmill walking (OTW) in people with hemiparesis post-stroke.
Eight participants post-stroke aged 58.5 ± 11.4 years and eight healthy adult controls aged 56.1 ± 8.6 years participated in a cross-sectional comparative study. Participants completed three 8-minute walking sessions separated by at least 72-hour rest. On the first visit, participants identified their comfortable walking speed on an aquatic and overground treadmill. The second and third visit consisted of either ATW or OTW at a matched speed. Oxygen consumption (VO2 ), carbon dioxide production (VCO2 ), minute ventilation (VE ) and energy expenditure (EE) were measured at rest and during walking in both exercise modes.
Mean steady-state cardiorespiratory responses during ATW showed a significant decrease compared with OTW at a matched speed. During ATW, mean VO2 values decreased by 39% in the stroke group and 21% in the control group, mean VCO2 values decreased by 42% in the stroke group and 30% in the control group, and mean EE decreased by 40% in the stroke group and 25% in the control group. Mean steady-state VE values and resting cardiorespiratory response values showed no significant change between the two conditions.
This study demonstrated a decreased metabolic cost when ATW at matched speeds to that of OTW. Reduced metabolic cost during ATW may allow for longer durations of treadmill-induced gait training compared with OTW for improved outcomes. This knowledge may aid clinicians when prescribing aquatic treadmill exercise for people post-stroke with goals of improving gait and functional mobility. However, decreased metabolic cost during ATW suggests that to improve cardiovascular fitness, ATW may not be a time-efficient method of cardiovascular exercise for healthy adults and people post-stroke. Copyright © 2013 John Wiley & Sons, Ltd.
Available from: Antti M Kiviniemi
- "Regular physical activity and good physical fitness are widely accepted as factors that reduce all-cause mortality and improve a number of health outcomes (Kesäniemi et al., 2001; Kurl et al., 2003; Laukkanen et al., 2004; LaMonte et al., 2005). A study of Myers et al. (2002) showed that low maximal aerobic capacity is closely related to an increase of untoward cardiac events. "
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ABSTRACT: Purpose: Individual responses to aerobic training vary from almost none to a 40% increase in aerobic fitness in healthy subjects. We hypothesized that the baseline self-rated mental stress may influence to the training response. Methods: The study population included 44 healthy sedentary subjects (22 women) and 14 controls. The laboratory controlled training period was 2 weeks, including five sessions a week at an intensity of 75% of the maximum heart rate for 40 min/session. Self-rated mental stress was assessed by inquiry prior to the training period from 1 (low psychological resources and a lot of stressors in my life) to 10 (high psychological resources and no stressors in my life), respectively. Results: Mean peak oxygen uptake [Formula: see text] increased from 34 ± 7 to 37 ± 7 ml kg(-1) min(-1) in training group (p < 0.001) and did not change in control group (from 34 ± 7 to 34 ± 7 ml kg(-1) min(-1)). Among the training group, the self-rated stress at the baseline condition correlated with the change in fitness after training intervention, e.g., with the change in maximal power (r = 0.45, p = 0.002, W/kg) and with the change in [Formula: see text] (r = 0.32, p = 0.039, ml kg(-1) min(-1)). The self-rated stress at the baseline correlated with the change in fitness in both female and male, e.g., r = 0.44, p = 0.039 and r = 0.43, p = 0.045 for ΔW/kg in female and male, respectively. Conclusion: As a novel finding the baseline self-rated mental stress is associated with the individual training response among healthy females and males after highly controlled aerobic training intervention. The changes in fitness were very low or absent in the subjects who experience their psychological resources low and a lot of stressors in their life at the beginning of aerobic training intervention.
Available from: Elizabeth Dean
- "Therefore, despite our knowledge and considerable understanding of its etiology, stroke risk and other risks associated with hypertension are far from being well controlled; hence, hypertension remains a major but preventable health threat to many people. Risk factors for stroke include previous stroke, hypertension, IHD, atrial fibrillation, hyperlipidemia, diabetes , abnormal ankle-to-brachial pressure index, reduced exercise endurance, retinopathy, albuminuria, autonomic neuropathy, smoking, alcohol consumption, and lack of exercise (Cohen et al, 2003; Hart and Halperin, 1999; Kirschner, 2003; Kurl et al, 2003; Kurth et al, 2003). Walking as little as 2 hours a week can reduce stroke risk by 50% (Costa, 2002). "
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ABSTRACT: Part II of this two-part introduction to this Special Issue on physical therapy practice in the 21st century outlines a health-focused strategy for physical therapists to lead in the assault on lifestyle conditions, global health care priorities, described in Part I. Consistent with contemporary definitions of physical therapy, its practice, professional education, and research, physical therapy needs to reflect 21st-century health priorities and be aligned with global and regional public health strategies. A proposed focus on health emphasizes clinical competencies, including assessments of health, lifestyle health behaviors, and lifestyle risk factors; and the prescription of interventions to promote health and well-being in every client or patient. Such an approach is aimed to increase the threshold for chronic conditions over the life cycle and reduce their rate of progression, thereby preventing, delaying, or minimizing the severity of illness and disability. The 21st-century physical therapist needs to be able to practice such competencies within the context of a culturally diverse society to effect positive health behavior change. The physical therapist is uniquely positioned to lead in health promotion and prevention of the lifestyle conditions, address many of their causes, as well as manage these conditions. Physical therapists need to impact health globally through public and social health policy as well as one-on-one care. This role is consistent with contemporary definitions of physical therapy as the quintessential noninvasive health care practitioner, and the established efficacy and often superiority of lifestyle and lifestyle change on health outcomes compared with invasive interventions, namely, drugs and surgery. A concerted commitment by physical therapists to health and well-being and reduced health risk is consistent with minimizing the substantial social and economic burdens of lifestyle conditions globally.
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