Cardiovascular Response to Physical Therapy in Stroke Rehabilitation ^{1 2}

Heart disease is a frequent concomitant to stroke. This study was designed to determine the utility of a noninvasive, continuous, dynamic cardiovascular monitoring procedure to evaluate 106 stroke patients during physical therapy, and to provide information from which to determine the cardiovascular response of stroke patients to physical therapy activities. A history of cardiac disease was present in 88% of the patients, and resting electrocardiographic changes were present in 83%. During the physical therapy session, significant increases were noted in mean heart rate (from 82 to 110 beats/min), blood pressure (from 129/76 to 146/81 mm Hg), and rate-pressure product (from 10,699 to 12,528). Stair climbing, walking, stationary bicycle riding, and kneeling activities had the greatest effects on heart rate response. More than one-half of the patients demonstrated abnormalities of heart rate, rhythm, blood pressure, or electrocardiographic response during therapy. Patients with congestive heart failure were significantly more likely to demonstrate these abnormalities than were those without congestive heart failure. Some patients underwent changes in their medical and rehabilitation regimens based on results of the procedure. The technique used in this study is a simple, safe, and noninvasive method that can provide useful information about the cardiovascular effects of specific functional activities in patients with stroke.