Assessing Training Intensity During Physical Therapy Sessions for Subacute Stroke Patients in Rehabilitation: Initial Phase of a Multi-Stage Implementation Program.

The long term goal of this study is to Implement a multi- stage program of aerobic training for subacute persons with stroke hospitalized in rehabilitation. The specific objectives were: 1) To characterize the intensity (in terms of % of Heart rate reserve, HHR) of routine physical therapy sessions for subacute PwS hospitalized in a rehabilitation setting, 2) To assess physical therapists’ level of knowledge and self-efficacy regarding aerobic walking training before their participation in the implementation process.

Persons with stroke (PwS), hospitalized at Loewenstein Rehabilitation Medical Center, Israel, wore heart rate monitors during routine physical therapy sessions for five consecutive days. For each patient, the 40% heart rate reserve (HHR) was calculated. The following parameters were then extracted for each training session: average heart rate, maximum heart rate, time spent in the target heart rate zone, and the longest period spent in the target heart rate zone. Additionally, PwS rated the level of perceived exertion on the modified Borg scale (0-10), at the end of each session. Also, physical therapists were asked to complete a questionnaire assessing their knowledge and self-efficacy regarding aerobic training, rated on a 1-5 scale.

 Twenty PwS (16 males, age: 54±11.3 years, time after stroke onset: 45±14.8 days, 6-minute walk test distance: 327.3±128.1 meters) were monitored, with an average session monitoring time of 36.2±11.2 minutes. No significant differences were found between sessions for all heart rate measures. The mean heart rate, expressed as a percentage of HHR, was 81.7±10.2% and the maximum heart rate achieved during training was 98.7±12.0%. The total time PwS spent at their maximum heart rate was 6.39±5.5 seconds. The mean Borg scale score was 4.85±2.5. 46 physical therapists responded to the questionnaire. The mean knowledge level regarding aerobic training was 2.8±1.0, and the mean self-efficacy score was 3.1±0.2. 

The results demonstrate that the intensity of routine physical therapy sessions is lower than 40% HRR and the period spent in the target heart rate zone was very short. Physical therapists rated their knowledge and self-efficacy regarding aerobic training as low-moderate.   

Bridging the gap between training intensity recommendations and clinical practice of  PwS is important and requires a structured, multi-stage process.