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Physical fitness in persons with hemiparetic stroke: its structure and longitudinal changes during an inpatient rehabilitation programme

Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo and Department of Rehabilitation Medicine, Shizuoka Cancer Center Hospital and Research Institute, Tokyo

Meigen Liu

Kimitaka Hase

Yoshihisa Masakado

Hidetoshi Takahashi

Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo

Yukihiro Hara

Department of Rehabilitation Medicine, Nippon Medical School, Chiba Hokusoh Hospital, Chiba

Naoichi Chino

Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan

Objective: To test the hypothesis that the structure of fitness in patients with hemiparetic stroke can be categorized into impairment/disability, cardiopulmonary, muscular and metabolic domains, and to study longitudinal changes in their fitness during an inpatient rehabilitation programme.

Design: Structure analysis of multiple fitness parameters with principlal component analysis (PCA), and a before and after trial.

Setting: Tertiary rehabilitation centre in Japan.

Patients: One hundred and seven consecutive inpatients with hemiparetic stroke.

Intervention: A conventional stroke rehabilitation programme consisting of 80 minutes of physical therapy and occupational therapy sessions five days a week, and daily rehabilitation nursing for a median duration of 105.5 days.

Main outcome measures: Principal component scores extracted from measurement of paresis/daily living (the Stroke Impairment Assessment Set (SIAS) and the Functional Independence Measure (FIM)); muscular (grip strength (GS), knee extensor torque, and cross-sectional areas of thigh muscles); metabolic (body mass index (BMI) and fat accumulation on CT); cardiopulmonary (heart rate oxygen coefficient (HR-O₂-Coeff) obtained with a graded bridging activity and a 12-minute propulsion distance).

Results: PCA categorized the original 15 variables into four factors corresponding to paresis/activities of daily living, muscular, metabolic and cardiopulmonary domains, and explained 78.1% of the total variance at admission and 69.6% at discharge. Except the metabolic domain, PCA scores for the other three domains improved significantly at discharge (paired t-test, p B=0.05).

Conclusion: The hypothetical structure of fitness was confirmed, and the PCA scores were useful in following longitudinal changes of fitness during inpatient rehabilitation.

Clinical Rehabilitation, Vol. 18, No. 4, 450-460 (2004)
DOI: 10.1191/0269215504cr717oa


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