Optimizing aerobic exercise testing to improve stroke recovery

New research from Michelle Legasto-Mulvale (MScPT ‘14, RSI PhD ‘24) examines the aerobic exercise testing practices of physiotherapists working with individuals undergoing in-patient stroke rehabilitation and highlights the barriers and facilitators to best practices.  

While we know that it is important for people who have experienced a stroke to participate in aerobic exercise as part of their recovery, Legasto-Mulvale's research finds that physiotherapists need more guidance and support to test patients’ readiness for aerobic exercise and to prescribe a safe and effective training program. 

This research was born out of Legasto-Mulvale's own experience working in an in-patient stroke rehabilitation setting. She says, “Despite aerobic exercise testing being a best practice, I noticed that it was something we had difficulty doing at my hospital. I thought there might be barriers to this practice that other hospitals faced, too.” 

Aerobic exercise testing is used to determine how a patient responds to aerobic exercise and to guide the prescription of an appropriate aerobic exercise training intensity by gradually increasing the intensity of an exercise, like cycling or walking, and monitoring the patient’s heart rate, blood pressure and rating of perceived exertion. 

“The physiotherapists we surveyed for this study all agree that aerobic exercise is important for post-stroke recovery. However, the majority also report lacking the skills, knowledge, confidence and resources to perform aerobic exercise testing and to use its results to guide prescription,” says Legasto-Mulvale. 

Poor cardiovascular fitness is one of the main risk factors for cardiovascular disease and stroke. Ensuring post-stroke patients are exercising at an intensity that will improve their cardiovascular fitness will help minimize the risk for further cardiovascular events, including stroke. 

“As physiotherapists, we are seen as experts in balance, mobility, and functional recovery. But we are also experts in aerobic exercise and cardiovascular fitness,” notes Legasto-Mulvale. “In-patient stroke rehabilitation programs – where patients are with us for up to a month – are a unique opportunity for us to get individuals recovering from stroke in the habit of adding aerobic exercise to their routine.” 

Legasto-Mulvale hopes these findings will lead to policy changes that will give physiotherapists more guidelines, resources, and organizational support for aerobic exercise testing. She adds, “In-patient stroke rehabilitation is a busy practice setting with many competing priorities. We know this is a best practice, but it is clear physiotherapists are not well-supported to do the testing. If we want to shift towards preventative medicine, healthcare policies need to better reflect the importance of aerobic exercise testing and training post-stroke. Organizations need to provide physiotherapists with the necessary training and resources so they can better address cardiovascular health and fitness during stroke rehabilitation.” 

Legasto-Mulvale currently works as a physiotherapist at St. John’s Rehab Hospital and as the study coordinator for the TIMETM at Home trial. She also teaches physical therapy students in Unit 4 in the department of physical therapy. She recently completed her PhD post-graduate studies in the Rehabilitation Sciences Institute and successfully defended her thesis in January 2024 under the supervision of Nancy Salbach, a professor in the department of physical therapy, and thesis committee members Elizabeth Inness and Crystal MacKay.