Background: People with stroke often have low cardiorespiratory fitness, hindering daily activities and rehabilitation participation. Cardiorespiratory exercise (CRE) early post-stroke can improve fitness, facilitating participation in rehabilitation, and may promote neuroplasticity. This longitudinal observational study aimed to determine the effect of CRE during routine inpatient stroke rehabilitation on motor and cognitive function, functional ambulation, and motor impairment. Methods: Data were collected from charts of patients (n=504) admitted to two rehabilitation hospitals in Ontario, Canada, over 14 month periods. Patients were classified into three groups: 'Prescribed', 'Incidental', or no cardiorespiratory exercise ('None'). Functional independence Measure (FIM), Functional Ambulation Category (FAC), and Chedoke-McMaster Stroke Assessment (CMSA) scores were compared between groups at discharge from rehabilitation, controlling for age, length of stay, and scores at baseline. Results: Patients who had cardiorespiratory exercise included in their treatment plan (i.e., Prescribed group) had higher FIM total and motor sub-scores at discharge than the None group (Site A; FIM total mean between-group difference: 13.2, p<0.0001; FIM motor mean between-group difference: 13.1, p<0.0001), or than those that completed cardiorespiratory exercise without a prescription ('Incidental' group; Site B; FIM Total mean between-group difference: 13.6, p=0.031; FIM motor mean between-group difference: 12.9, p=0.010). At both sites, FIM cognitive sub-scores and CMSA leg scores were higher at discharge for the Prescribed group than the None group (FIM cognitive mean between-group difference: 1.2, p=0.038; CMSA leg mean between-group difference: 0.5, p=0.0099). FAC scores were higher at discharge for the two exercise groups compared to the group that did not complete cardiorespiratory exercise at Site A only (p=0.0010). Conclusions: Findings support that cardiorespiratory exercise as part of routine in-patient rehabilitation early post-stroke is associated with improved functional independence and ambulation. However, the observational design limits causal inferences, highlighting the need for controlled studies to confirm cardiorespiratory exercise benefits in early stroke recovery.

The authors have declared no competing interest.

This study is not a clinical trial.

This study was supported by the Canadian Institutes of Health Research (PJT-173472). Sarah Thompson was supported by an Undergraduate Grant from the Branch Out Neurological Foundation.

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The study was approved by the research ethics boards of both sites (University Health Network protocol number: 20-5695, Sunnybrook Research Institute protocol number: 3605).

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