Cardiovascular fitness is improved post-stroke with upper-limb Wii-based Movement Therapy but not dose-matched constraint therapy

Introduction: Post-stroke cardiovascular fitness is typically half that of healthy age-matched people. Cardiovascular deconditioning is a risk factor for recurrent stroke that may be overlooked during routine rehabilitation. This study investigated the cardiovascular responses of two upper limb rehabilitation protocols. Methods: Forty-six stroke patients completed a dose-matched program of Wii-based Movement Therapy ( WMT ) or modified Constraint-induced Movement Therapy ( mCIMT ). Heart rate and stepping were recorded during early ( day 2 )- and late ( day 12–14 )-therapy. Pre- and post-therapy motor assessments included the Wolf Motor Function Test and 6-min walk. Results: Upper limb motor function improved for both groups after therapy ( WMT p = 0.003, mCIMT p = 0.04 ). Relative peak heart rate increased from early- to late-therapy WMT by 33% ( p < 0.001 ) and heart rate recovery ( HRR ) time was 40% faster ( p = 0.04 ). Peak heart rate was higher and HRR faster during mCIMT than WMT, but neither measure changed during mCIMT. Stepping increased by 88% during Wii-tennis ( p < 0.001 ) and 21% during Wii-boxing ( p = 0.045 ) while mCIMT activities were predominantly sedentary. Six-min walk distances increased by 8% ( p = 0.001 ) and 4% ( p = 0.02 ) for WMT and mCIMT, respectively. Discussion: Cardiovascular benefits were evident after WMT as both a cardiovascular challenge and improved cardiovascular fitness. The peak heart rate gradient across WMT activities suggests this therapy can be further individualized to address cardiovascular needs. The mCIMT data suggest a cardiovascular stress response. Conclusions: This is the first study to demonstrate a cardiovascular benefit during specifically targeted upper limb rehabilitation. Thus, WMT not only improves upper limb motor function but also improves cardiovascular fitness.