Cardiorespiratory training after stroke or transient ischemic attack in the United Kingdom: a national survey

Abstract Objective To assess the current provision and beliefs regarding benefits and risks, barriers, and potential future service models of cardiorespiratory training after stroke and transient ischaemic attack (TIA) in the United Kingdom. Methods An online survey of physiotherapists and exercise professionals working in stroke or cardiac rehabilitation. Results The 253 respondents were separated into groups, Group 1: those integrating cardiorespiratory training into routine stroke rehabilitation (n=113); Group 2: those in specialist cardiorespiratory services including people after stroke or TIA (n=40); Group 3: those in stroke rehabilitation not integrating cardiorespiratory training (n=74); Group 4: those in specialist cardiorespiratory services not seeing people after stroke or TIA (n=26). Delivery of cardiorespiratory training varied in frequency and duration of supervised sessions, and people with minimal disability may be more likely to receive cardiorespiratory training. Identified stroke-specific risk factors for cardiorespiratory training varied both in the factors identified, and whether they were considered precautions or contraindications. The most frequently identified concerns were risk of serious adverse events, fatigue, and falls. The most common barriers to delivering cardiorespiratory training included commissioning of services, resources, skills and knowledge, and a lack of guidelines. Conclusions Most respondents reported providing cardiorespiratory training after stroke or TIA, though many people who have a stroke or TIA may not receive this training. The results highlight a potential inequality where people with greater disability may be less likely to receive or be eligible for cardiorespiratory training. There are many factors making cardiorespiratory training a complex challenge to deliver in clinical practice.