Abstract
Objective: To investigate the immediate effects (before, during, and after exercise) of bed-based rehabilitation exercises on blood pressure and heart rate in patients with acute ischemic stroke prescribed early rehabilitation at the bedside. This study also preliminarily explores factors related to changes in blood pressure and heart rate in stroke patients undergoing early rehabilitation.
Subjects and methods: This cross-sectional descriptive study included patients diagnosed with acute ischemic stroke treated at the Cardiology Institute, Bach Mai Hospital, from March 2023 to March 2024. Clinical and paraclinical characteristics were recorded for all patients, who then underwent early bedside rehabilitation exercises to evaluate the impact of these exercises on variations in blood pressure and heart rate.
Results: Most stroke patients started rehabilitation relatively early, mostly on day 2 and day 3 (60% and 24%, respectively). The first session mainly consisted of passive bed mobility exercises (60.5%), while the second session combined passive and active exercises (57.9%). The duration of the second rehabilitation session was significantly longer than the first (46±11.2 minutes vs. 35±7.2 minutes). During early bedside rehabilitation, heart rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP) gradually increased, reaching a peak immediately post-exercise, then steadily decreased to near pre-exercise values. Pre-exercise SBP before session 2 was 2 mmHg lower compared to session 1 (p=0.4). Pre-exercise heart rate and DBP did not change between sessions. Five patients (13%) had to stop exercising mid-session due to criteria such as blood pressure ≥ 180 mmHg, heart rate ≥ 110 beats per minute, chest pain, or shortness of breath. Pre-exercise heart rate and SBP were positively correlated with post-exercise heart rate and SBP. Univariate regression analysis showed that post-exercise heart rate was influenced by pre-exercise heart rate (p < 0.001); post-exercise SBP was affected by pre-exercise heart rate, history of hypertension, history of coronary artery disease, and the number of heart rate-lowering medications (p < 0.05); post-exercise DBP was influenced by history of hypertension and the Rankin score (p < 0.05).
Conclusion: Early bedside rehabilitation is an effective and safe supportive treatment for patients with acute stroke. Further research is needed to explore the effects of early rehabilitation exercises on cardiovascular health, which will help develop guidelines and design rehabilitation programs tailored to individual patients.