Mobilização muito Precoce após trombolise e exercícios intervalados de alta intensidade no tratamento do acidente vascular cerebral

Abstract

Introduction: Stroke is an acute impairment of the neurological system, which has a vascular origin and develops clinical signs due to disturbances in brain function, lasting more than 24 hours. With high prevalence and currently 90% of survivors develop sequelae, making it an important cause of disability in adults. Objective: To examine the effects of high-intensity interval training on functionality and health-related quality of life in patients with post-stroke sequelae and to assess the safety and efficacy of very early mobilization of thrombolyzed post-ischemic stroke patients on the degree of disability and dependence for activities of daily living, balance, functional mobility and complications within 7 days of hospitalization and 90 days after hospital discharge. Methodology: To examine the effects of high-intensity interval training on functionality and quality of life, a systematic review with meta-analysis was performed by searching the following electronic databases: MEDLINE/Pubmed, Cochrane Central Register of Controlled Trials, PEDro database and Scielo by January 2022 for randomized clinical trials investigating the effects of high-intensity interval training in post-stroke patients. Two reviewers independently selected the studies. Study quality was assessed using the PEDro scale. Mean difference (MD), standard mean difference (SMD) and 95% confidence intervals (CIs) were calculated. A randomized clinical trial was also performed comparing very early mobilization after thrombolysis and the usual care of patients with acute ischemic stroke in safety and functional recovery within 7 days of hospitalization and after 90 days of hospital discharge. Results: For the systematic review, nine studies met the study criteria (375 patients). The age of the participants ranged from 55.8 to 72.1 years. The studies ranged from patients within 2 weeks of stroke onset to patients with more than 1 month of stroke. High-intensity interval training resulted in improved cardiorespiratory fitness (peak oxygen consumption) MD (3.8 mL/kg/min, 95% CI: 2.62, 5.01, n=91), balance MD 5 .7 (95% CI: 3.50, 7.91; N = 64) and SMD gait speed (0.2 m/s; 95% CI: 0.05, 0.27; N = 100) in comparison with continuous aerobic training. Health-related quality of life did not differ between groups. Compared with usual care, high-intensity interval training improved SMD cardiorespiratory fitness (0.5 95% CI: 0.14, 0.81, n=239). No serious adverse events were observed. For the randomized clinical trial, a total of 104 patients with ischemic stroke who received thrombolytic treatment between August 2020 and July 2021 were prospectively recruited into the study. Of these, 51 patients received very early mobilization (VEMG) within 24 hours after the ictus and another 53 patients received usual care (UCG) with mobilization 24 hours after the ictus. When comparing the groups within 7 days of hospitalization and after 90 days of discharge, there were no differences in the degree of disability and dependence for activities of daily living (p= 0.44; p=0.15), balance (p=0 .17; p=0.27), functional mobility (p= 0.33; p=0.65), complications (p=0.55; p=0.56) and length of hospital stay (p=0. 69). Conclusion: High-intensity interval training was more efficient than continuous aerobic training for gaining cardiorespiratory fitness, balance and walking speed in patients with post-stroke sequelae and was not superior with regard to health-related quality of life. The very early mobilization strategy after thrombolysis in ischemic stroke was safe, but without evidence of short-term benefit.