Download PDF
neuroreha 2012; 4(04): 178-183
DOI: 10.1055/s-0032-1331359
Schwerpunkt Fitness
Georg Thieme Verlag KG Stuttgart · New York

Wichtig: Ausdauertraining nach Schlaganfall

Jan Mehrholz
1   SRH Hochschule für Gesundheit, Gera gGmbH, Villa Hirsch, Hermann-Drechsler-Str. 2, 07548 Gera
› Author Affiliations
Further Information

Publication History

Publication Date:
29 November 2012 (online)

    Permissions and Reprints

Zusammenfassung

Die kardiologische Rehabilitation beinhaltet schon seit vielen Jahren ein kardiopulmonales Training im aeroben Belastungsbereich. Patienten nach herzchirurgischen Eingriffen wissen, dass sie trainieren müssen, um Kraft, Ausdauer und Fitness wiederzuerlangen. Der Schwerpunkt in der Rehabilitation nach Schlaganfall dagegen liegt primär auf der neurologischen Schädigungsebene. Die funktionelle Erholung nach einem Schlaganfall und die Rückkehr zur Selbstständigkeit werden jedoch nicht allein durch das neuromuskuläre System erreicht [] [7]. Durch die Folgen körperlicher Inaktivität können Patienten den hohen Energieanforderungen bestimmter Alltagsaktivitäten nicht mehr gerecht werden [17], [32]. Dieser Artikel gibt einen Überblick über Leitlinien, Studien und Behandlungsansätze, die eine moderne neurologische Rehabilitation nach Schlaganfall einfordern. Sehr praxisnah sind vor allem die Tipps für das aerobe Training am Patienten.

 

  • Literatur

  • 1 American College of Sports Medicine: Guidelines for exercise testing and prescription. Baltimore: Williams & Wilkins; 2000
    CrossrefGoogle Scholar
  • 2 Billinger SA, Coughenour E, MacKay-Lyons MJ et al. Reduced cardiorespiratory fitness after stroke: biological consequences and exercise-induced adaptations. Stroke Res Treat 2012; 9: 59-120
    Google Scholar
  • 3 Borg G. Anstrengungsempfinden und körperliche Aktivität. Dtsch. Ärzteblatt 2004; 101: 1016-1021
    Google Scholar
  • 4 Brazzelli M, Saunders DH, Greig CA et al. Physical fitness training for patients with stroke: updated review. Stroke 2012; 4: e39-e40
    Google Scholar
  • 5 Brazzelli M, Saunders DH, Greig CA et al. Physical fitness training for stroke patients. Cochrane Database Syst Rev 2011; 11 CD003316
    Google Scholar
  • 6 Canning CG, Shepherd RB, Carr JH et al. A randomized controlled trial of the effects of intensive sit-to-stand training after recent traumatic brain injury on sit-to-stand performance. Clin Rehabil 2003; 4: 355-362
    Google Scholar
  • 7 Carr J, Shepherd R. Optimizing functional motor recovery after stroke. In: Mehrholz J, ed. Physical Therapy for the Stroke Patient. Stuttgart: Thieme; 2012: 51-133
    Google Scholar
  • 8 Carr J, Shepherd R. Stroke Rehabilitation: Guidelines for exercises and training. London: Butterworth Heinemann; 2003
    Google Scholar
  • 9 Eich HJ, Mach H, Werner C et al. Aerobic treadmill plus Bobath walking training improves walking in subacute stroke: a randomized controlled trial. Clin Rehabil 2004; 6: 640-651
    Google Scholar
  • 10 Eng JJ, Chu KS, Dawson AS et al. Functional walk tests in individuals with stroke: relation to perceived exertion and myocardial exertion. Stroke 2002; 3: 756-761
    Google Scholar
  • 11 Förster O. Handbuch der Therapie der Nervenkrankheiten. Jena: Gustav Fischer Verlag; 1916
    Google Scholar
  • 12 Gordon NF, Gulanick M, Costa F et al. hysical activity and exercise recommendations for stroke survivors: an American Heart Association scientific statement from the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council. Stroke 2004; 5: 1230-1240
    Google Scholar
  • 13 Hassett L, Moseley A, Tate R et al. Fitness training for cardiorespiratory conditioning after traumatic brain injury. Cochrane Database Syst Rev 2008; 2 CD006123
    Google Scholar
  • 14 Hesse S, Staats M, Werner C et al. Ambulatory rehabilitation exercises for stroke patients at home. Preliminary results of scope, methods and effectiveness. Nervenarzt 2001; 12: 950-954
    Google Scholar
  • 15 Ivey FM, Hafer-Macko CE, Ryan AS et al. Impaired leg vasodilatory function after stroke: adaptations with treadmill exercise training. Stroke 2010; 12: 2913-2917
    Google Scholar
  • 16 Ivey FM, Ryan AS, Hafer-Macko CE et al. Treadmill aerobic training improves glucose tolerance and indices of insulin sensitivity in disabled stroke survivors: a preliminary report. Stroke 2007; 10: 2752-2758
    Google Scholar
  • 17 Ivey FM, Macko RF, Ryan AS et al. Cardiovascular health and fitness after stroke. Top Stroke Rehabil 2005; 1: 1-16
    Google Scholar
  • 18 Katz-Leurer M, Carmeli E, Shochina M. The effect of early aerobic training on independence six months post stroke. Clin Rehabil 2003; 7: 735-741
    Google Scholar
  • 19 Kluding P, Billinger SA. Exercise-induced changes of the upper extremity in chronic stroke survivors. Top Stroke Rehabil 2005; 1: 58-68
    Google Scholar
  • 20 Lennon S, Ashburn A. The Bobath concept in stroke rehabilitation: a focus group study of the experienced physiotherapists’ perspective. Disabil Rehabil 2000; 15: 665-674
    Google Scholar
  • 21 Luft AR, Macko RF, Forrester LW et al. Treadmill exercise activates subcortical neural networks and improves walking after stroke: a randomized controlled trial. Stroke 2008; 12: 3341-3350
    Google Scholar
  • 22 MacKay-Lyons M, Macko R, Howlett J. Cardiovascular Fitness and Adaptations to Aerobic Training after Stroke. Physiotherapy Canada 2006; 2: 103-113
    Google Scholar
  • 23 MacKay-Lyons MJ, Howlett J. Exercise capacity and cardiovascular adaptations to aerobic training early after stroke. Top Stroke Rehabil 2005; 1: 31-44
    Google Scholar
  • 24 MacKay-Lyons MJ, Makrides L. Longitudinal changes in exercise capacity after stroke. Arch Phys Med Rehabil 2004; 10: 1608-1612
    Google Scholar
  • 25 MacKay-Lyons MJ, Makrides L. Exercise capacity early after stroke. Arch Phys Med Rehabil 2002; 12: 1697-1702
    Google Scholar
  • 26 MacKay-Lyons MJ, Makrides L. Cardiovascular stress during a contemporary stroke rehabilitation program: is the intensity adequate to induce a training effect?. Arch Phys Med Rehabil 2002; 10: 1378-1383
    Google Scholar
  • 27 Macko RF, Ivey FM, Forrester LW et al. Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: a randomized, controlled trial. Stroke 2005; 10: 2206-2211
    Google Scholar
  • 28 Macko RF, Ivey FM, Forrester LW. Task-oriented aerobic exercise in chronic hemiparetic stroke: training protocols and treatment effects. Top Stroke Rehabil 2005; 1: 45-57
    Google Scholar
  • 29 Macko RF, Smith GV, Dobrovolny CL et al. Treadmill training improves fitness reserve in chronic stroke patients. Arch Phys Med Rehabil 2001; 7: 879-884
    Google Scholar
  • 30 Macko RF, DeSouza CA, Tretter LD et al. Treadmill aerobic exercise training reduces the energy expenditure and cardiovascular demands of hemiparetic gait in chronic stroke patients. A preliminary report. Stroke 1997; 2: 326-330
    Google Scholar
  • 31 Marchionni N, Fattirolli F, Fumagalli S et al. Improved exercise tolerance and quality of life with cardiac rehabilitation of older patients after myocardial infarction: results of a randomized, controlled trial. Circulation 2003; 17: 2201-2206
    Google Scholar
  • 32 Meek C, Pollock A, Potter J et al. A systematic review of exercise trials post stroke. Clin Rehabil 2003; 1: 6-13
    Google Scholar
  • 33 Mehrholz J, Werner C, Hesse S et al. Immediate and long-term functional impact of repetitive locomotor training as an adjunct to conventional physiotherapy for non-ambulatory patients after stroke. Disability and Rehabilitation 2008; 11: 830-806
    Google Scholar
  • 34 Mehrholz J, Pohl M. Wird in der neurologischen Rehabilitation seitens der Physiotherapie ausreichend das Herz-Kreislaufsystem trainiert? Ein Vergleich verschiedener Übungen bei gehfähigen Patienten mit Hemiparese nach Schlaganfall. Neurologie und Rehabilitation 2005; 3: 126-130
    Google Scholar
  • 35 Mehrholz J, Pohl M. Aktuelle Konzepte zur Gangrehabilitation nach Schlaganfall. Z f Physiotherapeuten 2005; 1: 2-9
    Google Scholar
  • 36 Mehrholz J, Pohl M. Klinische Gehtests bei Patienten mit Hemiparese nach Schlaganfall. Z f Physiotherapeuten 2004; 9: 1628-1638
    Google Scholar
  • 37 Michael KM, Allen JK, Macko RF. Reduced ambulatory activity after stroke: the role of balance, gait, and cardiovascular fitness. Arch Phys Med Rehabil 2005; 8: 1552-1556
    Google Scholar
  • 38 Pang MY, Eng JJ, Dawson AS et al. The use of aerobic exercise training in improving aerobic capacity in individuals with stroke: a meta-analysis. Clin Rehabil 2006; 2: 97-111
    Google Scholar
  • 39 Pang MY, Eng JJ, Dawson AS. Relationship between ambulatory capacity and cardiorespiratory fitness in chronic stroke: influence of stroke-specific impairments. Chest 2005; 2: 495-501
    Google Scholar
  • 40 Rimmer JH, Wang E. Aerobic exercise training in stroke survivors. Top Stroke Rehabil 2005; 1: 17-30
    Google Scholar
  • 41 Roth EJ. Heart disease in patients with stroke. Part II: Impact and implications for rehabilitation. Arch Phys Med Rehabil 1994; 1: 94-101
    Google Scholar
  • 42 Roth EJ. Heart disease in patients with stroke: incidence, impact, and implications for rehabilitation. Part 1: Classification and prevalence. Arch Phys Med Rehabil 1993; 7: 752-760
    Google Scholar
  • 43 Saunders D, Greig C, Mead G et al. Physical fitness training for stroke patients. Cochrane Database Syst Rev 2009; 4 CD003316
    Google Scholar