Kathleen Potempa

Physiological Outcomes of Aerobic Exercise Training in Hemiparetic Stroke Patients

BACKGROUND AND PURPOSE In hemiparetic individuals, low endurance to exercise may compound the increased energy cost of movement and contribute to poor rehabilitation outcomes. The purpose of this investigation was to describe how hemiparetic stroke patients responded to intense exercise and aerobic training. METHODS Forty-two subjects were randomly assigned to an exercise training group or to a control group. Treatments were given three times per week for 10 weeks in similar laboratory settings. Baseline and posttest measurements were made of maximal oxygen consumption, heart rate, workload, exercise time, resting and submaximal blood pressures, and sensorimotor function. RESULTS Only experimental subjects showed significant improvement in maximal oxygen consumption, workload, and exercise time. Improvement in sensorimotor function was significantly related to the improvement in aerobic capacity. After treatment, experimental subjects showed significantly lower systolic blood pressure at submaximal workloads during the graded exercise test. CONCLUSIONS We conclude that hemiparetic stroke patients may improve their aerobic capacity and submaximal exercise systolic blood pressure response with training. Sensorimotor improvement is related to the improvement in aerobic capacity.

Benefits of Aerobic Exercise After Stroke

SummaryThe debilitating loss of function after a stroke has both primary and secondary effects on sensorimotor function. Primary effects include paresis, paralysis, spasticity, and sensory-perceptual dysfunction due to upper motor neuron damage. Secondary effects, contractures and disuse muscle atrophy, are also debilitating. This paper presents theoretical and empirical benefits of aerobic exercise after stroke, issues relevant to measuring peak capacity, exercise training protocols, and the clinical use of aerobic exercise in this patient population. A stroke, and resulting hemiparesis, produces physiological changes in muscle fibres and muscle metabolism during exercise. These changes, along with comorbid cardiovascular disease, must be considered when exercising stroke patients. While few studies have measured peak exercise capacity in hemiparetic populations, it has been consistently observed in these studies that stroke patients have a lower functional capacity than healthy populations. Hemiparetic patients have low peak exercise responses probably due to a reduced number of motor units available for recruitment during dynamic exercise, the reduced oxidative capacity of paretic muscle, and decreased overall endurance. Consequently, traditional methods to predict aerobic capacity are not appropriate for use with stroke patients. Endurance exercise training is increasingly recognised as an important component in rehabilitation. An average improvement in maximal oxygen consumption (V̇O2max) of 13.3% in stroke patients who participated in a 10-week aerobic exercise training programme has been reported compared with controls. This study underscored the potential benefits of aerobic exercise training in stroke patients. In this paper, advantages and disadvantages of exercise modalities are discussed in relation to stroke patients. Recommendations are presented to maximise physical performance and minimise potential cardiac risks during exercise.

Anxiety, depression and coping methods of hospitalized patients with myocardial infarction in Taiwan

The purpose of this study was to determine the relationship among anxiety, depression, and coping methods reported by myocardial infarction (MI) patients in Taiwan. Forty post-MI patients were interviewed in the general cardiovascular unit. A subset of patients (n = 15) had high levels of anxiety and depression, however, most patients displayed low levels of anxiety and depression. A significant, moderately positive relationship was found between anxiety and the use of coping styles. An association between depression and coping styles was not found. The optimistic coping style of the Jalowiec Coping Scale was the most often used and most helpful coping method described by subjects. Emotional reactions and coping methods were related to age, social class, and actual or perceived severity of MI. Results of this study lend further support for the need to evaluate the presence, intensity and influencing factors of anxiety and depression in the recovery phase of MI.

A challenge to meet the future: nursing education in Oregon, 2010.

Nursing leadership in Oregon has united behind a plan to address the nursing shortage, setting forth five strategic goals. Two of these are specific to nursing education--to double enrollment by 2004 and redesign nursing education to more directly meet the changing health care needs of Oregonians. This article describes the Oregon Nursing Leadership Council plan and the processes used to develop it. Controversial issues, challenges, and future directions also are discussed.

An overview of the role of cardiovascular reactivity to stressful challenges in the etiology of hypertension

There is significant variability among individuals in the cardiovascular responses to both physical and psychologic stimuli, a phenomenon called cardiovascular reactivity, The magnitude of cardiovascular reactivity may distinguish those prone to develop cardiovascular disease or differentiate pathophysiologic states among individuals who have existing pathologies such as hypertension. This article describes the cardiovascular reactivity hypothesis as a proposed mechanism of hypertension development, Furthermore, proposed mechanisms underlying the pathophysiology of hyperreactivity are also discussed. The value of assessing stress–induced cardiovascular reactivity is evaluated with special regard to hypertension, and future avenues for nursing research are presented.

Adaptation after treatment for heart disease: preliminary examination within a stress appraisal context.

OBJECTIVE To examine, within a stress appraisal framework, intrapersonal psychosocial factors that may affect adaptation after treatment for heart disease. Hostility was examined as a variable that may affect cognitive appraisal of stress and, thus, adaptation. DESIGN Quasi-experimental design with measures before and after treatment. SETTING Large, Midwest hospital preadmitting department with follow-up by mail 1 month after treatment. OUTCOME MEASURE Adaptation, operationalized as perceived quality of life. RESULTS There was a significant, positive relation between hostility and cognitive appraisal of heart disease threat. Threat appraisal and state anxiety before treatment were significantly inversely related to posttreatment quality of life. Hostility was modestly, although nonsignificantly inversely related to posttreatment quality of life. Results provide tentative support for the theory-defined role of appraisal as a mediator between hostility and quality of life. CONCLUSIONS Stress appraisal theory is tentatively supported as a useful framework for examining the adaptational outcome of quality of life in patients with heart disease.

Finding the courage to lead: The oregon experience

A severe nursing shortage has the profession in crisis. The national picture is paralleled in Oregon. The Oregon Nursing Leadership Council (ONLC), through intense dialogue, developed a comprehensive statewide plan to resolve the shortage. From the perspective of group relations and leadership theories, this article describes the issues and events that contributed to the remarkable journey that culminated in this plan. Motivated by our concern for the public welfare and the survival of our profession, individual ONLC members surrendered their own narrow organizational goals to achieve a more effective collective outcome.

Drug use and effects in older adults in the United States

Aging markedly influences drug use and drug effects. The purpose of this review is two-fold: (i) to examine how social, economic, and psychological factors, compliance, and prescribing patterns affect drug use in institutionalized and non-institutionalized older adults in the United States, and (ii) to illustrate how physiological aging, actions of drugs, and adverse drug reactions influence drug effects. Recommendations for further study include identification of adverse reactions, and examination of drug taking behavior in older adults who are alone or debilitated. Research is especially needed for those in nursing homes and for those who are old-old (over 85 years).

Blood pressure and mood responses in hypertensive patients on antihypertensive medications.

&NA; Nurse practitioners who are responsible for the clinical management of patients with hypertension must choose antihypertensive medications that minimize side effects. Nurse practitioners must be aware of the drugs’ potential influences on physiologic and psychological variables and include adequate assessment of these responses in patients during treatment. Pindolol, propranolol, and hydrochlorothiazide were equally effective in reducing systolic and diastolic blood pressure in essential hypertensives, although pindolol and hydrochlorothiazide did not affect resting heart rate (an advantage in some patients). Hydrochlorothiazide was associated with a trend for several negative mood changes in black subjects; depression scores of black subjects were significantly increased with hydrochlorothiazide. The results of this study indicate the need to consider race and other factors in research about antihypertensive mood responses.

Reduced cardiac output and exercise capacity in patients after MI

This article summarizes the literature and suggests directions for future research concerning rehabilitation potential, impairment, and reduced cardiac output after myocardial infarction (MI). Current evidence suggests that cardiac output and maximal exercise capacity are reduced in some post-MI patients. The conceptual model of rehabilitation potential presented emphasizes the need for careful assessment of the state of underlying pathology present after MI when evaluating the response to exercise or exercise training.