COVID-19 Pandemic: Clinical Guidance for Aerobic Exercise-Based Stroke Rehabilitation

OBJECTIVE(S): 1) To discuss the implications of COVID-19 for exercise in the setting of stroke rehabilitation and 2) to guide and inform the clinical implementation of evidence-based aerobic exercise in stroke rehabilitation. DATA SOURCES: A literature search was conducted using 4 databases: MEDLINE, EMBASE, PsycINFO, and AMED Allied and Complementary Medicine, from inception to January 27th, 2021. STUDY SELECTION: We utilized keywords related to COVID-19, exercise, rehabilitation, and included published athletic return to play after COVID-19 infection and clinical practice guidelines on exercise-based recommendations for COVID-19. Out of 391 published articles, none were related to exercise recommendations and stroke rehabilitation in the context of the COVID-19 pandemic. DATA EXTRACTION: In the absence of stroke-specific guidance, we drew upon pre-COVID clinical practice aerobic exercise guidelines for stroke (n=2) and COVID-19 exercise recommendations for other populations (e.g., athletic [n=6], pulmonary [n=1] and cardiac rehabilitation [n=2]). DATA SYNTHESIS: Clinical considerations were developed for hospital and out-patient settings to outline safety considerations to reduce the risk of viral transmission and implementation strategies for pre-participation screening, prescription, and progression of aerobic exercise for symptomatic and asymptomatic cases of COVID-19. Based on limited evidence, we suggest that cardiopulmonary exercise stress testing with electrocardiography be conducted following COVID-19 infection and identify subjective and physiological measures to guide decision making regarding the suitability and prescription of aerobic exercise. Finally, we recommend that clinicians and researchers stay abreast with the literature to implement evidence-based practice relating to stroke, aerobic exercise, and COVID-19. CONCLUSIONS: Using a patient and clinician approach, we have developed COVID-19 specific guidance as a framework for restoring aerobic exercise implementation in stroke rehabilitation settings. AUTHOR(S) DISCLOSURES: No conflicts of interest.