{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:27:40Z","timestamp":1788827260863,"version":"build-2803163510"},"reference-count":34,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Post-stroke spasticity is a frequent complication that contributes to impaired mobility, reduced functional independence, and decreased exercise tolerance. While botulinum toxin A (BoNT-A) is widely used to improve muscle tone, its effects on cardiopulmonary exercise capacity remain insufficiently characterized. This study aimed to evaluate the impact of BoNT-A treatment on cardiopulmonary performance and functional outcomes in patients with post-stroke spasticity. Materials and Methods: A prospective before\u2013after study was conducted including 50 patients with post-stroke spasticity. Cardiopulmonary exercise testing was performed before and after BoNT-A administration. The primary outcome was peak oxygen consumption (VO2 peak), while secondary outcomes included anaerobic threshold (AT), exercise duration, maximal workload, 10 m walk test time, Barthel Index, and modified Rankin Scale (mRS). Paired comparisons and multivariable linear regression analyses were performed to assess changes and associated factors. Results: VO2 peak increased significantly following treatment (12.96 \u00b1 2.70 vs. 13.55 \u00b1 2.85 mL\/kg\/min; mean change 0.59 mL\/kg\/min, 95% CI 0.36\u20130.82; p &lt; 0.001). Similar improvements were observed for AT (10.47 \u00b1 2.77 vs. 10.97 \u00b1 2.97 mL\/kg\/min; p &lt; 0.001), exercise duration (6.70 \u00b1 1.48 vs. 7.11 \u00b1 1.55 min; p &lt; 0.001), and maximal workload (44.70 \u00b1 10.97 vs. 48.06 \u00b1 12.60 W; p &lt; 0.001). Functional performance improved, as indicated by reduced 10 m walk time (18.33 \u00b1 4.67 vs. 17.36 \u00b1 4.82 s; p &lt; 0.001) and increased Barthel Index (57.62 \u00b1 19.18 vs. 61.92 \u00b1 21.10; p &lt; 0.001). A modest but significant reduction in disability was observed on the mRS (p = 0.003). Baseline values were the strongest predictors of post-treatment outcomes, while smoking status was associated with worse walking performance. Conclusions: BoNT-A treatment was associated with modest but consistent improvements in cardiopulmonary exercise capacity and functional performance in patients with post-stroke spasticity. These findings suggest that spasticity management may be associated with functional and exercise-related benefits extending beyond local neuromuscular effects, although causal relationships cannot be established based on the present study design. Further controlled studies are needed to confirm these findings and evaluate their long-term clinical significance.<\/jats:p>","DOI":"10.3390\/medicina62061066","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T08:09:16Z","timestamp":1780301356000},"page":"1066","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Enhancing Cardiopulmonary Function Through Spasticity Reduction\u2014Effects of Botulinum Toxin A After Stroke: A Prospective Before\u2013After Study"],"prefix":"10.3390","volume":"62","author":[{"given":"Laura Marieta","family":"Alexa","sequence":"first","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Ia\u0219i, Romania"},{"name":"Neuromotor Rehabilitation Clinic, Clinical Rehabilitation Hospital, 700661 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5145-5404","authenticated-orcid":false,"given":"Alexandru-Cosmin","family":"Palc\u0103u","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of General Surgery, C.F. 2 Clinical Hospital, 011464 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livia Florentina","family":"P\u0103duraru","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiology, Elias Emergency University Hospital, 011461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Alexa","sequence":"additional","affiliation":[{"name":"Department of Neurology, Clinical Rehabilitation Hospital, 700661 Iasi, Romania"},{"name":"Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700111 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Andreea","family":"Palc\u0103u","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiology, Elias Emergency University Hospital, 011461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5836-1322","authenticated-orcid":false,"given":"Maria Magdalena","family":"Leon","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700111 Ia\u0219i, Romania"},{"name":"Department of Cardiology, Clinical Rehabilitation Hospital, 700661 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai","family":"Roca","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700111 Ia\u0219i, Romania"},{"name":"Respiratory Rehabilitation Department, Clinical Rehabilitation Hospital, 700661 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana Mihaela","family":"Ilie\u0219iu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiology, \u201cProf. Dr. Theodor Burghele\u201d Clinical Hospital, 050659 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia Corina","family":"Dima-Cozma","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700111 Ia\u0219i, Romania"},{"name":"Department of Cardiology, Clinical Rehabilitation Hospital, 700661 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1177\/17474930241308142","article-title":"World Stroke Organization: Global Stroke Fact Sheet 2025","volume":"20","author":"Feigin","year":"2025","journal-title":"Int. J. Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Chen, C.H., Chang, T.Y., Sung, P.S., Su, H.C., Chou, C.H., Tung, H., Tsai, L.K., Tang, S.C., and Jeng, J.S. (2025). An overview of post-stroke disability. J. Formos. Med. 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