Andrew S. Dawson

A Community-Based Fitness and Mobility Exercise Program for Older Adults with Chronic Stroke: A Randomized, Controlled Trial

Objectives: To examine the effects of a community‐based group exercise program for older individuals with chronic stroke.

Submaximal exercise in persons with stroke: Test-retest reliability and concurrent validity with maximal oxygen consumption

OBJECTIVE To establish the test-retest reliability and concurrent validity with maximum oxygen consumption (VO2max) for 3 submaximal exercise tests in persons with chronic stroke: (1) submaximal treadmill test, (2) submaximal cycle ergometer test, and (3) 6-minute walk test (6MWT). DESIGN Prospective study using a convenience sample. SETTING Free-standing tertiary rehabilitation center. PARTICIPANTS A volunteer sample of 12 community-dwelling individuals who had a stroke with moderate motor deficits. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Heart rate, blood pressure, and oxygen consumption (VO2) were assessed during the exercise tests. RESULTS Test-retest reliability was good to excellent for the exercise tests (maximal and submaximal tests). VO2 for all submaximal measures related to VO2max (r range, .66-.80). Neither the 6MWT distance, self-selected gait speed, nor hemodynamic measures related to VO2max. CONCLUSION The VO2 measures of the submaximal exercise tests had excellent reliability and good concurrent validity with VO2max. Submaximal exercise tests may be a method by which to monitor the effects of interventions after a screening test (eg, symptom-limited graded exercise test, dobutamine stress echocardiograph).

The use of aerobic exercise training in improving aerobic capacity in individuals with stroke: a meta-analysis

Objective: To determine whether aerobic exercise improves aerobic capacity in individuals with stroke. Design: A systematic review of randomized controlled trials. Databases searched: MEDLINE, CINAHL, EMBASE, Cochrane Database of Systematic Reviews and Physiotherapy Evidence Database were searched. Inclusion criteria: Design: randomized controlled trials (RCTs). Participants: individuals with stroke. Interventions: aerobic exercise training aimed at improving aerobic capacity. Outcomes: Primary outcomes: aerobic capacity (peak oxygen consumption (VO2), peak workload). Secondary outcomes: walking velocity, walking endurance. Data analysis: The methodological quality was assessed by the PEDro scale. Meta-analyses were performed for all primary and secondary outcomes. Results: Nine articles (seven RCTs) were identified. The exercise intensity ranged from 50% to 80% heart rate reserve. Exercise duration was 20–40 min for 3–5 days a week. The total number of subjects included in the studies was 480. All studies reported positive effects on aerobic capacity, regardless of the stage of stroke recovery. Meta-analysis revealed a significant homogeneous standardized effect size (SES) in favour of aerobic exercise to improve peak VO2 (SES 0.42; 95% confidence interval (CI) 0.15–0.69; P=0.001) and peak workload (SES 0.50; 95% CI 0.26–0.73; P<0.001). There was also a significant homogeneous SES in favour of aerobic training to improve walking velocity (SES 0.26; 95% CI 0.05–0.48; P=0.008) and walking endurance (SES 0.30; 95% CI 0.06–0.55; P=0.008). Conclusions: There is good evidence that aerobic exercise is beneficial for improving aerobic capacity in people with mild and moderate stroke. Aerobic exercise should be an important component of stroke rehabilitation.

Exercise leads to faster postural reflexes, improved balance and mobility, and fewer falls in older persons with chronic stroke.

Objectives: To determine the effect of two different community‐based group exercise programs on functional balance, mobility, postural reflexes, and falls in older adults with chronic stroke.

A community-based group exercise program for persons with chronic stroke

PURPOSE The purpose of this study was to evaluate the physical and psychosocial effects of an 8-wk community-based functional exercise program in a group of individuals with chronic stroke. METHODS Twenty-five subjects (mean age 63 yr) participated in a repeated measures design that evaluated the subjects with two baseline assessments 1 month apart, one postintervention assessment, and one retention assessment 1 month postintervention. Physical outcome measures assessed were the Berg Balance Test, 12-Minute Walk Test distance, gait speed, and stair climbing speed. Psychosocial measures assessed were the Reintegration to Normal Living Index (RNL) and Canadian Occupational Performance Measure (COPM). The 8-wk training consisted of a 60-min, 3 x wk-1 group program that focused on balance, mobility, functional strength, and functional capacity. The program was designed to be accessible by reducing the need for costly one-on-one supervision, specialized settings, and expensive equipment. RESULTS Improvements from the exercise program were found for all physical measures and these effects were retained 1-month postintervention. Subjects with lower function improved the most relative to their initial physical status. Significant effects were found for the COPM, but not the RNL Index; however, subjects with lower RNL improved the most relative to their initial RNL Score. CONCLUSION A short-term community-based exercise program can improve and retain mobility, functional capacity, and balance and result in a demonstrable impact upon the performance of activities and abilities that were considered meaningful to the subjects. Implementation of such community-based programs has potential for improving activity tolerance and reducing the risk for secondary complications common to stroke (e.g., falls resulting in fractures and cardiac events).

A Self-Administered Graded Repetitive Arm Supplementary Program (GRASP) Improves Arm Function During Inpatient Stroke Rehabilitation A Multi-Site Randomized Controlled Trial

Background and Purpose— More than 70% of individuals who have a stroke experience upper limb deficits that impact daily activities. Increased amount of upper limb therapy has positive effects; however, practical and inexpensive methods of therapy are needed to deliver this increase in therapy. Methods— This was a multi-site single blind randomized controlled trial to determine the effectiveness of a 4-week self-administered graded repetitive upper limb supplementary program (GRASP) on arm recovery in stroke. 103 inpatients with stroke were randomized to the experimental group (GRASP group, n=53) or the control group (education protocol, n=50). The primary outcome measure was the Chedoke Arm and Hand Activity Inventory (CAHAI), a measure of upper limb function in activities of daily living. Secondary measures were used to evaluate grip strength and paretic upper limb use outside of therapy time. Intention-to-treat analysis was performed. Group differences were tested using analysis of covariance. Results— At the end of the 4-week intervention (approximately 7 weeks poststroke), the GRASP group showed greater improvement in upper limb function (CAHAI) compared to the control group (mean difference 6.2; 95% CI: 3.4 to 9.0; P<0.001). The GRASP group maintained this significant gain at 5 months poststroke. Significant differences were also found in favor of the GRASP protocol for grip strength and paretic upper limb use. No serious adverse effects were experienced. Conclusion— A self-administered homework exercise program provides a cost-, time-, and treatment-effective delivery model for improving upper limb recovery in subacute stroke.

A 19-week exercise program for people with chronic stroke enhances bone geometry at the tibia: a peripheral quantitative computed tomography study

BackgroundWe assessed the impact of a 19-week exercise program on bone health in chronic stroke.ResultsThose who underwent the program reported significantly more gain in tibial trabecular bone content and cortical bone thickness on the affected side.ConclusionRegular exercise is thus beneficial for enhancing bone health in this population.

The Role of Caregiver Involvement in Upper-Limb Treatment in Individuals With Subacute Stroke

Background Initial severity of upper-limb motor impairment and exercise intensity are important predictors of improved upper-limb function during stroke rehabilitation. Initial severity of motor impairment, however, is not modifiable by rehabilitation, and increased one-on-one treatment is not always feasible. Alternative methods to increase intensity and improve upper-limb function are needed. Objective The purpose of this study was to examine caregiver involvement in upper-limb treatment as a method to improve upper-limb function. Design This study was a secondary analysis of a multi-site randomized controlled trial for upper-limb recovery during subacute inpatient stroke rehabilitation. Methods Data from 50 individuals with subacute stroke who were randomly assigned to the experimental group (upper-limb exercise) were used for the analysis. Outcome variables were measured at baseline and at completion of the 4-week intervention. Group comparisons between participants with caregiver support and participants without caregiver support were done using an analysis of variance. Using the Fugl-Meyer Upper-Limb Motor Impairment Scale and time spent in treatment (intensity) as covariates, a multivariate regression analysis was performed to determine the additive value of caregiver support on upper-limb function, as measured by change scores on the Chedoke Arm and Hand Activity Inventory and the Motor Activity Log. Results Group comparisons revealed that participants with caregiver support had improved upper-limb function compared with those without caregiver support and were more likely to increase the amount of time spent doing exercise. The multiple regression analysis showed that Fugl-Meyer score, treatment intensity, and caregiver support were significant predictors of upper-limb improvement (R2=.240–.292). In the regression models, caregiver support accounted for 5% to 9% of upper-limb improvement. Limitations Support was coded as a dichotomous variable, and thus the degree of support or qualitative nature of support was not captured. Conclusions Involvement of caregivers was a determinant of improved upper-limb function over and above initial severity of motor impairment and exercise intensity. Further research is needed to determine the optimal qualitative and quantitative elements of caregiver involvement in stroke rehabilitation in order to maximize results.