Has your stroke hospital done ONE DAMN THING to implement group exercises for survivors in the last 7 years? If not, everyone in the stroke hospital, including the board of directors needs to be fired.
A community-based group exercise program for persons with chronic stroke
Med Sci Sports Exerc. Author manuscript; available in PMC 2012 Oct 15.
Published in final edited form as:
The publisher's final edited version of this article is available at Med Sci Sports Exerc
See other articles in PMC that cite the published article.
Abstract
PURPOSE
The
purpose of this study was to evaluate the physical and psychosocial
effects of an 8-week community-based functional exercise program in a
group of individuals with chronic stroke.
METHODS
Twenty-five
subjects (mean age 63 years) participated in a repeated measures design
which evaluated the subjects with two baseline assessments one month
apart, one post-intervention assessment, and one retention assessment
one month post-intervention. 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-week training consisted of a 60 min, 3 times per week
group program which 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 one-month post-intervention. 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 have potential for improving activity tolerance
and reducing the risk for secondary complications common to stroke
(e.g., falls resulting in fractures and cardiac events).
Keywords: cerebrovascular accident, physical activity, disability, function, walk
INTRODUCTION
Over
fifty thousand Canadians suffer from stroke each year making it the
number one cause of neurological disability in Canada today (23) and a leading cause of disability in the community (19). Ninety percent of stroke survivors have some functional disability with mobility being the major impairment (21).
Although some individuals with stroke will have received some
rehabilitation during the acute and sub-acute phase, rarely does
rehabilitation extend beyond one year post-injury due to the belief that
functional recovery has plateaued by this time (42).
Impairments resulting from stroke, such as muscle weakness, pain,
spasticity and poor balance, in addition to the lack of accessible and
appropriate community-based exercise programs can lead to reduced
tolerance to activity, further sedentary lifestyle, and additional
declines in function and disability status (32).
Activities
which promote mobility and fitness are imperative for the prevention of
further pathological events (e.g., falls resulting in fracture,
recurrent strokes or cardiac events). Stroke is one of the top risk
factors for incurring fractures as a result of a fall in older adults;
Kanis et al. (24)
analyzed 16.3 million hospitalizations due to fractures and reported a
7-fold hip fracture risk for individuals with stroke. In fact, the
incidence of falls has been reported to be as high as 73% of individuals
with stroke falling within six months following hospital discharge to
home with an average of 3.4 falls per person during this six month time
period (18).
In addition, cardiovascular disease is the leading prospective cause of
death in chronic stroke. Inactivity and low cardiovascular fitness, a
major occurrence in persons with stroke, is one of the modifiable risk
factors associated with cardiovascular disease.
In the
past, intensive training in persons with stroke has been controversial
due to the belief that strenuous activity would increase spasticity and
reinforce abnormal movement (5). However, recent evaluation of intensive exercise programs has not found any evidence of an increase in spasticity (39).
Intensive treadmill protocols (30, 34, 37)
are a recent addition to stroke rehabilitation and have resulted in
improvements in gait and aerobic capacity, however, Smith et al. (38)
found no significant improvements in reactive balance using an
endurance treadmill protocol and suggested that functional or
task-specific training may be needed to improve balance. Duncan et al. (14)
also reported no significant improvements for the Berg Balance score
using a randomized controlled home-based individual exercise program
(strengthening and walking program). Functional balance may be difficult
to improve due to the varied tasks and movements under which balance is
required. The one exception was a non-controlled pilot study by Weiss
et al. (43)
which reported a 12% improvement in the Berg Balance Score for 7
individuals with stroke using a one-to-one high intensity strengthening
program. However, Kim et al. (26)
recently undertook a double-blind randomized controlled trial of
strength training in chronic stroke found no carry-over into functional
tasks and these authors emphasized the need for functional task-based
practice.
Intensive rehabilitation programs for
individuals with stroke have traditionally involved a one-to-one
client-therapist ratio due to the close supervision required when
challenging balance in these individuals, in addition to the necessary
monitoring when taxing their cardiovascular function. However, given the
current limited rehabilitation resources, it would be ideal to develop
safe and effective community-based group exercise programs which are
accessible to larger numbers of individuals. There is a clear and
impressive void in the current literature which evaluates
community-based group exercise programs for individuals with stroke and
only three studies have examined such programs. Rimmer et al. (37)
undertook an intensive 12-week community-based group training program
(seven staff to 18 clients) which resulted in improvements in peak VO2,
strength, and back flexibility, but did not measure or train balance. A
recent controlled pilot study which evaluated an 8-week circuit
training program found improvements in walking speed, six minute walk
distance, in addition to weight-bearing ability through the affected
limb for the five experimental subjects (supervised by two physical
therapists) compared to the four control subjects (12). Teixeira-Salmela et al. (39)
found improvements in gait and stair climbing speed, in addition to
muscle strength from a 10-week muscle strengthening and physical
conditioning program for 13 individuals with stroke. No studies to date
have assessed the effect of a community-based group exercise program on
both balance and functional capacity in individuals with stroke, and in
addition, the retention of these effects has never been evaluated.
The
purpose of this study was to evaluate a community-based group exercise
intervention on both balance and functional capacity, two functions
which are severely compromised in persons with stroke and can lead to
devastating secondary complications We evaluated the effects of an
8-week group exercise intervention on balance, walking ability and
functional capacity and the retention of these effects one month
post-intervention. Lastly, the psychosocial effects of exercise are
infrequently evaluated in stroke, despite the well-documented high
incidence of clinical depression in this population (4, 10) and the knowledge that exercise can have substantial benefits to one’s well-being (11, 25). Therefore, we also evaluated the effect of the exercise intervention on measures of health-related quality of life.
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