Community-Based Adaptive Physical Activity Program for Chronic Stroke: Feasibility, Safety, and Efficacy of the Empoli Model

Abstract

Objective-To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercise program for participants with hemiparetic stroke, improves function in the community.Methods-Nonrandomized controlled study in Tuscany, Italy, of participants with mild to moderate hemiparesis at least 9 months after stroke. Forty-nine participants in a geographic health authority (Empoli) were offered APA-stroke (40 completed the study). Forty-four control participants in neighboring health authorities (Florence and Pisa) received usual care (38 completed the study). The APA intervention was a community-based progressive group exercise regimen that included walking, strength, and balance training for 1 hour, thrice a week, in local gyms, supervised by gym instructors. No serious adverse clinical events occurred during the exercise intervention. Outcome measures included the following: 6-month change in gait velocity (6-Minute Timed Walk), Short Physical Performance Battery (SPPB), Berg Balance Scale, Stroke Impact Scale (SIS), Barthel Index, Hamilton Rating Scale for Depression, and Index of Caregivers Strain.Results-After 6 months, the intervention group improved whereas controls declined in gait velocity, balance, SPPB, and SIS social participation domains. These between-group comparisons were statistically significant at P < .00015. Individuals with depressive symptoms at baseline improved whereas controls were unchanged (P < .003). Oral glucose tolerance tests were performed on a subset of participants in the intervention group. For these individuals, insulin secretion declined 29% after 6 months (P = .01).Address correspondence to Mary Stuart, ScD, Health Administration and Policy Program, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250. stuart@umbc.edu. Drs Stuart and Benvenuti contributed to this work equally.For reprints and permission queries, please visit SAGE's Web site at http://www.sagepub.com/journalsPermissions.nav. NIH Public Access Author ManuscriptNeurorehabil Neural Repair. Author manuscript; available in PMC 2011 January 20. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptConclusion-APA-stroke appears to be safe, feasible, and efficacious in a community setting. KeywordsStroke; Exercise; Community; Rehabilitation Stroke is one of the leading causes of death and long-term disability. 1 The Framingham study found that at 6 months following a stroke (ie, after the period of natural recovery 2 ) 50% of stroke survivors aged 65 years or older had some hemiparesis and 30% were unable to walk without assistance. 3 Due in part to the sedentary lifestyle associated with these limitations, the stroke survivor is at increased risk of diabetes, glucose intolerance, heart disease, subsequent stroke death, and depression. 4,5 There is substantial evidence supporting a protective role for exercise in the prevention of stroke. 1 For stroke survivors, increasing evidence also links exercise to improved cardiovascular health, with decreased ris...

Community Walking Training Program Improves Walking Function and Social Participation in Chronic Stroke Patients

“…For instance, Park et al (2011) demonstrated that four weeks of community-based ambulation training consisting of various community situations helped improve walking ability of stroke patients. In addition, Stuart et al (2009) reported that community-based physical therapy involving environmental options was effective for improving ambulation in stroke patients. The current and previous studies were based on eight environmental dimensions (Shumway-Cook et al 2002), including distance, temporal factors, ambient conditions, physical load, terrain, attentional demands, postural transitions, and traffic density.…”

“…Thus, many therapeutic methods for improvement of independent walking ability in stroke patients have been attempted, such as task-related circuit training (Dean et al 2000), community-based physical activity programs (Stuart et al 2009), and virtual reality training (Cho and Lee 2013). However, most studies on stroke rehabilitation have been conducted in clinical or hospital settings, where it is difficult to reflect home environmental conditions and a complex external environment (Park et al 2011).…”

“…Recently, community-based ambulation training has been used as a therapeutic method to enhance walking ability in stroke patients (Stuart et al 2009;Park et al 2011). Community walking is defined as a complicated and challenging activity requiring the ability to walk at a given speed for a minimum requisite distance and to adapt to changes in various environments (Shumway-Cook et al 2002).…”

Usability and Effects of an Exergame-Based Balance Training Program

“…[5][6][7][8][9] Six months post-stroke, one-third of elderly stroke survivors are not able to walk independently. 10 An intense, structured therapy program offering numerous repetitions of various, challenging tasks improves motor skills. 11 For best recovery results, a rehabilitation program should be conducted regularly over an extended period of time.…”

Rehabilitation and Plasticity

“…Additional leg training resulted in better walking ability and arm training in better dexterity as compared with immobilization in subacute stroke survivors enrolled within 14 days of stroke onset indicating that the intensity of training counts (Kwakkel et al 1999). Similarly, a community-based physical activity program improved walking velocity, balance and quality of life measures as compared with standard care also emphasizing training intensity (Stuart et al 2009). On the other hand as mentioned above, high intensity early after stroke may result in adverse functional outcomeds (Dromerick et al 2009).…”