Randomized Clinical Trial of Therapeutic Exercise in Subacute Stroke

Abstract

Background and Purpose-Rehabilitation care after stroke is highly variable and increasingly shorter in duration. The effect of therapeutic exercise on impairments and functional limitations after stroke is not clear. The objective of this study was to determine whether a structured, progressive, physiologically based exercise program for subacute stroke produces gains greater than those attributable to spontaneous recovery and usual care. Methods-This randomized, controlled, single-blind clinical trial was conducted in a metropolitan area and 17 participating healthcare institutions. We included persons with stroke who were living in the community. One hundred patients (mean age, 70 years; mean Orpington score, 3.4) consented and were randomized from a screened sample of 582. Ninety-two subjects completed the trial. Intervention was a structured, progressive, physiologically based, therapist-supervised, in-home program of thirty-six 90-minute sessions over 12 weeks targeting flexibility, strength, balance, endurance, and upper-extremity function. Main outcome measures were postintervention strength (ankle and knee isometric peak torque, grip strength), upper-and lower-extremity motor control (Fugl Meyer), balance (Berg and functional reach), endurance (peak aerobic capacity and exercise duration), upper-extremity function (Wolf Motor Function Test), and mobility (timed 10-m walk and 6-minute walk distance). Results-In the intention-to-treat multivariate analysis of variance testing the overall effect, the intervention produced greater gains than usual care (Wilk's ϭ0.64, Pϭ0.0056). Both intervention and usual care groups improved in strength, balance, upper-and lower-extremity motor control, upper-extremity function, and gait velocity. Gains for the intervention group exceeded those in the usual care group in balance, endurance, peak aerobic capacity, and mobility. Upper-extremity gains exceeded those in the usual care group only in patients with higher baseline function. Conclusions-This structured, progressive program of therapeutic exercise in persons who had completed acute rehabilitation services produced gains in endurance, balance, and mobility beyond those attributable to spontaneous recovery and usual care.

A Community-Based Upper-Extremity Group Exercise Program Improves Motor Function and Performance of Functional Activities in Chronic Stroke: A Randomized Controlled Trial

“…It consists of 15 tasks and quantifies upper extremity movement through timed joint-segment movements (tasks 1-7) and functional tasks (tasks [8][9][10][11][12][13][14][15]. The higher the score, the closer the movement appears to be normal.…”

Task-oriented treadmill exercise training in chronic hemiparetic stroke

“…Cardiac monitoring during conventional physical therapy reveals that low aerobic intensity is reached for <3 minutes in a typical physical therapy session [21]. Further, usual care for outpatient physical therapy, while quite variable in its application, was recently found to consist of only 9 ± 5 (mean ± standard deviation) visits that end 30 to 180 days poststroke [22]. Hence, conventional subacute stroke rehabilitation likely does not provide adequate exercise to reverse profound deconditioning [16].…”

A Review of the Effectiveness of Aerobic Training in Increasing Endurance in Subacute Stroke Patients

“…A randomized, single blinded, controlled trial, regarding the effectiveness of a structured, supervised home program for patients with subacute stroke, was conducted in 17 health care institutions [17]. A large sample of 92 patients was selected.…”

“…The keywords "subacute stroke" and "endurance" or "aerobic" were selected, rendering 14 and 29 results respectively. Of the 7 studies initially selected only 3 RCTs (Tables 1 and 2) [1,6,17] and one RCT study protocol [18] met the inclusion criteria. Dunkan et al [17] 92 Exercise program designed to improve strength, balance, and endurance.…”