Adaptive physical activity improves mobility function and quality of life in chronic hemiparesis.

This study investigated the effects of an adaptive physical activity (APA) program on mobility function and quality of life (QOL) in chronic stroke patients. Twenty subjects with chronic hemiparesis completed a 2-month, combined group, class-home exercise regimen that emphasized mobility training. APA improved Berg Balance Scale scores (35 +/- 2 vs 45 +/- 2, p = 0.001), 6-minute walk distances (114 +/- 15 vs 142 +/- 7 m, p < 0.001), and Short Physical Performance Battery scores (3.2 +/- 0.4 vs 5.2 +/- 0.6, p < 0.001). Barthel Index scores increased (75 +/- 4 vs 84 +/- 4, p < 0.001), but Lawton scores were unchanged. Geriatric Depression Scale (p < 0.01) and Stroke Impact Scale (SIS), Mobility, Participation, and Recovery improved with APA (p < 0.03). APA has the potential to improve gait, balance, and basic but not instrumental activities of daily living profiles in individuals with chronic stroke. Improved depression and SIS scores suggest APA improves stroke-specific outcomes related to QOL.

[1]  J. Rimmer,et al.  Exercise training in a predominantly African-American group of stroke survivors. , 2000, Medicine and science in sports and exercise.

[2]  S. Embretson,et al.  The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change. , 1999, Stroke.

[3]  R. Macko,et al.  Testing a Model of Post‐Stroke Exercise Behavior , 2006, Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses.

[4]  M. Lawton,et al.  Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living , 1969 .

[5]  Amy L Shortal.  Recovery of Walking Function in Stroke Patients: The Copenhagen Stroke Study , 1996 .

[6]  A. Sanabria,et al.  Randomized controlled trial. , 2005, World journal of surgery.

[7]  S. Olney,et al.  Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors. , 1999, Archives of physical medicine and rehabilitation.

[8]  Gerald V. Smith,et al.  Treadmill training improves fitness reserve in chronic stroke patients. , 2001, Archives of physical medicine and rehabilitation.

[9]  L. Ferrucci,et al.  A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. , 1994, Journal of gerontology.

[10]  D. Wade,et al.  Assessing motor impairment after stroke: a pilot reliability study. , 1990, Journal of neurology, neurosurgery, and psychiatry.

[11]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[12]  B. Resnick,et al.  Motivating minority older adults to exercise. , 2006, Cultural diversity & ethnic minority psychology.

[13]  O. Almeida,et al.  Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD‐10 and DSM‐IV , 1999, International journal of geriatric psychiatry.

[14]  R. Macko,et al.  Elevated Tumor Necrosis Factor-&agr; in Skeletal Muscle After Stroke , 2005, Stroke.

[15]  A. Forster,et al.  Physiotherapy for patients with mobility problems more than 1 year after stroke: a randomised controlled trial , 2002, The Lancet.

[16]  R. Macko,et al.  High Prevalence of Abnormal Glucose Metabolism and Poor Sensitivity of Fasting Plasma Glucose in the Chronic Phase of Stroke , 2006, Cerebrovascular Diseases.

[17]  M. Lawton,et al.  Assessment of older people: self-maintaining and instrumental activities of daily living. , 1969, The Gerontologist.

[18]  B. E. Maki,et al.  Measuring balance in the elderly: validation of an instrument. , 1992, Canadian journal of public health = Revue canadienne de sante publique.

[19]  Mahoney Fi,et al.  FUNCTIONAL EVALUATION: THE BARTHEL INDEX. , 1965 .

[20]  R. Macko,et al.  Cardiovascular Health and Fitness After Stroke , 2005, Topics in stroke rehabilitation.

[21]  R. Shepherd,et al.  Task-related training improves performance of seated reaching tasks after stroke. A randomized controlled trial. , 1997, Stroke.

[22]  S Hesse,et al.  Aerobic treadmill plus Bobath walking training improves walking in subacute stroke: a randomized controlled trial , 2004, Clinical rehabilitation.

[23]  D. Wade,et al.  Physiotherapy intervention late after stroke and mobility. , 1992, BMJ.

[24]  L. Forrester,et al.  Treadmill Exercise Rehabilitation Improves Ambulatory Function and Cardiovascular Fitness in Patients With Chronic Stroke: A Randomized, Controlled Trial , 2005, Stroke.

[25]  Janice J Eng,et al.  Exercise Leads to Faster Postural Reflexes, Improved Balance and Mobility, and Fewer Falls in Older Persons with Chronic Stroke , 2005, Journal of the American Geriatrics Society.

[26]  Suzanne G. Leveille,et al.  Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[27]  Janice J Eng,et al.  A Community‐Based Fitness and Mobility Exercise Program for Older Adults with Chronic Stroke: A Randomized, Controlled Trial , 2005, Journal of the American Geriatrics Society.

[28]  J. Eng,et al.  Water-based exercise for cardiovascular fitness in people with chronic stroke: a randomized controlled trial. , 2004, Archives of physical medicine and rehabilitation.

[29]  K Potempa,et al.  Physiological outcomes of aerobic exercise training in hemiparetic stroke patients. , 1995, Stroke.

[30]  J. Rimmer,et al.  Exercise training for African Americans with disabilities residing in difficult social environments. , 2002, American journal of preventive medicine.

[31]  R. Werner,et al.  Effectiveness of an intensive outpatient rehabilitation program for postacute stroke patients. , 1996, American journal of physical medicine & rehabilitation.

[32]  T. Stevenson.  Detecting change in patients with stroke using the Berg Balance Scale. , 2001, The Australian journal of physiotherapy.

[33]  S. Studenski,et al.  Randomized clinical trial of therapeutic exercise in subacute stroke. , 2003, Stroke.

[34]  A. Rodriquez,et al.  Gait training efficacy using a home-based practice model in chronic hemiplegia. , 1996, Archives of physical medicine and rehabilitation.

[35]  J. Wee,et al.  Validation of the Berg Balance Scale as a predictor of length of stay and discharge destination in stroke rehabilitation. , 2003, Archives of physical medicine and rehabilitation.

[36]  L W Forrester,et al.  Task-Oriented Aerobic Exercise in Chronic Hemiparetic Stroke: Training Protocols and Treatment Effects , 2005, Topics in stroke rehabilitation.

[37]  V. Leirer,et al.  Development and validation of a geriatric depression screening scale: a preliminary report. , 1982, Journal of psychiatric research.

[38]  L. Ada,et al.  A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial. , 2003, Archives of physical medicine and rehabilitation.