Progressive resistance training after stroke: effects on muscle strength, muscle tone, gait performance and perceived participation.

OBJECTIVE To evaluate the effects of progressive resistance training on muscle strength, muscle tone, gait performance and perceived participation after stroke. DESIGN A randomized controlled trial. SUBJECTS Twenty-four subjects (mean age 61 years (standard deviation 5)) 6-48 months post-stroke. METHODS The training group (n = 15) participated in supervised progressive resistance training of the knee muscles (80% of maximum) twice weekly for 10 weeks, and the control group (n = 9) continued their usual daily activities. Both groups were assessed before and after the intervention and at follow-up after 5 months. Muscle strength was evaluated dynamically and isokinetically (60 degrees /sec) and muscle tone by the Modified Ashworth Scale. Gait performance was evaluated by Timed "Up & Go", Fast Gait Speed and 6-Minute Walk tests, and perceived participation by Stroke Impact Scale. RESULTS Muscle strength increased significantly after progressive resistance training with no increase in muscle tone and improvements were maintained at follow-up. Both groups improved in gait performance, but at follow-up only Timed "Up & Go" and perceived participation were significantly better for the training group. CONCLUSIONS Progressive resistance training is an effective intervention to improve muscle strength in chronic stroke. There appear to be long-term benefits, but further studies are needed to clarify the effects, specifically of progressive resistance training on gait performance and participation.

[1]  J. Gladman,et al.  The role of leisure in stroke rehabilitation. , 1997, Disability and rehabilitation.

[2]  References , 1971 .

[3]  L. Mollinger,et al.  Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. , 2002, Physical therapy.

[4]  L. Ada,et al.  Strengthening interventions increase strength and improve activity after stroke: a systematic review. , 2006, The Australian journal of physiotherapy.

[5]  E H Wagner,et al.  Effects of physical activity on health status in older adults. II. Intervention studies. , 1992, Annual review of public health.

[6]  P. van Vliet,et al.  Reliability of measurements obtained with the modified Ashworth scale in the lower extremities of people with stroke. , 2002, Physical therapy.

[7]  Richard W. Bohannon.  Muscle strength and muscle training after stroke. , 2007, Journal of rehabilitation medicine.

[8]  C. Richards,et al.  Gait in stroke: assessment and rehabilitation. , 1999, Clinics in geriatric medicine.

[9]  J. Bean,et al.  High intensity strength training improves strength and functional performance after stroke. , 2000, American journal of physical medicine & rehabilitation.

[10]  R. Shepherd,et al.  Weakness in Patients with Stroke: Implications for Strength Training in Neurorehabilitation , 2000 .

[11]  B. Brouwer,et al.  Isokinetic strength training of the hemiparetic knee: effects on function and spasticity. , 1997, Archives of physical medicine and rehabilitation.

[12]  D. Downham,et al.  What change in isokinetic knee muscle strength can be detected in men and women with hemiparesis after stroke? , 2005, Clinical rehabilitation.

[13]  E Knutsson,et al.  Dynamic muscle strength training in stroke patients: effects on knee extension torque, electromyographic activity, and motor function. , 1995, Archives of physical medicine and rehabilitation.

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

[15]  M. T. J. Buñuales,et al.  La clasificación internacional del funcionamiento de la discapacidad y de la salud (CIF) 2001 , 2002 .

[16]  E. Badics,et al.  Systematic muscle building exercises in the rehabilitation of stroke patients. , 2002, NeuroRehabilitation.

[17]  C. Patten,et al.  Weakness and strength training in persons with poststroke hemiplegia: rationale, method, and efficacy. , 2004, Journal of rehabilitation research and development.

[18]  Joel Stein,et al.  High-Intensity Resistance Training Improves Muscle Strength, Self-Reported Function, and Disability in Long-Term Stroke Survivors , 2004, Stroke.

[19]  E. Roth,et al.  Physical activity and exercise recommendations for stroke survivors: an American Heart Association scientific statement from the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical , 2004, Circulation.

[20]  Per Aagaard,et al.  Neuromuscular activation in conventional therapeutic exercises and heavy resistance exercises: implications for rehabilitation. , 2006, Physical therapy.

[21]  Gwyn McClelland.  Survivors , 1891, The Hospital.

[22]  M. Morris,et al.  Outcomes of progressive resistance strength training following stroke: a systematic review , 2004, Clinical rehabilitation.

[23]  D G Sale,et al.  Neural adaptation to resistance training. , 1988, Medicine and science in sports and exercise.

[24]  B. Bobath.  Adult hemiplegia: Evaluation and treatment , 1978 .

[25]  G. Kwakkel,et al.  Effects of Exercise Training Programs on Walking Competency After Stroke: A Systematic Review , 2007, American journal of physical medicine & rehabilitation.

[26]  Denis Gravel,et al.  Effect of Force-Feedback Treatments in Patients with Chronic Motor Deficits After a Stroke , 2002, American journal of physical medicine & rehabilitation.

[27]  S J Pocock,et al.  Allocation of patients to treatment in clinical trials. , 1979, Biometrics.

[28]  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.

[29]  P. Langhorne,et al.  Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke. , 2003, The Cochrane database of systematic reviews.

[30]  B. Edwards,et al.  Internal consistency and validity of the Stroke Impact Scale 2.0 (SIS 2.0) and SIS-16 in an Australian sample , 2003, Quality of Life Research.

[31]  D. Downham,et al.  Knee muscle strength, gait performance, and perceived participation after stroke. , 2006, Archives of physical medicine and rehabilitation.

[32]  J. Eng,et al.  Effects of isokinetic strength training on walking in persons with stroke: a double-blind controlled pilot study. , 2001, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[33]  Carolynn Patten,et al.  Reliability of gait performance tests in men and women with hemiparesis after stroke. , 2005, Journal of rehabilitation medicine.

[34]  William J Kraemer,et al.  Fundamentals of resistance training: progression and exercise prescription. , 2004, Medicine and science in sports and exercise.

[35]  M. V. von Arbin,et al.  Spasticity After Stroke: Its Occurrence and Association With Motor Impairments and Activity Limitations , 2003, Stroke.

[36]  Cedric X. Bryant,et al.  ACSM's guidelines for exercise testing and prescription , 1995 .