High-intensity arm resistance training does not lead to better outcomes than low-intensity resistance training in patients after subacute stroke: A randomized controlled trial.

OBJECTIVE: To describe the effects of 2 levels of intensity of arm resistance training on grip strength, arm function, activities, participation, and adverse events in patients with subacute stroke. DESIGN: A randomized controlled and preregistered trial with concealed allocation, assessor blinding and intention-to-treat analysis. PATIENTS: Patients with subacute stroke and upper extremity hemiparesis. METHODS: After randomization the experimental group received a 3-week high-intensity arm resistance training (HIT). The control group completed a 3-week low-intensity arm resistance training (LIT). The primary outcome was grip strength. Secondary outcomes included the Motricity Index, Fugl-Meyer Assessment for the upper limb, Box and Block Test, Goal Attainment Scale, Modified Ashworth Scale, and adverse events. All outcomes were assessed at baseline and after 3 weeks of intervention. RESULTS: A total of 43 patients were investigated (HIT, n = 23; LIT, n = 20). All primary and secondary outcomes improved after the 3-week training, but no significant between-group differences were found. Adverse events occurred in 5% of training sessions (19/369). CONCLUSION: The results of this study did not show differential effects on any outcome of 2 forms of arm resistance training in patients with subacute stroke.

Upper limb strength training in subacute stroke patients: study protocol of a randomised controlled trial.

BACKGROUND: Stroke patients are often affected by arm paresis, have functional impairments and receive help from professional or informal caregivers. Progressive resistance training is a common intervention for functional impairments after paresis. Randomised controlled trials (RCT) showed benefits for functional recovery after resistance training. However, there is a lack of evidence for strength training in subacute stroke patients. The aim of this study is to investigate safety and effectiveness of arm strength training in subacute stroke patients. METHODS: We will conduct a prospective, assessor-blinded RCT of people with subacute stroke. We will randomly assign patients to one of two parallel groups in a 1:1 ratio and will use concealed allocation. The intervention group will receive, in addition to standard treatment, high-intensity arm training (three times per week, over three weeks; 60 min each session; with a total of nine additional sessions). The control group will receive, in addition to standard treatment, low-intensity arm training (same quantity, frequency and treatment time as the intervention group). Standard treatment for the affected arm includes mobilisation, stretching, therapeutic positioning, arm and hand motor training, strengthening exercises, mechanical assisted training, functional training and task-oriented training. The primary efficacy endpoint will be grip strength. Secondary outcome measures will be Modified Ashworth Scale, Motricity Index, Fugl-Meyer Assessment for the upper limb, Box and Block Test and Goal Attainment Scale for individual participatory goals. We will measure primary and secondary outcomes with blinded assessors at baseline and immediately after three weeks of additional therapy. Based on our sample size calculation, 78 patients will be recruited from our rehabilitation hospital in two and a half years. Drop-out rates and adverse events will be systematically recorded. DISCUSSION: This study attempts to close the evidence gap for effects of arm strength training in subacute stroke patients. The results of this trial will provide robust evidence for effects and safety of high-intensity arm training for people with stroke. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00012484 . Registered on 26 May 2017.