Bicycle ergometry in subacute-stroke survivors: feasibility, safety, and exercise performance.

This study evaluated the feasibility, safety, and findings from a protocol for exercise-bicycle ergometry in subacute-stroke survivors. Of 117 eligible candidates, 14 could not perform the test and 3 discontinued because of cardiac safety criteria. In the 100 completed tests, peak heart rate was 116 +/- 19.1 beats/min; peak VO(2) was 11.4 +/- 3.7 ml x kg x min(-1), peak METs were 3.3 +/- 0.91, exercise duration was 5.1 +/- 2.84 min, and Borg score was 14 +/- 2.6. Among 71 tests, anaerobic threshold was achieved in 3.0 +/- 1.7 min with a VO(2) of 8.6 +/- 1.7 ml x kg x min(-1). After screening, this protocol is feasible and safe in subacute-stroke survivors with mild to moderate deficits. These stroke survivors have severely limited functional exercise capacity. Research and clinical practice in stroke rehabilitation should incorporate more comprehensive evaluation and treatment of endurance limitations.

Randomized clinical trial of therapeutic exercise in subacute stroke.

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 lambda=0.64, P=0.0056). 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.

Falls in community-dwelling stroke survivors: an accumulated impairments model.

UNLABELLED: Falling has been identified as a major complication in persons who have had a stroke. The purpose of this study was to investigate the effect of accumulated impairments on the risk of falling in community-dwelling stroke survivors. METHODS: Community-dwelling stroke survivors were identified from the Kansas City Stroke Study, a large cohort study of stroke survivors. We evaluated the subjects within 14 days of stroke onset. Impairments were determined at baseline and were defined as motor = Fugl-Meyer lower-limb score > 28, sensory = sensory score on National Institutes of Health (NIH) Stroke Scale > 0, and visual = hemianopsia score on NIH Stroke Scale > 0. Accumulated impairments were characterized as motor only (n = 101), motor + sensory (n = 88), and motor + sensory + visual (n = 47). The reference group did not possess motor, sensory, or visual impairments. We completed follow-ups at 1 month, 3 months, and 6 months poststroke to determine the fall status of the subjects. RESULTS: Two hundred eighty subjects were included. Falls were reported by 142 subjects (51%) between 1 month and 6 months poststroke. Univariate analysis revealed that the risk of falling for subjects with motor impairment only was odds ratio (OR) = 2.2 (95% confidence interval [CI] 1.05 to 4.70), motor + sensory impairments OR = 3.1 (95% CI 1.46 to 6.79), and motor + sensory + visual impairments OR = 2.4 (95% CI 1.05 to 5.83) as compared to the group with no motor, sensory, and visual impairments. In multiple logistic regression, the risk of falling increased with motor impairment only and motor + sensory impairments. However, the motor + sensory + visual impairments group had a lower risk of falling. Secondary analysis revealed a significant difference in mobility scores (Orpington Prognostic Scale-balance) among individuals with motor impairment only, motor + sensory impairments, motor + sensory + visual impairments, and the reference group. This lower risk of falling in stroke survivors with motor + sensory + visual impairments may be explained by more involved strokes, more impaired balance, and subsequently less mobility, therefore, lowering their risk of falling. In conclusion, community-dwelling persons who have had a stroke are at a higher risk of falling. However, the risk of falling is not linearly related to the number of impairments. Individuals with motor, sensory, and visual impairments are less mobile and less likely to fall than those individuals with motor deficits only or motor and sensory deficits.