EFFECTS OF MIXED AND COLLECTIVE PHYSICAL EXERCISE ON ACTIVITY AND PARTICIPATION OF PEOPLE WITH CHRONIC STROKE: A RANDOMIZED CROSS-OVER TRIAL

F. Nindorera^1,2, I. Nduwimana², A. Sinzakaraye², E. Havyarimana², Y. Bleyenheuft¹, J.L. Thonnard¹, O. Kossi^3,4

¹Université Catholique de Louvain (UCLouvain), Institute of Neuroscience, Motor Skills Learning and Intensive Neurorehab Lab, Brussels, Belgium, ²University Hospital Roi-khaled, National Center of Reference in Physical Therapy and Medical Rehabilitation, Bujumbura, Burundi, ³Université de Parakou, Service de Kinésithérapie et d’Appareillage Orthopédique, Parakou, Benin, ⁴Université de Parakou, ENATSE, Ecole Nationale de Santé Publique et d’Epidémiologie, Parakou, Benin

Background: Physical inactivity after stroke is highly prevalent in addition to activity limitations and participation restrictions. Although several protocols of exercise training have been shown to be effective for poststroke people, access to these training protocols is limited in community especially low-income settings.

Purpose: To investigate the efficacy of a new intervention: “Circuit walking, Balance, Cycling and Strength trainings (CBCS) trial on activities of daily living (ADL) limitations and social participation restrictions in stroke survivors.

Methods: Forty-six (46) community-dwelling post-stroke people, no longer in conventional rehabilitation were randomized into Immediate CBCS group (IG, n=23; initially receiving CBCS training for 12 weeks in phase 1), and a delayed CBCS group (DG, n=23) which participated in socio-cultural activities for 12 weeks. In phase 2, participants in the DG group were crossed over to receive CBCS and those of the IG were followed in socio-cultural activities. The interventions were applied three times a week for 12 weeks in either phase 1 or phase 2. Participants were assessed at baseline, after intervention (12 weeks), after cross-over (24 weeks) and at follow up (3 months). The primary outcome was ADL limitations, measured with the ACTIVLIM-Stroke scale and social participation was amnong the secondary outcomes.

Results: The CBCS group improved significantly and clinically functional independence (ADL limitations; ACTIVLIM-stroke, +3,4 logits, P < .001, effect size [ES] 0.87). Social participation was improved similarly in both groups. The benefits persisted for at least 3 months after intervention completion.

Conclusions: CBCS improved functional independence (ADL limitations) in chronic stage of stroke. CBCS attendance yields benefits on social participation that are similar to socio-cultural activity attendance.

Implications: Developing and delivering cost-effective, equitable-access rehabilitation services to stroke people is still a challenge in low- and middle-income countries. This study highlights the value of mixed, group and community-based training, a cost-effective intervention in low-income countries, where its ease of administration and local accessibility may be key to improving adherence and long-term outcomes due to limited geographical and financial access to conventional rehabilitation. This group-based intervention could also help to prevent recurrence of stroke.

Funding acknowledgements: Félix NINDORERA and Ildephonse NINDORERA received a PhD scholarships from Université Catholique de Louvain and Wallonie Bruxelles International

Keywords:
Activities of daily living
Community stroke rehabilitation
Group-based exercise training

Topics:
Neurology: stroke
Community based rehabilitation
Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? Yes

Institution: Burundi National Ethique Comity

Committee: Comité National d'Ethique

Ethics number: CNE/25/2019