Grau-Pellicer M1, Campos-Marti C2, Casimiro-Arias N2, Chamarro-Lusar A3, Medina-Casanovas J4, Rodriguez-Villanueva V2, Yedra-Galindo S2, Serdà i Ferrer B-C5
1Autonomous University of Barcelona, Physical Therapy, Barcelona, Spain, 2Consorci Sanitari de Terrassa, Rehabilitation Unit, Terrassa, Spain, 3Autonomous University of Barcelona, Basic, Evolutionary, and Educational Psychology Department, Barcelona, Spain, 4Institut Guttmann, Functional Rehabilitation Department, Badalona, Spain, 5Universitat de Girona, Department of Nursing, and Biomedical Research Institute, Girona, Spain
Background: The number of people who survive a stroke is increasing annually. People with stroke suffer neurological deficits and a physical deconditioning that compromise walking ability, basic activities of daily living (ADL) and quality of life (QoL). This may involve further secondary complications such as progressive muscular atrophy, osteoporosis, deterioration in peripheral circulation and increased cardiovascular risk. All these factors cause increased dependence, need of assistance from third parties and a restriction on participation that may have a profound psychosocial impact. Conventional rehabilitation programs after stroke typically focus on the subacute period; the aim is to recover basic ADLs, but they do not provide maintenance exercises to provide long term health gains.
Purpose: To determine the effects of a 12-week community-based rehabilitation program based on aerobic exercise (RPAE), among people who had suffered a stroke, on their physical condition, walking speed, activities of daily living (ADL) and quality of life (QoL).
Methods: An observational repeated-measures design was used. Participants were evaluated at baseline, post-intervention and at six months. Thirty one participants underwent the RPAE twice a week. Physical outcome measures assessed were: physical condition (6MWT), walking speed (10MWT), ambulation capacity (FAC) and ADL (Barthel). QoL was assessed with the Euroqol-5D (EQ-5D-5L). Data analysis: A repeated-measures analysis of variance was carried out on the data. Statistical significance was set at P0.05*. The effect size was estimated using Cohen's d as follows: values up to ≤0.2 low, 0.5-0.8 moderate and >0.8 high.
Results: Twenty-five participants completed the rehabilitation program. Improvements were statistically significant for all outcome measures (**p≤0,0001 and *p≤0,005). Physical condition assessed with the walking distance in the 6MWT** increased an average of 57.8m at the end of intervention and 43.3m six month later. 10MWT assessed comfortable walking speed* that increased an average of 0.16 at the end of the intervention and 0.23m/six month later. Fast walking speed** increased an average of 0.40 at the end of the intervention and 0.44 m/s. six month later. At the end of the intervention, FAC* improved in all the participants. They achieved independent ambulation both indoors and outdoors. Walking capacity was maintained six month later. In Barthel**, 40% were independent at baseline vs. 64% at the end of the intervention. It was maintained six month later. QoL, assessed with the EQ-5D-5L**, before the intervention, participants identified important limitations that affected their QoL Those limitations improved significantly after the intervention and, six month later, it allowed patients to accomplish a better self-perceived QoL.
Conclusion(s): The results obtained demonstrate that aerobic exercise improves physical function, walking speed, walking independence, self-reliance in ADL and a better QoL of stroke survivors.
Implications: Therapeutic physical exercise to optimize function, physical condition and cardiovascular health after a stroke is an emerging field within physical therapy. There is a need to implement rehabilitation programs designed to promote an overall improvement and to maintain the gains obtained after rehabilitation programs with long-term physical therapy programs.
Keywords: Stroke, Physical Therapy, Exercise
Funding acknowledgements: The authors declare no conflict of interest
Purpose: To determine the effects of a 12-week community-based rehabilitation program based on aerobic exercise (RPAE), among people who had suffered a stroke, on their physical condition, walking speed, activities of daily living (ADL) and quality of life (QoL).
Methods: An observational repeated-measures design was used. Participants were evaluated at baseline, post-intervention and at six months. Thirty one participants underwent the RPAE twice a week. Physical outcome measures assessed were: physical condition (6MWT), walking speed (10MWT), ambulation capacity (FAC) and ADL (Barthel). QoL was assessed with the Euroqol-5D (EQ-5D-5L). Data analysis: A repeated-measures analysis of variance was carried out on the data. Statistical significance was set at P0.05*. The effect size was estimated using Cohen's d as follows: values up to ≤0.2 low, 0.5-0.8 moderate and >0.8 high.
Results: Twenty-five participants completed the rehabilitation program. Improvements were statistically significant for all outcome measures (**p≤0,0001 and *p≤0,005). Physical condition assessed with the walking distance in the 6MWT** increased an average of 57.8m at the end of intervention and 43.3m six month later. 10MWT assessed comfortable walking speed* that increased an average of 0.16 at the end of the intervention and 0.23m/six month later. Fast walking speed** increased an average of 0.40 at the end of the intervention and 0.44 m/s. six month later. At the end of the intervention, FAC* improved in all the participants. They achieved independent ambulation both indoors and outdoors. Walking capacity was maintained six month later. In Barthel**, 40% were independent at baseline vs. 64% at the end of the intervention. It was maintained six month later. QoL, assessed with the EQ-5D-5L**, before the intervention, participants identified important limitations that affected their QoL Those limitations improved significantly after the intervention and, six month later, it allowed patients to accomplish a better self-perceived QoL.
Conclusion(s): The results obtained demonstrate that aerobic exercise improves physical function, walking speed, walking independence, self-reliance in ADL and a better QoL of stroke survivors.
Implications: Therapeutic physical exercise to optimize function, physical condition and cardiovascular health after a stroke is an emerging field within physical therapy. There is a need to implement rehabilitation programs designed to promote an overall improvement and to maintain the gains obtained after rehabilitation programs with long-term physical therapy programs.
Keywords: Stroke, Physical Therapy, Exercise
Funding acknowledgements: The authors declare no conflict of interest
Topic: Neurology: stroke
Ethics approval required: Yes
Institution: Hospital-Consorci Sanitari de Terrassa, Barcelona (Spain)
Ethics committee: Medical Ethical Committee of the Hospital-Consorci Sanitari de Terrassa
Ethics number: 02-13-119-020.
All authors, affiliations and abstracts have been published as submitted.
