From the Center on Aging, University of Kansas Medical Center (P.D.,
L.R., D.W., J.S-Y., P.P., C.L., S.S.); Department of Veterans Affairs Medical
Center, Kansas City (P.D., S.S.); and Departments of Health Services
Administration (P.D.), Physical (P.P.) and Occupational Therapy (L.R.),
Internal Medicine (S.S.), Preventive Medicine (D.W.), and Physical Medicine
and Rehabilitation (A.O.), School of Engineering, University of Kansas (C.L.),
Kansas City, Kan.
Correspondence to Pamela Duncan, PhD, PT, University of Kansas Medical Center, Center on Aging, 3901 Rainbow Blvd, Kansas City, KS 66160-7117. E-mail pduncan{at}kumc.edu
Background and Purpose—Many
stroke survivors have minimal to moderate neurological deficits but are
physically deconditioned and have a high prevalence of
cardiovascular problems; all of these are potentially
modifiable with exercise. The purposes of this randomized, controlled
pilot study were (1) to develop a home-based balance, strength, and
endurance program; (2) to evaluate the ability to recruit and retain
stroke subjects; and (3) to assess the effects of the
interventions used.
Methods—Twenty minimally and moderately impaired stroke patients
who had completed inpatient rehabilitation and who were 30 to 90 days
after stroke onset were randomized to a control group or to an
experimental group that received a therapist-supervised, 8-week,
3-times-per-week, home-based exercise program. The control group
received usual care as prescribed by the patients' physicians.
Baseline and postintervention assessments included the Fugl-Meyer Motor
Assessment, the Barthel Index of Activities of Daily Living (ADL), the
Lawton Scale of Instrumental ADL, and the Medical Outcomes Study–36
Health Status Measurement. Functional assessments of balance and gait
included a 10-m walk, 6-Minute Walk, and the Berg Balance Scale. Upper
extremity function was evaluated by the Jebsen Test of Hand
Function.
Results—Of 22 patients who met study criteria, 20 completed the
study and 2 refused to participate. The experimental group tended to
improve more than the control group in motor function (Fugl-Meyer Upper
Extremity: mean change in score, 8.4 versus 2.2; Fugl-Meyer Lower
Extremity: 4.7 versus -0.9; gait velocity: median change, 0.25 versus
.09 m/s; 6-Minute Walk: 195 versus 114 ft; Berg Balance Score: 7.8
versus 5; and Medical Outcomes Study–36 Health Status Measurement of
Physical Function: 15.5 versus 9). There were no trends in differences
in change scores by the Jebsen Test of Hand Function, Barthel Index,
and Lawton Instrumental ADL Scale.
Conclusions—This study demonstrated that a randomized, controlled
clinical trial of a poststroke exercise program is feasible. Measures
of neurological impairments and lower extremity function showed the
most benefit. Effects of the intervention on upper extremity dexterity
and functional health status were equivocal. The lasting effects of the
intervention were not assessed.
© 1998 American Heart Association, Inc.
Original Contributions
A Randomized, Controlled Pilot Study of a Home-Based Exercise Program for Individuals With Mild and Moderate Stroke
Key Words: exercise • rehabilitation • stroke management
This article has been cited by other articles:
 |
|
 |
|
  R. Dickstein Rehabilitation of Gait Speed After Stroke: A Critical Review of Intervention Approaches Neurorehabil Neural Repair, November 1, 2008; 22(6): 649 - 660. [Abstract] [PDF]
|
|
|
|
 |
|
 P. L Scheets, S. A Sahrmann, and B. J Norton Use of Movement System Diagnoses in the Management of Patients With Neuromuscular Conditions: A Multiple-Patient Case Report Physical Therapy, June 1, 2007; 87(6): 654 - 669. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Blennerhassett, T. A. Matyas, and L. M. Carey Impaired Discrimination of Surface Friction Contributes to Pinch Grip Deficit After Stroke Neurorehabil Neural Repair, May 1, 2007; 21(3): 263 - 272. [Abstract] [PDF]
|
|
|
|
|
|
G. Alon, A. F. Levitt, and P. A. McCarthy Functional Electrical Stimulation Enhancement of Upper Extremity Functional Recovery During Stroke Rehabilitation: A Pilot Study Neurorehabil Neural Repair, May 1, 2007; 21(3): 207 - 215. [Abstract] [PDF]
|
|
|
|
|
|
P. Plummer, A. L. Behrman, P. W. Duncan, P. Spigel, D. Saracino, J. Martin, E. Fox, M. Thigpen, and S. A. Kautz Effects of Stroke Severity and Training Duration on Locomotor Recovery After Stroke: A Pilot Study Neurorehabil Neural Repair, March 1, 2007; 21(2): 137 - 151. [Abstract] [PDF]
|
|
|
|
|
|
S. Blanton, D. M Morris, M. G Prettyman, K. McCulloch, S. Redmond, K. E Light, and S. L Wolf Lessons Learned in Participant Recruitment and Retention: The EXCITE Trial Physical Therapy, November 1, 2006; 86(11): 1520 - 1533. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H Dawes, N Korpershoek, J Freebody, C Elsworth, N van Tintelen, D T Wade, H Izadi, and D H Jones A pilot randomised controlled trial of a home-based exercise programme aimed at improving endurance and function in adults with neuromuscular disorders J. Neurol. Neurosurg. Psychiatry, August 1, 2006; 77(8): 959 - 962. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Y. Pang, J. J Eng, A. S Dawson, and S. Gylfadottir The use of aerobic exercise training in improving aerobic capacity in individuals with stroke: a meta-analysis Clinical Rehabilitation, February 1, 2006; 20(2): 97 - 111. [Abstract] [PDF]
|
|
|
|
 |
|
 S. J. Olney, J. Nymark, B. Brouwer, E. Culham, A. Day, J. Heard, M. Henderson, and K. Parvataneni A Randomized Controlled Trial of Supervised Versus Unsupervised Exercise Programs for Ambulatory Stroke Survivors Stroke, February 1, 2006; 37(2): 476 - 481. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. L. Richards, F. Malouin, G. Bravo, F. Dumas, and S. Wood-Dauphinee The Role of Technology in Task-Oriented Training in Persons with Subacute Stroke: A Randomized Controlled Trial Neurorehabil Neural Repair, December 1, 2004; 18(4): 199 - 211. [Abstract] [PDF]
|
|
|
|
|
|
R P. Van Peppen, G Kwakkel, S Wood-Dauphinee, H J. Hendriks, P. J Van der Wees, and J Dekker The impact of physical therapy on functional outcomes after stroke: what's the evidence? Clinical Rehabilitation, August 1, 2004; 18(8): 833 - 862. [Abstract] [PDF]
|
|
|
|
|
|
M. M. Ouellette, N. K. LeBrasseur, J. F. Bean, E. Phillips, J. Stein, W. R. Frontera, and R. A. Fielding High-Intensity Resistance Training Improves Muscle Strength, Self-Reported Function, and Disability in Long-Term Stroke Survivors Stroke, June 1, 2004; 35(6): 1404 - 1409. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. F. Gordon, M. Gulanick, F. Costa, G. Fletcher, B. A. Franklin, E. J. Roth, and T. Shephard 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 Activity, and Metabolism; and the Stroke Council Stroke, May 1, 2004; 35(5): 1230 - 1240. [Full Text] [PDF]
|
|
|
|
 |
|
 N. F. Gordon, M. Gulanick, F. Costa, G. Fletcher, B. A. Franklin, E. J. Roth, and T. Shephard 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 Activity, and Metabolism; and the Stroke Council Circulation, April 27, 2004; 109(16): 2031 - 2041. [Full Text] [PDF]
|
|
|
|
|
|
P. S. Pohl, S. Perera, P. W. Duncan, R. Maletsky, R. Whitman, and S. Studenski Gains in Distance Walking in a 3-Month Follow-Up Poststroke: What Changes? Neurorehabil Neural Repair, March 1, 2004; 18(1): 30 - 36. [Abstract] [PDF]
|
|
|
|
|
|
C. G Canning, L. Ada, R. Adams, and N. J O'Dwyer Loss of strength contributes more to physical disability after stroke than loss of dexterity Clinical Rehabilitation, March 1, 2004; 18(3): 300 - 308. [Abstract] [PDF]
|
|
|
|
|
|
S. L Morris, K. J Dodd, and M. E Morris Outcomes of progressive resistance strength training following stroke: a systematic review Clinical Rehabilitation, January 1, 2004; 18(1): 27 - 39. [Abstract] [PDF]
|
|
|
|
|
|
S. Barreca, S. L. Wolf, S. Fasoli, and R. Bohannon Treatment Interventions for the Paretic Upper Limb of Stroke Survivors: A Critical Review Neurorehabil Neural Repair, December 1, 2003; 17(4): 220 - 226. [Abstract] [PDF]
|
|
|
|
|
|
C. C Bassile, C. Dean, B. Boden-Albala, and R. Sacco Obstacle training programme for individuals post stroke: feasibility study Clinical Rehabilitation, February 1, 2003; 17(2): 130 - 136. [Abstract] [PDF]
|
|
|
|
|
|
C Meek, A Pollock, J Potter, and P Langhorne A systematic review of exercise trials post stroke Clinical Rehabilitation, January 1, 2003; 17(1): 6 - 13. [Abstract] [PDF]
|
|
|
|
|
|
H. E. Andersen, K. Eriksen, A. Brown, K. Schultz-Larsen, and B. H. Forchhammer Follow-up services for stroke survivors after hospital discharge-a randomized control study Clinical Rehabilitation, June 1, 2002; 16(6): 593 - 603. [Abstract] [PDF]
|
|
|
|
|
|
J. Green, A. Forster, and J. Young Reliability of gait speed measured by a timed walking test in patients one year after stroke Clinical Rehabilitation, March 1, 2002; 16(3): 306 - 314. [Abstract] [PDF]
|
|
|
|
|
|
J. J. Eng, K. S. Chu, A. S. Dawson, C.M. Kim, and K. E. Hepburn Functional Walk Tests in Individuals With Stroke: Relation to Perceived Exertion and Myocardial Exertion Stroke, March 1, 2002; 33(3): 756 - 761. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. M Steffen, T. A Hacker, and L. Mollinger 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 Physical Therapy, February 1, 2002; 82(2): 128 - 137. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Jackson, L. Turner-Stokes, J. Culpan, A. Bateman, O. Scott, J. Powell, and R. Greenwood Can brain-injured patients participate in an aerobic exercise programme during early inpatient rehabilitation? Clinical Rehabilitation, May 1, 2001; 15(5): 535 - 544. [Abstract] [PDF]
|
|
|
|
|
|
C. M Dean, C. L. Richards, and F. Malouin Walking speed over 10 metres overestimates locomotor capacity after stroke Clinical Rehabilitation, April 1, 2001; 15(4): 415 - 421. [Abstract] [PDF]
|
|
|
|
|
|
J. H van der Lee, I. A. Snels, H. Beckerman, G. J Lankhorst, R. C Wagenaar, and L. M Bouter Exercise therapy for arm function in stroke patients: a systematic review of randomized controlled trials Clinical Rehabilitation, January 1, 2001; 15(1): 20 - 31. [Abstract] [PDF]
|
|
|
|
|
|
P. S Pohl, J. K Startzell, P. W Duncan, and D. Wallace Reliability of lower extremity isokinetic strength testing in adults with stroke Clinical Rehabilitation, June 1, 2000; 14(6): 601 - 607. [Abstract] [PDF]
|
|