A community-based fitness and mobility exercise program for older adults with chronic stroke: A randomized controlled trial
Pang, M. Y. C., Eng, J. J., Dawson, A. S., McKay, H. A., & Harris, J. E. (2005). A community-based fitness and mobility exercise program for older adults with chronic stroke: A randomized controlled trial. J Am Geriatr Soc, 53, 1667-1674.
Purpose: Stroke is one of the most common chronic conditions seen in older adults. Stroke survivors are frequently left with physical impairments which have been shown to increase sedentary lifestyle and result in secondary complications such as reduced cardio-respiratory fitness and increased risk for cardiovascular disease and recurrent stroke. Other common impairments include poor balance and muscle weakness, which may contribute to higher incidence of falling and a decline in hip bone mineral density (BMD). Since physical inactivity in older adults with chronic stroke could lead to devastating secondary health complications, an accessible and multidimensional fitness program is needed. The purpose of this study was to see whether a comprehensive, community-based exercise program could help stroke survivors improve their balance, ability to move, and strength, resulting in more physical activity and decreasing the risk for recurrent stroke and other health problems.
Participants: Inclusion criteria included: a single stroke more than 1 year before, aged 50 and older, ability to walk more than 10 m independently, and living at home. Exclusion criteria included: a history of serious cardiac disease, systolic blood pressure > 140 and diastolic blood pressure > 90, pain while walking, neurological conditions in addition to stroke, and other serious diseases that impaired the individual from participating in the study. Those who fulfilled the criteria signed a written consent and underwent further laboratory screenings. The subjects ultimately consisted of 63 older individuals with chronic stroke who were living in the community.
Method: Participants were randomly assigned to an intervention group or control group. The intervention group underwent the Fitness and Mobility Exercise (FAME) program designed to improve cardio-respiratory fitness, ability to move, leg muscle strength, balance, and hip BMD, while the control group underwent a seated upper-extremity program. Both groups met for 1 hour, three times per week, for 19 weeks in a multipurpose room at a local community hall. At each session, a physical therapist, an occupational therapist, and exercise instructor were present to supervise the subjects. Measurements were taken immediately before and after the interventions, which included VO2max, 6-minute walk test, isometric knee extension, Berg Balance Scale, Physical Activity Scale for Individuals with Physical Disabilities, and femoral neck BMD.
Results: After 19 weeks, the participants were tested for cardio-respiratory fitness, ability to move, leg muscle strength, balance, and hip BMD. Individuals in the intervention group showed significantly more improvement in cardio-respiratory fitness (10.7%), ability to move, and paretic leg strength than did those in the control group. A significant decrease of 2.5% in hip BMD was seen in the paretic leg of the control group, while the intervention group maintained its hip BMD throughout the study. No significant interactions were shown in either group for balance, activity and participation, nonparetic leg muscle strength, or nonparetic hip BMD. Five falls were reported in the intervention group and one in the control group. Three individuals dropped out of the study, and on average, the two groups attended a similar number of sessions.
Discussion: The study showed that the FAME program may be a practical and beneficial way for improving cardio-respiratory fitness, ability to move, and paretic leg strength and maintaining hip BMD in stroke survivors. The program may also serve as a good model for community-based fitness programs targeting the prevention of secondary diseases in older adults living with chronic disabilities. The results were shown to support the hypothesis that the intervention group would have greater gains than the control group in cardio-respiratory fitness, which in turn may have tremendous effects on functional abilities. Also, this is the first study to provide evidence that regular exercise is beneficial for hip BMD in the chronic stroke population. It was noted that several limitations were present in this study, such as subject population, sample size, and duration of the study.