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Short-term and long-term effects of a progressive resistance and balance exercise program in individuals with chronic stroke: a randomized controlled trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. (Klinisk nutrition och metabolism)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
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2017 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 39, no 16, 1615-1622 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate the effects of progressive resistance and balance (PRB) exercises on physical and psychological functions of post-stroke individuals.

MATERIALS AND METHODS: In a randomized controlled trial with follow-up at 3, 6 and 15 months, 67 community-living individuals (76% male; 65-85 years) with a stroke 1-3 years previously were allocated to an intervention group (IG, n = 34; PRB exercises combined with motivational group discussions twice weekly for 3 months) or a control group (CG, n = 33). The primary outcomes were balance (Berg Balance Scale, 0-56 points) and mobility (Short Physical Performance Battery, 0-12 points) at 3 months. The secondary outcomes were 10 m comfortable walking speed, physical activity levels, health-related quality of life, depression and fall-related self-efficacy.

RESULTS: At 3 months, the IG exhibited significant improvements in balance (MD 2.5 versus 0 points; effect size [ES], 0.72; p < 0.01) and comfortable walking speed (MD 0.04 versus -0.05 m/s; ES, 0.68; p = 0.01) relative to the CG. A faster walking speed persisted at 6 months. No differences were found for the other outcomes.

CONCLUSIONS: In chronic stroke patients, 3 months of PRB exercises and motivational discussions induced improvements in balance at 3 months and in walking speed at 3 and 6 months. Implications for Rehabilitation A progressive resistance and balance exercise program supported by motivational group discussions and one home-based exercise appears to be an effective means of improving the short-term balance and the walking speed in individuals with chronic stroke. People with poor balance and motor function discontinued the study more often and may require additional support. There is a need for powerful and cost-effective strategies that target changes in behavior to obtain long-term changes in physical function after exercising.

Place, publisher, year, edition, pages
2017. Vol. 39, no 16, 1615-1622 p.
Keyword [en]
Depression; health-related quality of life, high-intensity functional exercise, self-related self-efficacy, walking
National Category
Medical and Health Sciences
Research subject
Neurology; Geriatrics; Physiotherapy
Identifiers
URN: urn:nbn:se:uu:diva-236912DOI: 10.1080/09638288.2016.1206631PubMedID: 27415645OAI: oai:DiVA.org:uu-236912DiVA: diva2:765937
Note

Title in Thesis list of papers: Effects of Progressive Resistance and Balance training in Chronic Stroke: A Randomized Controlled Trial

Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2017-06-16Bibliographically approved
In thesis
1. Physical Functioning, Body Composition and Exercise in Elderly Community-living Individuals with Stroke
Open this publication in new window or tab >>Physical Functioning, Body Composition and Exercise in Elderly Community-living Individuals with Stroke
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A comprehensive view of physical function, body composition and exercise post-stroke that is based on clinical examination is lacking. The effects of a progressive resistance and balance (PRB) exercise program have not been fully evaluated in community-living individuals after stroke.

The overall aim of this thesis was to explore and describe physical function, physical activity, body composition, nutritional status and psychological factors. Another aim was to evaluate both the short-term and long-term effects of a PRB exercise program.

Physical function, physical activity, body composition, nutritional status and psychological factors were assessed in community-living individuals (65-85 years) approximately 1 year after stroke. Paper I-II (n=195, n=134) had a cross-sectional design and the main outcome was mobility and physical activity. In paper III-IV, (n=67, n=43) individuals were randomly assigned to either a PRB exercise program group or a control group. The main outcomes were balance, mobility, fat-free mass (FFM) and fat-mass (FM).

In paper I, mobility was reduced and physical activity level was low compared to age-matched healthy controls. Factors explaining the variance in mobility were age, physical activity, fall-related self-efficacy and EQ-5D. In paper II, >20% had a BMI ≥30 kg/m2 and had an altered body composition that was mainly characterised by a high fat-mass index (FMI). Neither fat-free nor FM were associated with mobility in this cohort. The factors associated with low mobility were low physical activity Odds ratio (OR) (CI 95%) 8.2 (2.8-24.2), risk for malnutrition, OR 5.8 (1.6-21.1), and each 10-year period, OR 2.8 (1.24-6.24). Individuals participating in the PRB exercise program (paper III, n=67) revealed significantly higher balance, walking capacity and comfortable walking speed compared to the control group at 3 months. The faster walking speed persisted at 6 and 15 months. In paper IV (n=43), at 3 months, the PRB exercise group had a significant reduction in FM percentage and a decrease in IGF-1 compared with the control group. Further, changes in FMI were associated with improved walking capacity.

Many individuals perceived partly modifiable disabilities 1 year after stroke. Exercising in groups for 3 months improved physical function and decreased fat-mass percentage and IGF-1.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 81 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1058
National Category
Medical and Health Sciences
Research subject
Geriatrics; Neurology; Nutrition
Identifiers
urn:nbn:se:uu:diva-236899 (URN)978-91-554-9120-8 (ISBN)
Public defence
2015-01-23, Gunne-salen, Ingång 10, Akademiska sjukhuset, Uppsala, 09:00 (English)
Opponent
Supervisors
Available from: 2014-12-18 Created: 2014-11-25 Last updated: 2015-02-03

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Vahlberg, BirgitCederholm, TommyLindmark, BirgittaZetterberg, LenaHellström, Karin

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