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Body composition and physical function after progressive resistance and balance training among older adults after stroke: an exploratory 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 Neuroscience, Physiotherapy.
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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2016 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: To evaluate whether improvements in physical function are related to changes in body composition after a three-month progressive resistance and balance exercise program among individuals approximately one to three years after stroke.

METHODS: In this randomized controlled trial, 43 community-dwelling subjects (65-85 years, mean age 73 ± 5 years, 73% men) were allocated to a progressive resistance and balance exercise program twice weekly for three months (intervention group [IG], n = 20) or a control group (n = 23). The main outcome measures were fat mass (kg) and fat-free mass (kg), as measured by bioelectrical impedance analyses (Tanita®). Physical function was measured using the six-minute walk test.

RESULTS: Complete case analyses revealed reduced fat mass in the IG compared with the control (-1.5 vs. (0).13% of body weight, respectively; effect size =0.62; p = 0.048). In contrast, no between-group difference in fat-free mass was observed. The six-minute walk test was improved (25 vs. -10 m, respectively, effect size =0.69, p = 0.039) at three months in favor of the IG. The reduced fat mass was associated with an improved six-minute walk test (r = 0.48, p = 0.038) in the IG.

CONCLUSIONS: Three-month progressive resistance and balance training was associated with reduced fat mass, which was related to improvements in walking capacity in older adults approximately one year after stroke.

Implications for rehabilitation - This three-month PRB group exercise program supported by motivational discussions and daily home-based exercises indicate the following:

• Improved walking capacity was associated with a reduction in fat mass.

• IGF-1 is reduced, possibly indicating improved insulin sensitivity.

Place, publisher, year, edition, pages
2016.
Keyword [en]
Exercise, fat mass, muscles, postural balance, stroke, walking capacity
National Category
Medical and Health Sciences
Research subject
Geriatrics; Nutrition; Physiotherapy
Identifiers
URN: urn:nbn:se:uu:diva-236914DOI: 10.1080/09638288.2016.1191551PubMedID: 27341068OAI: oai:DiVA.org:uu-236914DiVA: diva2:765942
Note

Title in Thesis list of papers: Body composition and physical function after progressive resistance and balance training among older adults after stroke

Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2017-12-05Bibliographically 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, BirgitLindmark, BirgittaZetterberg, LenaHellström, KarinCederholm, Tommy

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