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Physical Functioning, Body Composition and Exercise in Elderly Community-living Individuals with Stroke
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.ORCID iD: 0000-0002-1508-1435
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: urn:nbn:se:uu:diva-236899ISBN: 978-91-554-9120-8 (print)OAI: oai:DiVA.org:uu-236899DiVA: diva2:766433
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
List of papers
1. Factors Related to Performance-Based Mobility and Self-reported Physical Activity in Individuals 1-3 Years after Stroke: A Cross-sectional Cohort Study
Open this publication in new window or tab >>Factors Related to Performance-Based Mobility and Self-reported Physical Activity in Individuals 1-3 Years after Stroke: A Cross-sectional Cohort Study
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2013 (English)In: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 22, no 8, E426-E434 p.Article in journal (Refereed) Published
Abstract [en]

Background: Low mobility and low level of physical activity is common after stroke. The objective of this study was to relate these outcomes to physical, psychological, and demographic determinants. Methods: In this cross-sectional cohort study, a consecutive sample of 195 community-living individuals, 65-85 years of age (74 +/- 5 years, 71% men) with a previous stroke was included. Exclusion criteria were severe aphasia and severe cognitive dysfunction. Mobility status was measured by the Short Physical Performance Battery (SPPB, 0-12 points), and physical activity was measured using the Physical Activity Scale for the Elderly (PASE). Results: Mobility (SPPB, median 9 points) and level of physical activity were low (mean PASE 97 +/- 66 points), and walking speed was slow (1.10 +/- .86 m/s), in relation to a healthy population-based sample. In multiple regression analyses, age (P = .001), physical activity (P < .001), fall-related self-efficacy (P = .001), and health-related quality of life (HRQoL) (P = .02) were associated with mobility (SPPB). Mobility (P < .001), HRQoL (P = .014), and fall-related self-efficacy (P = .031) were likewise associated with self-reported physical activity as the dependent variable. The regression models described 42% and 31% of the variance in mobility and physical activity, respectively. Conclusions: Individuals perceived disabilities that are partly potentially modifiable 1-3 years after stroke. Future poststroke rehabilitation studies need to evaluate if actions to improve fall-related self-efficacy and mobility could promote the physical activity level in this patient population.

Keyword
Stroke, mobility, walking speed, physical activity, health-related quality of life, fall-related self-efficacy, multiple regression
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-213936 (URN)10.1016/j.jstrokecerebrovasdis.2013.04.028 (DOI)000327719000024 ()
Available from: 2014-01-05 Created: 2014-01-05 Last updated: 2017-12-06Bibliographically approved
2. Functional performance, nutritional status, and body composition in ambulant community-dwelling individuals 1-3 years after suffering from a cerebral infarction or intracerebral bleeding
Open this publication in new window or tab >>Functional performance, nutritional status, and body composition in ambulant community-dwelling individuals 1-3 years after suffering from a cerebral infarction or intracerebral bleeding
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2016 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, 48Article in journal (Refereed) Published
Abstract [en]

Background:Muscle wasting and obesity may complicate the post-stroke trajectory. We investigated the relationshipsbetween nutritional status, body composition, and mobility one to 3 years after stroke.

Methods:Among 279 eligible home-dwelling individuals who had suffered a stroke (except for subarachnoidbleeding) 1–3 years earlier, 134 (74 ± 5 years, 69 % men) were examined according to the Mini NutritionalAssessment-Short Form (MNA-SF, 0–14 points), including body mass index (BMI, kg/m2), body composition bybio-impedance analyses (Tanita BC-545), the Short Physical Performance Battery (SPPB, 0–12 points) combiningwalking speed, balance, and chair stand capacity, and the self-reported Physical Activity Scale for the Elderly (PASE).

Results:BMI≥30 kg/m2was observed in 22 % of cases, and 14 % were at risk for malnutrition according to theMNA-SF. SPPB scores≤8 in 28 % of cases indicated high risk for disability. Mobility based on the SPPB was notassociated with the fat-free mass index (FFMI) or fat mass index (FMI). Multivariate logistic regression indicatedthat low mobility, i.e., SPPB≤8 points, was independently related to risk for malnutrition (OR 4.3, CI 1.7–10.5,P= 0.02), low physical activity (PASE) (OR 6.5, CI 2.0–21.2,P= 0.02), and high age (OR 0.36, CI 0.15–0.85,P= 0.02).Sarcopenia, defined as a reduced FFMI combined with SPPB scores≤8 or reduced gait speed (<1 m/s), was observedin 7 % of cases. None of the individuals displayed sarcopenic obesity (SO), defined as sarcopenia with BMI > 30 kg/m2.

Conclusions:Nutritional disorders, i.e., obesity, sarcopenia, or risk for malnutrition, were observed in about one-thirdof individuals 1 year after stroke. Risk for malnutrition, self-reported physical activity, and age were related to mobility(SPPB), whereas fat-free mass (FFM) and fat mass (FM) were not. Nutrition and exercise treatment could be furtherevaluated as rehabilitation opportunities after stroke

Keyword
mobility limitations, stroke, sarcopenia, muscle atrophy, sarcopen obesitas, physical activity, obesity, malnutrition, aging
National Category
Medical and Health Sciences
Research subject
Geriatrics; Nutrition
Identifiers
urn:nbn:se:uu:diva-236911 (URN)10.1186/s12877-016-0226-1 (DOI)000370483600001 ()26895855 (PubMedID)
Note

Title in Thesis list of papers: Body Composition, Nutritional Status, and Physical Function in Community-Living Individuals 1-2 Years after Suffering a Stroke

Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2017-12-05Bibliographically approved
3. Short-term and long-term effects of a progressive resistance and balance exercise program in individuals with chronic stroke: a randomized controlled trial
Open this publication in new window or tab >>Short-term and long-term effects of a progressive resistance and balance exercise program in individuals with chronic stroke: a randomized controlled trial
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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.

Keyword
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:nbn:se:uu:diva-236912 (URN)10.1080/09638288.2016.1206631 (DOI)27415645 (PubMedID)
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
4. Body composition and physical function after progressive resistance and balance training among older adults after stroke: an exploratory randomized controlled trial
Open this publication in new window or tab >>Body composition and physical function after progressive resistance and balance training among older adults after stroke: an exploratory randomized controlled trial
Show others...
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.

Keyword
Exercise, fat mass, muscles, postural balance, stroke, walking capacity
National Category
Medical and Health Sciences
Research subject
Geriatrics; Nutrition; Physiotherapy
Identifiers
urn:nbn:se:uu:diva-236914 (URN)10.1080/09638288.2016.1191551 (DOI)27341068 (PubMedID)
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

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