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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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European Journal of Physical and Rehabilitation Medicine 2016 Sep 14

language: English

Effects of low-intensity endurance and resistance training on mobility in chronic stroke survivors. A pilot, randomized, controlled study.

Nicola LAMBERTI 1, Sofia STRAUDI 2, Anna M. MALAGONI 3, Matteo ARGIRò 1, Michele FELISATTI 4, Eleonora NARDINI 1, Christel ZAMBON 1, Nino BASAGLIA 2, Fabio MANFREDINI 1, 2

1 Department of Biomedical Sciences and Surgical Specialties, Section of Sport Sciences, University of Ferrara, Italy; 2 Department of Rehabilitation Medicine, Hospital University of Ferrara, Ferrara, Italy; 3 Unit of Translational Surgery, Hospital University of Ferrara, Ferrara, Italy; 4 Esercizio Vita ONLUS, Ferrara, Italy


BACKGROUND: Chronic stroke survivors are exposed to long-term disability and physical deconditioning, effects that may impact their independence and quality of life. Community-based programs optimizing the dose of exercise therapy that are simultaneously low risk and able to achieve high adherence should be identified.
AIM: We tested the hypothesis that an 8-week, community-based, progressive mixed endurance- resistance exercise program at lower cardiovascular and muscular load yielded more mobility benefits than a higher-intensity program in chronic stroke survivors.
DESIGN: A two-arm, parallel-group, pilot randomized, controlled clinical trial.
SETTING: Hospital (recruitment); community-based adapted physical activity center (training). POPULATION: Thirty-five chronic stroke patients (mean age: 68.4±10.4 years; 27 males). METHODS: Participants were randomized to a Low-intensity Experimental (LI-E; n=18) or a High-intensity Active Control group (HI-C; n=17). Patients in the LI-E group performed over- ground intermittent walking (weeks 1-8) and muscle power training with portable tools (weeks 5-8); patients in the HI-C group executed treadmill walking (weeks 1-8) and strength training with gym machines (weeks 5-8). Changes in mobility, assessed using the 6-Minute Walking Distance (6MWD), were the primary outcome. Secondary outcomes included quality of life (Short Form-36 questionnaire; SF-36), gait speed (10-meter walking test), balance (Berg Balance Scale) and muscle performance of the lower limbs (strength and power of the quadriceps and femoral biceps). RESULTS: After 8 weeks, the 6MWD revealed more improvement for the LI-E group than the HI- C group (P=0.009). The SF36 physical activity domain (P=0.012) and peak power of the femoral quadriceps and biceps were also significantly improved for the LI-E group (P=0.008 and P<0.001, respectively) compared with the HI-C. Gait speed, balance and lower-limb strength increased in both groups; no significant differences were noted. The muscle power of the affected limb was the muscle parameter most correlated with mobility in the entire population.
CONCLUSION: A low-intensity exercise program exhibited better results in terms of mobility, quality of life and muscle power compared with a higher-intensity program. Data need to be confirmed in a larger trial.
CLINICAL REHABILITATION IMPACT: The effectiveness, low-intensity and possible implementation in poorly equipped community-based settings make the LI-E program potentially suitable for stroke survivors and frail individuals.

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