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European Journal of Physical and Rehabilitation Medicine 2017 April;53(2):228-39

DOI: 10.23736/S1973-9087.16.04322-7


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 Maria 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, Ferrara, Italy; 2 Department of Rehabilitation Medicine, Ferrara University Hospital, Ferrara, Italy; 3 Vascular Diseases Center, Unit of Translational Surgery, Ferrara University Hospital, Ferrara, Italy; 4 Esercizio Vita Nonprofit Cooperative, 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 test, were the primary outcome. Secondary outcomes included quality of life (Short-Form-36 Questionnaire), 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.
CONCLUSIONS: 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.

KEY WORDS: Clinical trial - Exercise therapy - Mobility limitation - Resistance training - Stroke

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