A randomized controlled trial of supervised versus unsupervised exercise programs for ambulatory stroke survivors.
OBJECTIVE
Little is known about the relative efficacy of supervised versus unsupervised community exercise programs for stroke survivors. This study compared the effectiveness of a 10-week supervised strengthening and conditioning program (supervised) with a 1-week supervised instruction program followed by a 9-week unsupervised home program (unsupervised) and evaluated retention of changes at 6 months and 1 year after program completion.


METHODS
Seventy-two subjects retained at baseline (27 women, 45 men; mean+/-SD age, 64.6+/-11.8 years) were randomly allocated to receive the supervised or unsupervised program. The primary outcome was walking speed over 6 minutes, and secondary outcome measures were Human Activity Profile, Medical Outcome Study 36-Item Short-Form survey (SF-36), Physiological Cost Index, and lower extremity muscle strength.


RESULTS
The 6-minute walking speed increased significantly in both groups and remained significantly improved by 1 year. The Human Activity Profile demonstrated an increasing trend only in the supervised group that was significant by 1 year. The SF-36 Physical Component summary score increased significantly in the supervised group and remained improved by 1 year; the unsupervised group showed significant improvement at 1 year. Women made greater gains in supervised programs, but men made greater gains in unsupervised programs.


CONCLUSIONS
Supervised exercise programs and unsupervised programs after initial supervised instruction were both associated with physical benefits that were retained for 1 year, although supervised programs showed trends to greater improvements in self-reported gains. Gender differences require further research.
Olney
Sandra J
SJ
Motor Performance Group, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada. olneys@post.queensu.ca
Nymark
Jennifer
J
Brouwer
Brenda
B
Culham
Elsie
E
Day
Andrew
A
Heard
Joan
J
Henderson
Margaret
M
Parvataneni
Krishna
K
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D015444:Exercise; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000473:pathology; D010349:Patient Compliance; D012648:Self Care; D012737:Sex Factors; D020521:Stroke / Q000628:therapy*; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking