title: Community-based adaptive physical activity program for chronic stroke: feasibility, safety, and efficacy of the Empoli model.
abstract: OBJECTIVE
  To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercise program for participants with hemiparetic stroke, improves function in the community.
  
  
  METHODS
  Nonrandomized controlled study in Tuscany, Italy, of participants with mild to moderate hemiparesis at least 9 months after stroke. Forty-nine participants in a geographic health authority (Empoli) were offered APA-stroke (40 completed the study). Forty-four control participants in neighboring health authorities (Florence and Pisa) received usual care (38 completed the study). The APA intervention was a community-based progressive group exercise regimen that included walking, strength, and balance training for 1 hour, thrice a week, in local gyms, supervised by gym instructors. No serious adverse clinical events occurred during the exercise intervention. Outcome measures included the following: 6-month change in gait velocity (6-Minute Timed Walk), Short Physical Performance Battery (SPPB), Berg Balance Scale, Stroke Impact Scale (SIS), Barthel Index, Hamilton Rating Scale for Depression, and Index of Caregivers Strain.
  
  
  RESULTS
  After 6 months, the intervention group improved whereas controls declined in gait velocity, balance, SPPB, and SIS social participation domains. These between-group comparisons were statistically significant at P<.00015. Individuals with depressive symptoms at baseline improved whereas controls were unchanged (P<.003). Oral glucose tolerance tests were performed on a subset of participants in the intervention group. For these individuals, insulin secretion declined 29% after 6 months (P=.01).
  
  
  CONCLUSIONS
  APA-stroke appears to be safe, feasible, and efficacious in a community setting.
authors.affiliation: Health Administration and Policy Program, University of Maryland, Baltimore County, Baltimore, Maryland 21250, USA. stuart@umbc.edu
authors.forename: Mary
authors.initials: M
authors.lastname: Stuart
authors.forename: Francesco
authors.initials: F
authors.lastname: Benvenuti
authors.forename: Richard
authors.initials: R
authors.lastname: Macko
authors.forename: Antonio
authors.initials: A
authors.lastname: Taviani
authors.forename: Lucianna
authors.initials: L
authors.lastname: Segenni
authors.forename: Federico
authors.initials: F
authors.lastname: Mayer
authors.forename: John D
authors.initials: JD
authors.lastname: Sorkin
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Stanhope
authors.forename: Velio
authors.initials: V
authors.lastname: Macellari
authors.forename: Michael
authors.initials: M
authors.lastname: Weinrich