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


OBJECTIVE
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.


METHODS
A two-arm, parallel-group, pilot randomized, controlled clinical trial.


METHODS
Hospital (recruitment); community-based adapted physical activity center (training).


METHODS
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.


CONCLUSIONS
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.
Department of Biomedical Sciences and Surgical Specialties, Section of Sport Sciences, University of Ferrara, Ferrara, Italy.
Nicola
N
Lamberti
Department of Rehabilitation Medicine, Ferrara University Hospital, Ferrara, Italy.
Sofia
S
Straudi
Vascular Diseases Center, Unit of Translational Surgery, Ferrara University Hospital, Ferrara, Italy - mlgnmr@unife.it.
Anna Maria
AM
Malagoni
Department of Biomedical Sciences and Surgical Specialties, Section of Sport Sciences, University of Ferrara, Ferrara, Italy.
Matteo
M
Argirò
Esercizio Vita Nonprofit Cooperative, Ferrara, Italy.
Michele
M
Felisatti
Department of Biomedical Sciences and Surgical Specialties, Section of Sport Sciences, University of Ferrara, Ferrara, Italy.
Eleonora
E
Nardini
Department of Biomedical Sciences and Surgical Specialties, Section of Sport Sciences, University of Ferrara, Ferrara, Italy.
Christel
C
Zambon
Department of Rehabilitation Medicine, Ferrara University Hospital, Ferrara, Italy.
Nino
N
Basaglia
Department of Biomedical Sciences and Surgical Specialties, Section of Sport Sciences, University of Ferrara, Ferrara, Italy.|Department of Rehabilitation Medicine, Ferrara University Hospital, Ferrara, Italy.
Fabio
F
Manfredini
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D010807:Physical Endurance / Q000502:physiology*; D010809:Physical Fitness / Q000502:physiology*; D010865:Pilot Projects; D055070:Resistance Training / Q000379:methods*; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology* / Q000503:physiopathology; D000071939:Stroke Rehabilitation / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult