From the Center on Aging, University of Kansas Medical Center (P.D.,
L.R., D.W., J.S-Y., P.P., C.L., S.S.); Department of Veterans Affairs Medical
Center, Kansas City (P.D., S.S.); and Departments of Health Services
Administration (P.D.), Physical (P.P.) and Occupational Therapy (L.R.),
Internal Medicine (S.S.), Preventive Medicine (D.W.), and Physical Medicine
and Rehabilitation (A.O.), School of Engineering, University of Kansas (C.L.),
Kansas City, Kan.
Correspondence to Pamela Duncan, PhD, PT, University of Kansas Medical Center, Center on Aging, 3901 Rainbow Blvd, Kansas City, KS 66160-7117. E-mail pduncan{at}kumc.edu
Background and Purpose—Many
stroke survivors have minimal to moderate neurological deficits but are
physically deconditioned and have a high prevalence of
cardiovascular problems; all of these are potentially
modifiable with exercise. The purposes of this randomized, controlled
pilot study were (1) to develop a home-based balance, strength, and
endurance program; (2) to evaluate the ability to recruit and retain
stroke subjects; and (3) to assess the effects of the
interventions used.
Methods—Twenty minimally and moderately impaired stroke patients
who had completed inpatient rehabilitation and who were 30 to 90 days
after stroke onset were randomized to a control group or to an
experimental group that received a therapist-supervised, 8-week,
3-times-per-week, home-based exercise program. The control group
received usual care as prescribed by the patients' physicians.
Baseline and postintervention assessments included the Fugl-Meyer Motor
Assessment, the Barthel Index of Activities of Daily Living (ADL), the
Lawton Scale of Instrumental ADL, and the Medical Outcomes Study–36
Health Status Measurement. Functional assessments of balance and gait
included a 10-m walk, 6-Minute Walk, and the Berg Balance Scale. Upper
extremity function was evaluated by the Jebsen Test of Hand
Function.
Results—Of 22 patients who met study criteria, 20 completed the
study and 2 refused to participate. The experimental group tended to
improve more than the control group in motor function (Fugl-Meyer Upper
Extremity: mean change in score, 8.4 versus 2.2; Fugl-Meyer Lower
Extremity: 4.7 versus -0.9; gait velocity: median change, 0.25 versus
.09 m/s; 6-Minute Walk: 195 versus 114 ft; Berg Balance Score: 7.8
versus 5; and Medical Outcomes Study–36 Health Status Measurement of
Physical Function: 15.5 versus 9). There were no trends in differences
in change scores by the Jebsen Test of Hand Function, Barthel Index,
and Lawton Instrumental ADL Scale.
Conclusions—This study demonstrated that a randomized, controlled
clinical trial of a poststroke exercise program is feasible. Measures
of neurological impairments and lower extremity function showed the
most benefit. Effects of the intervention on upper extremity dexterity
and functional health status were equivocal. The lasting effects of the
intervention were not assessed.
© 1998 American Heart Association, Inc.
Original Contributions
A Randomized, Controlled Pilot Study of a Home-Based Exercise Program for Individuals With Mild and Moderate Stroke
Key Words: exercise • rehabilitation • stroke management
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