Abstract NS 11: Reshaping Exercise Habits And Beliefs (REHAB): A Randomized Trial Of Home-based Exercise In Sub-acute Stroke
Background: Following conventional rehabilitation, many stroke survivors adopt sedentary activity patterns that contribute to a cycle for “learned non-use” and cardiovascular deconditioning that compounds disability. These patterns become established in the sub-acute recovery period, when opportunities to alter behavior patterns may be most timely. This randomized study investigated the hypothesis that the 12-week REHAB behavior modification intervention would increase ambulatory function, falls efficacy and quality of life compared to matched attention controls.
Methods: Subjects were recruited following discharge from acute rehabilitation, screened for hemiparetic gait deficit and randomized to intervention or control groups. Intervention subjects received education on the benefits of exercise and a home-based exercise prescription that included a progressive walking program, and “homework” tasks to perform daily that were tailored to their stroke deficit and personal goals. This group also received telephone contacts each week for 12 weeks to assess compliance with exercise program, address barriers to exercise and receive positive reinforcement for exercise. Control subjects received education regarding risk factors for stroke, warning signs and symptoms and surveillance for weekly activity and exercise patterns. Measures were taken at baseline, 12 and 24 weeks (to assess sustained effects), and included visual analog quality of life scale, step activity profiles and self efficacy for falls.
Results: Thirty-seven stroke survivors enrolled and 35 completed the entire protocol. The average age was 60.4 years (SD+10.9), and there were 21 males, 15 African Americans, 16 Caucasians and 1 Hispanic participants, with 3 not selecting a racial/ethnic background. Seventeen were randomized to the intervention. Repeated measures ANOVA revealed a significant time effect on step activity between 0, 12 and 24 weeks F(2.34, 77.23)= 2.972, p<.05, but no group by time interaction (p=.195). Similarly, in quality of life, a significant time effect was noted, F(2,62)=6.425, p<.05, but no treatment by time interaction (p=.363). Finally, a significant group by time interaction was noted for falls efficacy, indicating that the intervention group had a significant increase in confidence they could keep from falling, F(2,32)=5.012, p<.05.
Conclusion: The improvement of both groups in these measures was not unexpected due to spontaneous recovery, but the program did not provide sufficient stimulus to effect significant changes in the outcomes measured. The intervention subjects reported relatively high levels of compliance with the intervention protocol. Additional study using a more rigorous home program post discharge may yield significant improvements in community ambulation.
- © 2012 by American Heart Association, Inc.