An evaluation of two different exercise regimes during the first year following stroke : A randomised controlled trial.

Abstract

Objective: To evaluate effects of two exercise approaches during the first year after stroke on instrumental activities of daily living (IADL), gait performance, balance, grip strength and muscle tone and to investigate explanatory factors for some IADL activities. Design: A double-blind longitudinal randomised trial of first-time-ever stroke patients. Setting: cute hospital and community. Participants: Seventy-five patients: 35 in an intensive exercise group and 40 in a regular exercise group. Interventions: The intensive exercise group received intensive functional endurance, strength and balance training. The regular exercise group was not recommended any specific training. Main Outcome Measures: Instrumental Activities for Daily Living according to Fillenbaum, 6- Minute Walk Test, Berg Balance Scale, Timed Up and Go, grip strength, Modified Ashworth Scale, and pulse monitoring. Results: One year post stroke both groups showed higher participation in all items of the Instrumental Activities for Daily Living Test and improved in the results of 6-Minute Walk Test, Berg Balance Scale, Timed-Up-and-Go and grip strength. At 3, 6 and 12 months followups there were some significant differences in favour of the regular exercise group. A multiple regression analysis revealed that scores of Berg Balance Scale were the strongest explanatory factor for Instrumental Activities of Daily Living item 2 “get to places out of walking distance” at both 3-month and 1-year follow-ups and that (R 2 = 0.63 / 0.67 and that 6-Minute Walk Test was the strongest explanatory factor for item 7 “can you handle your own money” at the 1-year follow-up. Conclusion: Both groups improved to similar degrees in IADL, gait, balance and grip strength. The test occasions themselves were strong motivators for training, irrespective of group allocation. IADL was to a higher degree explained by the results of 6-Minute walk test and Berg Balance Scale than Timed-Up-and-Go and grip strength.