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The impact of an high intensive exercise program on gait after stroke: a randomized controlled trial
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.ORCID iD: 0000-0003-0394-5096
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Stroke often results in asymmetric gait with disturbed balance, which may increase the risk of accidental falls.

The purpose of this study was to evaluate the impact of a high intensive exercise program after stroke on gait. 34 post-stroke individuals with risk of falls were included in the five week randomized controlled trial. The participants were assessed, included and randomized to the intervention group (IG) or control group (CG) at 3 to 6 months after stroke onset. The IG received a high intensive strength and balance exercise program along with a weekly educational group discussion on fall risk and security aspects, whereas the CG received weekly group discussions on hidden dysfunctions after stroke. Assessments were made before, post-intervention and at 3-months follow-up. Statistically significant (p<0.05) improvements were seen in the IG vs. the CG at post intervention compared with baseline in double support time for the non-paretic leg (DSTnp), variability (measured as coefficient of variation, CV) in Step Time for the paretic leg (STCVp) and the non-paretic leg (STCVnp), and in variability in Cycle Time for the paretic (CTCVp) and non-paretic leg (CTCVnp); at 3-months follow-up compared with baseline in DSTnp, STCVp, CTCVp and CTCVnp, and DSTCVp. At 3-months follow-up, the decrease in the STCVnp and the variability in Step Length of the non-paretic leg (SLCVnp) were more pronounced in the CG than in the IG.

The findings suggest that high intensive exercise programs have a positive effect on gait, and can be useful in diminishing gait asymmetry as a fall-risk factor in people after stroke.

Keyword [en]
exercise, falls, gait, rehabilitation, stroke, symmetry, variability
Research subject
URN: urn:nbn:se:umu:diva-33910OAI: diva2:319993
Available from: 2010-05-20 Created: 2010-05-10 Last updated: 2015-06-11Bibliographically approved
In thesis
1. Getting up when falling down: reducing fall risk factors after stroke through an exercise program
Open this publication in new window or tab >>Getting up when falling down: reducing fall risk factors after stroke through an exercise program
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The purpose of this thesis was to identify fall risk individuals (+55) after stroke by validating a fall risk index and in post-stroke individuals with high risk of falls evaluate the impact of an intervention program on fall risk factors.A previously developed fall risk index was validated, modified and re-validated. The validation showed a sensitivity of 97% and a specificity of 26%. This result was not considered sufficiently accurate. Therefore a modified index was created in the Validation sample and re-validated back in the Model fit sample. The modified index was reduced to three items and included postural stability + visuospatial hemi-inattention + male sex.The randomized controlled trial contained an intervention program (IP) with High-Intensity Functional Exercises as well as implementation these exercises in to real life situations together with educational group discussions. The participants were enrolled and randomized three to six months after their stroke. The assessments were performed at the Clinical Research Center at Norrlands University Hospital. The Intervention Group (IG) received a program of 35 sessions (exercise and group discussions) and the Control Group (CG) received five group discussions.Performing daily activities at 6 months follow-up and falls-efficacy post-intervention and at the 3 months follow-up showed significant improvement in the IG compared with the CG (p<0.05). The IP did not have a statistically significant impact on Balance or Lifestyle activities. When evaluating gait, step time variability for the paretic leg and the variability in Cycle Time for the paretic and non-paretic leg were improved for the IG. The time spent on the non –paretic leg in the gait cycles’ most stable phase, Double Support, was reduced by almost half (0.9 sec to 0.4 sec) since baseline for the IG after the intervention and remained reduced to the three month follow-up. Quality of Life showed an improvement in the CG compared with the IG for the mental scales, Mental Component Scale and Mental Health subscale at the 3 month follow-up (p=.02).In conclusion, this intervention program significantly improved performance of everyday life activities, falls-efficacy and the variability in gait. These are three major fall risk factors and might in the long run have an impact on decreasing falls in persons that had a stroke.


Place, publisher, year, edition, pages
Umeå: Umeå university, 2010. 81 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1357
ADL, Balance, Depression, Exercise, Falls, Falls-efficacy, Gait, Health-related Quality of Life, Lifestyle Activities, Physiotherapy, Prevention, Rehabilitation, Stroke, Variability.
National Category
Medical and Health Sciences
Research subject
urn:nbn:se:umu:diva-34209 (URN)978-91-7459-031-9 (ISBN)
Public defence
2010-06-11, Aulan, Vårdvetarhuset, Umeå universitet, Vårdvetarhuset, Umeå, 09:00 (Swedish)
Available from: 2010-05-21 Created: 2010-05-20 Last updated: 2015-06-11Bibliographically approved

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