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What is the benefit of a high intensive exercise program?: A randomized controlled trial
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
3Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg.
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
2010 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 12, no 3, 115-124 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to evaluate a high intensive exercise program in stroke subjects with risk of falls regarding balance, activities of daily life, falls efficacy, number of falls and lifestyle activities. The intervention program contained high intensity functional exercises (HIFE) implemented to real-life situations together with education on falls and security aspects. This was a single-center, single-blinded, randomized controlled trial. Consecutive >55-year-old patients with risk of falls were enrolled and randomized 3–6 months after first or recurrent stroke to the intervention group (IG, n=15) or to the control group (CG, n=19) who received group discussions about hidden dysfunctions after stroke. Outcomes were Berg Balance Scale (BBS) primarily, Barthel Index (BI), Falls Efficacy Scale – International (FES-I) and number of falls secondarily and Frenchay Activities Index last 3 months (FAI-3) tertially. Assessments were done at baseline, post-intervention, 3- and 6-month follow-up by two physiotherapists and one nurse blinded to group allocation. Generalized Estimating Equations with Repeated-measure statistics were used to analyze the data. There were no significant differences between the IG and the CG regarding balance (BBS). BI at 6 months and FES-I post-intervention and 3 months follow-up showed significant improvement in the IG compared with the CG (p<0.05). Number of falls and FAI-3 were without significant change. This study suggests that our program consisting of HIFE implemented in real-life situations together with educational discussions may improve performance of everyday life activities and improve falls efficacy in stroke subjects with risk of falls.

Place, publisher, year, edition, pages
2010. Vol. 12, no 3, 115-124 p.
Keyword [en]
Accidental falls, activities of daily life, cerebrovascular disorders, exercise, rehabilitation
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-33913DOI: 10.3109/14038196.2010.491555OAI: oai:DiVA.org:umu-33913DiVA: diva2:319994
Available from: 2010-05-20 Created: 2010-05-10 Last updated: 2017-12-12Bibliographically 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.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1357
Keyword
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
Physiotherapy
Identifiers
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)
Opponent
Supervisors
Available from: 2010-05-21 Created: 2010-05-20 Last updated: 2015-06-11Bibliographically approved

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