Exercise Programs Improve Stroke Outcome

Nearly 800,000 Americans suffering a stroke each year, and two-thirds of stroke survivors experience limited walking ability after 3 months. Pamela W. Duncan, from Duke University (North Carolina, USA), and colleagues in the Locomotor Experience Applied Post-stroke (LEAPS) study report that one year after having a stroke, 52% of people who participate in either a physical therapy program that includes a walking program using a body-weight supported treadmill or a home-based program focused on progressive strength and balance exercises experience improved functional walking ability.  The researchers assessed data collected on 408 participants (average age 62 years) with recent stroke, recruited from 6 US stroke rehabilitation centers between during a three-year period.  All subjects were assigned to 36 sessions of 75 to 90 minutes for 12 to 16 weeks in either a structured and progressive task-specific walking program that included body weight supported treadmill training provided early (2 months post-stroke) or late (6 months post-stroke), or a structured and progressive home-based exercise program of strength and balance provided 2 months post-stroke. The team observed that at one-year post=stroke, the early walking group, late walking group, and exercise program targeting strength and balance achieved similar important gains in walking speed, motor recovery, balance, functional status, and quality of life, and walkers with severe and moderate limitations improved with all programs. In all groups, the biggest improvements in outcomes were made after the first 12 sessions of therapy, but 13% of the subjects continued to make functional gains in walking recovery by 24 sessions and another 7% improved by 30 to 36 sessions.  A secondary finding of the study shows that at 6 months post-stroke, a group who had not yet received any therapy beyond usual care showed improved walking speed, but only about half as much as the participants who received either the walking or home-based program at 2 months. The researchers posit that the 6-month findings suggest that both programs are effective forms of physical therapy and are superior to usual care provided according to current standards of practice.