Early Aerobic Training After Stroke Does Not Improve Functional Ability

By Will Boggs MD

October 24, 2019

NEW YORK (Reuters Health) - Aerobic training in the first several weeks after a stroke does not improve walking speed or reduce functional disability, according to results from a randomized controlled trial.

"I found most surprising that additional aerobic physical fitness intervention, as delivered via bodyweight-supported treadmill or an electromechanical gait trainer, did not improve maximal walking speed, not even in the subgroup of patients that walked independently at baseline," Dr. Agnes Floeel of the University Medicine Greifswald, in Germany, told Reuters Health by email.

The American Heart Association/American Stroke Association recommends aerobic exercise for stroke survivors, but few studies have included patients within the first six weeks after stroke.

Dr. Floeel and colleagues evaluated the efficacy of aerobic treadmill-based training (25 minutes to a target heart rate of 50-60% of the individual's maximum heart rate, five times weekly over four weeks) in 200 adults with subacute stroke (5-45 days after the event), compared with similar-duration relaxation training as a control intervention.

By three months after stroke, 34 participants had been lost to follow-up, and exclusion of those who completed less than 75% of the assigned intervention left 80 participants in the aerobic-training group and 71 in the relaxation group for the per-protocol analysis.

Maximal walking speed increased from baseline to three months after stroke by 0.4 m/s in the aerobic-training group versus 0.3 m/s in the relaxation group, a non-significant difference, the researchers reported in The BMJ, online September 18.

The Barthel index score, a commonly used measure of activities of daily living (range, 0-100 points, with higher scores indicating less dependence), increased a mean 30 points three months after stroke in both groups.

Results were similar in the per-protocol analysis: maximal walking speed increased by 0.4 m/s in the aerobic training group and by 0.3 m/s in the relaxation group, and the mean increase in Barthel index score was 32 points in the aerobic-training group and 31 points in the relaxation group.

The aerobic-training group experienced 22 serious adverse events in the three months after stroke, compared with only nine serious adverse events in the relaxation group. Compared with the relaxation group, the aerobic-training group experienced more hospitalizations, more recurrent strokes, significantly more self-reported falls, and significantly less self-reported dizziness.

"Early after moderate to severe stroke, physicians should focus on function-specific therapy and not force a cardiovascular active intensity of training," Dr. Floeel said. "Moreover, they should closely monitor patients for recurrent stroke or heart attacks and provide the support needed to prevent falls."

"Based on our results, trials should investigate if longer intervention periods are necessary to capture major changes in activities of daily living, assess the treatment effects of relaxation programs compared with usual care, and recruit participants at fixed time points after stroke to reduce variance in outcome measures," the researchers suggest.

SOURCE: https://bit.ly/2mlCwKP

BMJ 2019.


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