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Effects of Twice-Weekly Intense Aerobic Exercise in Early Subacute Stroke: A Randomized Controlled Trial

  • Klas Sandberg
    Correspondence
    Corresponding author Klas Sandberg, MSc, RPT, Vrinnevi Hospital, SE-601 82 Norrköping, Sweden.
    Affiliations
    Department of Rehabilitation and Department of Medical and Health Sciences, Linköping University, Norrköping, Sweden

    Department of Internal Medicine, Vrinnevi Hospital, Norrköping, Sweden
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  • Marie Kleist
    Affiliations
    Department of Rehabilitation and Department of Medical and Health Sciences, Linköping University, Norrköping, Sweden
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  • Lars Falk
    Affiliations
    Research and Development Unit of Local Health Care and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden

    Department of Dermatology and Venereology Linköping University, Linköping, Sweden

    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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  • Paul Enthoven
    Affiliations
    Research and Development Unit of Local Health Care and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden

    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Published:February 20, 2016DOI:https://doi.org/10.1016/j.apmr.2016.01.030

      Abstract

      Objective

      To examine the effects of 12 weeks of twice-weekly intensive aerobic exercise on physical function and quality of life after subacute stroke.

      Design

      Randomized controlled trial.

      Setting

      Ambulatory care.

      Participants

      Patients (N=56; 28 women) aged ≥50 years who had a mild stroke (98% ischemic) and were discharged to independent living and enrolled 20 days (median) after stroke onset.

      Interventions

      Sixty minutes of group aerobic exercise, including 2 sets of 8 minutes of exercise with intensity up to exertion level 14 or 15 of 20 on the Borg rating of perceived exertion scale, twice weekly for 12 weeks (n=29). The nonintervention group (n=27) received no organized rehabilitation or scheduled physical exercise.

      Main Outcome Measures

      Primary outcome measures included aerobic capacity on the standard ergometer exercise stress test (peak work rate) and walking distance on the 6-minute walk test (6MWT). Secondary outcome measures included maximum walking speed for 10m, balance on the timed Up and Go (TUG) test and single leg stance (SLS), health-related quality of life on the European Quality of Life Scale (EQ-5D), and participation and recovery after stroke on the Stroke Impact Scale (SIS) version 2.0 domains 8 and 9. Participants were evaluated pre- and postintervention. Patient-reported measures were also evaluated at 6-month follow-up.

      Results

      The following improved significantly more in the intervention group (pre- to postintervention): peak work rate (group × time interaction, P=.006), 6MWT (P=.011), maximum walking speed for 10m (P<.001), TUG test (P<.001), SLS right and left (eyes open) (P<.001 and P=.022, respectively), and SLS right (eyes closed) (P=.019). Aerobic exercise was associated with improved EQ-5D scores (visual analog scale, P=.008) and perceived recovery (SIS domain 9, P=.002). These patient-reported improvements persisted at 6-month follow-up.

      Conclusions

      Intensive aerobic exercise twice weekly early in subacute mild stroke improved aerobic capacity, walking, balance, health-related quality of life, and patient-reported recovery.

      Keywords

      List of abbreviations:

      EQ-5D (European Quality of Life Scale), HRQOL (health-related quality of life), RPE (rating of perceived exertion), SIS (Stroke Impact Scale), SLS (single leg stance), 6MWT (6-minute walk test), TUG (timed Up and Go), VAS (visual analog scale)
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