Abstract
Objective
To establish the feasibility and effectiveness of a 6-week ballistic strength training
protocol in people with stroke.
Design
Randomized, controlled, assessor-blinded study.
Setting
Subacute inpatient rehabilitation.
Participants
Consecutively admitted inpatients with a primary diagnosis of first-ever stroke with
lower limb weakness, functional ambulation category score of ≥3, and ability to walk
≥14 m were screened for eligibility to recruit 30 participants for randomization.
Interventions
Participants were randomized to standard therapy or ballistic strength training 3
times per week for 6 weeks.
Main Outcome Measures
The primary aim was to evaluate feasibility and outcomes included recruitment rate,
participant retention and attrition, feasibility of the exercise protocol, therapist
burden, and participant safety. Secondary outcomes included measures of mobility,
lower limb muscle strength, muscle power, and quality of life.
Results
A total of 30 participants (11% of those screened) with mean age of 50 years (SD 18)
were randomized. The median number of sessions attended was 15 of 18 and 17 of 18
for the ballistic and control groups, respectively. Earlier than expected discharge
to home (n=4) and illness (n=7) were the most common reasons for nonattendance. Participants
performed the exercises safely, with no study-related adverse events. There were significant
(P<.05) between-group changes favoring the ballistic group for comfortable gait velocity
(mean difference [MD] 0.31m/s, 95% confidence interval [CI]: 0.08-0.52), muscle power,
as measured by peak jump height (MD 8cm, 95% CI: 3-13), and peak propulsive velocity
(MD 64cm/s, 95% CI: 17-112).
Conclusions
Ballistic training was safe and feasible in select ambulant people with stroke. Similar
rates of retention and attrition suggest that ballistic training was acceptable to
patients. Secondary outcomes provide promising results that warrant further investigation
in a larger trial.
Keywords
List of abbreviations:
BST (ballistic strength training), CI (confidence interval), MD (mean difference)To read this article in full you will need to make a payment
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References
- Plantarflexor weakness as a limiting factor of gait speed in stroke subjects and the compensating role of hip flexors.Clin Biomech. 1999; 14: 125-135
- Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke.Am J Phys Med Rehabil. 1999; 78: 123-130
- Little therapy, little physical activity: rehabilitation within the first 14 days of organized stroke unit care.J Rehabil Med. 2007; 39: 43-48
- Physiotherapy in stroke rehabilitation: bases for Australian physiotherapists’ choice of treatment.Physiother Theory Pract. 1994; 10: 201-209
- Patterns of therapy activities across length of stay and impairment levels: peering inside the “black box” of inpatient stroke rehabilitation.Arch Phys Med Rehabil. 2004; 85: 1901-1908
- Strengthening interventions increase strength and improve activity after stroke: a systematic review.Aust J Physiother. 2006; 52: 241-248
- Outcomes of progressive resistance strength training following stroke: a systematic review.Clin Rehabil. 2004; 18: 27-39
- Strength training for walking in neurologic rehabilitation is not task specific: a focused review.Am J Phys Med Rehabil. 2014; 93: 511-522
- In the first 3 months after stroke is progressive resistance training safe and does it improve activity? A systematic review.Top Stroke Rehabil. 2016; 23: 366-375
- American College of Sports Medicine position stand. Progression models in resistance training for healthy adults.Med Sci Sports Exerc. 2009; 41: 687-708
- Riebe D. Ehrman J.K. Liguori G. Magal M. ACSM’s guidelines for exercise testing and prescription. 10th ed. Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia, PA2017
- Muscle contributions to support and progression over a range of walking speeds.J Biomech. 2008; 41: 3243-3252
- Muscles that support the body also modulate forward progression during walking.J Biomech. 2006; 39: 2623-2630
- Muscle force redistributes segmental power for body progression during walking.Gait Posture. 2004; 19: 194-205
- The effect of walking speed on muscle function and mechanical energetics.Gait Posture. 2008; 28: 135-143
- Contributions of the individual ankle plantar flexors to support, forward progression and swing initiaition during walking.J Biomech. 2001; 34: 1387-1398
- Quantification of level of effort at the plantarflexors and hip extensors and flexor muscles in healthy subjects walking at different cadences.J Electromyogr Kinesiol. 2005; 15: 393-405
- Do trials of resistance training to improve mobility after stroke adhere to the American College of Sports Medicine guidelines? A systematic review.Arch Phys Med Rehabil. 2018; 99: 584-597
- Developing maximal neuromuscular power. Part 1—biological basis of maximal power production.Sports Med. 2011; 41: 17-38
- Developing maximal neuromusclar power. Part 2—training considerations for improving maximal power production.Sports Med. 2011; 41: 125-146
- Comparing the effectiveness of a short-term vertical jump vs. weightlifting program on athletic power development.J Strength Cond Res. 2016; 30: 2741-2748
- Effects of ballistic training on preseason preparation of elite voleyball players.Med Sci Sports Exerc. 1999; 31: 323-330
- Four weeks of optimal load ballistic resistance training at the end of season attenuates declining jump performance of women volleyball players.J Strength Cond Res. 2006; 20: 955-961
- Effects of lower limb plyometric training on body composition, explosive strength, and kicking speed in female soccer players.J Strength Cond Res. 2009; 23: 1714-1722
- Feasibiliy of ballistic strengthening exercises in neurologic rehabilitation.Am J Phys Med Rehabil. 2014; 93: 828-833
- Improved walking capacity and muscle strength after functional power-training in young children with cerebral palsy.Neurorehabil Neural Repair. 2017; 31: 827-841
- Jump training is feasible for nearly ambulatory patients after stroke.Clin Rehabil. 2006; 20: 406-412
- CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials.J Clin Epidemiol. 2010; 63: e1-e37
- Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide.BMJ. 2014; 348: g1687
- Gait assessment for neurologically impaired patients: standards for outcome assessment.Phys Ther. 1986; 66: 1530-1539
- Effects of additional, dynamic supported standing practice on functional recovery in patients with sub-acute stroke: a randomized pilot and feasibility trial.Clin Rehabil. 2016; 30: 374-382
- Reducing sitting time after stroke: a phase II safety and feasibility randomized controlled trial.Arch Phys Med Rehabil. 2016; 97: 273-280
- Very early rehabilitation or intensive telemetry after stroke: a pilot randomised trial.Cerebrovasc Dis. 2010; 29: 352-360
- An observational study on usual physiotherapy care in a stroke rehabilitation unit for patients with mobility deficits.Int J Ther Rehabil. 2014; 21: 585-589
- Responsiveness and predictability of gait speed and other disability measures in acute stroke.Arch Phys Med Rehabil. 2001; 82: 1204-1212
- The timed up and go test: its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke.Arch Phys Med Rehabil. 2005; 86: 1641-1647
- Comparison of the force-, velocity-, and power-time curves recorded with a force plate and a linear velocity transducer.Sports Biomech. 2016; 15: 329-341
- Quality of life: an important outcome measure in a trial of very early mobilisation after stroke.Disabil Rehabil. 2010; 32: 875-884
- Using thematic analysis in psychology.Qual Res Psychol. 2006; 3: 77-101
- Efficacy of functional strength training on restoration of lower-limb motor function early after stroke: phase I randomized controlled trial.Neurorehabil Neural Repair. 2010; 24: 88-96
- What is the benefit of a high intensive exercise programme? A randomised controlled trial.Adv Physiother. 2010; 12: 115-124
- Meaningful gait speed improvement during the first 60 days poststroke: minimal clinically important difference.Phys Ther. 2010; 90: 196-208
- Estimating clinically important change in gait speed in people with stroke undergoing outpatient rehabilitation.J Neurol Phys Ther. 2011; 35: 82-89
- The high-level mobility assessment tool (HiMAT) for traumatic brain injury. Part 2: content validity and discriminability.Brain Inj. 2005; 19: 833-843
- High-Level Mobility Assessment Tool (HiMAT): interrater reliability, retest reliability, and internal consistency.Phys Ther. 2006; 86: 395-400
- Classification of walking handicap in the stroke population.Stroke. 1995; 26: 982-989
- Assessment of lower limb muscle strength and power using hand-held and fixed dynamometry: a reliability and validity study.PLoS One. 2015; 10: 1-18
- Brief comprehensive quality of life assessment after stroke. The assessment of quality of life instrument in the north east Melbourne stroke incidence study (NEMESIS).Stroke. 2002; 33: 2888-2894
Article info
Publication history
Published online: May 30, 2018
Footnotes
Supported by an Australian Government Research Training Program Scholarship and research grants received by Alfred Health and the Australian Catholic University. Ross A. Clark is supported by a National Health and Medical Research Council RD Wright Biomedical Fellowship.
Clinical Trial Registration No.: NCT01958736.
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
