Lamberti Nicola, Straudi Sofia, Malagoni Anna Maria, Argirò Matteo, Felisatti Michele, Nardini Eleonora, Zambon Christel, Basaglia Nino, Manfredini Fabio
Department of Biomedical Sciences and Surgical Specialties, Section of Sport Sciences, University of Ferrara, Ferrara, Italy.
Department of Rehabilitation Medicine, Ferrara University Hospital, Ferrara, Italy.
Eur J Phys Rehabil Med. 2017 Apr;53(2):228-239. doi: 10.23736/S1973-9087.16.04322-7. Epub 2016 Sep 14.
Chronic stroke survivors are exposed to long-term disability and physical deconditioning, effects that may impact their independence and quality of life. Community-based programs optimizing the dose of exercise therapy that are simultaneously low risk and able to achieve high adherence should be identified.
We tested the hypothesis that an 8-week, community-based, progressive mixed endurance-resistance exercise program at lower cardiovascular and muscular load yielded more mobility benefits than a higher-intensity program in chronic stroke survivors.
A two-arm, parallel-group, pilot randomized, controlled clinical trial.
Hospital (recruitment); community-based adapted physical activity center (training).
Thirty-five chronic stroke patients (mean age: 68.4±10.4 years; 27 males).
Participants were randomized to a low-intensity experimental (LI-E; N.=18) or a high-intensity active control group (HI-C; N.=17). Patients in the LI-E group performed over-ground intermittent walking (weeks 1-8) and muscle power training with portable tools (weeks 5-8); patients in the HI-C group executed treadmill walking (weeks 1-8) and strength training with gym machines (weeks 5-8). Changes in mobility, assessed using the 6-Minute Walking Distance test, were the primary outcome. Secondary outcomes included quality of life (Short-Form-36 Questionnaire), gait speed (10-Meter Walking Test), balance (Berg Balance Scale) and muscle performance of the lower limbs (strength and power of the quadriceps and femoral biceps).
After 8 weeks, the 6MWD revealed more improvement for the LI-E group than the HI-C group (P=0.009). The SF36 physical activity domain (P=0.012) and peak power of the femoral quadriceps and biceps were also significantly improved for the LI-E group (P=0.008 and P<0.001, respectively) compared with the HI-C. Gait speed, balance and lower-limb strength increased in both groups; no significant differences were noted. The muscle power of the affected limb was the muscle parameter most correlated with mobility in the entire population.
A low-intensity exercise program exhibited better results in terms of mobility, quality of life and muscle power compared with a higher-intensity program. Data need to be confirmed in a larger trial.
The effectiveness, low-intensity and possible implementation in poorly equipped community-based settings make the LI-E program potentially suitable for stroke survivors and frail individuals.
慢性卒中幸存者面临长期残疾和身体机能下降的问题，这些影响可能会对他们的独立性和生活质量产生冲击。应确定基于社区的、同时具备低风险且能实现高依从性的优化运动疗法剂量的项目。
我们检验了这样一个假设：对于慢性卒中幸存者，一个为期8周、基于社区的、在较低心血管和肌肉负荷下的渐进式混合耐力-阻力运动项目，比高强度项目能带来更多的运动功能改善。
双臂、平行组、试点随机对照临床试验。
医院（招募）；基于社区的适应性体育活动中心（训练）。
35名慢性卒中患者（平均年龄：68.4±10.4岁；男性27名）。
参与者被随机分为低强度实验组（LI-E；n = 18）或高强度活性对照组（HI-C；n = 17）。LI-E组患者进行地面间歇行走（第1 - 8周）和使用便携式工具进行肌肉力量训练（第5 - 8周）；HI-C组患者进行跑步机行走（第1 - 8周）和使用健身器械进行力量训练（第5 - 8周）。使用6分钟步行距离测试评估的运动功能变化是主要结局。次要结局包括生活质量（简明健康状况调查问卷）、步速（10米步行测试）、平衡（伯格平衡量表）以及下肢肌肉性能（股四头肌和股二头肌的力量和功率）。
8周后，6分钟步行距离测试显示LI-E组比HI-C组改善更明显（P = 0.009）。与HI-C组相比，LI-E组的SF36身体活动领域（P = 0.012）以及股四头肌和股二头肌的峰值功率也有显著改善（分别为P = 0.008和P < 0.001）。两组的步速、平衡和下肢力量均有所增加；未发现显著差异。在整个人群中，患侧肢体的肌肉力量是与运动功能最相关的肌肉参数。
与高强度项目相比，低强度运动项目在运动功能、生活质量和肌肉力量方面表现出更好的效果。数据需要在更大规模的试验中得到证实。
LI-E项目的有效性、低强度以及在设备简陋的社区环境中可能的实施情况，使其有可能适用于卒中幸存者和体弱个体。
