Release date: 2016-11-10
Stroke patients often have disabilities, and 15% to 30% of them are lifelong disability. Stroke also significantly affects independence, quality of life, and productivity. Restoring the walking ability of stroke patients is the primary problem.
Aerobic training and resistance training can improve aerobic capacity, walking distance, muscle strength and physical status in stroke patients. Progressive resistance training has been shown to stimulate muscle growth by modulating myostatin, thereby improving muscle composition in stroke patients.
Nicola Lamberti of the University of Ferrara in Italy designed a low-intensity training program and conducted a randomized controlled trial to determine whether the training program is more effective than a high-intensity training program. The findings were published in Eur J Rehabil Med's September 2016 e-journal.
The study included 35 patients with chronic stroke, including 27 males with an average age of 68.4 years. Patients were randomly assigned to a low-intensity test group (n=18) or a high-intensity control group (n=17). The trial lasted for 8 weeks and was practiced 3 times a week for about 1 hour each time. Both groups received endurance training in the first to fourth weeks, and mixed training in the 5th to 8th weeks. The focus of the mixed training was on strengthening muscle strength.
The endurance training of the low-intensity test group consisted of two 10-minute intermittent walking exercises (one minute walk and one minute rest), during which the lower limbs were subjected to passive loosening and stretching exercises for 10 minutes. The walking speed is set in advance and controlled by the metronome. When the patient cannot tolerate the set speed, walk 4 steps per minute.
The focus of the low-intensity test group's mixed training is the resistance exercise of the target muscle group. The patient was first tested with the Italian-made ErgoPower to determine the force-velocity relationship of each group of muscles to calculate the optimal load and speed. Both legs were subjected to leg extension and flexion exercises, and each group was repeated 5 times for a total of 5 groups with a 1 minute break between each group. In addition, the low-intensity training group also performed a 5-minute stretching exercise and a walking practice similar to the endurance training period, but the walking practice was only 2 minutes in a single time, 5 times in total, and 1 minute rest between each time.
The endurance training of the high-intensity control group was mainly plate walking. Patients were plated for 30 to 35 minutes with a reserve heart rate of 60% to 70% (calculated by the Karvonen formula). Start with a 40% reserve heart and walk for 5 minutes, then gradually increase to the target heart rate for at least 20 minutes. For patients who cannot tolerate, rest for 1 minute every 5 minutes of training. Like the low-intensity test group, the high-intensity control group also received 10 minutes of passive loosening and stretching exercises on the lower extremities.
In the high-intensity control group, the quadriceps and biceps femoris on each side were practiced using a gym apparatus with leg flexion and extension during the mixed training period. Repeatedly 8 to 10 times with a maximum load equivalent to 70%, a total of 3 groups, each group rested for 3 minutes. A 5-minute stretch treatment was then performed and a 10-minute plate walk was performed with a 60% to 70% reserve heart rate.
The primary measure of the test was the 6-minute walking distance (6 MWD) used to assess mobility. Other indicators include quality of life (SF-36), pace (10-meter walk test), balance (Berg balance scale) and lower limb muscles (strength and power of quadriceps and biceps).
The results showed that after 8 weeks, the 6-minute walking distance of the low-intensity test group was significantly improved compared with the high-intensity control group, and the quality of life and the peak power of the quadriceps and biceps femoris were also significantly improved in the high-intensity control group. The pace, balance and lower limb strength of both groups increased, but there was no significant difference between the two groups. The muscle power of the affected limb is the muscle index most relevant to the ability to move.
This study suggests that low-intensity exercise training is superior to high-intensity training in improving the mobility, quality of life, and muscle power of stroke patients.
Source: Lilac Garden
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